India coronavirus: The 'mystery' of low Covid-19 death rates | Hacker News Reader

India coronavirus: The 'mystery' of low Covid-19 death rates

bbc.com

240 pointshappy-go-lucky361 comments

This should not be a mystery at all. India locked down entire country (no state rights in Epidemics laws), despite federal structure. Very few things can be bought, even Amazon is only delivering "essentials."

But more importantly, India has been contact tracing like a greedy algorithm on steroids since case #1. There was a positive case in a condo nearby mine. The entire condominium building and adjacent locality is sealed. Not a lockdown, sealed. Nobody in, nobody out. The authorities spent over 9 hours interviewing all family members, neighbors, and friends of the infected for contact tracing. Every contact is being monitored, with police showing up randomly to make sure of no symptoms and adherence to home quarantine.

People are self policing mainly to avoid police, but they are self policing each other because nobody wants their buildings sealed. It really is working, I see people unwilling to hand over their credit cards in shops insisting to tap to avoid infections. In my state, there are only 85 active infections, only 2 are residents of my city, and even then I'm given gloves and sanitizer when I enter minimarts, with only 10 minute allowance to go and shop with maximum 4 shoppers allowed inside.

Edit: It becomes a big news when a positive case is found nearby. There is a distributed effort of volunteers to monitor infections (http://covid19india.org). There is no way government can lie about numbers.

Absolutely this: nobody wants their buildings sealed. In most apartments, people have continued to pay full salaries to their domestic help and insist that they do not show up for work. In some cases where the domestic help are young migrants from other states, the employer families have even invited them to stay over until the lockdown is over. They continue with their daily chores with full payment and the additional benefits of being taken care of by a family instead of being on their own. Whenever someone requests the HOA to allow outside workers, other residents immediately express concern about what happens if even a single person is tested positive. Nobody wants to spend a fortnight confined to their houses, and not allowed to venture out of their house for even a walk.

India going all Wuhan on the virus. The difference between India and the US particularly is that it's lockdown lite in USA while it's full on there. You can't take a walk, you can't drive farther than 3 KM, cops will kick your butt and impound your vehicle. And the population by and large listens, while we have morons here who want lockdown eased to get haircuts.

I'm in Canada (west coast). No restrictions on driving. People are still taveling to their cabins on the weekend. They get yelled at by other people but are not breaking any laws. My neighourhood is full of elderly people walking their dogs. Bicylists are everywhere. Restaurants never stopped doing takeout. But we cannot get haircuts.

Cops have stopped speed enforcement in my area, at least the dedicated speed traps.

The speeding has been happening all over the US too and it makes me sick. These people should be fined into oblivion, cars impounded, licenses revoked. Now is not the time to be creating extra problems for society.

I'm in Western Canada, too. Seeing the same thing here.

Cases keep dropping, regardless.

I suspect a late cold snap and some snow a month ago, followed by a lot of rains in the last couple weeks, have also helped.

Calgary is having trouble -- that's where most of the cases are in AB -- but case load across AB and Western provinces is stable and below projections.

edit: cases in the province, via the CBC:

Calgary zone: 3,366

South zone: 685

Edmonton zone: 486

North zone: 202

Central zone: 84

Unknown: 27

https://www.cbc.ca/news/canada/edmonton/covid-19-deena-hinsh...

there is no evidence for that whatsoever. You have absolutely no data on what takes place in India - it is a gigantic country with gigantic variation across. Plus the families are much larger, all confined together. When the train was shut down millions traveled back home for days on packed buses, it unlikely that any lockdown could have had such a pronounced effect so quickly.

The truth probably lies elsewhere, perhaps the population is overall a lot less susceptible, perhaps the genetics is such that adverse reactions are far less common, perhaps the weather conditions make the virus less virulent etc.

There is no way in hell that India was more locked down than Spain - yet Spain, with a population that is of a tiny fraction of India is still producing many more cases per day even today, more than a month after a full lockdown.

If anything Spain compared to say Sweden shows that brutal lockdowns don't work, the disease would have taken the same course had there been much less strict measures.

India has some of the densest urban environments on the planet... Mumbai, Calcutta, Howraw, etc.

And, it has pockets of density that are mind-boggling, such as the slums at Dharavi. 9 to 10 people in a room, families taking 'shifts' in the same living areas, 100+ people per latrine in some parts.

Yet, absent a massive cover-up, no reports of mass deaths.

The same goes for many of the world's other dense cities: Manila, Caloocan, Port-au-Prince, Kathmandu, Subang Jaya, Tokyo (not to mention the dozen or so 10mill+ cities in China.)

When this is mentioned, the response is invariably that "they have an amazing lockdown system with state-of-the art contact tracing." Or, "well, THOSE people are very submissive and obedient to authority."

It's not believable.

What does it even mean to "lock-down" Dharavi?! That's absurd...

Millions of deaths were predicted. There aren't millions of deaths. Great. The lethality of the virus was grossly over-estimated. Yet, instead of happily acknowledging this, there are some bending over backwards trying to maintain that the Virus magically avoids places like Dharavi (or homeless camps in LA, or San Fran, or the elderly-populated Florida) because of government pronouncements.

I don't live in Dharavi. I've been there. And, I know there are plenty of people from India on this site. Maybe I'm wrong, but I cannot wrap my head around ANY lockdown policy that would make a rat's ass worth of a difference to virus spread in Dharavi. Ditto for Mexico City, the slums in Monterrey, Lagos, and the urban/slum sprawl in the metro areas of S. America.

this is the elephant in the room,

it is not fashionable to talk about, it does not fit the current narrative - the scientific "group think" when it comes to the virus is incredibly strong

Edit: "I don't live in Dharavi. I've never been there."

If Spain had taken strict lockdown measures before the virus took hold they would not be in the mess that they are in now.

Compare Denmark to Sweden and it gets pretty obvious that early lockdowns have an effect

They simply don't test and don't count. There is a strong incentive to show low numbers at state level. They conduct covid test on everyone who come to hospital for any reason, but not anyone outside hospital.

There are serious issues with the numbers coming out of India. For instance, some states which share huge borders with other states are showing far less numbers than the states they share the borders with even though these states didn't really implement movement restrictions at the border.

Heh, families in India have started doing haircuts at home. Some people get it right, and some people don't ... it's not even funny anymore.

I could have been the moron standing with a placard demanding a haircut, but I took the simpler route by buzzing my hair with a clipper :-)

People are largely forced to comply to the lockdown because police are often resorting to using of indiscriminate force, which isn't becoming in any modern country. Serious lack of empathy from the Police and Governments in India.

India has one of the lowest police officers to population ratio in the world, with 144 policemen to 100,000 citizens [1].Significanty, large majority of the policemen do not even carry guns or even tasers. The public trust of the police is also fairly low.

People are staying in and following the curfew because thanks to a robust media ecosystem and insane connectivity facilitated by cheap data plans and accessible smart phones, most folks are aware of the severity of the challenge confronting the country.

There are significant issues, especially with testing and the plight of the unorganised migrant labour, with how this is playing out, many due to simply the massive scale and relatively poor Indian state capacity, as well as some political football from all players involved.

Nonetheless, a large reason why people are "complying" with the lockdown is (IMO) because of a lot of awareness and a high degree of social responsibility.

It is difficult to imagine how the microscopic "blue line", or khakhi line, in India, as it were, could "force compliance" in this situation if the society at large did not accept that it was required.

This argument that the large majority of the population is complying due to fear of the police or authorities is (IMO) a disservice to the maturity demonstrated by the Indian society.

I can only hope the Indian govt and political class can step up to the plate and manage the exit and restart of the economy with the same maturity and sagacity.

[1] https://www.livemint.com/news/india/india-s-police-force-amo...

Edit: added link and clarified 2 sentences to improve readability

The level of ignorance exhibited here is breathtaking!

And then there are city level containment zones for tiny colonies (say 3-4 km^2 Radius) when even a single case is detected, where nothing is allowed, groceries are delivered by authorities.

Then there are sub - total city wide lockdowns in certain states where absolutely no travel is allowed.

Lockdown limits can be increased by the states, but limits imposed by the center can't be diluted.

Overall, the reason is very clear as the parent says - Most extreme lockdown of any country (or) at-least compared to other countries where death rates are high; subsequently the cost being paid is extraordinarily high[1].

[1]https://news.ycombinator.com/item?id=22676312

These are interesting strategies, are there places to read more? Most of my Indian friends are the South and wealthy, they're locked down in multi generation compounds and lamenting cleaning for themselves for the first time - maids sent home. The situation doesn't sound as bad on the ground but I'm skeptical in the sense that my province in Canada has imported 16 cases from India, which is on par with Iran (19), Cuba, while it's not as high as US (393), UK (124), or other hard hit European countries (30-40), it dose seem like there as some moderate level of spread in the country for that much to be exported. For reference China only exported 5. Are there discussions about follow up strategies? Contact tracing apps etc, or is the process going to be manual.

> These are interesting strategies, are there places to read more?

Here's WEF's report on India's cluster-containment strategy[1].

>Most of my Indian friends are the South and wealthy

India of Wealthy is radically different from others, Just $77,000 is required to be at the top 1% in the country[2].

> my province in Canada has imported 16 cases from India,

That's indeed very interesting. India stopped International flights on Mar 23 and the infections as of Mar23 were < ~500[3]. Though it is possible that those 16 acquired the disease from super spreaders in India[4], the likelihood of them arriving in Canada is extremely low. May be they contracted it in their flight to Canada or did they cross land border from US?

Do note that, India's infection rate is among the highest in Asia as of writing [5].

[1] https://www.weforum.org/agenda/2020/04/india-covid19-coronav...

[2] https://www.businessinsider.in/slideshows/miscellaneous/here...

[3] https://www.worldometers.info/coronavirus/country/india/

[4] https://www.google.com/search?q=India+super+spreader

[5] https://www.thehindu.com/data/indias-coronavirus-infection-r...

Regarding [5], it says infection rate but talks about absolute number of cases. Which isn't a big surprise to be second in, India is a big country.

Government of India launched an app for contact tracing weeks before Google and Apple announced making one, which relies on GPS and bluetooth to monitor.

What is the official end game? Are they hoping that it will be eliminated worldwide, will they continue in this mode indefinitely assuming it won't be, or do they plan to basically close the borders forever (i.e. anyone who enters has to be strictly quarantined so that the internal contact tracing regime could be relaxed)?

What is the official end game for all the countries that have lockdown?

Have control over new infections and resulting hospitalizations so as to not overwhelm healthcare infrastructure. This is especially required in India, where a large section of the population is uneducated, lack propee facilities and live on daily wages, with little to no savings or assets.

As in South Korea, the idea is to ramp up testing so that the country can limp back to normalcy while affected areas are isolated.

Absent the strict lockdown, I dia does not have the infrastructure to handle the surge in cases.

Hopefully, the population gets immunity and effective medicines are developed to immunize or treat the disease.

There's a painful cognitive dissonance that people seem to have about this disease. If your lockdown stops the spread of the disease, your population doesn't get immunity. No amount of infrastructure will allow the population to get immunity without all of the deaths that come with it.

Absent effective medicines being developed, which are very unlikely to appear for a long time, countries need to consider that they're choosing somewhere to fall along a spectrum of disease, or disease + poverty.

