I've mentioned this before, but I remain puzzled by the repeated claim that India is facing an unprecedented surge of COVID-19 cases and deaths. Unless India is massively undercounting things, neither is true:
India's case load peaked at about the same level as Europe's recent peak, and well below the previous peaks of both Europe and the United States. The same is true for deaths, but even more dramatically. India is nowhere near the December peaks of either Europe or the United States.
India's problem is not that its surge of COVID-19 cases is exceptionally high or that its variant is exceptionally deadly. India's problem is that its health care system is nowhere near as good as that of the US or Europe. This is a tragedy in and of itself, but it's a different tragedy than the one that keeps getting reported.
I've heard they are dramatically undercounting, that the real case numbers are 5 - 10x the reported numbers.
And virtually everyone believes India’s counts are indeed massively low. Which seems completely plausible given as you have asserted India’s healthcare system is so overwhelmed.
I'd add that the Indian beaurocracy is notoriously corrupt and the current government is very Trumpy in their handling of the crisis. "India is massively undercounting covid cases" seems incredibly overdetermined.
Ditto.
Indeed, has Drum actually never been to a real developing country? His comments on this subject are bizarrely naive.
There seems to be zero doubt that there is a very very solid basis to say there is a huge under-count going on.
While anecdote does not data make, the consistent stories of unprecedented observations around non-controlled body disposal, from running out of wood for cremations, to rifts of bodies floating down rivers as the poor try to dispose of their dead and can't afford the cremations.... everything points to a very good basis to say the official data is shit.
https://www.nytimes.com/2021/04/24/world/asia/india-coronavirus-deaths.html suggests at least 2x, maybe 5x undercounting:
"“It’s a complete massacre of data,” said Bhramar Mukherjee, an epidemiologist at the University of Michigan who has been following India closely. “From all the modeling we’ve done, we believe the true number of deaths is two to five times what is being reported.”"
and
"across Gujarat, where, during a similar period in mid-April, the authorities reported between 73 and 121 Covid-related deaths each day.
But a detailed count compiled by one of Gujarat’s leading newspapers, Sandesh, which sent reporters to cremation and burial grounds across the state, indicated that the number was several times higher, around 610 each day."
Kevin shows the per-million view. Here are the same data on an absolute scale:
https://ig.ft.com/coronavirus-chart/?areas=usa&areas=eur&areas=ind&areasRegional=usny&areasRegional=usnj&areasRegional=usca&areasRegional=usnd&areasRegional=ussd&areasRegional=usmi&cumulative=0&logScale=0&per100K=0&startDate=2020-01-27&values=cases
This is probably what the media are going by.
India has about 12 times the population density as the US, so the reporters will be seeing more cases/deaths in any given area at the same rate per million.
Undercounting or not, the dramatic reporting we see daily is based on the stated case and death rates.
India's population is 4x that of the US. When India has 4,000 deaths a day, we get blaring headlines. But when 1,000 Americans were dying every day, the reporting barely changed.
When that first happened, Trump declared it was fake news. Recently, when it hit 1000 deaths/day, that was because the number was falling, so maybe a blurb since we've become inured. (I really should look that word up). However, 4000 deaths a day does sound high and people will listen--esp since it is some one else doing poorly.
Unstated but obviously implied that SARS-CoV-2 may have moved from bats to dogs then to humans,
https://www.reuters.com/world/asia-pacific/new-type-coronavirus-originating-dogs-found-study-2021-05-21/
That is not at all what it is implying. It’s saying that coronaviruses are common in many animal hosts including those with frequent human contact so we need to have more surveillance to watch for the next potential pandemic virus.
That's what it's concluding. There has been much discussion of what the animal reservoir is between bats and humans and this article presents the first serious evidence of a candidate, therefore it's an implication.
This approach is kind of like saying that the real tragedy on the titanic was the lack of sufficient life boats (or other emergency rescue equipment). Sure, it’s sort of true: but discounting the collision between iceberg and boat really does seem a bit misleading.
Yes: India’s healthcare system, and it’s current authoritarian federal government, are extremely poor “lifeboats” during the ongoing pandemic surge. But the big story still strikes me as the massive collision between their second (or third?) Covid wave and their unsuspecting (or criminally misled) population 😐
Absolutely true, that when calculated per 100K, infections and deaths are lower relative to the US and Europe. Think about how much worse it could have been if India's infection trajectory had been as bad as some US states. We're talking a million+ infections per day.
But, because their population is so large, the sheer number of infections means that they're sprouting thousands of variants, of which a handful may prove terribly catastrophic for vaccinated humans.
Also, the sheer number of dead floating down the Ganges.
