Low Covid-19 death toll puzzles experts

India's confirmed coronavirus death toll passed 1,000 on Wednesday following its highest daily increase, but the numbers remain low compared with Europe and the United States in a phenomenon that is puzzling experts.

With massive slums and a shaky healthcare system, there were fears India would be ravaged by the pandemic that has killed more than 227,000 people worldwide.

The latest daily toll of 73 deaths was India's highest, offering a warning that the giant South Asian nation is not yet in the clear.

A lack of testing and many other factors mean that India's official toll of 1,008 deaths could be far below the real number of coronavirus victims.

"We see low numbers but we do not know how to validate those numbers or rates," virologist T. Jacob John said. "Governments desire under-reporting and we are flying blind for true rates and numbers."

India appears to have been spared the devastation seen in New York, Milan and other hard-hit parts of the world where hospitals have been overwhelmed by coronavirus cases.

Experts have offered a number of theories and factors, but there is no definitive explanation yet. "It might well be true that the trajectory of the Indian epidemic is very different for reasons that we do not understand... but those are all theories right now," Mr Prabhat Jha, an epidemiologist at the University of Toronto, said.

One possible factor is that India imposed a lockdown on its 1.3 billion people on March 25, when there were 606 confirmed cases and 10 deaths, and it has been rigidly enforced. The government says the number of infections could have reached 100,000 without it.

There are also other issues that could have kept the risk low - including a young population and the possible positive effects of the BCG tuberculosis vaccine, said Mr John.

Another factor could be decades of widespread dengue fever providing communities with some "innate immunity", he speculated.

Still, experts caution that no one has an accurate picture of the pandemic in remote rural villages and deep in slums. Even in normal times, accurately recording deaths or causes can be a difficult task in India, where many poor people fall sick and die without entering a hospital or seeing a doctor.

Just under half of the country's estimated 10 million annual deaths are not recorded, according to Mr Jha, who leads the Million Death Study that regularly surveys Indian households on the issue.

Despite the strain of weeks of lockdown, the vast majority of people in India are not experiencing the feared exponential surge in infections, said the head of a government think-tank.

"Our analysis finds that the rate of growth in positive cases and fatalities has been consistently lower - linear but non-exponential," said Mr Amitabh Kant, chief executive of the government think-tank Niti Aayog.

The Aayog urged a phased exit from the shutdown, but the government has a difficult decision ahead.

Big cities Delhi, Mumbai and Ahmedabad - which are also India's economic growth engines - top the list of cases and there are no signs of the pandemic abating there.

"When I see Delhi's Covid-19 map, I see only red and orange colours which is extremely worrying," Health Minister Harsh Vardhan said.

Red zones indicate infection hotspots, orange denotes some infection, while green indicates an area with no infection.

Wednesday's daily increase in cases, 1,897, was the highest in weeks.

AFP, Reuters

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