In Star Trek there's the famous unwinnable test, the kobayashi maru, and our hero Kirk says there's no such thing. This is the kind of naive arrogance that is going to amplify an already bad situation.

I don't know much about India or its particular situation but rising food prices are going to be a hell of a struggle.

Aside from the fact that the jury's still out on whether infection actually confers immunity with Covid-19, the options are not just "get everyone infected" vs "eternal lockdown", you can actually suppress the disease to a level where new infections are rare and easily enough traced, or even completely absent.

It's interesting that you mention cognitive dissonance while presenting a false dichotomy.

There's a painful cognitive dissonance that people seem to have about this disease - there isn't an option (unless you don't care about lots of people dying) where the economy doesn't take a big hit in order to contain the exponential phase.

It's not clear what the alternatives are?

I assume you're not advocating a no measures approach.

No lockdown even with social distancing still does huge economic damage and even then you would not get herd immunity - 60% infection rate is required.

German government declined the herd immunity strategy with the argument that for it to succseed in a year's time we have to increase the rate of new infections every day to 70k. No way our health care system can handle this. And there is also no need since we expect to have a vaccine ready in one year.

This is ignoring that disease immunity can massively vary, and if the antibodies only confer immunity for a few months, then this naive approach means we're back to step 1 relatively quickly.

This also ignores the potential for a chickenpox-like situation where the virus could reactivate itself, in which case exposing our population to the disease is just going to cause further issues down the line.

Yeah, I don't see the point of crushing the curve in developing countries where it's not feasible to elevate substantially medical capacities. Where many people's ability to support themselves is a day by day process not paycheck to paycheck. It makes no sense to shut down hard other than political optics - all the rich countries are doing it therefore there's an expectation and pressure for leaders in these countries to as well, even though the outcomes will not be the same. Cure is worse than the disease territory. Developing countries with demographics that skew young might actually do better with herd immunity approach.

I am pretty sure that international travel will stay banned for quite some time more, maybe the end of the year? But the current lockdown is supposed to be "eased" on May 3, and we are already seeing lists of districts with zero new case, where things will become really easy. But at the other extreme, there are "hotspots" where the lockdown will not ease at all for some more time. The lockdown won't just end on May 3. Some states intend to continue the lockdown on their own beyond that. Local shops have been allowed to open already. Some travel will become possible, probably within city limits or state limits. Restaurants and malls are unlikely to be opened any time soon. Everyone is still waiting to see what the official policy is.

I think India opted to err on the side of caution. Now where is required or possible, the lockdown can be eased. Opposite strategy would have been far worse.

This is the main question I have too. We have a disease that is pretty much guaranteed to be endemic so there will always be the ever present threat of re-importing the disease.

- guaranteed to be endemic in countries that have not taken the necessary public health measures. Consequently there will be very tough restrictions on travellers from those countries. Maybe the world will divide into green and red zones?

It's simply not realistic to keep a highly infectious disease forever out of a country like India (unless the virus just doesn't thrive there for environmental or demographic reasons). What are they going to do, shut down entire cities every time there's a lapse in security?

If the world did somehow divide into green and red zones, you would have a worse problem on your hands. The red zones are the wealthier western countries, and are more desirable than the green zones. Good luck trying to maintain global economic relevance when you don't allow immigrants from the wealthiest countries in the world. There's a similar argument to immunity passports. If people need to be immune to the disease to re enter the workforce safely, they will infect themselves with the disease to do so.

I'm in Austin. There was a confirmed case in my building and the best we got was a vague email from the management saying that someone had it and that the person had used the mailroom the Saturday before (we got the email on a Wednesday).

assuming that that person self-quarantined, it seems reasonable they informed the building but didn't do anything other than maybe wiping down the mailroom and door handles to mollify the paranoid. just having someone in the building doesn't pose appreciable added risk. would you rather they didn't tell you?

Remarkably I hear that Austin is going to be un-locking soon? Is that true?

Texas in general and especially Austin have also had a very mild version of all of this compared to some places. At peak we used something like a quarter of our available ICU beds before things started going back down, from the numbers I've seen. There basically haven't been any shortages of anything (at worst, people would buy up all the toilet paper in the morning and it'd all be restocked the next day).

Of course, one way to reverse that situation would be to start opening things back up.

Our state is going to attempt "phases" - https://www.politico.com/news/2020/04/27/texas-loosen-restri...

Management is being vague on purpose, due to HIPAA.

it's unlikely an apartment building's management is familiar at all with HIPAA. it's more likely incompetence or like most things in the u.s., a lackadaisical attitude towards the viral outbreak. i doubt HIPAA applies to a global pandemic. that's not its purpose.

HIPAA only covers health care providers, so does not apply to employers.

> But more importantly, India has been contact tracing like a greedy algorithm on steroids since case #1.

So looks like India is doing in practice what they show CDC doing in the US in the movies, such as in Outbreak.

Clips from my friend in Goa show the street scene hasn't changed. People still loitering and buying things in the open air and forming dense crowds. From the clip maybe less than half had masks. Super disappointing and concerning.

These numbers seem far to low given the flippant nature most city dwellers are appearing to have to this disease and taking necessary precautions. To me, this is the calm before the storm.

Goa was declared COVID-free when the last cases recovered and there were no new cases. That is probably the reason - the situation in other parts of India is quite different.

Source: https://m.timesofindia.com/india/goa-covid-free-but-risks-lo...

Goa doesn't have any active cases and the borders with other states are still locked: https://timesofindia.indiatimes.com/city/goa/state-govt-want....

Absolutely this. My hometown, whole hometown, home to 55k people, got sealed on just one single case. National highway is blocked. All previous passes invalidated. New passes were issued to ensure delivery of groceries. In a town where no company does grocery delivery, local vendors have started doing home delivery.

> Not a lockdown, sealed.

How does this work with essentials like food and medical care? Does the government bring supplies to people since they can't go to the store?

Really though the governments planning has been very opaque. Even now they don't seem to give any clue on what is going to happen once the declared lockdowns end.

Also government is keen on pushing a shady app for monitoring purposes, I home some one does a security audit of that app.

And the police has been acting in heavy handed manner. Instead of seeing this is a health care issue, the government seems to view this as some kind of law and order issue, and turned the whole country into a police state, putting countless people into misery, especially migrant labourers with hardly any concrete scheme put in to take care of them during this.

There has been serious lack of empathy and care towards the citizens from the government. Government seems to act to preserved face and reputation, rather than for the peoples welfare. Testing rates has been low, also testing is slow, it seems to take 2 or 3 days for people to get their test results. Projections, analyses etc has been hardly published by the government. Also many people have been testing positive more that 30 days, after they have arrived from out of country, that is still yet to be explained by the government.

Unfortunately, from what I have heard from my doctor friends, the government does lie about the numbers. Not all the state govts are doing this to the same extent but I have heard first hand information for doctors on the ground that the govt is hiding and misreporting numbers.

>India has been contact tracing like a greedy algorithm on steroids since case #1.

Care to provide source?

>People are self policing mainly to avoid police, but they are self policing each other because nobody wants their buildings sealed.

I have seen videos of people violating lockdown without fear.

>There are only 85 active infections

85 infections which were caught.

> Care to provide source?

There is some info here: https://www.nytimes.com/2020/03/17/world/asia/india-coronavi...

The US is #1 in infections for a reason: we are doing it wrong.

>The US is #1 in infections for a reason: we are doing it wrong.

It's more likely that we're testing far more than most countries than "we're doing it wrong."

No. Per capita, our testing is absolute crap--South Korea and Singapore are good examples of countries that actually have done thorough jobs in testing everybody.

South Korea's positive test rates are somewhere in the single digits, the US is around 20-30%. That's not a sign we're "testing far more than most countries."

Have you looked at deaths? Or are you suggesting india's creating mass graves that media is not aware of, or doctors who aren't speaking out.

I have a lot of relatives back in India who are doctors, and our hospitals aren't overwhelmed. There are very few cases. And they test every ICU admit for coronavirus.

What is that based on?

As a relatively rich country, the US has a natural advantage compared to poorer countries, but compared to other countries that have a similar per-capita GDP, that doesn't seem like an obvious conclusion. Hell, given how badly the creation of the original assays by the CDC went, and how distributed the healthcare system is, on top of the current political climate, the opposite conclusion seems warranted.

> testing far more than most countries

source?

>India has been contact tracing like a greedy algorithm on steroids since case #1.

Some states like Kerala is doing active contact tracing. Also the first case was reported 3 months ago and not 2 months ago.

https://www.theguardian.com/commentisfree/2020/apr/21/kerala...

> >There are only 85 active infections

I am not sure which area the original author is talking about but less than 150 is the real active cases in some states https://dashboard.kerala.gov.in/

all my relatives in india, incl 60+ yr old folks are using contact tracing apps. In the US people are completely ignorant about these things and there's no effort from the govt to push these apps.

So what if you have seen videos where people violate the lockdown?

What are you trying to say? That there is no lockdown, or that a few people violate it or that its no use to lockdown?

Violations of lockdown are happening all over the world. If you are from the USA, better worry about the 60k+counting, avoidable deaths due to avoiding a lockdown.

Lol where does the 5% of yearly deaths from TB factor into all this? You mean the millions dead in India over the past decade is still happening, but they stopped this brand new considerably less deadly virus right away?

Do you live in Noida?

>But more importantly, India has been contact tracing like a greedy algorithm on steroids since case #1.

How is what you're describing a greedy algorithm? The behavior is based on self-interest, but that's not what a greedy algorithm is. https://en.wikipedia.org/wiki/Greedy_algorithm

I can give some ground level information. I live in a very densely populated street (total length is just two hundred meters, my guess is at least a thousand people live here). No one is dying here without others noticing. Further, there's a great amount of scrutiny into whether anyone's sick (see the reports of doctors getting beaten up even by the cops).

As far as I know, no one has died in this street in a month. The ambulance hasn't entered the street either. So unless there's a great conspiracy which most of us in the street are unaware, there really doesn't seem to be that many deaths. In fact the death rate is lower than normal, when people normally die, the first ritual is the blowing of a very loud horn in front of their house for an entire day. Haven't heard that in weeks. I live in the middle of the fifth biggest city in the country as well. It's likely many people in the street already have this but it's very unlikely that many or any have died from covid.

For reference, official disease tally for my city is now 570 cases.

My own personal experience : A close relative passed away in a large city early April (of pneumonia caused by COVID-19) complications. His entire family was interviewed for 2 hours and all contacts were screened - the family and some of the contacts were also put in quarantine and tested. The names of my relative and others who tested positive were put in the papers the next day (name, address etc) after the test, to help identify people who may be may have come in contact. This is obviously anecdotal - but i have so far seen the opposite of hiding data - some places are revealing too much rather than too little information.

But India has a federal structure, different states may have different policies. It is pointless to make one statement about the whole country, especially when the numbers are coming from states, not the center.

> Further, there's a great amount of scrutiny into whether anyone's sick (see the reports of doctors getting beaten up even by the cops).

What? Why are doctors being beaten up? I don't understand.

