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How Big Is the Indian COVID-19 Outbreak?

According to official figures, here is the size of the COVID-19 outbreak in India:

In no way am I trying to downplay the tragedy in India, but if these numbers are correct then India's outbreak is still only a fraction the size of the outbreak we went through just a few months ago—and it appears to be already peaking and starting to turn down.

Is this right? Or are the official figures nowhere close to the truth? Is the devastation in India really due to the size of its outbreak, or is it more about the inadequacy of its medical system?

36 thoughts on “How Big Is the Indian COVID-19 Outbreak?

  1. drfood4

    I think it is more about the inadequacy of the medical system (running out of oxygen) and the testosterone poisoning of their leader. I'm also pretty sure the actual numbers of victims are higher than what is currently being reported.

    1. fnordius

      One thing that stood out was the reports of crematoria being unable to keep up with demand. That alone signals that the actual number of fatalities is at least triple the official count. The problem is that large parts of India still are very poor, with little or no desire to cooperate with official reporting.

  2. Abe

    "Or are the official figures nowhere close to the truth?"

    Bingo!

    Just a few overview articles on the subject from international media (Indian/specialized media has covered the issue in much greater detail but often in piecemeal fashion concentrating on a city, region or metric):

    NYT: https://www.nytimes.com/2021/04/24/world/asia/india-coronavirus-deaths.html

    Washington Post: https://www.washingtonpost.com/world/2021/05/06/india-coronavirus-deaths/

    FT: https://www.ft.com/content/683914a3-134f-40b6-989b-21e0ba1dc403

    TLDR: Reasonable back-of-the-envelop estimates are that India is currently experiencing 2-5 million new cases and 25,000-50,000 Covid-19 related deaths daily.

    (See https://twitter.com/ashishkjha/status/1391238136219512833)

  3. Jasper_in_Boston

    i’m always extremely skeptical of any pandemic statistics relying mainly on confirmed cases, which are entirely dependent on the adequacy or lack thereof of testing capacity. Plus, I think we need to be extremely skeptical in general of India’s ability to compile statistics given the countries still enormous poverty.

    1. skeptonomist

      But the media reports are based on confirmed cases too. From those reports you would think that India is much worse that the US was, which the data do not support.

      1. Jasper_in_Boston

        India has tested a proportion of its population about 1/6th the size of what the US has managed so, yeah, I'm skeptical their covid situation is only a modest portion of what America's was "a few months ago."

    2. skeptonomist

      Are the media exaggerating the current case/death rate in India in their anecdotal stories, or are the official counts way too low (with respect to counts in the US)? Both of these have to be taken seriously, although we know for sure that the media almost always exaggerate things.

  4. Jasper_in_Boston

    I’m always extremely skeptical of any pandemic statistics relying mainly on confirmed cases, which are entirely dependent on the adequacy or lack thereof of testing capacity. Plus, I think we need to be extremely skeptical in general of India’s ability to compile statistics given the country’s still enormous poverty.

      1. Jasper_in_Boston

        Given the lack of an editing (or even delete) feature, that's what I get for trying to: A) post with my phone (I'm much better with a laptop); B) without my glasses; C) while emerging from a nap.

  5. kenalovell

    are the official figures nowhere close to the truth ... or is it more about the inadequacy of its medical system?

    Both, from all the reports I've read. And if Indian slums are like those in the Philippines, which I know well, the victims are simply dying in their homes with no medical care while their families try to scrape together the price for a burial.

    1. FMias

      Indeed extensive reporting give substantial reason to doubt the Indian figures, Indian sub-national governments themselves are stating that.

      It would be grotesquely naive given Indian sources themselves stating that the poor are dying in their homes and not getting into official system to think those figures are reliable and comparable to US or even other developing countries not in their level of crisis.

      Frankly Kevin is being absurd in the manner he's posing this given there's semi-official statements on the record indicating the figures are certainly significant undercount.

        1. MontyTheClipArtMongoose

          Democrat uncivil servants are trying to cover up the shaky handoff from the dedicated team under El Jefe to the amateurs installed by El Pepe.

          1. Total

            What on earth are you talking about? Unless you think the US is responsible for India's covid response, the Biden admin has overseen a remarkably successful handling of the pandemic, unlike Trump.

  6. weirdnoise

    A cluster in Singapore. Note the graphic, in which the cases marked with yellow dots were previously vaccinated (Singapore is using only Pfizer and Moderna). Several of the cases, marked with asterisks, have been preliminarily identified as the B1.617 variant which seems to be increasing in prevalence in India relative to other variants, including B1.1.7. https://www.channelnewsasia.com/news/singapore/covid-19-changi-airport-cluster-household-contacts-b1617-variant-14787262

    This twitter thread by Trevor Bedford of the Nextstrain project follows the evolving variants. The sub-variant B1.617.2, if trends continue, looks especially scary. https://twitter.com/trvrb/status/1392132892185165828

    1. weirdnoise

      Lest the Singapore cluster sound too alarming, two facts to keep in mind: it remains pretty small, much too small to draw any statistically significant conclusions beyond the fact that vaccine breakthrough is a real thing. Now, the vaccination rate for workers at the airport at the center of the cluster is more than 90%. Thus, if vaccines didn't work such an outbreak would, on average, have 90% of cases in vaccinated individuals. The actual percentage is considerably less than that. Combined with the small sample size it's not incompatible with the protection rates we seen from large studies. However, the presence of a variant that first appeared in India only two months ago and is strongly suspected of higher transmissibility is something to worry about (but once again still too small to make any firm conclusions).

