By Nilanjan Banik and Parikshit Bhargava
In a bizarre move, Mamata Banerjee’s government now favours home quarantine. The State of West Bengal, it seems, do not have adequate health infrastructure to quarantine “lakhs and lakhs of people”. This apprehension may be true for other parts of India as well. For India, given its fragile healthcare infrastructure, lockdown is seen as a preventive measure. With a community spread of COVID-19, India does not have enough doctors and hospital beds to provide treatment. India has 0.9 hospital beds and 0.7 doctors for every 1000 people, against the WHO mandate of 1.9 hospital beds and 1 doctor per 1000 population. For any state in India, unable to implement lockdown measures properly, home quarantine becomes the second-best option.
The lockdown is a way to implement state enforced social distancing. The virus spread through person-to-person contact, and the only way to limit its spread is to identify the people who got affected. With proper screening and lockdown of the affected person, the virus can be eradicated within 14 days.
The reason why South Korea is successful is because testing and isolation of the affected are done at a rapid speed. Latest figures from Our World in Data suggest as on 23 April 2020, South Korea tested 11.34 people for every 1000 people in comparison to Italy testing 26.72, UK testing 8.67, and the US testing 14.06 people for every 1000 population. However, on 1st March, Italy tested 0.357, UK tested 0.17, and the US 0.007 tested people, in comparison to South Korea testing 1.88 for every 1000 people. This points out to the importance of testing and isolation in controlling the spread. Italy, UK, and the US have learnt in a hard way. The number of fresh cases has almost stopped emerging in case of South Korea, whereas for the other three countries thousands of fresh cases are emerging every day.
In India, we do not have adequate number of testing kits. As on 23 April 2020, India has tested only 0.362 for every 1000 people in spite of having a much higher population than UK, South Korea, and the US. In fact, the State of Kerala which has successfully dealt with controlling number of corona-related death has pointed out to the importance of aggressive testing and contact tracing.
There is a belief that India is under-reporting actual number of affected persons. As is the case with West Bengal, the suggestion for home quarantine is a way to signal that there may be more number of affected persons in the state than what the official figure suggests. The question everyone is asking how will be the statistics change if India is to do proper number of testing – as is done in the case of the developed countries.
India is a hugely populous country. To do any meaningful comparison, ideally, we should compare states in India with their counterpart in the developed world. For instance, population-wise, Odisha is similar to Spain, Karnataka is similar to the United Kingdom, Andhra Pradesh is similar to South Korea, Gujarat is similar to Italy, West Bengal is similar to Germany, and the States of Uttar Pradesh (U.P.) and Bihar are similar to the United States.
We do a counterfactual experiment, and try to estimate total number of cases detected and expected number of death, if these states were to do the testing similar to their counterpart countries.
How will the Situation Change?
Country Pop( in 1000) Comparable State Pop( in 1000) Actual
Deaths Actual
Cases Expected Deaths Expected Cases
United States 329064.917 U.P. + Bihar 355635.5 23 1657 6803.6 213727.9
Italy 60,550 Gujarat 64801.9 103 2407 2355.6 74000.0
South Korea 51269.185 Andhra Pradesh 53390.8 27 895 823.6 25872.8
United Kingdom 67886.011 Karnataka 66834.2 17 443 788.0 24754.7
Germany 83517.045 West Bengal 98662.1 15 456 3370.6 105885.6
Spain 46736.776 Odisha 45861.0 1 83 1249.2 39241.7
Note: Figures are based on the latest available figures, as of 23 April 2020. The figures for Spain is on 13 April, and that for Germany is 19 April 2020.
Actual deaths and actual cases are figures reported for each one of these states as on 23 April 2020. Expected cases and expected deaths are the figures if these states were to do the testing in semblance to their counterpart in developed world. The results are quite overwhelming. On average, number of detected case in India goes up by 150 percent. For the calculation in individual states we consider the test per confirmed case for India, which is 23.4. Interestingly, the increase in expected number of cases detected and number of deaths happens in spite of India having a lower fatality rate in comparison to the developed countries. There are few limitations in the data. For calculation we have used the national average (test per confirmed case). Second, the COVID test figures may give some false positive, and may not necessarily means that the person is affected with the virus. Third, many people may not opt to go to hospital for testing at all. And last but an important point, the tropical hot weather in India may result in far more less number of death and people affected, even if India were to do testing as is done elsewhere in developed world.
Country Deaths per million Cases Cases per million Tests per thousand Tests per confirmed case Fatality rate
(in %)
United States 141.3403 842629 2545.7 14.061 5.5 5.6
Italy 414.8899 187327 3098.3 26.718 8.4 13.4
South Korea 4.681175 10702 208.7 11.338 54.6 2.2
United Kingdom 266.6234 133495 1966.5 8.666 4.4 13.6
Germany 60.79924 148046 1767.0 25.11 14.8 3.4
Spain 464.4872 208389 4457.1 20.02 5.6 10.4
India 0.493477 21393 15.5 0.362 23.4 3.2
In fact, around 80 percent of the people in India are asymptomatic. India also has a much younger population in comparison to the developed world. Indians while growing up have an early exposure to vector borne diseases such as malaria, dengue and chikungunya, and may have developed state of resistance to COVID-19. Therefore, even if India were to test in proportion to what is done with respect to the developed world, our sense is, the number of death recorded will be “much less” than what we see in the case of USA, Italy, and Spain. However, we need to be cautious for the elderly co-morbid population in India. Most of them suffer from cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. COVID-19 is likely to affect this group more, and therefore need a different attention from the welfare state. (IPA Service)
The authors are with Bennett University, Greater Noida.
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