It's very stupid, but a (very) few people see them as potential spreaders of the disease. Public health workers going into the community to find infected people have also been attacked. Also, until recently, suspected COVID patients had to be in hospital -- no home isolation allowed -- and some of these patients (or their relatives) thought that venting their anger on doctors would help.

Unfortunately, the law of large numbers in India means that a "very few" can mean tens of thousands of people.

[1] https://www.bbc.co.uk/news/world-asia-india-52151141

[2] https://www.bloomberg.com/news/articles/2020-04-13/doctors-c...

In North American long term care facilities, this is exactly what's happening. In Canada, a ban was put in place to prevent health workers from working in multiple long term care facilities - it was found that infectious material was making its way via health workers from one home to another, all full of high risk populations.

Add in the fact that many hospitals in North America are short on PPE, and some are even preventing nurses and care personnelle from wearing PPE (or to bring their own, etc) - and you can see how much of an issue this can be.

Of course, beating up the doctors is a bad idea, but the roots of the idea that health workers are potential spreaders isn't all that far fetched.

> a (very) few people see them as potential spreaders

One problem is that although only a very few will see it this way, other people would be cautious about being caught up in it. This could affect the way they behave because if they think that somebody died in their house from this disease then they won't want to advertise that at all (eg by blowing horns) in case they were subsequently targeted. The fear is likely worse than the reality but behavior like this is driven more by fear.

However I can understand that ramraj07 says it seems unlikely on their street as it would surely be difficult in a close community to hide a van coming to take Auntie-ji away.

Few isolated incidents mostly in slum areas where rumors spread of a government conspiracy of targeting muslims. This government's anti-minority image did not help.

Source: https://www.hindustantimes.com/india-news/assam-mla-held-for...

> What? Why are doctors being beaten up? I don't understand.

The anti-vax crowd in India tends to be on the violent side of things.

when people normally die, the first ritual is the blowing of a very loud horn in front of their house for an entire day. Haven't heard that in weeks.

Could people be hiding deaths due to the stigma around COVID? Quietly taking their loved ones' bodies out of the neighborhood for funerals?

Never say never, but when I say crowded small street, I definitely mean it, nothing larger than a tote bag moves without gossip spreading, unless maybe at 3 am. So, perhaps? But I wouldn't bet much money on it personally! We will know in a few weeks though, if people are dying in our street, given the absolute lack of any distancing measures inside the streets (lockdown is only at a block level), more people should get very sick very soon.. hope not.

There are some numbers which simply don't make any sense.

Take today's data:

Delhi - 3,314 cases. (likely to go up as data is updated for tonight). Total population of Delhi is 19 Million.

Rajasthan - 2,438 cases. Total population: 68.9 Million

Haryana - 311 cases. Total population: 25.4 Million

Haryana has less than 10% of Delhi's covid case numbers while being a much larger state and while sharing a big border with both Delhi and Rajasthan where the covid cases are much higher. Also, huge numbers of people travel between Haryana and Delhi on a daily basis. Haryana's numbers make no sense.

Uttar Pradesh - 2,134 cases. Total population: 204 Million

About 30% less than Delhi while being much, much larger than Delhi and sharing a huge border with Delhi with vast numbers of people travelling to and from Delhi! Uttar Pradesh numbers too seem heavily under reported.

Bihar - 403 cases. Total population: 99 Million

Bihar has much, much lower covid cases than even Uttar Pradesh when Uttar Pradesh's numbers were themselves already suspiciously low. Bihar shares a huge border with Uttar Pradesh and there is simply no way Bihar with a much poorer healthcare infrastructure can have such low covid numbers.

Both UP and Bihar has huge numbers of migrants working in Delhi, Mumbai etc which makes these numbers even more dubious.

So on the face of it, there are big issues with these numbers being put out by some of the biggest states in India. If these numbers were more accurate, the overall figures for covid cases from India will be much higher.

India shares a massive border with China and is right next to China while having almost the same number of covid cases as Peru - which is halfway across the world from China and which is relatively shielded from the rest of the world in comparison to India - in terms of number of travellers coming in etc.

570 official cases in the city would mean 5-20 deaths. You most lokely wouldn’t noce those deaths on your street unless the street has 20% of the popularion of the city.

His comment is addressing thoughts about whether official numbers are off by a couple orders of magnitude

I'm guessing you live in Hyderabad. Clearly your street is not a hotspot, and you really shouldn't be extrapolating from it to the rest of India. As far as people having it while being asymptomatic, that is unfalsifiable until they are tested.

Don't think I mentioned anything to generalize. Just what I observed in my city (Chennai) in my street.

What I was implying is that perhaps things did go okay in terms of slowing the spread in India: of course, there's probably more spread than is being reported, but that seems par for course everywhere.

I'm only worried that the lockdown is going to significantly affect the poorer communities worse at the expense of richer folks.

>>the lockdown is going to significantly affect the poorer communities worse at the expense of richer folks.

In such situations that is always the case. If there is a lockdown, poor will suffer financially. If no lockdown, poor will be exposed to the infection more than others since they have to be out working.

Apologies, I read that as extrapolation. Also assumed Hyderabad as that is the fifth biggest city in size, and cases are around the same in number.

uh ... India has so many cities, how can you assume any city unless the person says?

GP did say that they lived in 1) the fifth biggest city in India, and 2) the case count was currently 570 in their city.

The fifth biggest city in India population-wise is Ahmedabad but its case count is 2378.

The fifth biggest city in India area-wise is Hyderabad whose case count is 542.

Therefore I assumed OP meant Hyderabad. Both counts are from https://www.covid19india.org/

It’s not your fault. This kind of positive outcome just isn’t acceptable to a lot of people so they’re going to at best claim you’re the exception and at worst that you’re fudging the numbers.

Today’s fashion is drama and any not hysteric action must end in doom and gloom.

> I'm only worried that the lockdown is going to significantly affect the poorer communities worse at the expense of richer folks.

Sorry, what? The lockdown isn't about the rich or the poor. It is mostly about containing a deadly disease we don't fully understand yet. It is for the medics but also mostly to keep the social fabric intact. No one wants this to descent into chaos and madness without controls in-place. A deliberated and measured response is warranted despite an unprecedented loss of livelihood and absence of any real infrastructure to handle the fallout, especially to support the 500m people who live on daily-wages. Unless an effective prophylactic or a therapeutic treatment is discovered, lifting the lockdown can be disastrous for a country as dense as India and for incubation periods as long as they are for a rabidly contagious SARS-CoV-2.

Hopefully, the current situation improves in a month (most cities and states could possibly reopen in the coming weeks), but I wish the conversation around UBI (food subsidies including) and universal healthcare picks up steam rather than the pathetic pettiness around religious faultlines that seems to be in focus, all the time, aided by the ruling party's inclination to make a mockery out of democracy and India's minorities. I digress.

>> I'm only worried that the lockdown is going to significantly affect the poorer communities worse at the expense of richer folks.

> Sorry, what? The lockdown isn't about rich or poor.

I think you misunderstood the parent comment. They are worried that the poor will be more negatively effected by the lockdown than by the coronavirus, in contrast to the rich. This has been observed in other countries, where the poor have had no way to sustain themselves without work, whereas the rich can just hide inside and wait it out without a problem.

> I think you misunderstood the parent comment... the poor will be more negatively effected by the lockdown than by the coronavirus, in contrast to the rich.

GP said and I quote, "at the expense of the rich", which, to me, implies that somehow the rich are conspiring to persist with the lockdown. The families reliant on dialy-wages have always had massive problems in terms of education, healthcare, food, and shelter, and it isn't something the pandemic has birthed though it has aggravated it. There exists central and state government schemes to address these issues, but I wish there was a more systemic, consorted, and uniform approach to it with UBI and universal healthcare, instead.

It sounds like you're taking the opportunity, a grammatical error in the op's comment, to be combative and argumentative. Now you're just being dismissive of the plight of others and using your command of the language to minimize the situation.

The pandemic and quarantine haven't just aggravated an untenable situation, they're pushing it to the limits. The poor can't afford to not work, the rich can afford to remain in lock down. It's happening everywhere, not just in India.

There are those of us who can afford to be out of work for a long time, and there are those of us who can continue to work while maintaining quarantine, however there is a significant portion of the population that has run out of reserves and must work to live. These are people driving trucks, delivering packages, stocking shelves, generally putting themselves at risk while enabling the wealthy to remain quarantined.

> It sounds like you're taking the opportunity... to be combative and argumentative.

I'm sorry it comes off like that. My intention was to point out that this situation isn't of advantage to anyone regardless of their social or economic standing. Sure, a lockdown is harsher on some people than the others, but life, in general, is harsher on some people more than on the others.

The pandemic is doing a great job at ringing the alarm bells. I hope it stirs the government and the policy makers into action and not use it instead for abhorrent religious and political mileage at the expense of steering away from building a support framework for all its citizens.

> ...using your command of the language to minimize the situation.

I'm not the one mentally replacing at the expense of with in contrast to.

> The pandemic and quarantine haven't just aggravated an untenable situation, they're pushing it to the limits.

You'd find that we are in agreement. I don't understand what part of my comment made you think I'm cold to their struggles.

> I don't understand what part of my comment made you think I'm cold to their struggles.

As I said, it's the minimizing choice of language and your choice to ignore a grammatical error.

> I'm not the one mentally replacing at the expense of with in contrast to.

As I said before you're ignoring the grammatical errors in that sentence and paraphrasing to suit your argument.

> GP said and I quote, "at the expense of the rich",

That isn't what was said. The full quote:

> I'm only worried that the lockdown is going to significantly affect the poorer communities worse at the expense of richer folks.

Which is grammatically incorrect and doesn't make sense. However given the context and the structure of the sentence it's hard to draw the conclusion that you did. Rather, it's more likely the op mean to say something like:

> I'm only worried that the lockdown is going to significantly affect the poorer communities worse than richer folks.

But some how you've interpreted it to mean that the richer are willing to accept some self harm if it means harming poor communities?

Ah, gotcha. Thanks for clearing that up.

Fwiw, I didn't somehow interpret it purposefully in any sinsiter way or choose to ignore an error to start an argument. For some reason, that's just how I read it.

> Fwiw, I didn't somehow interpret it purposefully in any sinsiter way or choose to ignore an error to start an argument.

No worries, a lot of that was probably how it sounded in my head.

"can be disastrous for a country as dense as India and for incubation periods as long as they are for a rabidly contagious SARS-CoV-2."

Isn't the whole point of the article that this isn't the case?

> Isn't the whole point of the article that this isn't the case?

The author rather paints a skeptical view of the numbers coming out of India.

He didn't extrapolate - the article is about the country, his comment is about his street, "on the ground".

I’m a (foreign) American citizen staying in India and happened to arrive here a few days before lockdown started. I don’t understand how this is a mystery: India quickly locked down the entire country and going outdoors was consistently punishable by police hitting people with sticks (thankfully it seems like the brutality has eased up since the start and police are doing things like making people write sorry on the beach or do squats instead) People are taking the virus and situation seriously, without an unusual spike in fake news. You can’t even order anything outside a narrowly defined “essentials” category online. Thankfully food delivery is opened up.

To all the Indians here who are in the same situation, phew, I understand your pain. Hopefully this next extension is the last one and then it’ll be more limited to hotspots: and we will all be able to order from amazon again soon. I also hope the economy can open quickly and smoothly when the time comes.

