COVID-19 is one of the main issues currently facing the world, and discussion of topics - including finding a possible vaccine, whether the number of daily infections is decreasing or not, effective social distancing measures, and the overall prognosis - continue apace.

With 1.33 billion people, India is one of the most populated countries in the world.¹ While other “hotspot” countries have experienced peaks of COVID-19 cases, India has, so far, recorded relatively few cases. According to the Indian government, there were 354,708 COVID-19 cases as of June 18, 2020.² When you compare those numbers with Russia’s (553,301 cases) or Brazil’s (928,834 cases) at June 17, 2020, one must wonder why the number of cases in India remains comparatively “small”.³ In this blog, we explore some possible reasons for this discrepancy.

It’s worth noting that COVID-19 isn’t the only pressing health issue in India. Beyond the current pandemic, the country is facing other challenges such as malaria, hepatitis, tuberculosis, and HIV.⁴ The number of people with health insurance is very low, and millions of low-income people do not even have access to basic medical treatment, so focusing on COVID-19 becomes a very challenging task.

To better understand the modest number of cases in India, one of the first questions is testing and how widespread it is. As we know, the WHO has identified testing as one of the main keys to controlling the virus.⁵ While testing for COVID-19 is widespread in countries such as Belgium and Germany,⁶ in India cities like Mumbai have over 15 million inhabitants, and comprehensive testing, much less testing the majority, for COVID-19 is almost impossible.

As of June 2020, the rate of testing in India was 3,462 per million population,⁷ so a large proportion of COVID-19 cases could be going unreported. Another crucial distinction could be the limited testing of younger adults. Currently, testing is focused on patients with severe lung disease or those already admitted to hospital.

Others claim the comparatively low number of COVID-19 cases is due to the climate in India. Recent studies investigating the association between increased temperature and possible transmission of COVID-19 have suggested that the transmission is lower in regions with high temperature and humidity.⁸ However, opinions vary, and not everyone agrees with this hypothesis.⁹

Since March 24, this country of a billion people has been under lockdown, with people only allowed to leave their homes for essential trips. Lockdowns have shown to significantly reduce virus transmission throughout the whole world, so the decision by India to lockdown quickly may have helped to reduce the number of cases.

Another contributing factor could be the mean age in India. In contrast to some of the world’s COVID-19 hotspots - such as Russia or Italy, where the mean age is 40 and 47.3 years, respectively - the median age of India’s population is much younger, at 28.4 years.¹⁰ According to the WHO, people over 60 and people with underlying health conditions have a higher risk of severe complications through COVID-19.¹¹ In addition, India’s younger population - with few-to-no symptoms - is not getting tested, which may also play a role in the smaller number of cases.

One more popular explanation points to the large use of spices in India, such as turmeric, that contain curcumin. Curcumin has anti-viral properties and its usage has been suggested by a study as a therapeutic and preventive measure against COVID-19.¹² Curcumin as part of a daily diet could lead to a stronger immune system, thus slowing the outbreak of the disease.

Many reasons are being touted to explain India’s low number of COVID-19 cases compared to other coronavirus hotspots with lower populations. The factors described above, however, should be taken with caution. The pandemic is not over yet and the number of cases has recently started to rise rapidly in India. To ensure the number stays within the capabilities of the Indian health system, it’s crucial that testing is increased, and that strict social distancing measures continue to be practiced.

Endnotes

1. Statista - www.statista.com.
2. Ministry of health and family welfare government of India - https://www.mohfw.gov.in/.
3. Ibid. at Note 1.
4. WHO - Burden of disease in India.
5. WHO - Coronavirus disease 2019 (COVID-19). Situation Report - 51.
6. Ibid. at Note 1.
7. Ibid.
8. Wang et. al. High Temperature and High Humidity Reduce the Transmission of COVID-19. (March 9, 2020). http://dx.doi.org/10.2139/ssrn.3551767.
9. Q. Bukhari et. al. Will Coronavirus Pandemic Diminish by Summer? SSRN, a. (2020); doi: 10.2139/ssrn.3556998.
10. Ibid. at Note 1.
11. Ibid. at Note 5.
12. Zahedipour et. al. Potential effects of curcumin in the treatment of COVID-19 infection (May 9, 2020 https://doi.org/10.1002/ptr.6738).