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The Interstate Variation in Mortality from COVID-19 in India
While the response to COVID-19 by the Government of India has been more or less uniform across the country, in that a lockdown was imposed throughout, the death rate has varied across the states. This suggests that region-specific factors are likely to be relevant to the determination of this rate. A significant aspect of this study is the use of three different measures of the death rate in the empirical exercise. This showed all three measures of the death rate to be strongly related to health expenditure as a share of the gross domestic product but hardly at all to public health infrastructure. This can be interpreted as a sign of the role of the public health system—comprising medical personnel, infrastructure and protocols—in the prevention of death, with health expenditure as a key determinant of its effectiveness. It has an implication for public policy beyond the immediate health emergency due to COVID-19.
An earlier version of this paper was presented at the Society for Economic Research in India workshop on COVID-19 held online over 18–19 September 2020. The authors thank the organisers and participants in the workshop, Bhaskar Dutta, Parikshit Ghosh and Aditya Dar in particular, for valuable comments. We have benefited from discussions with Gautam Menon, M Suresh Babu, M Parameswaran, Bharat Ramaswami, J V Meenakshi, S Irudaya Rajan and Deepak Dayanithy.
The death rate from COVID-19 in India is relatively low in a global comparison.1 However, it is not widely known that there is a variation in this rate across the states of the country. In fact, it varies considerably. On 3 October 2020, the range recorded for the case fatality rate was 3.8% while the median was 1.3%.2 This may be considered surprising, given that, at least in its initial phase, the lockdown has been quite uniform across the country, having been imposed by the central government. This had lasted from the last week of March to the last week of May amounting to a duration of about nine weeks. Since then, there have been total or partial—in the form of containment zones—lockdowns in the different states, but these do not amount to the same as the countrywide lockdown either in geographic coverage or duration. An interstate variation in the death rate does not necessarily imply that the initial lockdown had no effect but it does suggest that some state-specific factors could be responsible for it. In this paper, we explore likely such factors.
Writing on the topic of COVID-19 in India has appeared more in the media than in professional fora. This is understandable as there was need for immediate dissemination of data and some quick analysis based on it. However, there is relatively little by way of economic analysis of the death rate. A rare study in this vein is that of Chatterjee and Jain (2020) who aimed to establish the “state-level pattern of casualty” and explore “plausible reasons” for it. They argue for the adoption of an appropriate measure of the fatality rate and go on to compute it for the states of India, showing that a variation exists. They then plot this measure of fatality against the age profile of the population, the extent of testing, an indirect indicator of the public heath infrastructure and the practice of social distancing, respectively, and conclude that these are relevant to an explanation of the variation. While this being a valuable study, it had come at a very early stage of the pandemic, in April 2020, and the empirical strategy can be improved upon. We believe that our study constitutes an advance on both counts, while also providing a more granular picture.
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