COVID-19: Understanding the lower mortality rate in South Asian countries

Death rate due to COVID-19 is lower in South Asian countries like India, when compared to the Western countries, which boast of a robust healthcare system. A recent study, published in the International Journal of Infectious Diseases, could perhaps explain this paradox.

Dr. Giridhar R. Babu, a Bengaluru-based epidemiologist, who was part of the research team, attributes low COVID-19 mortality rate in South Asia to cross-reactive immunity, which plays a significant role in reducing the severity of the disease. ''The presence of cross-reactive T cells presumably from prior coronavirus infections can also attenuate the severity of the disease. Another reason for the low mortality is based on the emerging evidence suggesting asymptomatic and mildly symptomatic patients have high SARS-CoV2 specific cytotoxic T-cell responses, '' says Babu.

The research team consisted of Daisy A. John and R. Deepa from Public Health Foundation of India, Dr. Sonalini Khetrapal, a South Asia specialist at Asian Development Bank and Dr. K. M. Venkat Narayan, a professor of Global Health and Epidemiology at the Rollins School of Public Health at the Emory University, besides Babu.

According to Babu, one of the reasons for the low COVID-19 fatality rate in South Asia could be the lack of prompt reporting of deaths. Eight countries in the South Asian region—Pakistan, Afghanistan, Bangladesh, Bhutan, India, Sri Lanka, Nepal, and the Maldives—account for about one-fifth of the world's population. ''Also, South Asian countries have a demographically younger population. These countries got good enough time to prepare for the attack of the pandemic. This further helped in early lockdown and other similar interventions such as reallocation of funds, and human resources to COVID-19 response. Other hypotheses implicate some genetic advantage. But, this is a theory that needs more evaluation studies,'' he adds.

Most of us presumed that South Asian countries did not have a chance against the pandemic, says Babu. ''The South Asia region bears the brunt of the dual burden of non-communicable and communicable diseases. Lack of human resources and infrastructures poses a greater problem. However, to everyone’s surprise, they put up a good fight by taking simple measures of restricting incoming foreigners, not permitting foreign travel, suspending air routes, and quarantining travellers from abroad. These countries also had luck on their side, with a younger population and late arrival of COVID-19 pandemic compared to the other world countries,'' he observes.

According to Narayan, the pandemic has highlighted areas and systems where the countries of South Asia need to invest in to prevent even worse pandemics in the future. Such system-wide investments will also help countries manage chronic diseases and other health threats. Investment in public health infrastructure is critical for the economy and for the health of people and the planet.

The pandemic has been a clarion call for South Asian countries to overhaul their healthcare systems. These countries need to strengthen their health security as there could be potential pandemics in the future, says John, one of the authors in this study. ''COVID-19 has exposed the vulnerabilities of the South Asian countries. Most of the South Asian countries are already dreaded with a high burden of non-communicable diseases, limited or low access to quality healthcare, widespread poverty, and malnourishment. They would need international collaboration and support. Evaluation of the capacities of these countries and appropriate investment is a requirement.''

Building a strong regional plan for universal health coverage can enhance social protection for livelihood security as well as mitigate the potential deaths among the poor and vulnerable, suggests John. ''The region needs to rapidly scale up the existing social safety net programmes. It requires strong leadership and greater political will to allocate substantial resources to prepare for future pandemics.''