Why Are Indians Under 60 Dying From COVID-19 in India?
In India, lifestyle diseases among the youth may cause COVID-19 complications.
With the steady rise this past week, India India has risen to 11th spot among countries with the highest number of confirmed infection and has a current death toll of 2,752.
Global statistics paint a picture that this disease is especially harmful to people with co-morbidities and those over 60.
But with India’s largely young population, the evidence is surfacing that suggests its not just the elderly who have to worry - COVID-19 is hitting the below 60 in India hard.
Diabetes, Heart Conditions - The Real Danger for Indians Under 60
Delhi state health bulletin on 16 May showed 438 positive cases making a cumulative number of 9333. Six new deaths were reported taking the death tally in the state to 129.
In those in the age bracket of less than 50 years:
- 27 deaths occurred (20.93 % of the total)
- 23 deaths were due to co-morbidities (85.18%)
In those in the 50-59 year age group:
- 35 deaths (27.13 %)
- 27 had co-morbidities (77.14 %)
In those above 60:
- 67 deaths (51.94 %)
- 63 had co-morbidities (94.03 %)
In Delhi’s 129 deaths, 113 or 87.6 % of people had co-morbidities. 72 were under the age of 60.
Meanwhile, a similar story is unfolding in India’s worst hit state. In their daily report, the Maharashtra government on Friday, 15 May, at 9 pm recorded 1576 new cases.
According to the report by the BMC, of the 34 deaths in Mumbai - one of the red zones - between 10 to 12 May, “16 patients had co-morbidities, 3 deaths were below 40 years, 18 deaths were between 40 to 60 years and 13 deaths were above 60 years.”
Again, in most deaths, the common factor was that the patients had existing morbidities. And 21 of 34 deaths were among those under 60.
In fact, the Union Health Ministry data has a note that says that more than 70% of the deaths in India are due to comorbidities.
Lifestyle Related Co-Morbidities
This is not news to us: Indians have an alarmingly high incidence of diabetes and heart diseases. In 2016, the number of adults over 20 recorded with diabetes in India was 65 million as per The Lancet.
“For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016.” That's almost double the global number.
We carried a considerable share of the global diabetes burden, and studies showed this was not just confined to urban areas. Pre diabetes is also increasingly common.
Among other lifestyle diseases for Indians are high blood pressure, hypertension and heart conditions. Almost one in three Indians suffers from hypertension as per various studies. Hypertension is a major risk factor for cardiovascular morbidity and mortality.
Further, according to the WHO, India has a high burden of tobacco use. And this coupled with our disastrous pollution rates is not a good sign for our respiratory health.
COVID-19 is a respiratory disease and all the current evidence suggests that those with high blood pressure, diabetes, heart conditions, lung conditions and other severe diseases are at risk.
In a report for the Times of India, a state official from Delhi who wished to stay anonymous said that a 45-year-old with diabetes and hypertension is at a higher risk of COVID-19 complications than a healthy 60-year-old with no chronic disorders.
How will the youngest democracy, with more than half of its population below 50, and heavy incidences of lifestyle diseases cope with COVID-19?
India's COVID-19 Fatality Rate
In a country as large as India, the numbers have to be analysed holistically. We have 85,940 cases currently, yes, but we also have 30,152 recoveries against the 2,752 deaths.
Arguably, India - like the rest of the world - is not testing enough and the ‘real numbers’ of the disease could be murky.
But at face value, our fatality rate is not that high.
According to a data-set on COVID-19 released by Public Health Foundation of India (PHFI), as on May 7, India's cumulative deaths per million is 1.29, which is lowest in comparison with many countries -- US (196.97), China (3.23), France (394.91), UK (443.04), Sweden (291.21), Italy (490.85), Spain (553.06), Germany (84.97).
At 3.2 per cent, India also has one of the lowest case fatality rate (CFR) in the world.
So what does this mean? Frustratingly, we cannot say for certain but Indians with their lifestyle diseases need to be wary - at every age- and take precautions.
Our death rate may be low, but COVID-19 complications can be avoided by maintaining physical distance, hand hygiene and regular exercise.
Also, what impact will lifting of restrictions have on India's young population with co morbidities will have to be seen in Lockdown 4.0.
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