India’s Low Hygiene May have Helped in Low COVID-19 Mortality Rate

India is a country with polluted air, unhygienic food, mostly contaminated water sources, and densely packed dwellings. Researchers have found this whole hap-hazard living situation of millions of Indians makes them susceptible to many non-communicable illnesses such as chronic respiratory diseases, cancer, heart conditions, and diabetes.

The World Health Organization says that clean water, sanitization, and hygienic conditions are essential for protection of health against the coronavirus pandemic. But most of the Indians do not have access to these primary and essential facilities, and still the country has quite low mortality rate.

The mortality rate of COVID-19 has been much higher in European countries and in the US, as compared to India and Southeast Asian countries. It is speculated that people in poor countries have become more immune to infections and diseases, in comparison to the rich countries with better hygiene conditions.

Coronavirus in India

Many studies over years have confirmed that nearly three billion people – some 40 percent of the global population and living almost entirely in developing countries – lack even the basic hand-washing facilities. These assessments ignited concerns over the impact of coronavirus on the Indian population once the outbreak happened in the country.

Typically access to healthcare facilities, hygiene and sanitation is poorer in these countries and is often believed to be the contributing factor of higher incidence of communicable diseases there. It was not unexpected that Covid-19 would have catastrophic consequences in the low and low-middle income countries.

Said Dr. Shekhar Mande, director-general of the Council of Scientific and Industrial Research (CSIR).

Also Read: High Population and Dicey Health Facilities Have Made India ‘Coronavirus Hotspot’

India has a sixth of the world’s total population and a sixth of the reported cases. But surprisingly, it accounts only for 10 percent of the world’s deaths from the coronavirus. Its case fatality rate, which processes deaths among Covid-19 patients, is less than 2% – among the lowest in the world.

India’s low hygiene might have helped in low COVID-19 mortality rate | Image: Prashanth Vishwanthan/Bloomberg

India’s Low Hygiene and COVID-19 Mortality Rate

A recent study by Indian scientists revealed that low hygiene, lack of clean potable water, and unsanitary conditions may have actually prevented many fatalities from COVID-19. The study proposed that people living in low and low middle-income countries may have been able to stave off severe forms of the infection owing to the exposure to various pathogens from childhood, which gives them strong immunity to the coronavirus.

The study, yet to be peer-reviewed, compared the fatality rates of various countries for this study. It concluded that people in poorer, low-income countries seem to have a higher immunological reaction to the disease in comparison to high-income peers. Though paradoxical, this hypothesis may have some truth behind it.

Praveen Kumar and Bal Chander from Dr. Rajendra Prasad Government Medical College analyzed the data from 122 nations, including 80 high and upper-middle-income ones. They suggested that deaths occurred from the novel coronavirus are lower in countries with a higher population exposed to a diverse range of microbes, most of what is called “gram-negative bacteria”.

These bacteria usually are accountable for severe pneumonia, blood and urinary tract infections, and skin infections. But they are also believed to produce an antiviral cytokine – molecules which help fight pathogens – called interferon that protects cells against the coronavirus. So far, the existing predictive models for the coronavirus have not considered the immunity status of populations caused by microbiome or environment microbial disclosure.

Hygiene Hypothesis

According to Matt Richtell, author of “An Elegant Defense: The Extraordinary New Science of the Immune System” – the philosophy of the “hygiene hypothesis” is that our surroundings have become so clean that it has left our immune system inadequately trained.

However, the idea of the hygiene hypothesis isn’t a novel one. A 1989 paper on hay fever found a striking association between the possibility of a child getting hay fever allergy and the number of his or her siblings. The paper hypothesised that “allergic diseases were prevented by infection in early childhood, transmitted by unhygienic contact with older siblings or acquired prenatally from a mother infected by contact with her older children”.

Another paper published by the World Allergy Organisation and quoted by Richtell noted that migration studies revealed the types of both allergy and auto-immunity “rise as people move from poorer to richer countries”.

Smita Iyer, an immunologist at the University of California, Davis, is of the belief that the “hygiene hypothesis” in COVID-19 “does fly in the face of our understanding of anti-viral immune responses”. Dr. Iyer said,

However, in recognising that our immune system can face many formidable foes in relatively quick succession or even all at once, we can construct a model where immune responses to a previously or contemporaneously encountered pathogen might impact immune response to the current invader.

As there is no scientific explanation yet, such studies are strictly considered as observational. Moreover, scientists urge that these conclusions should not be inferred as advocating “a move towards poor hygienic practices for managing future pandemics.”

Krutika Kuppalli, an assistant professor in infectious diseases at the Medical University of South Carolina, stated that the new research takes into account a diversity of assumptions that have not been scientifically established. They are more hypothesis than scientific fact.

Moreover, epidemiologists have credited the low fatality rate in nations such as India to a young population – the elderly are usually more susceptible to the disease. It is, however, not evident whether other factors, like immunity deriving from previous infections from other coronaviruses, are also responsible for staving off the novel coronavirus.

Undoubtedly, a wide variety of reasons could be responsible for the low fatality rate. Nonetheless, there is still a lot more to learn about the virus as humanity is still only 10 months into the pandemic. There is much to know before a cure can be developed, even though many vaccine candidates are currently under trial.