Does poverty protect most Indians from Covid-19
By Ashok K Nag, consultant and retired adviser Reserve Bank of India*
Evidence from the U.S., U.K., Spain and Italy show that the probability of Covid-19 infections and deaths is higher in densely populated areas and that too among the elderly male population with severe existing ailments. In New York City, for instance, a recent analysis of about 7,000 coronavirus related deaths found that three quarters of the deceased were those over 65 years old and with lung, diabetes, heart and other medical conditions.Link.
Based on such data, many experts assumed there would be a sharp rise in Covid-19 cases and deaths in India, given its densely populated urban areas and large numbers of males with severe ailments. LInk. But an analysis, of infection and mortality data available so far, reveals that the virus has had a weak impact in India compared to that in the wealthy Western countries.
A wealthy country problem
The U.S., U.K. and other western countries, with high per capita income and a large elderly population, have suffered disproportionately more from the global pandemic. As of today, western countries, which account for a tenth of the world’s population, recorded two thirds of both the 3.8 million total global cases and 265,000 deaths from the coronavirus. Link.
The superior and expensive healthcare systems in these countries do not provide greater protection against the invisible killer. Spain, for instance, has 50 doctors serving 10,000 people, the sixth highest ratio in the world. Yet that did not protect Spain from being one of the worst affected country with 26,000 deaths and 220,000 infections, among a population 47 million.
Germany and South Korea though do not fit into the western pattern, given their low levels of infections and deaths. Like the other severely impacted western countries, they have large elderly populations. The fact that Germany tested a large number of people may not be a good explanation since Spain and Italy also tested a similar proportion of their population. It is possible that early and strict enforcement of lock-down and social distancing measures, together with a better equipped and well managed public healthcare system, may have helped Germany and South Korea.
Covid-19 impacts the poor in the U.S. and England
In the western countries, the impact of the virus is most severe among the poor. For instance, a recent study in the U.S. analyzed data from counties with large black communities, which account for about a third of the country’s population. But these counties accounted for half of the infections and 58% of the deaths from Covid-19. Link.
Similarly, findings from a study in England released yesterday, show that deaths among those of African and Pakistani origin were three times, and for Indians twice, as high when compared to whites. During the seven weeks ended April 21, 492 Indians died from the virus, the highest among ethnic groups in England. Most of the Black and Asian deaths were in the Greater London area and urban parts of the West Midlands. Link.
The study notes that Covid-19 deaths are higher among Asians and Blacks in England since, with low incomes, they are forced to work in health care and other risky jobs during the pandemic and have little or no protective equipment at work and inferior health care.
Low infections in India a mystery
While the virus disproportionately infects more low-income Indians in England, its spread in India, even among the poor, has been very limited. With about 18% of the world’s population and spending relatively tiny amounts on health care, India accounts for only 1.4% of global cases and 0.7% of total deaths; 57,000 infections and about 1,900 deaths. Link. Such low numbers have mystified leading medical experts around the world.
Coronavirus infections in India may be under-reported due to lack of testing. At present, about 75,000 tests are conducted a day, in a country with a population of 1.4 billion. In the U.K., about 80,000 tests are conducted daily, among a population of 66 million. Link. Also, the number of deaths from the virus in India could be higher. Even in normal times, about 80% of deaths in the country are not officially recorded since they occur in homes and not at hospitals. Link.
Poverty protects most Indians?
Some argue that India’s high temperature and humidity, especially now during the peak summer season, reduces the infectiousness of the virus. Another explanation being put forth is that the majority of Indians, being poor or with little or no access to medical care, and having survived numerous severe infectious diseases as well as constant exposure since they live in very un-hygienic conditions, have developed immunity to Covid-19 and other diseases. Such a thesis, though widely discussed in the Indian media, is yet to be proven through research.
A young population is one positive factor in India’s favor. Two thirds of Indians are under age 35, who are far less susceptible to being infected and killed by Covid-19. Only six percent of Indians are in the vulnerable age group of over 65 years, compared to over 17% in the U.S. and U.K.
Blessed are the poor
Currently, on the advice of medical experts, India is in a nationwide lock-down, with social distancing measures, to tackle the spread of the virus. However, given the low penetration and to revive parts of the economy, the Indian government needs to modify its actions. For instance, data analysis shows that a complete nationwide lock-down is not medically necessary as well as causing unnecessary job losses and economic damage.
Many large companies run manufacturing and other operations in segregated places. In such locations, like Jamshedpur for instance, most workers reside on company campuses, adjacent to or near the plants. Similarly, there are several university campuses, like the Indian Institutes of Technology, which are in remote areas, miles away from cities and towns.
It is madness to impose a total lock down in such places. Remote plants and universities should be re-opened, provided they take adequate precautionary measures. For instance, they should test all the people living within a campus, isolate those with the virus, make sure the residents stay within the campus and quarantine all supplies coming in, as needed. .
Blessed are the poor for whom poverty is an enabling condition that better prepares them to face the vagaries of nature; otherwise they would have died young. Cursed are the rich who are shielded by their wealth from various known diseases but make them ill-prepared to face an unknown one.
*Ashok Kumar Nag is an alumnus of the Indian Statistical Institute, Kolkata India. After spending more than two decades in the Statistics and Information Management department of the Reserve Bank of India he retired as an adviser. Currently he works as consultant in the area of information management and data analysis. For the research paper, from which this article is adapted: Link