India Coronavirus Cases May Be 10 Times Higher Than Official Figure

Coronavirus cases in India could be as high as over 60 million—10 times higher than the current official count, the Indian Council of Medical Research (ICMR) revealed Tuesday following the latest serological survey conducted in the country.

"Serology tests are blood-based tests that can be used to identify whether people have been exposed to a particular pathogen by looking at their antibodies, or specific proteins produced by the body in response to an infection. Serology tests can be helpful in determining whether someone was infected in the past with the coronavirus, whether or not they ever developed symptoms of the disease," Johns Hopkins University (JHU) explains.

At a health ministry press briefing Tuesday. ICMR Director-General Balram Bhargava confirmed: "The main conclusions from this sero-survey are that one in 15 individuals aged more than 10 have been exposed to SARS-CoV-2 by August."

Blood samples were collected from over 29,000 people across 21 states or territories between mid-August and mid-September.

Evidence of COVID-19 exposure was found to be more prevalent among the urban population (15.6 percent in slum urban areas, 8.2 percent in non-slum urban areas) than in rural areas, where 4.4 percent of those tested were found to have antibodies, Bhargava confirmed.

India currently has the world's second-highest number of infections after the U.S.

Speaking to Newsweek, Dr. Bhramar Mukherjee, a senior author on a March study looking at the COVID-19 outbreak in India and chair of the biostatistics department and professor of epidemiology at the University of Michigan School of Public Health, said: "Our models estimate a much larger number of undetected cases in India compared to the U.S., so in terms of the number of true infections, I believe India has surpassed the U.S. already if we could test everyone."

As of Tuesday, 74,196,729 samples have been tested among India's population of over 1.3 billion, according to the ICMR.

The U.S. has tested 103,155,189 of its population of over 332 million, according to the latest report Wednesday from JHU.

Mukherjee told Newsweek: "The reality on the ground changes every day. In the U.S. we are seeing slight uptick with fall reopening of educational institutions and other increased mobility. However, with about 40,000 cases each day in the U.S. that we are seeing now, and with India seeing a steady growth of 90,000 daily new cases, we can do a rough comparison.

"Assuming things go this way, and do not explode exponentially, our calculations show it will be right around a month to 40 days when India takes over the U.S. in reported cases. Of course this could change given how people behave and how much we test in these two countries," Mukherjee added.

Speaking to Newsweek, Dr. D. Dhanuraj, chairman of India's Centre for Public Policy Research, said: "The actual infection rate in India is estimated to be very high compared to what is reported on a daily basis.

"Also, the newly introduced Feluda [COVID-19] test, which is cheaper and more accurate, could play a major role in tracing and tracking the infected and quarantine them. The state capacity of India is historically very weak but this time, with increased tests, it is expected that the center and the state governments get their act together to contain the pandemic.

Dhanuraj also noted: "The death rates [in India] are low. Not only the reported numbers but in general, neither any state nor city has witnessed the rush in the crematoriums. As per the present rate it would take at least two months to reach 200,000 deaths in India. By that time, it is expected that there would be some positive news on the vaccine research front."

The latest ICMR figures marked a sharp rise from the results of the country's first serological survey, which indicated around 0.73 percent of adults in India (about six million people) had been infected by May, according to the ICMR.

Other antibody studies carried out in New Delhi, the Indian capital, as well as in Mumbai also suggested the country's actual case count may be higher than the latest recorded figure.

Scientists have warned the accuracy of serology tests is limited as they can also detect exposure to other coronaviruses and not just the one that causes COVID-19.

JHU noted: "Unlike PCR [polymerase chain reaction]-based tests that test for presence of the SARS-CoV-2 virus, serology tests cannot be used to diagnose whether someone currently has the COVID-19 disease. Also, antibody levels have not been correlated with immunity; while people who have been infected are presumed to have some immunity, it is unclear how much and for how long.

"Though labs that perform or companies selling tests to diagnose COVID-19 must receive Emergency Use Authorization [EUA] from the FDA [Food and Drug Administration], the FDA has granted regulatory discretion to companies that develop and market serology tests and does not require them to apply for an EUA. As a result, there has not been a formal evaluation of the performance of serology tests that are currently available.

"Some reports have raised concerns about the validity of serology tests currently being used. The NIH [National Institutes of Health], FDA, CDC [Centers for Disease Control and Prevention], and academic investigators are in the process of validating serology tests," JHU noted.

Weekly new cases in India have been increasing throughout the outbreak since late March before briefly flattening from early to mid-September. The weekly case count declined for the first time in the week commencing September 21, according to the latest report Tuesday by the World Health Organization.

A nationwide lockdown was issued across India in late March, but restrictions have gradually been eased from late May.

The wider picture

The novel coronavirus has infected over 33.6 million people across the globe, including 7.1 million in the U.S. Over a million people have died globally, while more than 23.4 million people have recovered from infection, as of Wednesday, according to the latest figures from JHU.

The below graphics, provided by Statista, illustrate the spread of COVID-19 cases in countries across the globe.

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The graphic below, also provided by Statista, illustrates U.S. states with the most COVID-19 cases.