Please wait a minute...
 Home  About the Journal Editorial Board Aims & Scope Peer Review Policy Subscription Contact us
Early Edition  //  Current Issue  //  Open Special Issues  //  Archives  //  Most Read  //  Most Downloaded  //  Most Cited
Aging and disease    2020, Vol. 11 Issue (3) : 480-488     DOI: 10.14336/AD.2020.0402
Perspective |
COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity?
Chakrabarti Sankha Shubhra1, Kaur Upinder2, Banerjee Anindita3, Ganguly Upasana3, Banerjee Tuhina4, Saha Sarama5, Parashar Gaurav6, Prasad Suvarna7, Chakrabarti Suddhachitta8, Mittal Amit9, Agrawal Bimal Kumar10, Rawal Ravindra Kumar11, Zhao Robert Chunhua12, Gambhir Indrajeet Singh13, Khanna Rahul14, Shetty Ashok K15, Jin Kunlin16, Chakrabarti Sasanka17,*
1Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
2Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, UP, India.
3Department of Biochemistry, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
4Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, UP, India.
5Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
6Department of Biotechnology, Maharishi Markandeshwar (deemed to be) University, Mullana, Haryana, India.
7Department of Biochemistry, MM Institute of Medical Sciences & Research, Maharishi Markandeshwar (deemed to be) University, Mullana, Haryana, India.
8Health Department, Kolkata Municipal Corporation, West Bengal, India.
9Department of Radiodiagnosis, MM Institute of Medical Sciences & Research, Maharishi Markandeshwar (deemed to be) University, Mullana, Haryana, India.
10Department of General Medicine, MM Institute of Medical Sciences & Research, Maharishi Markandeshwar (deemed to be) University, Mullana, Haryana, India.
11Department of Chemistry, Maharishi Markandeshwar (deemed to be) University, Mullana, Haryana, India.
12School of Life Sciences, Shanghai University, Shanghai, China.
13Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
14Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
15Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, Texas, USA.
16Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA.
17Department of Biochemistry and Central Research Cell, MM Institute of Medical Sciences & Research, Maharishi Markandeshwar (deemed to be) University, Mullana, Haryana, India.
Download: PDF(726 KB)   HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks    

The ongoing Corona virus (COVID-19) pandemic has witnessed global political responses of unimaginable proportions. Many nations have implemented lockdowns that involve mandating citizens not to leave their residences for non-essential work. The Indian government has taken appropriate and commendable steps to curtail the community spread of COVID-19. While this may be extremely beneficial, this perspective discusses the other reasons why COVID-19 may have a lesser impact on India. We analyze the current pattern of SARS-CoV-2 transmission, testing, and mortality in India with an emphasis on the importance of mortality as a marker of the clinical relevance of COVID-19 disease. We also analyze the environmental and biological factors which may lessen the impact of COVID-19 in India. The importance of cross-immunity, innate immune responses, ACE polymorphism, and viral genetic mutations are discussed.

Keywords COVID-19      India      transmission      mortality      ACE2      cross-immunity     
Corresponding Authors: Chakrabarti Sasanka   
About author:

These authors shared first-authorship.