A lockdown is not supposed to reduce the total number of cases; it is supposed to "flatten the curve" so those cases take a lot longer to develop. The intent is to drag the virus out for as long as possible so we can prepare our hospitals, develop more effective treatments, and get closer to a vaccine. A lockdown does not make the virus go away sooner; it prolongs it.

According to the Johns Hopkins dashboard[0], India has peeked. Just like most other nations, India seems to have made it through the worst of it and is now on a downward trend. That is the mystery.

The article makes a few suggestions. Maybe the virus hindered by the warmer climate. Maybe the strain in India is weaker than others. Maybe India's relatively young population is just more resilient. Unfortunately, we just don't know yet.

[0] https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594...

Nah, a stay at home order is to flatten the curve. A lockdown is to burnout the virus. If you lockdown for about 2x the time the virus incubates and people follow the lockdown. You can snuff the virus out. At the beginning of the lockdown, assume someone just got it and lives at home with others no symptoms but they spread it to other's that live at home, assume those don't have symptoms and they stay in for the recommended quarantine period, then the virus should have subsided. In the case of sars-cov-2 2weeks+2weeks. So 4 weeks minimum, add 1 or 2 more for safety measure. If people are sick enough to go to the hospital, they get treated, contact tracing is done. It's tough, but if everyone said home for 6 weeks. Absolutely no contact, the virus will burn out since it won't have any new hosts to infect. China didn't do their lockdown to flatten the curve, they did it to snuff out the virus, that's the same strategy India is attempting.

Snuffing out the virus would be a pretty impressive feat and it might just work. It might even be awesome for a while - but wouldn't you have to completely eliminate any potential vectors for the virus to get into the country again? Does that really mean virtually no immigration? Even with rigorous testing, if there's a single false negative, wouldn't that completely eliminate the gains of having gotten rid of the virus?

Obviously a lockdown can cause the number of cases to go down. There's no mystery here. There are many countries doing the same.

Yes, it is "supposed" to flatten the curve always keeping some manageable number of people infected. So if you reduce the number of cases any further you are doing it wrong; because no, you won't extinguish the virus, you'll only prolong the lockdown.

You can absolutely extinguish the virus if you have good border control. What makes you think you can't? The infection numbers exponentially decay toward zero when the replication rate is below one. At some point, the last infection recovers or dies without passing it on, and the virus is gone.

So what do you think is the alternative?

> Obviously a lockdown can cause the number of cases to go down.

Maybe I'm just ignorant, but could you explain how a lockdown is supposed to decrease the total number of cases rather than just prolong it?

A lockdown does not make a population more resilient to a virus. It just reduces contagion vectors so it spreads more slowly. The virus still spreads, though. Eventually, enough of the population will catch the virus and build up a resistance to it so that herd immunity kicks in. At that point, enough people will have been exposed to the virus that it does not have enough people to spread to and simply dies out.

I suppose the threshold for herd immunity is lower in a lockdown situation, but I am skeptical about it working to that extent. If my skepticism is misplaced and the lockdown really is that effective, then that also means India will have to stay on lockdown for a very long time to keep that herd immunity threshold low and completely starve the virus out.

It only takes one person to turn it around: https://www.aljazeera.com/news/2020/03/31-south-korea-sudden...

Did you see police beating people yourself? I have a suspicion that it was made just for camera to scare people.

I have heard first-hand reports from people that saw a little of it.

Police beating people with lathis happened in many places all across the country, where people were insisting on breaking curfew, until people got the message. It’s also not terribly uncommon for the police to use such measures, especially where curfews are involved. I see no reason to doubt that it has been happening.

‘Beaten’ for stepping out for biscuits, UP teen dies

'Eyewitnesses said the cops beat Rizwan with batons and rifle butts'

https://www.telegraphindia.com/india/coronavirus-lockdown-be...

In India there's never a shortage of people (police or civilians) beating each other with sticks. Happened long before COVID and will continue long after.

One of the most eye-opening things I've ever seen was the crush of people trying to get on the general admission train car being beaten back with sticks before the train even stopped moving.

You could see several videos of it on major Indian news outlets. (With people in masks standing around.)

Corporal punishment is still very much a thing in many parts of India, for better or for worse.

As a foreigner who has spent time working in India over several years, I've seen it happen multiple times. Each time I was with India colleagues, and nobody batted an eyelid. It seems to be pretty "normal".

That did happen. A good number of people in India only take things seriously when there is some degree of harshness from the administration.

Ah yet another cant-be-true-they're-hiding-something article? Surely they can't be doing better than developed countries?

FWIW, India did implement a stronger lockdown much earlier on in the curve than other countries. State and federal authorities went lock-step in their actions, and with consistent messaging. Police enforced the lockdown at times even brutally, getting the point across to the general public. Indians watched UK and US struggle through a denial and late response in disbelief, like watching a car crash in slow motion.

This is something that has really struck me during the Corona crisis: the misplaced Western believe of superiority towards Asian countries. I am European and I feel embarrassed about how much arrogance is displayed by some people and governments.

It started already in the beginning, when the virus was spreading rapidly in China. Reports about the failing Chinese authority were all over the place, but nobody seemed to worry that when the virus would eventually reach Europe, we would be in trouble as well. After all how could we, with our superior health system and our governments that would react quickly and rationally on such a trivial threat as this.

When the virus had reached Europe, it had already reached South Korea and Taiwan as well. These countries had learned from the earlier SARS outbreak how to deal with it and thoroughly tested everyone that could possibly have the virus, symptoms or not. The reaction I saw in the media was mostly about the breach in privacy that these measures brought. Surely this was not something that we, as enlightened Western societies, would want. And anyway, what were we frightened of. This virus could never spread so fast in Europe as it did in China, because .. Well because of what actually.

Now that the pandemic has wrecked havoc in the entire Western world and most people are realising that a strategy of first constraining the virus (like in Wuhan) and then testing everybody to contain in (like in South Korea) is the only realistic way to deal with it, one might think that a bit of humbleness towards Asia would be in place. Think again. What we're seeing more and more instead is denial. Investigations are started if the Covid virus was manifactured in a laboratory in Wuhan for instance.

I agree with you and I’ve made the same observation but I don’t think it’s due to some misplaced sense of superiority.

I think it’s simply because it has been a while since disease and pestilence was a worry for the average Western country so the average citizen (and therefore the leaders) are complacent in a sort of “It can’t happen here” way. There have been outbreaks such as the AIDS epidemic or swine flu but nothing as impactful, infectious, and at the scale of COVID.

Whereas Asian countries have grappled with issues of SARS, Malaria, AIDS, Polio, and many more in the not so distant past and have learned the importance of taking public health seriously. The experience of the outcome of mismanaging a response to a previous epidemic is still “fresh” so to say in many of these countries. I think a good example of this is how South Korea dealt with SARS and evolved their response to COVID based on the learnings from that.

Lastly I wonder if the prevalence of more communal societies in Asian cultures make a difference. I can imagine it could make the problem worse but it could also be beneficial in the sense of providing strong societal pressures to quarantine/hand wash/social distance/etc.

Edit: And of course the misguided leaders in particular Western countries are not helping. Maybe the US this particular time is just a statistical outlier due to some mismanagement and there is nothing more to read into further than that?

> I think it’s simply because it has been a while since disease and pestilence was a worry for the average Western country so the average citizen (and therefore the leaders) are complacent in a sort of “It can’t happen here” way. There have been outbreaks such as the AIDS epidemic or swine flu but nothing as impactful, infectious, and at the scale of COVID.

I agree that this is the main factor. Consequently I proposed the concept of the "civilization immune system" to explain how it works: https://www.sonyasupposedly.com/civilizational-immune-system...

China’s first response to doctors reporting the virus was to send police to them and shut them up. I’ll gladly believe I live in a better country.

I had the impression, based on news articles at the time, that local officials were behind the initial coverup in Wuhan, lasting until national officials rectified the situation.

I've not seen this - which country are you in? I've seen acknowledgement of South Korea's success, and criticism of China's failings.

How about acknowledgement of success in Vietnam, Eastern Europe, India, China, etc?

GP is right, that you hardly hear it in the news.

Right, we can't have it both ways:

Either Asian countries are lying because they are extremely advanced in their population centers and also authoritarian, which would be the only way for it to be news.

Asian countries are lying because they have the exact same organizational dysfunction as every country in 'the west', and also authoritarian, in which case it isn't news.

so which is it folks, superior technology cohesive culture and leadership, or organizational dysfunction no different from the west.

There was some interesting article about possibility that this virus is artificial. Author came to conclusion that it's possible, but there's no way to prove that (other than insider leaking strong proofs, of course). Modern virusology laboratory can create such a virus indeed and it'll be indistinguishable from a wild virus.

Unfortunately this article is in Russian, I'll provide google translate link, but it probably will be translated with errors.

https://translate.google.com/translate?sl=ru&tl=en&u=https%3...

I flew from India to the US in early February (2nd week).

Indian airports were doing thermal checks on passengers (using tech that had been installed during the Zika virus scare a few years back, I believe). The newspapers also had info about how anyone found with elevated temperatures were being asked to self quarantine, and the police was also following up.

The US had, absolutely nothing. Nada. Before the flight I was afraid that entering the US would be difficult, but it was clear (and it remained this way for over a month), that if anything, entering India, if not difficult, would actually involve checks, something that was non existent in US ports.

Further, and I don’t know if this is mentioned, the flight into India involved the cabin crew spraying some sort of pest control spray in the cabins before we landed. They mentioned it was due to regulations. Considering SARS-COV-2 has been found to have been easily killed (within minutes) of exposure to common disinfectants, could this spray have greatly minimized the virus entering the country, on baggage’s and clothing, etc?

Similar situation here. I travelled from Bangalore to the UK, around the first week of March, almost everyone at Bangalore airport had masks, workers had masks and gloves.

When I landed at Heathrow, not even immigration folks had masks

People in India took it seriously in the beginning

To be fair with the disinfectant that's been the case with India for years - I went in 2016 and they were doing it then as well.

Yep, since 2014 at least. I always assumed it was some kind of insecticide/pesticide? Is it just a disinfectant?

They started doing it after SARS-COV-1 back in 2002. The rest of the world actually respects intelligence and science (so far) but unfortunately in India it looks like the Fox-News/AM-Radio playbook is starting to win.

I flew into the US end of last week, more than a month since shelter in place started in many states. Still no checks of any sort. There were a couple of questions by the airline during check in but nothing after that. No questions at customs, no temperature checks.

I don't think that's disinfectant they were spraying, but rather insecticide for biosecurity. They do it on the way into Australia and New Zealand too prevent the spread of agricultural pests.

The entire gist of the article isn't "it can't be true they're hiding something", it's "if statistics in the West are underreported which they likely are, why on earth would one believe they're not underreported in a country with far more limited access to medical care for much of the population where deaths from respiratory diseases are far more commonplace in normal times"

India's lockdown started the day after the UK, and whilst undoubtedly the government has taken some strong measures to make the lockdown viable, it also faced unique challenges like significant parts of the urban poor population attempting to return home to families in their villages. Of course, despite being later than Western lockdowns chronologically, India's lockdown was earlier with respect to the known spread of the disease, but that in itself is a phenomena worthy of explanation.

