India’s Poor Hygiene Level Helps Protect Against COVID-19, Suggests Study

A new study by Indian scientists at the Centre for Scientific and Industrial Research (CSIR) suggests that Indians are being able to fight COVID-19 better because of less than desirable hygiene levels across the country.

The majority of India has limited access to clean water and sanitation, breathes in foul air on a daily basis, and lives in densely populated areas. On an average, 1.2 million Indians die every year due to air pollution. But the study suggests that these poor living conditions may have actually saved many lives from severe COVID-19.

India ranks sixth when it comes to the total number of reported cases of COVID-19. A sixth of the world's population lives in India. But when we look at the deaths from the virus, they only account for 10 percent of the world’s, and its case fatality rate is less than 2 percent which happens to be among the lowest in the world. 

However, critics also believe this might be because of India’s weak public health infrastructure which has failed to accurately record the death of its citizens.

The study has not been peer-reviewed yet but it claims that high parasite and bacterial diseases are very common in “low and low-middle income countries.” Usually these people tend to have a higher exposure to communicable disease which leads to “immune training” among the population. 

The study is drawn on an immune hypothesis that states that better hygiene and decreasing incidence of infections in developed countries gave rise to autoimmune disorders and allergies. Autoimmune disorders are considered a risk factor in patients with coronavirus. 

“Our observation of the weak negative correlation of COVID-19 LDM (log of deaths per million) with communicable diseases, and its positive correlation with incidence of autoimmune disorders in the high GDP countries, is indication of the interplay of host immunity and viral infection,” reads the paper.

The study compared publicly available data from 106 countries, including COVID-19 deaths per million, GDP, incidences of non-communicable diseases such as diabetes and hypertension, and sanitation data.

Whether the person had BCG vaccinations, which are used to fight against tuberculosis, played an important role in studying the statistics. But the study later found “negligible correlation” between BCG vaccination and lower death rates.

“We analysed 25 parameters. It seemed paradoxical that people were dying more in countries with higher GDPs. The explanation is that in these countries, life expectancy is more, they have higher incidences of non-communicable diseases which are all risk factors for COVID-19 deaths”, said CSIR director general Shekhar Mande, who is also an author of the study, to The Print. 

The researchers also looked at the sanitation levels of other countries.  “There is a hygiene hypothesis that says if you are exposed to various pathogens since childhood, you are capable of dealing with them better,” said Mande. “Low hygiene means more pathogens and the body’s immune system is better trained to deal even with new ones. When that training is not there, it overreacts, leading to the cytokine storm which can turn fatal.”

The study also noted an important relationship between the severity of the virus and several non-communicable disorders such as diabetes.

“People above the age of 65 are also believed to be at a greater risk, with the percentage of such people being significantly more in the higher HDI countries. Thus, co-morbidities with non-communicable diseases and the fraction of people living above the age of 65, being skewed towards the high-income countries, offers possible explanations to the perplexing observation of CFR dichotomy among nations,” the study said.

Scientists have also mentioned that since correlation does not imply causation, such studies should be strictly regarded as observational.

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