Covid-19: The curious case of Gujarat's consistently high case fatality rate

NEW DELHI: One of the greatest puzzles of the Covid-19 pandemic in India so far is the consistently high case fatality rate (CFR) in Gujarat, a state not particularly known for weak health systems as compared to many other northern and eastern states.

The state has a CFR of 4.09% and what has intrigued many is that the western state has maintained the highest CFR in India almost consistently since the beginning of the pandemic, except for a brief spell initially when West Bengal was at the top.

The average CFR of the country on the other hand, which has been improving steadily, now stands at 2.23%.

Maharashtra, the worst-hit Indian state in the pandemic has a CFR of 3.6% while Tamil Nadu with the second-highest caseload has a CFR of 1.6% only.

When it comes to total confirmed Covid-19 cases, Gujarat stands at number 8 with 57,982 cases. With 2,372 confirmed fatalities, the state is followed by Maharashtra, Delhi, and Tamil Nadu, each of which has at least 2.5 times or more confirmed cases than Gujarat when it comes to recorded deaths.

Within the state, Ahmadabad has the highest number of confirmed cases at 26,032 and has witnessed 1,583 deaths so far taking the city’s CFR to a little above 6% while the second worst-hit city with 12,223 cases and 379 deaths fares much better in comparison with a CFR of around 3%.

The reasons being attributed to the high proportion of the deaths in the western state include late detection of cases, low testing rate, high burden of non-communicable diseases.

But even the governments at the state and the Centre seem to be struggling to find a definitive answer.

Earlier this month, the Centre had dispatched a four-member team led by Niti Aayog member (health) Dr V K Paul who also heads the country's top advisory task force on Covid-19 to the state to advise it on how to reduce the worrying infection fatalities.

“It's only a few districts such as Aravalli, Patan, Porbandar, and Ahmadabad, whose high CFRs are raising the CFR for the whole state,” a senior official in the Union Ministry of Health and Family Welfare told this newspaper.

When contacted for her comments, Union health secretary Preeti Sudan said “Gujarat is working to reduce its Covid-19 CFR.”

Some public health experts in the state said that they too are at a loss of exact explanation for the high Covid-19 fatalities in Gujarat and in the absence of a concrete answer—there are some theories doing the rounds.

It includes a high burden of non-communicable diseases such as hypertension and diabetes which considerably increase the risk of mortality in those infected and the possibility of a more virulent strain of SARS CoV 2 prevalent in the region.

“Then, there is very high penetration of the private sector in the state which means that a large number of people with mild infections may not be getting documented as they simply consult family physicians and get cured,” said Dr. Bhavesh Modi, a community medicine specialist at GMERS medical college, Gandhinagar.

He also pointed out that the H1N1 flu outbreak in 2009 had also caused a significantly higher mortality in the western India — mainly Gujarat and Maharashtra — a phenomenon that has not been properly explained even a decade later.

Public health researcher Dr Oommen John, on the other hand, reckoned that the high CFR could be a reflection of the demand on the health systems, when there are a large number of people requiring high dependency care and they don't get it as early intervention.  

“All other things being equal this looks like a plausible reason unless a large number of those who are infected in Gujarat are at high risk with co-morbidities or are elderly,” he said.