When New York went in to lockdown, it had ~7000 cases (20th March) [1]

When UK went in to lockdown, it had 6700 cases. (23rd March) [2]

When India went in to lockdown, it had 657 cases. (25th March) [2]

[1] https://edition.cnn.com/2020/03/20/politics/new-york-workfor... [2] https://coronavirus.jhu.edu/map.html

To top it, some states announced a lockdown a couple days before the country wide annoucnement. TN went into lockdown on 23rd Mar for ex. Overall, I think the local govt of some states (esply Kerala) did well by their people. However, we aren't out of risk by any measure. There are some interesting developments in the region as well. A friend in SG mentioned the 6000 odd cases of migrant workers who tested +ve in Singapore, but during the same period ICU occupancy reduced there, with only one case reaching critical condition .. and recovering. Most migrant workers in SG are from the Indian subcontinent and are generally young and healthy.

It sure feels like there are something not well understood about this virus from infection/death stats alone.

These are confirmed cases, i.e. people who have tested positive. Actual cases, either in India or the UK, are unknown.

Comparing cases is pretty meaningless if you don't also compare test rates.

Also, there are a few factors that are in favor of India. The number of international travelers between China and India is much lesser compared to European countries. I suspect this may have played a huge role in reducing the initial exposure.

Added to that, apart from major cities, international travelers are minuscule in the general population. Consequently, the largest group of exposed citizens are from Mumbai & Delhi. Other cities are relatively less exposed.

I agree with you. The condescending tone by Western media towards India is awful and disgusting.

The reality is probably that it's a combination of doing the lockdown well and the disease being far less deadly than initially thought due to very high asymptomatic infection rates. The latter is an emerging fact that the media here are in denial over. Therefore, they think India must be undercounting or something else. Awful and insulting.

BTW, in regards to US, the lockdowns here worked. NYC was the only place in the entire country that ended up getting hit bad. The rest of the nation has not been hit anywhere approaching what was predicted by models which took into account lockdowns. Outside of NYC, US statistics match Germany.

NYC certainly got hit bad, but I wouldn't say it's the only badly hit city. Here is deaths/total pop for some other cities >1mil population which I would also call "hit hard".

NYC: 1.07‰

New Orleans: 0.65‰

Detroit: 0.60‰

Boston: 0.44‰

Source: https://www.nytimes.com/interactive/2020/04/03/upshot/corona...

I think you're off by a factor of 10 in your numbers

I live in Kazakhstan and so far out country seems to be doing a right thing. We're heavily quarantined and I don't think that states are hiding anything. Economy implications of such a lockdown probably will be harsh, but that's a different thing. There was ill person in the building I'm living in and now entire building section just closed, nobody can go out and regular desinfections are performed (I don't think that they make any sense, but whatever).

So I'm absolutely sure that Kazakhstan is doing better than many European countries and for sure better than US. May be our government is not the most democratic one out there, but they care about citizens and their tight grip over country allows them to make an unpopular but effective decisions.

Some western people just think that they are strictly superior everywhere to the developing countries. That might be true in a lot of areas, but it's not an universal truth.

> Some western people just think that they are strictly superior everywhere to the developing countries.

The so-called western people, I'd argue, have the right mindset. I agree governments capable of draconian measures tend to do well when such behaviour control is desirable at a nationwide scale. That doesn't mean it is the only solution or even the best one.

I personally would pretty much prefer prevention, absent which, a measured, well thought-out, least disruptive policy around epidemics (I am looking at you South Korea, Taiwan, and Vietnam). Curtailing liberties, harsher restrictions, oppressive policing, regressive policies don't really fill me up with any sort of confidence. In fact, I worry that the citizens that are not just in acceptance of such a response, but in appraisal of it, are in for a grim reality-check when another unrest, epidemic or otherwise, rears its ugly head.

South Korean government did have strong laws on their side, some of which can be considered as draconian by American standards[1].

Considering behaviour of American population to the lax government measures, I guess strong laws/measures are the way to go.

1. https://www.lawfareblog.com/lessons-america-how-south-korean...

Came here to say this. When compared to the Western world, India did fare well and its not a mystery. Though the lock-downs were brutal for many Indians, they were strictly implemented and most people had the sense to follow the procedures. No denying that economic repercussions will be brutal as well but not many lives were lost. In my hometown, there isn't a single active case of COVID19 and its essentially a "green zone" now with most things returning back to normal. Local Police did a phenomenal job contact tracing and enforcing the lock-down. I wonder if life in USA would have gone back to normal by now if there was a better response and acceptance of the impending crisis. I am glad they don't have Fox news in India.

The Police, despite their shortcomings and inspite of their over-zealousness, must be commended. They really did show up for their country at the time of utmost need.

It's not really about judging or comparing unfairly, it's more about india's population density in the case of a contagious disease.

It seems countries are learning something from the those affected earlier which is good. But there are a huge number of under counts to be seen in the all-cause mortality data.

I have my fingers crossed for everyone going through this, but only after the fact are we going to get a good idea of what happened (and that goes for Western countries too).

"U.S. deaths soared in early weeks of pandemic, far exceeding number attributed to covid-19"

https://www.washingtonpost.com/investigations/2020/04/27/cov...

exactly.

The TL;DR is in the final sentence: "we don't know".

So many keystrokes and clicked bait on something nobody has any concrete insight into.

India started lockdown when confirmed Covid deaths was at about 200 or 300 total. Its now at ~900 and doubling every ~10 days.

You got the facts completely wrong, India started the lockdown when total deaths were just 10 !

Source: https://www.covid19india.org/

Right. My bad. I was looking at the lockdown extension date sorry.

It's not just COVID-19 deaths, raw death numbers (as measured by death certificates, you cannot cremate/bury people without one) are down as well -- this report has some evidence, including lower business in at crematoriums[1]. This is likely due to the very stringent lockdown in India, and the somewhat underrated fact that traffic collisions and accidents kill huge numbers of people every day in India.

That said, while lower death rates (India's seem to be about half of the world's death rate) are to be celebrated, there are confounding factors.

1) The reported death count are mostly hospital deaths only. Home deaths aren't counted.

2) As the article notes, mis-diagnosing is a problem especially outside hospitals.

But if there's something that genuinely is reducing the death rate, then that's obviously a huge opportunity to study and learn from.

[1] https://www.livemint.com/news/india/india-s-lower-death-rate...

IIRC, during the lockdown, every death is to be notified to the authorities.

Is that not normally the case? The pp says that every burial or cremation requires a death certificate, and who else but the authorities has the right to issue a death certificate?

The process for getting a death certificate usually takes a couple of weeks to a month or so. And normally, for natural deaths, there is nothing to be reported to anyone.

But during lockdown, reporting is to be done immediately.

It is mainly with a sense of relief (rather than disbelief) that I watch the progression of numbers daily. The lockdown was early and quite stringent and has definitely made a difference. The most stringent lockdown has little chance of being executed effectively in India and there are innumerable cases of people cheerfully ignoring or doing so in desperation. Regardless, the awareness of COVID-19 is extremely high, probably more than any other single critical disease that afflicts us. This should have made a significant difference in influencing the behaviour of the majority. Tests are for the most part only for the symptomatic or with known contact, if asymptomatic. Almost certainly infection cases will be much, much higher. But fatalities are tough to ignore. In today's environment even a death unrelated to COVID causes consternation amongst neighbours and gets known widely. I take that to mean that the fatalities are probably close enough to reality. And that's unbelievably good and I can only hope that it doesn't get bad in the near future.

Yup, there is a very large percentage of the population, even in rural areas, that are awareof the danger posed.

Politicians, including the PM have clearly and multiple times explained their actions in a very clear and lucid language. Stateministers also have conveyed the same in a similar manner.

There was no tolerance on stupid questions from the beginning, and a huge emphasis has been put on scientists amd healthcare experts. Most of the experts also did not talk publicly, but advised the politicians.

True. There has fortunately been no dithering or mixed messages. The clarity and consistency of the messaging has probably saved India.

The article while making some valid points is full of insinuations. This is disingenuous.

The main reason for the low death rates is the lock-down/quarantine in place. India did this very quickly and very comprehensively. I would never have believed that such a lock-down would be followed and enforced in India if i were not living through it. It would be interesting to see how quickly the slope changes once the lock-down is lifted.

Other maybe contributing factors are; Sunlight & UV exposure, High Humidity, a healthy younger population, a better immune system (hygiene hypothesis) etc.

Simply said, the "Developed Western Nations" dropped the ball on recognizing the threat and putting in counter-measures and are now paying the price.

Most Western nations are doing fine. There's really just a dozen or so countries that have been hit hard, and even then the impact has been uneven within the hardest hit countries.

Sorry, for 330 Million people, USA has had 60k deaths from C19 so far, whereas India has had about 1000 deaths in about 1300 Million people.

The western Nations are doing abysmally.

You ignored my comment to say what you wanted to say. Many Western nations are doing great. They are handling the pandemic very well and have less strict lockdowns than India.

I fail to follow from:

> USA has had [...]

to:

> The western Nations are doing [...]

Erasing the plural makes it better, though I have to wonder why wouldn't you just write "USA is doing" however you think it is.

Who counts as a 'Western Nation'? [0] I think most people would assume Western Europe and the Anglophones (USA, CAN, AUS, NZ).

If we assume that the US counts in the "hit hard" category, then we can partition western nations by per-capita deaths[1] like so:

Hit Hard: Belgium, Italy, France, Spain, UK, Netherlands, Ireland, Sweden, Switzerland, US

Not: Portugal, Canada, Denmark, Germany, Austria, Norway, Finland, Iceland, Australia, New Zealand

So I'm guessing that you either a) have a different definition of "hit hard" or b) have an expanded definition of "Western Nation". Eastern Europe and Latin America as regions haven't been hit hard yet.

The impact of covid-19 depends a lot on when it started spreading in a region. Most of the differences between European nations are probably due to when it started. A nation's response mostly affects how it compares to other nations which had outbreaks at the same time. I would guess that India is benefiting most from reacting early in the disease progression relative to other nations.

[0] https://en.wikipedia.org/wiki/Western_world

[1] https://www.worldometers.info/coronavirus/#countries

You excluded a dozen or more nations that are part of the Western world and have not been "hit hard" by your metric. The "hard hit" nations list is an exclusive club, even when you add in the rest of Europe.

The US and the UK are seeing a massive number of deaths.

It varies significantly within the US. In Oregon we have had 92 deaths for 4.2M people. Not massive at all.

That is in spite of what is pretty weak compliance with the shelter-in-place directives.

> Most Western nations are doing fine.

I think except the US, the UK, France, Spain and Italy; all other Western nations are doing fine.

Minor nitpick on reporting : literally every person they quoted with Indian sounding names live and work outside of India. And the lone Indian source they quoted, Prof Reddy, was the only one who lived in India and he was the only one who was not skeptical of the numbers. Not one expert from India was used in the article,besides Prof. Reddy, which is a relatively open society.

BBC and a myriad of British mainstream publications are decisively Anti India in their general narrative.

The NYT is also notorious for the same narrative building. Anyone who is serious about Indian news knows NYT, BBC et al report stories that are far away from ground realities.

