Even as the Covid toll in Odisha refuses to give up the ghost (57 deaths today), the State prides itself on still having one of the lowest case fatality ratios (CFR) in the country. While the State government pats itself by attributing the lowest CFR to effective case management, the recently released SBI research report links the low death rate to low per capita income in the State.
Though sounds strange, the latest SBI report said all states that have reported high deaths in the second wave belong to the group of high per capita income states. On the contrary, states like Bihar, Odisha, Rajasthan, UP Assam and Jharkhand, which are the states having low per capita income, have recorded lower Covid fatalities in the country.
The report said a similar trend has also been observed across the world, where low-income countries have reported lower deaths than their rich counterparts.
The report outlined how countries with high per capita income like Hungary, Slovakia, Italy, Spain, US, UK, France, Sweden and Germany have high deaths per million as compared to countries like Nigeria, Afghanistan, Pakistan, Ghana, Indonesia, Iran, India and China that have low per capita income and low deaths per million."
The SBI report, though, didn't cite any reason behind such a worldwide trend, when it is widely believed that low per capita income states/countries that have poor health capacity are most vulnerable to the pandemic.
However, analysing the reasons, Peter Sands, Executive Director of the Global Fund to fight HIV, TB and Malaria, in his address at the World Economic Forum earlier this year had said, “The most plausible reason could be that the lowest income countries have a very young population. In the poorest countries, the life expectancy is about 18 years lower than in the richest. This kind of demographic means that the mortality rate from COVID is relatively low. Because it is the elderly population who have mostly succumbed to the SARS-CoV2.”
The Indian Cause
As per an AIIMS - Patna study titled "Socioeconomic Inequality in National Incidence and Mortality Rates of Covid-19 in India: An Ecological Study" published in the Indian Journal of Community Health, the reason behind the low rate of infection in people of lower strata could be due to a better level of immunity which helped them in shielding from the pandemic impact.
"Observation of the positive cases admitted in AIIMS-Patna supported our research findings that persons of high socioeconomic status were more prone to succumbing to the lethal virus," said Dr PK Singh, Director, AIIMS-Patna.
The same study has grouped the states and UTs in India as per their HDI (Human Development Index), and it finds that states like Kerala, Delhi, Punjab, Tamil Nadu, Haryana, Maharashtra and some UTs recorded high incidence of the disease - cases and mortalities.
In contrast, states ranked lower in the HDI like Bihar, UP, Odisha, Chhattisgarh, Jharkhand, Assam and MP, have recorded a lower incidence of the disease, the report observed and further explained it very simply that poor rural people, labourers and slum dwellers have lower Covid cases.
The Odisha Angle
The AIIMS Patna study seems to have got support from data released by SBI research report recently on the second wave in the country, including Odisha. Details below.
- In the first wave, rural districts in Odisha took a mammoth 74.5 per cent of the daily caseload.
- In the second wave that started in the State in mid-April, the share in daily caseload inched up to touch 75.4 per cent.
- The rise in the peak month of May had been very sharp as it touched almost 80 per cent (79.6%) of the daily caseload.
- Chhattisgarh with a share of over 98 per cent of the daily caseload in rural districts topped the country.
- Andhra Pradesh with 84 per cent rural districts finished second.
- Rural Odisha by virtue of having a share of 79.6 per cent in the State's daily caseload ranked third.
- Bihar with 78.5% stood at 4th in the country.
A look at the 2011 census data suggests that when Tamil Nadu tops the country with a high of 832 towns, UP comes second with 704, MP (394), West Bengal (394), Maharashtra (378), Karnataka (270), Gujarat (242), Rajasthan (222), Andhra Pradesh (210) and Kerala (159).
Now consider the Covid-19 incidence chart.
Maharashtra tops the country and is followed by Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, UP, West Bengal, Delhi and Rajasthan. Be it incidence or the fatalities, these states lead the table in the country. The lone exception is Chhattisgarh.
Similarly, in the indicator of higher life expectancy period, as mentioned by Peter Sands, when the life expectancy in Odisha has been 65.8 years, the value for Maharashtra stood at 71.6 years, Kerala (74.9) and Tamil Nadu (70.9).
It has been observed that the life expectancy period of other states having lower Covid-19 fatalities like UP, Bihar etc have been below 70-years.
The Bottom line: Going by the AIIMS-Patna report and worldwide trend, the low case fatality rate in Odisha seems not due to better case management but for demographic reasons.