  7. Jerry O'Brien

    The graph seems to say that India's covid case rate is triple what the United States' was in April of 2020. That reminds us how a low level of testing can affect the counting.

    1. Jasper_in_Boston

      Good call. Surely very large numbers of Americans are walking around who had asymptomatic or very light covid cases. If the acquired immunity lasted a year +, the country would probably easily reach herd immunity, even with significant vaccination hesitancy.

      But that doesn't look to be the case.

  8. Krowe

    1) The chart lists cases per million people. India has many more millions of people (4x) than US, so in absolute terms, it's worse.
    2) As others have noted, numbers are definitely underreported. Most frightening indicator is how overwhelmed the creamatoria are - If India was experiencing the reported case rate and a deaths/case rate similar to US, they would not have this problem. One or both numbers is off.
    3) Medical systems are overwhelmed. Either that's because of fewer ICUs, etc. per capita, or vastly higher case numbers than reported. Probably both.

    So no matter how you look at it, yeah, it's really bad.

  9. matthewbhuff

    On an average day in India, around 27,000 people die. The "official" covid daily deaths are reported at around 4,000. That would be about a 15% increase above normal. Crematoriums are running 24x7 and having to create massive burns in open fields. This wouldn't be happening if it was just 15% above normal. My neighbor's brother-in-law just flew back to India to take care of his parents. His father is in India's army intelligence and both he and his wife are in the army hospital with covid. He has told his son that they believe the actual numbers are about 4x greater, about 16,000 deaths per day and about 1,000,000 new cases per day.

  10. DFPaul

    The reporter on the NYT podcast The Daily last week estimated that, because of limitations in testing capacity, the actual number of new cases was ten times the reported number. So who knows.

  11. Atticus

    "Is the devastation in India really due to the size of its outbreak, or is it more about the inadequacy of its medical system?"

    I'm no expert, but I would think both. I highly doubt India is reporting all of their deaths. Not out of intentional deception, I just doubt with all those people they have an accurate count. And, I'm sure outside of major cities there is adequate medical facilities.

    1. cephalopod

      Yep, sometimes it is "all of the above." India just doesn't have the ability to test everyone who is ill, it has a lot of young people who may be asymptomatic and therefore not even thinking about being tested, and the medical system is not funded well even in good times.

      We know that covid hopsitalization risk is related to age, weight, and particular preexisting conditions. These factors are nowhere near as common in India as they are in the US, but the sheer size of India means that the small percentages add up to huge real numbers. 1% of Indians is 13 million people.

      Last September serological testing found infection rates of nearly 20% in some urban slums. India was in nowhere near as bad a shape late last summer. There is no way you get to today's disaster without extremely high rates of infection.

  12. skhome

    A few days ago, Ashish K. Jha (of Brown) had a set of Tweets about what is likely really going on in India.

    Based on crematoriums being 2-3x busier than usual, his view was that there might be 25,000 - 50,000 Covid deaths per day in India.

  13. Total

    Come on, Kevin, you're using a misleading statistic in this case. On a per capita basis, the Indian case rate is below the US, but everyone is reacting to the sheer numbers, which are much higher because India's population is much larger than the United States. India's daily case count has hit highs no one else has seen, as have the daily death counts. I'll be sure to let all those people know that it's really not that bad.

  14. DaBunny

    Combination of things. As has been mentioned above, the Indian surge is being under reported by something between 2x and 10x. India's population is roughly 4x ours, so absolute #s are staggering. And India's medical infrastructure isn't anywhere near up to the job, from oxygen distribution to ICU beds to...etc.

    Any one of those factors is horrific. Stack 'em up, and it's a hellscape.

  15. James B. Shearer

    There could be regional differences in India with some areas badly hit and others less so making an overall average a little misleading. But I don't know how much variation there actually is. There are also regional differences in the US of course.

  16. D_Ohrk_E1

    Yeah, but are the implications of millions of infections and all those infected people in close proximity of each other?

    This: https://bityl.co/6oB2

    This only reflects a fraction of the total number of mutants out there. We're lucky that most mutations are inconsequential, but once in a while some bad combination occurs and you get a super pandemic.

  17. ey81

    I had also read that there is a severe stigma attached to COVID in India--partly because some of the early outbreaks were among Muslims--so there is widespread unwillingness to get tested or to publicize infections in one's family. Possibly even unwillingness to admit the cause of death in one's family.

  18. Leo1008

    Numbers may give some idea of the Covid situation, but the current tragedy unfolding in India simply cannot be understood without considering the societal and political collapse there as well. Unfortunately, we here in the US have some idea of what it’s like to go through a pandemic with an authoritarian leader. But imagine if Trump had never been removed from office, and if our current vaccine rollout had never taken shape in such an orderly manner, and if all of our news sources sounded like Fox News, and if trump had completed his purge of all dissenters from all government agencies: that’s something like what’s going on in India.

  19. TriassicSands

    Sigh, Kevin seems to have a near (?) pathological need to downplay virtually everything. I guess he thinks that's a way to show how responsible he is and the recklessness of everyone else.

    How bad is the outbreak in India? It depends on what one is trying to say. If one wants to compare how well one entity has responded compared with another, that's one thing? So is India's horrendous number of cases less serious than our own surge? Does that tell us how effective the US response is compared with India's?

    But what really matters? In terms of the future of the pandemic, not politics, what matters is how many people are infected and how many chances the virus has to mutate. In that case, India's situation is far worse than anything that has happened anywhere else in the world. The repercussions could be felt far beyond the borders of India.

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