With input from Dr Monica Vasudev

1098: An Indian study shows that the rate of death declined in patients over 65 and children of all ages contracted the infection and spread the virus to others.

1. A study from Tamil Nadu and Andhra Pradesh is among the first to suggest that children contract and spread the coronavirus.
2. The study of around 85,000 cases and nearly 600,000 of their contacts, published in the journal Science, offers significant insights not only for India, but for other low- and middle-income countries as well.
3. The median hospital stay prior to death from COVID-19 was five days in India, compared with two weeks in the United States.
4. The trend in increasing deaths with age appeared to come down after age 65.
5. The study demonstrated that children of all ages can contract COVID-19 infection and spread it to others.
6. It further stated that a small number of people are responsible for causing a vast majority of new infections.
7. Joseph Lewnard, an epidemiologist at the University of California, Berkeley, led the study.
8. The study focused on Andhra Pradesh and Tamil Nadu, which have a combined population of about 128 million, and are two of the five Indian states that have reported the most cases.
9. Contact tracers reached over three million contacts of the 435,539 cases in these two states; however, it still did not represent the full set of contacts. Researchers assessed data for the 575,071 contacts for whom test information was available.
10. Contact tracing data suggested that the index cases were more likely to be male and older than their contacts. The possible reasons for this finding could be that men are more likely to be out in situations where they might be infected, more likely to become symptomatic and get tested if they contract the infection, or perhaps more likely to respond to contact tracers’ calls for information.
11. Over 5,300 school-aged children were found to have infected 2,508 contacts but were more likely to spread the infection to other children of a similar age. The investigators could not get information for all of the contacts, therefore, they could not evaluate the children’s ability to transmit relative to adults. However, the finding is relevant in the school debate, as some people argue that children spread the virus to a negligible degree, if at all.
12. The claims that children have no role in the infection process are incorrect.
13. The researchers noted that 71% of the people in the study did not transmit the virus to anyone else. On the contrary, only 5% of people accounted for 80% of the infections detected by contact tracing.
14. This is different from the idea of “super spreader” events in which a single person infected hundreds of people at a crowded place.
15. There was a vital difference in those who got sick and were hospitalized: They died on average within five days of being hospitalized, compared with two to eight weeks in other countries. The condition of patients in India may decline faster because of other underlying conditions like diabetes and high blood pressure or poor overall health.
16. Among those who died, there was an overall case-fatality rate of 2%. The rate increased sharply with age, as it did elsewhere. Unlike in other countries, after age 65, the deaths declined again.
17. At 69 years of age, the life expectancy in India is 10 years lower than in the United States. Indians who survive into old age may have higher odds of surviving the disease because of better health and access to health care.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA