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Why Death Rates Vary Widely in States: Evidence May Be Key | India News

NEW DELHI: There is wide variation in case mortality rates (deaths as a percentage of cases) among states with more than 100 cases as of Friday morning, with Madhya Pradesh (7.7%) at the high end and Kerala , which registered the first Covid-19 case in India, only 0.6%.
Maharashtra, with the highest number of cases, is number 4 on this list. Tamil Nadu and Delhi, despite having the second and third highest number of cases, have one of the lowest mortality rates of 0.96% and 1.67%, respectively.
What explains this wide variation? There are no definitive answers, but the TOI epidemiology and public health experts he spoke to have some suggestions. They said that states that test more widely would have lower death rates, as they would detect even mild or asymptomatic cases.

Why Death Rates Vary Widely in States: Evidence May Be Key | India News

‘Age could be a factor in death Speed’
This would increase the denominator (the number of cases) and therefore lower the calculated value of the death rate, the experts noted.
Global health researcher Dr. Anant Bhan noted that if only severe cases or those reporting severe symptoms were being reported to hospitals, the case fatality rate would be high. “The data seems to indicate that in the initial stages, mortality rates are higher. But once they learn how to handle severe cases, then the death rate probably falls. Or maybe the reports of deaths cause more patients with mild symptoms to rush to the hospital and therefore the death rate drops, “said Dr. N Devadadan, former director of the Bangalore Institute of Public Health, adding that it was not possible to make definitive statements without further data, especially clinical data.

Why Death Rates Vary Widely in States: Evidence May Be Key | India News

Professor Rakhal Gaitonde, an expert in public health policy at the Sree Chitra Tirunal Institute of Medical Sciences and Technology, said the age structure of those diagnosed could be a factor. “In Kerala, for example, a large proportion are young adults (travelers / workers in other countries) and therefore the death rate among them will tend to be very low,” said Dr. Gaitonde, adding that it was too early to speculate on the difference in mortality rates given the wide range of testing strategies, testing coverage, and age structures in different states.
Dr. Giridhar Babu, an epidemiologist at the Indian Public Health Foundation, also considered that unreported cases would have the effect of lowering the denominator (cases) and inflating the case fatality rate above its actual value.
“In Maharashtra, surveillance efforts are better (than WB, Bihar, UP and MP), but there could be a selection bias, which means that people with serious illnesses undergo preferential testing. In addition, there could be a delay in admission and availability of specialty care, which is a function of how strong your public health system is, ”said Dr. Babu. He added that there may be delays between the onset of symptoms and death, which could lead to an underestimation of the fatality rate. Dr. Babu also cautioned that it was important to distinguish between deaths from those who tested positive for Covid. “Dying with the disease (association) is not the same as dying from the disease (causation),” he said.

Times of India