With respect to coverage of India, this is definitely true across center and left leaning media in Western countries these days. It has especially come about because the American progressive left has built their political coalition in alignment with Muslim/pro-Muslim groups, which has blinded them to a neutral view. I saw the John Oliver piece on Modi recently, and was shocked to hear how one sided it was from Indian colleagues.

Wow, I just noticed this after you pointed it out. I have learned to take news with a huge pinch of salt. Many of the "reputed" establishments fail miserably when covering India or China. If you are writing an opinion piece, fine. But whatever happened to nuance and covering multiple PoVs? I think with Covid it is really important for us to wait and watch and stop competing.

In case of China, they report it with fear and respect. In case of India it is a case of only one sided reporting and agenda building wrapped in fine English prose and intellectual arrogance.

I generally have a very poor opinion of the govt officials in my country owing to some very bad past experiences in India. But this time I too was pleasantly surprised.

My friend lives in a very populated area in Delhi called Tilak nagar and he told me in feb end iirc that the house opposite his has a huge plaque on it that says *Quarantine, this house has a covid patient" put on by police. This was the time when nobody knew how serious this thing was. So yeah it does seem they got some things right too this time.

Similar in my Apartment. An air hostess got quarantined for 14 days in her house with a big poster on outside door “ Flat under Quarantine “. It was not Red colour because it was not confirmed case. So basically National Disaster Mechanism are quite well planned and implemented.

In the state of India that I live in, at least three people have died in the hospital of very Covid-19-like symptoms, but they were not counted as Covid-19 deaths.

Two of double pneumonia, both with travel history, but their tests came up negative. They were both healthy until very recently. One had arrived from the US, where the chances of community-acquiring-pneumonia are low as I gather.

One of cardiac arrest, but AFAIK she wasn't tested because she had no travel history.

We shouldn't be including deaths in the Covid-19 total just because they involve similar symptoms. Lots of other problems cause pneumonia and cardiac arrest, and you said yourself that the pneumonia patients tested negative. Apparently healthy people die suddenly all the time, sadly.

The RT-PCR test apparently has a very high false negative rate; I've read up to 30% or even 40%.

Also, they had all the other symptoms as well including fever and shortness of breath. One arrived in India with respiratory distress. The other fell ill a week after visiting a Covid hotspot -- Mumbai -- which he managed to visit despite a travel ban because he was a hotshot politician.

Where did you read that? Was it a reputable source that cited peer-reviewed data? We use RT-PCR every single day at our company (vaccine development) and we couldn't do our jobs if it performed so abysmally. The RT-PCR is the gold standard when it comes to detection.

I am not seeing the theory of Vitamin D deficiency being highly correlated with severe outcomes from Covid-19 infections being suggested in the article. Please see links below for this theory:

1) https://www.bmj.com/content/369/bmj.m1548/rr-6

2) https://www.researchsquare.com/article/rs-21211/v1

3) https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3585561

BBC is a known for its India bashing. This article has no depth and is conjuring up some kind of conspiracy theory. HN quality is going down the drain.

https://en.wikipedia.org/wiki/Criticism_of_the_BBC

The BBC is known to write about ex-colonies with a certain level of contempt.

There is a thinly veiled nostalgia about British superiority and to an extent still consider the subcontinent to be some sort of 'unfinished work' that still requires 'civilizing'.

I have noticed a similar sentiment among French and Belgian people about their colonies, but I haven't read enough of their media or politics to know how pervasive it is.

Françafrique - https://en.wikipedia.org/wiki/Françafrique

Unfortunately UK government and Boris Johnson failed to take the pandemic seriously. This include BBC too. While the world was watching the kingdom with fear and awe, the establishment had a wandering attention.

Agreed re. Boris (but not about the BBC). Boris made easy decisions, not the right ones. He is expedient rather than well-judging, and he was too willing to treat politics as a game of 2 sides rather than trying to unify. Maybe he can learn from this.

Unlike what this article tries to subtly hint, there is no massive conspiracy theory stuff going on here. There are too many people in India (with smartphones and cameras and 3G/4G internet) to pull off anything covert. No one here views this as mystery but as a result of country's discipline in lockdown till now. The country imposed an early screening and tight lockdown and people followed it well till now.

> Unlike what this article tries to subtly hint, there is no massive conspiracy theory stuff going on here. There are too many people in India (with smartphones and cameras and 3G/4G internet) to pull off anything covert.

So you're saying there's no 5G?

Jokes aside, I would love a breakdown of all different hypotheses here and to revisit them in one year. (Eg therapies, heat/humidity effects, lockdown severity, lockdown timing, genetic factors, strain variations, etc)

India is doing the lockdown well. Apartment buildings apparently have taken it on themselves to not allow anyone in and out of the buildings. They let one vendor each for groceries, milk, vegetables, pharmacy etc and that's it. People are not allowed to go out or even play in the yard. And this is not government mandated, the HOA equivalent for apartment buildings are doing it themselves.

Germany has suspiciously lower death rates, too... And that's down to the superior healthcare infrastructure there? I was wondering if something similar was happening in India. I was expecting to read about it more from a therapeutic treatment point of view-- Is India doing anything differently that results in higher recovery and lower death rates?

Germany tested more heavily than neighbors earlier on, so probably discovered a higher proportion of "mild" cases. Also, Germany does have a superior healthcare infrastructure in some ways compared to the other big EU countries: in 2012, it had about 2.5 times as many ICU beds per capita as Italy, France and Spain, and 4.5 times that of the UK [1], along with more hospital beds overall [2]. The US had somewhat more ICU beds per capita than Germany, but only about a third of the hospital beds in general, so ICU beds are certainly not the only explanation for why it hasn't been quite as bad here.

As important as healthcare infrastructure is, it's worthless to someone without financial access to it, either directly due to lacking insurance or indirectly due to fear of losing one's job due to absence. Extremely few people (but not zero) in Germany would be hesitant to seek treatment for Covid-19 due to either of those worries, compared with a large (and due to the unemployment situation, growing) portion of people in the US. Americans are being told that they won't get surprise bills for Covid-10 treatment, but I imagine more than a few have wondered how a visit to the emergency room would affect their finances if they turned out not to have it, and decided to tough it out a bit too long.

So, if available healthcare infrastructure and individual financial access to that infrastructure are taken together, Germany looks to be ahead of both the other large EU countries and the US, all of which have suffered more deaths per capita these past few awful weeks.

If some of the German states try to get "back to normal" too fast, though, this relatively good situation could change...

[1] https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...

[2] https://www.oecd-ilibrary.org/sites/health_glance-2017-62-en...

The disease spreads exponentially. Germany's low death rate is probably due primarily to slowing the spread earlier. You don't need to treat infected people better to have fewer total deaths if there are fewer infected people.

https://91-divoc.com/pages/covid-visualization/?chart=countr...

There's a chance that climate is on the India's side here. "High Temperature and High Humidity Reduce the Transmission of COVID-19" https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767

Of all the large Brazilian cities, the one that is in a crisis due to the virus is the one with highest temperature and humidity.

There is a chance that in some regions of the world we have somewhat weaker strain of the virus.

Poor article, not even a single mention of the most likely reason for low death rate (apart from young population), the weather! Strong Sun (UV light) and high humidity quickly kills the virus. Warm countries like Thailand - despite millions of tourists from Wuhan - have low death rates. In Spain cold Madrid was affected much worse than sunnier south. Summer will soon rapidly kill of the virus in southern Europe.

Plenty of warm areas are being hit hard, but a lot of warm countries have "reporting issues" (look at the excess deaths in Jakarta for an example). Heat might lower R0 by some amount but it's still way above 1 without measures

There's also strong correlation inside the same countries regarding the more sun = less deaths vs less sun = more deaths. The best examples that I can give are Italy, where Rome and everything South of of it has ridden the pandemic wave pretty ok (with the slight exception of the region of Puglia) and Spain, where the region of Andalusia in the South has had only a 5% or so excess in the number of deaths for this year

It is possible the correlation is: more outdoors -> less deaths

Where the relationship with "more outdoors" is kinda temperature dependent (not too cold nor too hot) and culturally/regionally dependent

In Brazil the correlation is going almost perfectly as more sun = more deaths.

From the article: "Yet others talk about the possibilities of the presence of a less virulent strain of the virus in India, along with the possibility that its hot weather was diminishing the contagion. Both these claims are not backed by any evidence."

> "Both these claims are not backed by any evidence"

There is evidence for the weather claim, but it's complicated by other factors.

Multiple studies [1] have observed a correlation between weather/UV and severity of outbreak.

Wuhan, Milan, Madrid, Qom, UK, Korea and Northern USA have all fit a comparable weather profile during their outbreaks.

The problem is that this virus seems to be more durable/resilient than other seasonal viruses (flu, common cold), and even in hot climates, many people still spend a lot of time congregated in air conditioned office/residential buildings, shopping centres, public transportation systems, etc.

So it's true that hot weather alone is not enough to end an outbreak.

But it can reduce the extent/severity, and the observed evidence seems to bear that out.

[1] https://www.ft.com/content/c8ed3692-6db3-11ea-9bca-bf503995c...

Yeah. And yet...

- The statistics indicate the contagion is diminished.

- No one knows why.

- Someone posits a plausible explanation of an effect seen in some (but not all) similar viruses.

- Explanation is dismissed without consideration, and the working theory us that the statistics are wrong.

Seems strange given the fact that I've seen numerous academic papers shared over the last few months indicating that hot weather and high humidity do indeed have some kind of effect on the virus's transmission.

It doesn't "kill the virus". It reduces the half life of the virus, thereby reducing the time it has to spread from surfaces. This means the virus is less transmissible.

That alone cannot explain why deaths / infections ratio is low in India compared to the west. There are many hypothesis: - Higher testing in India - BCG vaccine immunity. None of these have been scientifically validated yet.

And then summer ends and fall begins and we start all over again. Only longer, this time.

Hey, guys I'm from India. There is a very strict lock down here. It has been there for a long time now. My city (Bangalore) did the lockdown a bit early. Like one more comment down this thread, there will be really loud horns in front of houses. That has not been going on around here.

India's median age is 28.1, US' is 38.1, Spain's is 42.7 and Italy's is 45.5.

the average life expectancy (especially for males) is relevant here. India's at 70 yo, while UK is 80

No news channel is unbiased these days but I don't know of any other news source that has as much criticism as BBC. They have a long history[1] of spreading misinformation and hate aginst many countries (specially India).

1. https://en.wikipedia.org/wiki/Criticism_of_the_BBC

While the reported deaths may be low, the 'they are hiding something' attitude is not helpful. India cannot do the level of testing that western countries do due to the humongous population. I can very well assure you in India you cannot hide mass deaths like China. A distant relative died of cardiac arrest and the measures were so strict that in a highly social society where paying respects to a deceased is considered a basic duty, only 5 close people were allowed. The body was directly cremated by specially appointed staff at the hospital.

While i am worried about the fact that social distancing is difficult to implement in India what has helped so far are the following measures:

1. Extremely strict lockdown - i have not gotten out of my home in more than a month, thankfully essential workers keep the essential supplies running. 2. I think BCG vaccination especially amongst young folks makes a difference and i think the immunity is higher amongst Indians (hypothesis) 3. Summer heat (hypothesis) 4. India had very early measures towards screening people coming from other countries since Jan which helped.

