India passed the threshold of recording seven million coronavirus cases on Sunday. But given the huge number of confirmed infections, second only to the US, experts are baffled as to why the country’s mortality rate is comparatively so low.
The world’s second-most populous country, with 1.3 billion people, it has the lowest number of deaths per 100 confirmed cases out of the 20 most-affected countries in the world.
AFP has examined some of the questions these figures raise.
India has recorded more than 7.05 million COVID-19 cases and 108,334 deaths from the disease since the first recorded death in mid-March.
In terms of deaths per 100 cases, this stands at 1.5%, according to Johns Hopkins University data.
The United States, which has the most cases in the world with more than 7.7 million, has an apparent lethality ratio of 2.8%, with 214,778 deaths.
In terms of mortality in relation to the population, the number of coronavirus deaths in India per 100,000 people is 7.73 compared to 64.74 in the United States.
What accounts for this?
India has a young population, with a median age of 28.4, according to the UN World Population Report.
By comparison, the median age in France is 42.3 and this country has reported nearly 700,000 cases and over 32,000 deaths with an apparent lethality ratio of 4.7%.
Experts believe that older people, who are more likely to have comorbidities such as diabetes or hypertension, are more likely to die from infectious disease.
Time to prepare
According to the Indian government, the first case was detected in the country on 30 January and the number of cases passed the 100 mark in mid-March.
At the same time, the pandemic was already spreading throughout Europe, with more than 24,000 cases and some 2,000 deaths in Italy and around 5,500 cases and 150 deaths in France.
India’s Prime Minister Narendra Modi enforced a national containment from 25 March that severely restricted travel.
According to experts, this gave India time to prepare for the arrival of the pandemic and gave doctors time to learn from the experiences of other countries.
"Many of the care protocols were much more stabilised (at that time) whether it was oxygen use or intensive care," Anand Krishnan, professor at the All India Institute of Medical Sciences (AIIMS) in Delhi, told AFP.
Some experts also think it is possible that antibody protection was already present in some of the population of India before the outbreak of the new coronavirus, due to earlier disease outbreaks such as dengue fever.
There is also the theory that other less virulent coronaviruses may have already provided some cross-immunity, but all experts say more research is needed on this issue.
Statistics not corresponding
Another explanation is the lack of official records of death in much of the country. Around 70% of people live in rural areas, where deaths and causes of deaths are often not recorded.
The pandemic has seen this phenomenon in action, with some areas showing the information provided by cities and cemeteries and crematoriums not corresponding.
"Our inadequate death surveillance system...is already forgetting many deaths in the first place. Only one in five deaths is registered with a definite cause," Hemant Shewade, a public health expert in Bangalore, told AFP.
He believes it is likely that many deaths related to Covid-19 have not been registered.
Government studies using serological tests show that the number of infected people is ten times higher than the official figures, which means that deaths from the disease may have been under-reported, he adds.
More accurate assessments are possible by increasing testing, better recording of deaths and autopsies of presumed victims, according to experts.
Tracking excess mortality - the number of deaths compared to "normal" figures - as well as deaths at home could also be useful, Shewade believes.