A crowded outdoor vegetable market in Chennai, the HQ of a Muslim missionary group in Delhi, Onam celebrations in Kerala, Ganesh Chaturthi festivities in Mumbai — all ended up being super-spreader events by causing a subsequent spike in the number of coronavirus disease (Covid-19) cases in their respective cities.
Indeed, in every country in the world, events and gatherings of this nature — from parties to a large motorcycle rally to even a biotech conference — have all been super-spreader events.
Yet, over the past two months, India has bucked the trend.
The elections in Bihar, a state with a population of at least 120 million, witnessed several large rallies and meetings. A review of video footage of these meetings and rallies shows poor Covid-19 safety protocols — not everyone is seen wearing masks, and there is no social distancing. Scenes from some of the large rallies by popular political leaders show tens of thousands of people crowding together, displaying behaviour that is all social and no distancing.
Yet, Bihar did not see a spike after these meetings. Sure, the state continues to rely almost exclusively on rapid antigen tests — these are unreliable — but there has been no spike in deaths that points to a corresponding surge in unrecorded cases.
As on December 12, Bihar had seen 1,317 deaths and recorded 242,748 cases. That translates into a case fatality rate of 0.54%. The corresponding numbers at the national level were 143,073 and 9,857,345, for a case fatality rate of 1.45%. If Bihar’s fatality rate were the same as the country’s, it would have seen 3,520 deaths to date — and 2,203 deaths are not easily hidden even in a state like Bihar. And anecdotally, there hasn’t been enough evidence of this happening in the state.
Sure, given patchy record keeping in most parts of India, it will be months before data on overall deaths in 2020 can be compared with that in 2019 (or a long-term average) to see whether there is an unexplained spike from unknown reasons. These deaths can then be attributed to Covid-19. This is how, early in the pandemic, The New York Times and the Financial Times found an under-reporting in deaths in many countries. A similar study in India will have to wait. It’s very likely there has been an under-reporting of deaths in most Indian states, but we have no way of knowing the magnitude of this (right now), except to recognise that this has not been significant enough to show up in death records (however patchy these are) or be noticed from a spike in burials or cremations.
Cases are a different issue. I have reasoned in past installments of the column that India’s infection death rate (number of deaths to total number of infections) could be 0.1%, which would mean that the country has seen 143 million coronavirus disease infections to date, with Bihar seeing 1.3 million of them.
Returning to the issue of super-spreader events, the elections in Bihar are not the only ones to have bucked the trend. So have Durga Puja and Diwali.
This is something that definitely merits further study — it’s the kind of thing the Indian Council of Medical Research must be doing — because it could shed light on the current and, more importantly, future trajectory of the coronavirus disease in the country.
Equally study-worthy (and I have written about this before) are the reasons behind Bihar and Uttar Pradesh’s low Covid-19 numbers, something that can’t be entirely explained by the adequacy of testing, the kind of tests used (UP does far more RT-PCR tests than Bihar and many other states), or poor documentation. Experts believe that Africa’s low Covid-19 numbers can be attributed to a younger demography and exposure to their infectious diseases (including those caused by other coronaviruses). That could be true of UP and Bihar as well — both their populations had a median age of just around 21 in 2011, almost the same as Kenya’s currently.