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Exactly two years ago, on March 12, India recorded its first Covid-19 fatality: Mohammed Hussain Siddiqui, a 76-year-old man from Kalburgi in Karnataka, died after he likely caught the Sars-CoV-2 virus during a recent trip out of the country.
On Friday, there were now 515,871 confirmed deaths in the country, a bulk of which occurred less than a year ago when the Delta variant triggered a devastating second wave of infections that pushed the country’s medical infrastructure over the brink.
In absolute terms, India stands third in the list of countries with the highest number of deaths.
India now has case fatality ratio of around 1%, lower than the global figure that has hovered around 1.5-2% of the total cases reported, although experts believe known deaths may be a fraction of the true toll in the country, which could be as high as four million.
But between the first and the most recent death, there has been significant evolution of India’s and the world’s response to the virus. In case of India, experts said the country has worked to better manage the disease, especially during the first wave that built up slowly as a hard lockdown remained in place for much of spring and summer in 2020, a time when the virus tore through the western parts of the world.
“The lead time that we got here in India helped us prepare better to manage Covid as compared to most western countries that were hit suddenly. It saved a lot of lives. Another factor is the age group as Western countries saw higher number of deaths in older population and India, being a relatively younger country, managed the disease slightly better.
“Then the most important factor during latter half of pandemic has been the robust vaccination program undertaken over last one year that played a significant part in reducing mortality in spite of concerns regarding immune escape with regards to Omicron. It clearly provided protection against death,” said Dr Neeraj Nischal, additional professor, All India Institute of Medical Sciences, Delhi.
Clinical guidelines were updated by the government on a regular basis as the scientific evidence evolved. In June 2020, Union heath ministry revised clinical management protocols to add the steroid dexamethasone for use on patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging, and excessive activation of the body’s inflammatory response.
Judicious use of steroids proved to be a life-saver for many hospitalised Covid patients.
“Standardisation of treatment protocol helped a great deal in charting the treatment course of patients; and since we have been following the west, we were wiser in making treatment choices as we got a fair idea on what worked better or what did not. Apart from that the government’s decision in the form of implementing a lockdown in time also provided time to upgrade health care infrastructure,” said Dr Sandeep Nayar, senior director and head, chest & respiratory diseases, BLK Super-Speciality Hospital.
Over time, India also ramped up testing capacity, though this suffered from significant under-capacity during the early stages and the second wave.
“From starting the Covid test in one lab in January 2020 at NIV-Pune, ICMR put together a network of over 3,000 labs in a short span of time. From 10,000 per day sample testing capacity to these labs now being capable of conducting about 2 million tests in a day, India’s testing capacity was significantly ramped up to meet the demand. It reflected in the way the outbreak was managed,” said a central government official on condition of anonymity.
India Council of Medical Research, which supervised the testing initiative, also collaborated with other science and research agencies such as the department of science and technology, department of biotechnology, Council of Scientific and Industrial Research, Defence Research and Development Organisation and the Department of Atomic Energy for use of their testing labs and developing research solutions that worked in overall pandemic management
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