India’s second wave: Deadly, but not more than transatlantic’s

Covid-19 deaths crossed the 3-million mark globally on April 16, 2021. These have doubled over the last four and a half months. There is continuing panic and media chatter regarding a deadly second, and possibly a third, Covid-19 wave. How does the latest available data—updated daily at the Worldometers website—square with popular perceptions?

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A deadly second wave shows up clearly in the global data with regional variations. It appears to have peaked in the Americas and Europe. It is still trending upwards in the Middle East, North Africa and Central Asia (MENACA) region. It is also trending upwards in Australasia, although the second wave is evident only in South Asia. Mortality in Australasia, including India, is, however, on a much lower base compared to the transatlantic region.

The accompanying graphics have aggregated Covid-19 mortality data in deaths per million to equalise for population differences across countries. Second, mortality is calculated for six-weekly intervals beginning March 6, 2020. This is when Covid-19 mortality, initially confined to China, started rising globally. There are nine six-weekly intervals in all, the last ending on April 21, 2021. Third, the data is from 37 major countries, and includes all countries with Covid-19 deaths exceeding 20,000, with the exception of South Africa (53,887 deaths so far). Together, these countries account for about 88% of Covid-19 mortality, and 72% of the global population. Fourth, the data is aggregated into four regions for analytical reasons. The regions are the Americas (10 countries), Europe (13 countries), MENACA (six countries), and Australasia (eight countries). Mortality in the rest of Africa (with the notable exception of South Africa) is minimal, and it has, therefore, been excluded from the graph to keep things simple.

The Covid-19 pandemic shows up in the graph as mostly a Transatlantic-Mediterranean phenomenon, taken to include the Americas, Europe and MENACA. With just a third of the global population, it accounts for 90% of Covid-19 mortality so far. Within this region, the Americas (1,608 per million), led by the US (one in five of all global deaths), has fared the worst, followed closely by Europe (1,349 per million), with MENACA a distant third (383 per million).

In sharp contrast, Australasia, with two-thirds of the global population, accounts for just 10% of total mortality. Its Covid-19 mortality of just 73 per million is overstated as the two outliers India (132 deaths per million) and Indonesia (160 deaths per million) account for well over 80% of Asian deaths. India is the only country outside the transatlantic region to have more than 1 lakh Covid-19 deaths. It accounts for two-thirds of the overall Australasian mortality, far out of proportion to its population share of 37%. Although India’s Covid-19 mortality is high by, and critical for, overall Australasian trends, it is nevertheless still a fraction of transatlantic levels.

There is a clear second wave in Europe. After having dropped from a high of 155 per million in April 2020 to 11 in September, mortality rose again to peak at 290 in January 2021, following which it started to recede. Current mortality at 201 in the last six weeks of March 6 to April 21, 2021, is nevertheless substantially higher than the peak of the first wave (155).

While the Americas also witnessed a second wave, this was superimposed on the first wave, which never receded. Starting with 53 per million in April 2020, Covid-19 mortality stayed steady at around 150 per million in each of the next five six-weekly intervals until December 2020. The Americas were then hit by an even more deadly second wave that peaked in March 2021, at 283 per million. This has declined only slightly to 235 during the last six weeks ending April 21, 2021. As in the case of the East Atlantic, mortality levels currently are still higher than the peak of the first wave (169).

Clearly, the second wave of Covid-19 is deadlier than the first wave on both sides of the Atlantic Ocean. This was also the case with the Spanish Flu a century ago, where overall mortality was much higher.

Asia presents an intriguing contrast. Its first wave peaked at 16 per million by October 2020. From then on, it showed a slow but steady decline till around March 2021, even as the transatlantic was embarking on a deadly second wave. Mortality has, however, risen slightly from 6 per million to 9 in the last six weeks ending April 21, 2021. But this is almost entirely on account of South Asia, particularly India, which alone shows a second wave. Indian mortality has risen from 3 per million in the six weeks ending March 6 to 15 in the six weeks ending April 21, 2021. While there is a distinct second wave in South Asia, unlike the transatlantic region, Covid-19 mortality is still lower than the peak of the first wave. The trend in MENACA is similar, but at significantly higher levels.

What then of the sharply rising and record number of Covid-19 cases being reported in India, anecdotal evidence of increased hospital admissions, overflowing mortuaries, humungous election rallies and the Kumbh Mela? It is possible that while the second wave is more virulent and infectious, it is not as deadly as the first wave, and that Covid-19 mutants in India are milder than in the West, being more flu-like from which most people recover. The vaccine drive may also have helped in keeping mortality in the second wave lower.

It is, however, still too early to comment on the severity of the ongoing second wave, as the Indian graph is still trending upward. We would need to watch out for incoming data. Though absolute mortality per million is modest compared to the transatlantic numbers, it has nevertheless increased six times over the last six weeks, from 3 per million to 16. While this is still significantly lower than the first wave peak of 36, the increase over the last six weeks (13) is higher than in any earlier six-weekly interval. The Lancet Covid-19 Commission India Task Force Report of April 2021 has raised the prospect of a worst-case scenario of daily mortality of 2,320 per day by early June in the absence of adequate mitigation efforts.

There is also the issue of reliability of data that makes cross-country comparisons problematic. Testing and reporting rates, including those relating to mortality, vary across countries. Positivity rates, and number of cases, are dependent on testing that may not be equally uniform over space and time, even within the same country. While recognising this difficulty, one has to necessarily work with what data is out there. Covid-19 mortality remains the single-best indicator because large-scale mortality is difficult to conceal. Within a country, the rate of underreporting can be assumed to remain constant over time. So, the mortality data is arguably the single-most reliable indicator for comparing Covid-19 trends across countries over time.

The author is RBI Chair professor in Macroeconomics, ICRIER