INDIA SEEMS TO BE BETTER PLACED IN FIGHTING AGAINST COVID-19: A REVIEW

1. Assistant Professor, Department of Biochemistry, Daulat Ram College, University of Delhi, Delhi, India. 2. Associate Professor, Department of Chemistry, Daulat Ram College, University of Delhi, Delhi, India. 3. Department of Biochemistry, Daulat Ram College, University of Delhi. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 April 2020 Final Accepted: 12 May 2020 Published: June 2020

When the whole world is reeling under a severe impact of Covid 19, India which is 4 times more populous than US and many other developed nations, is not so severely hit by the epidemic. Despite India's very low per capita income and poorly ranked healthcare system in the world, it has escaped the brunt of the pandemic. Generally epidemics exhibit exponential growth at the beginning but the initial delay and lower mortality have been ensued from many intriguing possibilities such as high geographical temperatures, high immunity due to poor hygiene, BCG vaccinations and lower average age of the population The ongoing review presents a brief perusal of the probable causes for the initial containment of the pandemic and its potential in India. India is a neighboring country and shares its political borders with China, the country from where the first case of infection came to be known. There has been an endless constant battle between countries to fight against the spread of the disease and safeguard its citizens since January'2020 when the virus was first noticed by the World Health Even though India is a populous country with the second highest population in the world, it has been better in controlling the spread of Coronavirus which being highly contagious continues to be a bigger threat to India which has 17.7% of the total world population [2].
Indian government has taken all necessary steps to ensure that the country is well prepared before it's too late by providing improvement in testing kits, labs, medical facilities and building of quarantine centers as India doesn't hold a good ranking in terms of its medical facilities. According to a study, the spread of this virus is seen lesser in countries that have earlier been hotspot of malarial infection indicating an inverse relation between the anti malaria prophylaxis and the prevention of COVID-19. Figure 1 shows the worldwide distribution of malaria and COVID-19 infection. It is suggested that this may be due to impairment of the terminal glycosylation of Angiotensin-converting enzyme2 (ACE2) receptor in pulmonary epithelial cells, when treated with chloroquine or its analog. Chloroquine is an effective drug used for treating malaria for prophylactic purposes mainly in the Sub-Saharan zones of the world. This prior treatment could have lead to reduced binding of SARS-CoV2 to its receptor and hence lesser no. of cases reported by countries that see a large number of cases of malaria every year or have been badly affected by it in the past i.e., areas with anti-malarial prophylaxis are naturally protected from COVID-19 infection. [4,5,6]  Similar pattern has been seen in countries where BCG (the vaccine for tuberculosis) is administered to neonates. Countries where this vaccine is a part of their scheduled vaccines chart have seen lesser number of cases till date. But there is no concrete proof that this vaccine can prevent infection against COVID19 also. This vaccine has shown some non-specific effects on immune system in body during clinical trials. So, WHO has not yet declared it as a vaccine for use in this pandemic and continues to recommend BCG for prevention against tuberculosis. [7] May 1125719  96559  145268  186603  217466  210717  163175  129708  42533  11-May 1271645  155939  221344  219187  224390  219070  169575  137073  67152  18-May 1409452  233142  290678  243699  231350  225435  174697  140036  96169  24-May 1592599  347398  344481  257158  235290  229327  178281  142173  131868 Graph 1:-Data of confirmed COVID-19 cases in nine different countries.  Graph 2:-Data of reported deaths due to COVID-19 in nine different countries across world. Table 2 and Graph 2 depict data of deaths in 9 countries since 20 th January'2020. There were no deaths reported from 20 th January' 2020 to 16 th February' 2020 for these nine countries. USA has maximum deaths due to COVID, followed by UK which has 2.5 times lesser deaths than USA. As per Table 2, USA saw a sudden increase in number of deaths from 5854 to 20444 from 6 th April to 13 th April, 2020 during which India saw cases increase from 109 to 308, which is 73.3 times less than USA. India saw a large increase in the no. of deaths from 1373 to 2206 from 4 th May to 11 th May, 2020. When compared, India has 25 times less deaths than USA, and 10 times less than UK. The ratio of total registered cases to total deaths for USA is 16.61, UK is 7, Russia is 97 and India is 34.
On comparing total cases to total deaths for each country from the values illustrated in Table 1 and 2, we can see that few countries like Russia and India have a high value for this ratio, which corresponds to a lower mortality rate. India has not seen more than 200 deaths in a single day (max. deaths reported being 195 on 5 th May' 2020) which is an indicator of how India and Indian government has been taking crucial steps in saving lives of its people. Italy ranks second in terms of medical and healthcare facilities in the world [10]. Despite that it has not been able to control the increasing cases (229327) and deaths (32735). This makes it even more important to take stricter actions for containment of the spread of disease.
The underlying graph shows the rise in cases and number of deaths reported in countries that have been hit the worst [11]. This data can be used to compare the status of spread of the disease in different geographical zones of the world: May 87180  15633  2722  34636  27650  31908  7935  28059  3029  24-May 95863  22013  3541  36675  28678  32735  8247  28281  3867 715

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Graph 3:-The graph depicts the comparison of number of total COVID19 cases and deaths of nine different countries as per 24 th May' 2020.
Graph 3 shows total cases and deaths due to COVID-19 in 8 worst hit countries, and compares that with India: Maximum deaths were reported in US since the pandemic spread was not taken seriously in its initial phase. The stats in US are approximately 5 times the count in the country following it in total COVID cases, i.e. Brazil. USA had its first corona case on 20 th January' 2020 [12] and 10 days from that India encountered its first case. India, Spain, UK, Russia, though, saw their first cases by the end of January 2020, the total rise in the number of cases had been very fast in other countries when compared to India.   (102) which is far less than that for Spain (6050), mainly due the initial lockdown in the country which was strictly implemented when cases had not even exceeded 1000. This not only helped in stopping the large increase in number of cases but also gave government time to make proper medical arrangements for future increase in cases. India, though crossed its 100,000 cases mark on 19 th May' 2020 [8], the recovery rate is 41%.
Germany tops in rate of recovery of infected patients with a huge percentile of 88.25%, while India is at a mediocre level of almost 41%. Fatality rate is highest in France amongst its affected population, followed by Italy and UK.

Discussion:-
Low mortality rate in India can be attributed to various factors like immunity of the people prevailing there, condition of medical services provided to COVID patients and percentage of people of different age groups, for instance India having more younger population seems to have less fatality than a country having more elderly or minor population, since the COVID-19 virus is considered more lethal to people having less immunity and to the people of older age groups or children. [13] Another reason could be the difference in temperature of different geographical zones of the world. Studies suggest that an increase in temperature and humidity reduces the stability of the virus, both in air and on different surfaces. A temperature of more than 95 degrees Fahrenheit and humidity can reduce the half life of virus on surfaces where it can live for hours to just a few minutes. This can be thought of as a reason why India and other countries of the temperate zone have not seen as many number of cases as in US or Italy. The R o value (average number of person infected by one sick person who have no immunity for the infection) is higher in places where the temperature is less-like in Northern Hemisphere-as compared to areas that are experiencing summers, as in southern hemisphere. [14,15] 717