The cases and deaths will undoubtedly increase, however the question i have a reasonable answer to is : Do you think the best and timely measures were taken given the constraints ? Undoubtedly yes.

Ever since the outbreak happened the usual suspects have been churning out article after article about the low numbers and it seems like some of the vested interests were expecting us to lead the world in deaths instead of EU and US.

For a second the folks need to commend the work done and what was done correctly. The sacrifice of millions of Indians who are following the lockdown diligently.

As a country with limited infrastructure we cannot work without social distancing, yet somehow we have survived through this period, which is undoubtedly a miracle. This has flattened the curve and the overworked healthcare professionals have a difficult year or 2 ahead of them to ensure the no of actively infected remains manageable.

A single case of suspected swine flu was reported so fast across whatsapp and social media. People don't understand how prevalent social media is in India and think people are just dying at homes. The BBC definitely is anti-India.

Calling them anti-India is a bit too much. Their shallow analysis might be the result of less people on the ground.

People also forget that India has a lot of experience in handling epidemics. Nipha virus(2016?) was quickly reported and the spread was drastically reduced.

However, I still am afraid that India might top the list of infections overtime. Its harder for a developing country to maintain a balance between economy and lockdown.

That experience was almost exclusively only one state - Kerala, and they have also handled this one in the best manner compared to the other states in the country.

Notwithstanding that, the provisions of the Epidemic Diseases Act of 1897 have been invoked a lot over the years—just normally in smaller areas than the entire country as it is at present. See https://en.wikipedia.org/wiki/Epidemic_Diseases_Act,_1897

That was just one example. In India, they regularly deal with breakouts like cholera, swine flu, malaria etc.

> While the reported deaths may be low, the 'they are hiding something' attitude is not helpful [...] in India you cannot hide mass deaths like China.

If you rightly don't want people taking an unhelpful attitude towards India, try not to do the same yourself about other countries.

Anecdotally I know ex-colleagues who got Covid19 in the US and one of them has died.

I literally know of no one who is sick, much less with covid19, here in India in my friend circle, in my family circle and across the 1000+ employee company I work in. Either there's asymptomatic sick in my circle or no one has it.

Granted I am anxious, and hope things don't get worse, but international media has been pathetic on reporting this. I like the work that local The Print is doing. Very informative reporting from them - https://www.youtube.com/channel/UCuyRsHZILrU7ZDIAbGASHdA

Here's a good example and relevant to this discussion - https://www.youtube.com/watch?v=yWuRA_2by-Q

Print's reporting has been a mixed bag.

For eg, the last video compares deaths vs testing in a poor country like Bolivia — situated many miles away from global hotspots to that of Belgium's — one of Europe's headquarters. It seems to suggest that increase in testing and quick isolation is somewhat of a "subjective" factor and doesn't help India.

This, completely disregarding factors like geography, demographics, Bolivia's first case landing a month after Belgium's, and Belgium being one of the few countries in Europe to actually count non-hospital deaths and more.

There's some confirmation bias here.

True, but same is applicable to India. India shouldn't have to test more just because US has to.

I don't think that was ever the argument. Increased testing has been recommended by the WHO, has noticeably helped prevent a bigger outbreak impact in South Korea & Germany and quick isolation makes a lot of sense for a disease that is asymptomatic in most patients.

Anecdotally, I'm in the US and I don't know anyone who has become sick. One person at our company (10000+ employees) became sick and recovered.

I know of an old man who died last week in an area a short way out of Hyderabad. That area was a Red Zone (presumably due to COVID-19 cases near it), so movement in and out of the area was very much more restricted even than usual. A couple of days before he died, they tried taking him to hospital, but were told that the hospital had no doctors there that could help. Next day ditto. It was only hours before he died that they let him in at all.

In this case there’s a fair probability that he would have died anyway (probable generic cause of death: old age), and there’s no reason to suspect any connection with COVID-19 in his death. But you can definitely have deaths indirectly caused by the coronavirus, because doctors are busy dealing with other things, or even can’t get to the hospital due to lockdown!

Rant Alert ! My response will come off as ranty, because I am a bit annoyed.

India takes strong and well executed action on lockdown. People in the West continue to loiter in the streets. ( I see it here in Boston at least, one of US's hot spots). West be like, "India's low death number is a mystery"

At this point, it almost sounds like the western media is mourning the lack of deaths in India. As though to say, "there is no way a "shithole country" can ever be well prepared for a pandemic. Hopefully India gets worse, so we can tend to our wounds by saying that at least it isn't as bad as it's in India."

When a lockdown works wonders in China or Korea -> "Swift response, responsible Govt. India does the same, and it's still a mystery.

Some points

* India has the world's most drastic lockdown in order. More stringent than China at their COVID peak.

* Indian public health is at the very least experienced, (I think competent as well, but opinions there may vary) with national epidemics.

* Indians know what mortality feels like. <- My opinion, but the west simply doesn't fear death the same way. For good reason, but in India a silent biological killer of millions is something people intuitively understand. In part due to wounds of Plague, TB, Aids, Malaria and Polio, all being quite fresh in memory.

* More fact, Indians also know what national emergencies and curfews feels like. We have had a few in the last few decades, and some have been nearly as drastic.

* India relied strongly on ICMR (it's medical research body) over WHO or the US's recommendations. That included using funding to push a lockdown far earlier into the spread than other nations, consistently recommending masks and contact tracing. On the other hand, testing and ventilator recommendations were not taken and it has worked. The death rate of COVID patients on ventilators is 88%. It is less a life saving device and more an expensive pyre. India has also been smart about running really intelligent statistical tests instead of mass testing. They randomly tested people coming in reporting pneumonia symptoms, they tested randomly sampled population and closely tracked the death rate, instead of spending 100s of millions on testing everyone. (esp. when everyone is 1 billion people) Additionally if high rates of testing only serve to better provide recommendations on distancing, mask wear and lockdowns, then India has jumped to stringent action already, making high rates of testing rather meaningless. (2 week delayed death number spikes are far more reliable for longer term decision making such as when to restart the economy)

(also, even more controversial, it doesn't help that the Indian intellectual and political left (esp. the Luthiens Delhi crowd), despises the current government, and would rather evangelize and believe in its incompetence, ever get caught giving it credit where it is due. I say this as someone who would be considered a proper social democrat in the US and is not a fan of the current US or Indian Govt.)

Is it possible that there are other reasons for why India has low Covid-19 death rates ? -> Of course it is possible. But, the pigheaded quest of the western media to find an alternative "godsent" reason to keep believing that India has an incompetent public health infrastructure is honestly quite appalling.

Hahaha people on Scandinavian social media think _South Korea_ and _Hong Kong_ are faking their case numbers and refuse to believe the virus is actually easily possible to contain.

Somehow lots of them believe their governments are acting competently and that herd immunity is "the only way to stop the epidemic".

This virus is probably the first visible sign that Western countries have fallen from their grace, and that the Asian century has begun.

I wouldn't go so far.

I see it more as "freedom even at the expense of lives". The west for the first time in a long time, is being asked what the value of a life is.

Is freedom to roam during a pandemic, worth the aggregated loss of life it causes ?

The question has been lingering around with ecological damage done by our lifestyles and the anti-intellectualism/ anti-vax movement, which is allowed free reign in many places. But, Covid has brought it into focus.

I have heard enough about India super-power 2040, to know that anyone who claims to know what the future holds is either lying, under informed, has an agenda or all 3.

Why? Norway and esp. Finland are doing very well. Australia (not Scandinavia, but very much West) is doing even better. There must be some difference in strains around the world.

As I write the word "immune" appears only twice in 161 comments.

In "Gandhi's Truth" by Erik Erikson, he wrote fifty years ago of adapting one's immune system to India as a rite of passage. Even today, one arrives with caution and does not live like an Indian. My friends born in India but raised elsewhere share this necessary caution with me.

This is more complex than the Indian immune system going "That's the best you got?" My friends have been following web seminars by medical specialists. The popular "binary" impression of developed immunity is hopelessly naive. The virus hacks an existing immune system; it depends on a functioning immune system to propagate. It does not strain credibility to suppose that the typical Indian immune system is different, and this affects virus propagation.

Here's a good specialist introduction to the virus, describing the complexity of the relationship with immune responses: https://youtu.be/wh-u2GDrmDA

Is there any scientific/medical feedback on India's official approach to give prophylaxis hydroxychloroquine to medical personnel and contacts of infected people? Could it be that this policy had some positive impact?

https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloro...

https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

ICMR doctor R Ganga Ketkar had made the statement on Apr 11 (https://www.youtube.com/watch?v=PP_ta25JcbU) that this is under study and at this point is not a recommended treatment.

Subsequently a recent study in the US has said that it has no positive effect. Seems to be a dead end at the moment.

on the other hand, at least one newspaper in India has an article [1] titled: "India's coronavirus infection rates are among the highest in Asia"

we are under lockdown for more than a month now, and in my state, there's even stricter lockdown for past few days (not even groceries/vegetable shops are open, supplies provided to some extent via government operated mobile vending, door deliveries, etc)

[1] https://www.thehindu.com/data/indias-coronavirus-infection-r...

Whoever wrote that article apparently has no idea what “rate” means, as they were comparing total case and death counts:

> India is among the four Asian countries with at least 25,000 confirmed COVID-19 cases and 800 related deaths as of April 26. China, Turkey and Iran are the other three.

India and China each has one fifth of world’s population ffs. The infection rate in each is tiny.

yeah, seems like a mixed bag with the wrong conclusion

they show the graphs, from which one can infer whether the infection is increasing/decreasing

but the top-5 conclusion seems to be based on total cases, which is probably not the case if rate is considered

I would like to point out that even with the existing amount of tests, that are much lower in number than those in the USA and Europe, the COVID19 test positivity rate in India is among the lowest in the world (4-5%).

One more possible factor for the low number of cases that has not been discussed in this thread is the high genetic diversity. Search for 'HLA covid india'.

https://www.ncbs.res.in/content/comparative-analyses-low-med...

There's plenty of evidence that this coronavirus is less stable in hotter, humid climates. Given India has some dense cities, diverse climates and lots of indoor buildings it obviously has spread a bit, but warm developing countries like India and Vietnam were among the first hit and have relatively little spread for their population density.

This virus seems sneaky. It's seasonal and it probably does not like heat. For countries closer to the equator, it has not done much damage. It's hard to hide deaths. I think the numbers are close to reality. But the virus may surge in these countries after summer when the heat recedes.

Sounds more and more like heat is a major factor, whose effect is amplified when coupled with the massive lockdown that India implemented. I wonder whether or not the heat will continue to keep it at bay after the lockdown is lifted.

There are mistakes in the article. To begin with the first case was reported 3 months ago and to be precise on Jan 30th. While its difficult to findout the strain of the virus, the first patient was a medical student returned Wuahn.

So, the conclusion of the article is “we know that we don't know”? One has to wonder, what is the point of publishing something useless like this, unless the author is trying to imply something completely different in the subtext.

Most countries in the tropics and southern henisphere are seeing low death rates regardless of how they handle the outbreak. Most likely heat stops covid-19, just like the cold.

You can verify this by graphing death rates against latitude.