Except for India’s authoritarian Modi regime itself, there is near unanimity that India is massively undercounting its covid infection and death rates. So, on the days when more than 300,000 infections were officially reported (or counted), there almost certainly were, in fact, the million+ infections per day that you mention.
Could be. I've read that the official (death and infection) counts only come from hospitals, leaving a lot uncounted. Not sure what level this implies, but it could certainly be 1M+ infections at peak.
> Unless India is massively undercounting things
Should be fixed to
"India is massively undercounting things"
There we go.
To judge how well countries are dealing with COVID-19, population density should be taken into account, not just deaths/million. After all people have to come into some kind of contact to pass the virus on; this is more likely to occur in a densely populated area than in a sparsely populated one. Sketonimist has made this point as well (1:15).
A simple attempt of doing this would be to divide deaths/million by population density. It’s obviously more complicated than that but this is better than just using deaths/million.
For (most) European countries plus the US, Brazil and Israel, for a total of 38 countries, the ratios come out like this (data from Worldometer, May 12th when I looked at this):
India with a ratio of 0.39 is the best, followed by Israel with 1.73. Then come in order Denmark, Switzerland, Germany, Belgium, Belarus, UK, Finland, Norway, and Italy all with a ratio below 10. Third from the bottom is the USA (ratio 49, next is Sweden (56.0) and last is Brazil (79.6). Seems reasonable.
I would suspect that housing density is more relevant than raw population density. If you measure square feet of housing per person, or number of people per bedroom, you will get an idea of how possible it is for people to avoid each other. In India's slums, the housing density is very high, so high that major cities probably have millions of people who are unable to isolate even as families, let alone as individuals. In those circumstances, contagious disease will spread widely and quickly.
Respectfully, this methodology strikes me as pretty questionable. I mean, we can speculate about how some countries may have done better than others because they've achieved such and such a level of success "despite their high population densities" but for this line of thought to be meaningful in the scientific sense we need precise definitions and parameters. So, what unit of population density is being cited? National? That itself is highly problematic: Australia, for instance, is one of the least densely countries on Earth; nonetheless its population is overwhelmingly concentrated in a handful or urbanized regions, so the actual, population density experienced by the overwhelming majority of Australians is unlikely to substantially differ from that of most Europeans, say, or residents of the northeastern United States. Finally, there's a difference between population density and housing conditions (the latter pretty clear is a relevant data-point for covid transmission). Last time I looked, for instance, Manhattan (easily the most densely populated county in the USA) had the lowest covid case rate of all five boroughs of NYC, despite the fact that it is the most densely populated of the five boroughs (indeed, Staten Island, NYC's least dense borough, has the highest case rate!).
https://www.statista.com/statistics/1109817/coronavirus-cases-rates-by-borough-new-york-city/
Have you ever seen a high velocity motor vehicle crash - Rolls or Toyota, still a lot of mush.
I lived in India for over six years while running a US subsidiary. Deaths are undercounted even in a normal years, especially in rural areas where about a third of people live. There is no workable nationwide or state system for reporting the cause of death. In fact, while I was living there, I had watched a documentary on a national news program that explained why cause of death was so difficult to collect and how it was hurting Indian public health efforts.
As an overpopulated, tropical country with poor sanitation and covered with aggressive mosquitoes, there are frequent outbreaks of both viral and bacterial diseases. Each year I would watch reports of hundreds of small children dying from Japanese encephalitis, but you could never know the actual number of deaths from government reports.
I lived in Bangalore, which each year would be hit with mosquito-borne dengue fever outbreaks, filling the hospitals. The local government, which is both incompetent and irredeemably corrupt, would routinely deny it. But everyone knew when it was happening, and you'd be lucky to find good treatment.
I speak almost daily to friends in India. The first wave did seem mild, but this current wave appears to be horrific. It may be no worse than Europe or the USA at their peaks, but this is a crowded poor country and it would be completely wrong to call it "mild". The fact that bodies are piling up, waiting to be buried or burned, is not exaggerated. Now, I've learned that my former apartment complex has acquired a few oxygen tanks on the black market for sick tenants because the hospitals are full and there is nowhere else to go.
I am fortunate to live in the US and am fully vaccinated. Please don't minimize the suffering of those on the other side of the world.
As others have said, there is a massive undercount. Anecdotally, pretty much all of my Indian friends have family / friends who have been sick. Since their healthcare system can’t keep up of course testing and official counts don’t give a full sense for the scope.
One other thing is that the media loves to point out that 4500 deaths in a day is a huge number, but that's *not* a per-capita number.
India is a huge country, and raw numbers are going to reflect that.