Maybe the warmer more humid weather in India combined with the measures they took against the virus delayed the spread enough that the number of deaths are lower.

I hope the reason is that Indians are intrinsically resistant to SARS-CoV-2, that would be a big relief.

Based on how many people of Indian, Pakistani and Bangladeshi descent are dying in the UK there is no indication that people form the Indian subcontinent have some genetic resiliency or immunity to the virus.

Also, how quickly the cases have been spreading through Singaporean's Foreign Worker Dormitories. I believe at some point, there were more Bangladeshis confirmed infected in Singapore than in Bangladesh.

Indian, living in India presently, who lived in the US for almost a decade. I can relate a strange experience: I was never severely bedridden by flu or viral fever in India. I caught the flu during my stay in the US one February. I was so weak I could not even sit up in a chair for more than 15 minutes, I would doze off. I was in my bed for practically 5 days, was weak for a couple of weeks afterwards.

I am back in India for a decade, never had such an experience again.

As you say, genetics is definitely not the reason for immunity or lower death rates. But I wonder whether human immunity is much lower coming out of the winter. India does not have severe subzero celsius winter except in the hills.

Because you are likely more resilient to local strains. Getting a flu / cold or the "shits" when traveling is very common, many westerners that travel to india and suffer some gastric discomfort blame the food for no real reason (tho ghee can have a cleansing effect if you over eat it).

India has quite high influenza mortality rates https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815659/

Could this be related to your levels of Vitamin D. I am not a doctor but since this pandemic, I have read some articles that suggests that people with black/brown skin need a lot more exposure to the sun to get good levels of Vitamin D with the situation getting worse during winter. That coupled with your stay in a colder country could have been the reason.

Resistance doesn't have to be genetic, it could be acquired through exposure to pathogens.

SARS and MERS did not provide immunity against each other nor against SARS2.

There is no indication that other common coronavirus infections such as those that cause 10-30% of common cold cases world wide provide any immunity to the current virus.

Also given the sheer size of India it’s unlikely that there would be a pathogen that provides immunity on this scale that would not have been identified previously since it would end up causing complications and deaths in some infections even if at much lower rates than previous epidemics.

If it also managed to spread across India It would’ve also spread worldwide.

Lastly like someone else mentioned migrants native to the region where hit pretty hard everywhere else.

There's some co-relation between receiving the BCG vaccine and symptom severity, which could explain some of what we are seeing.

Not enough people make it into their 80s to have a large vulnerable population. Mystery solved.

FUN FACT - India has the world's highest percentage of people with type B blood. (血液型)

Maybe it’s because Americans are fat. Especially poor Americans who subsist on fast food and other junk. My guess would be that Indians in poverty are more likely starving than diabetic. Starving has its own health risks obviously, but being fat enough to impede your breathing isn’t one of them.

Obesity affects fatality rates, not infection rates, due to greater chance of respiratory obstruction in advanced cases of the disease.

It appears that infection rates in India are low at the moment. It's not entirely clear why, but it could be a combination of hot weather, their nationally imposed lockdown, and lack of testing.

There's no mystery. India acted early and went into nation wide lockdown.

Is there a district-wise covid map that someone could keep a track of this?

They dont even mention other options such as previous vaccinations, cross effects from other drugs, antibodies from other coronaviruses , humidity/sunlight etc. "They must be hiding something" means they either believe it's a conspiracy, or is a borderline racist attitude

Or... the Covid is not as fatal as it is widely assumed.

Ground Report : I live in one of the major cities. Lockdown is reasonably well ensured. Our State Chief Minister was particularly vigilant and people are very alert.

There is not much misinformation in the media.

Basically, everyone has taken it seriously and is vigilant.

I also hear that those who took TB vaccine are more immune, and that is practically most of the younger and middle aged people in the country.

Not a mystery at all. Multiple factors work in India's favor in likely order of impact:

- Young Population

- Non-obese population

- Heat and Humidity across a lot of the country

- Widespread deployment of anti-malarials to combat malaria

- Wide spread deployment of BCG vaccine

- Tumeric heavy diet compared to the rest of the world

The top 3 are non-controversial. Young, skinny people are less susceptible, and the spread of the virus slows with sunlight, heat, and humidity.

Anti-malarials like Chloroquine, etc. are more controversial, but there is significant anecdotal evidence, as well as in vitro studies indicating they may be helpful. Furthermore, countries that widely deploy anti-malarials for malaria have so far shown lower death rates than expected (Brazil in particular should be on fire with COVID-19).

BCG vaccine for TB appears to help with COVID-19, through a heightened general immune response. Big studies going on right now to test this theory. There are six different formulations of the vaccine and it is unclear if the different formulations effect its potential efficacy against COVID-19. This is even more "on the edge" of science than the anti-malarials, but the BCG vaccine has shown long lasting resistance to all kinds of respiratory ailments in populations where it is deployed.

Tumeric is flat out a stretch. Curcumin has come up over and over again in studies of compounds that may help. But, there is absolutely no testing or real evidence at this time. It is merely a supposition based on molecular models and meta-studies of other studies on the compound. I included it for discussion, since Tumeric consumption is likely higher in India than many other countries. I also wonder if it plays any role in traditional medicine in the country.

People look for a silver bullet, but there are many factors at play here.

Curcumin downmodulates a few of the same inflammatory cytokines that spike in deadly covid-19 cases. It's also been shown as an effective adjunct therapy for people with asthma. It's really not a huge stretch to think that it could hinder the progression of covid-19, even if the only mechanism is that people feel less of an urge to cough.

Could this be related to mandatory BCG vaccination programme? If you compare Covid19 death rates between Portugal and Spain, or Ireland and UK, it is 3 times lower in favor of countries with BCG vaccinations.

A better question from everyone outside the US: what the flying f is with the huuuuuge (accounting for estimated no. of infected and other factors) number of deaths in the USA??!!?!

I mean, the US is (a) a developed country with modern health-care, (b) there is no common 'old parents living in same home with some of the adult children' situation you have in Italy + Eastern Europe, (c) there are no norms of common physical contact like 'kissing on meeting' (see France, Italy, northern Romania etc.), (d) the population is generally very dispersed (compare US density with areas of Western Europe or China) and (e) there is prevalent use of personal cars instead of public transport (as opposed to Western Europe and China, again), which should further diminish transmission.

US stats look worrying for everyone on Earth, it almost looks like a wild difference in viral strains or some other important but unknown factor.

Whilst I agree the USA has a lower population density than most of the world it is not exactly true. This figure assumes everyone is equally spread out. However many inhabitants of the USA live in cities therefore population density is much higher. The same thing happens in Spain which goes from one of the least dense countries in Europe to one of the most dense looking at it in these different ways.

The USA has a large population and I assume this is why you think the numbers are huge. Deaths per thousand are around a half of the UK and less than a third of Italy and Spain.

In not very worried by US stats they seem fairly similar to elsewhere in the world. What I'm worried about is that it seems like American politicians, media, people think they are much further along infection than they are.

Edit - typo

Not only is the population large, a lot of people are large as well. Obesity, diabetes, and cardiovascular health are huge factors in covid-19 mortality.

> A better question from everyone outside the US: what the flying f is with the huuuuuge (accounting for estimated no. of infected and other factors) number of deaths in the USA??!!?

That's only true if you don't know what "per capita" means.

So far the US has 172 death per 1M population. That's better than other countries with supposedly better healthcare including:

- Belgium

- France

- Spain

- Italy

- UK

- Netherlands

- Sweden

- Ireland

- Switzerland

And many more.

> US stats look worrying for everyone on Earth

I'm more worried about people's inability to understand the difference between stats and absolute numbers specially on this site where we're supposed to know better.

NYC is currently at 1462 deaths per million.

The whole country of Spain is at 510 deaths per million. How high do you think their biggest hot spot is?

I think it would be more honest if US statistics would be split per state or social/economic region otherwise you I would complain that you also are in the same catherogy with the ones you accuse.

Since the very beginning, everyone expected the US to have a very high percentage of death (remember discussing that my friends even before the US had a single casuality).

Hypertension and diabetes were listed as have a lot of impact of the mortality rates, and the general extremely bad health of the american population, coupled with the lack of a quality public health system made it the perfect target. That, plus more political issues, such as not being able to enforce curfew easily, a general mistrust in representatives, and a president that remained convinced it wasn't such a big deal for a very long time.

All in all, i think the number remain quite low compared to the worst case scenario.

Or we had a wildly incompetent response from the federal government.

https://www.nytimes.com/2020/04/28/opinion/coronavirus-trump...

Because societal norms in the US dictate that individualism takes priority over communalism no matter what.

Source: am American

The US has a low rate of testing, was late to impose lockdowns (mostly; a few states were fairly proactive), and is bad at enforcing them (again, mostly). Having a leader who spent the first few weeks of the crisis on TV denying there was a problem, _while people were already dying in the US_, probably didn't help; most countries don't have that.

> some other important but unknown factor

The important factor is probably just very poor crisis management. US death rates aren't _that_ high, anyway; on paper they're low to medium vs Europe, though given that the rate of testing is lower than almost anywhere in Western Europe that's probably understated.

What I always think of if I hear this is the tallness paradox between Europe and USA. When controlling for ethnicity, the modern white person from the US is on average about 1.5 inches (4 cm) shorter than the average person from the EU. As far as I know its uncertain why exactly this is (american used to be taller until mid of the last century) but the usual suspect is class inequality the lets to poorer sanitation for poorer people which in turn are also more likely to infect richer people which leads to less growth in adolescents. But ultimately, the cause of this phenomenon in not known.

Obesity?

Compare the US to the EU as a whole and you’ll see that the two are doing pretty similarly.

Well US has an obesity problem and this is considered to worsen Covid effects.

There are differences in vaccine regimen too, which lead to be a statistically significant factor. (edit) The first point is in reference to the BCG hypothesis, search at MedRHiv for similar entries such as: Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19"

In addition to early travel exposure, common travelling, social factors-vs-car culture, obesity and diabetes, etc.

Within Europe, the BCG hypothesis seems a differentiating factor, though further studies are necessary. The reason for the effect of the vaccine are not currently known.

About relative low death counts in some Asian countries by comparison with Europe or America, we must take in mind that Asian people could had been exposed in the past to a virus of Asian origin (or to a relatively similar virus strain), so they could have developed some immunity previously.

I would want to include in the discussion (and this is just my opinion and wild speculation by my part, not more, not less) the spring wildfires around Chernobyl area also in 2020. I wonder if ashes in the atmosphere are being also a hidden source of respiratory problems for Europe than nobody is taking in mind. Could explain the strange pattern of people that has recovered from the disease but somehow falls ill again and starts coughing again and again in waves, malaria style.

I remember similar massive coughs in all Europe in 2015 (if I'm not wrong) exactly at the same time that Russian and Ukrainian armies were burning forests in the North of Ukranie. I can be wrong, but there is not much to lose by researching that except time, and we have a lot currently. If we seen that spikes in hospital admissions match the burning periods and the wind direction plus a reasonable delay to reach the areas we could do further research.

I can agree with you about the burning forests.

Looking at the Spanish flu - it looks that if one were to account for famine, malnutrition, unsanitary conditions and other facts, it seems nothing out of the ordinary.

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