Just Accepted Date: 03 April 2020   Issue Date: 13 May 2020
E-mail this article
E-mail Alert
Articles by authors
Chakrabarti Sankha Shubhra
Kaur Upinder
Banerjee Anindita
Ganguly Upasana
Banerjee Tuhina
Saha Sarama
Parashar Gaurav
Prasad Suvarna
Chakrabarti Suddhachitta
Mittal Amit
Agrawal Bimal Kumar
Rawal Ravindra Kumar
Zhao Robert Chunhua
Gambhir Indrajeet Singh
Khanna Rahul
Shetty Ashok K
Jin Kunlin
Chakrabarti Sasanka
Cite this article:   
Chakrabarti Sankha Shubhra,Kaur Upinder,Banerjee Anindita, et al. COVID-19 in India: Are Biological and Environmental Factors Helping to Stem the Incidence and Severity?[J]. Aging and disease, 2020, 11(3): 480-488.
URL:     OR
Figure 1.  Representation of total COVID-19 tests performed in different countries for total confirmed cases of COVID-19. The status of India is shown with respect to other major nations. X-axis: total COVID-19 cases (logarithmic scale); Y-axis: total COVID-19 tests performed (logarithmic scale) (Figure courtesy
Age (years)GenderStateHistory of foreign travel in past 3 weeksCo-morbidities
38MBiharYes, returned from QatarRenal disease
68FDelhiSon returned from SwitzerlandDiabetes mellitus, hypertension
No, but domestic travel to Delhi#Cancer, diabetes mellitus, hypertension
69MNo, but domestic travel to Delhi & Jaipur##Asthma, kidney disease, sepsis, septic shock
85FYes (details NM)Yes, details NM
45MNMDiabetes mellitus
46MNMDiabetes mellitus, hypertension, pulmonary fibrosis
69MHimachal PradeshYes, returned from US------
65MJammu & KashmirNo, but domestic travel to multiple cities including Delhi----
Died of cardiac arrest
confusion in age
MNo, met a couple from Saudi ArabiaLiver disease
76MKarnatakaYes, returned from Saudi ArabiaAsthma
70 or 75FYes, returned from Mecca, Saudi ArabiaDiabetes mellitus, chest pain, hip fracture
65MNo, but domestic travel to DelhiNM
69MKeralaYes, returned from DubaiHypertension, brought dead to hospital
35 or 65,
(confusion in age)
Madhya Pradesh
NoYes, NM
47M (suspected)No---
68MYes, returned from PhilippinesDiabetes mellitus, asthma, acute renal failure
63 or 64 (confusion in age)MYes, returned from DubaiDiabetes mellitus, hypertension, ischaemic heart disease
40FNMHypertension, chest pain for last few days
71MYes, returned from Saudi ArabiaDiabetes mellitus, hypertension, CABG
45**MNMNM, yet to be found
70 or 72 (confusion in age)MPunjabYes, returned from Germany & Italy----
Died of cardiac arrest
73MRajasthanNMDiabetes mellitus, renal failure
54MTamil NaduNMSteroid dependant COPD, diabetes mellitus, hypertension
74MTelanganaNo, but domestic travel to DelhiYes, NM, Brought dead to hospital
57MWest BengalNo, but domestic travel to Bilaspur*----
Died of cardiac cause
Table 1  Demographic characteristics, travel history and health status of patients dying with COVID-19 positivity in India.
Figure 2.  Representation of country-wise timeline of COVID-19 case fatality rate. The status of India is shown with respect to other major nations. (Figure courtesy
Figure 3.  Representation of total confirmed cases with respect to total confirmed deaths in India, in comparison with other major nations. X-axis: total COVID-19 cases (logarithmic scale); Y-axis: total confirmed deaths due to COVID-19 (logarithmic scale) (Figure courtesy
[1] Rothan HA, Byrareddy SN (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun, 102433.
[2] Giovanetti M, Benvenuto D, Angeletti S, Ciccozzi M (2020). The first two cases of 2019-nCoV in Italy: Where they come from? J Med Virol, 92(5):518-521.
[3] Beck HE, Zimmermann NE, McVicar TR, Vergopolan N, Berg A, Wood EF (2018). Present and future Köppen-Geiger climate classification maps at 1-km resolution. Sci Data, 5:180214.
[4] Wang J, Tang K, Feng K, Lv W (2020). High Temperature and High Humidity Reduce the Transmission of COVID-19. Available at SSRN.doi: .
doi: 10.2139/ssrn.3551767
[5] Fehr AR, Perlman S (2015). Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol, 1282:1-23.
[6] Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al (2020). SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell, S0092-8674(20)30229-4.
[7] Hindson J (2020). COVID-19: faecal-oral transmission? Nat Rev Gastroenterol Hepatol, doi:.
doi: 10.1038/s41575-020-0295-7
[8] van der Hoek L (2007). Human coronaviruses: what do they cause? Antivir Ther, 12(4 Pt B):651-658.
[9] Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al (2020). Coronavirus infections and immune responses. J Med Virol, 92(4):424-432.
[10] Rathore APS, John AL St (2020). Cross-Reactive Immunity Among Flaviviruses. Front Immunol, 11:334.
[11] Montecillo-Aguado MR, Montes-Gómez AE, García-Cordero J, Corzo-Gómez J, Vivanco-Cid H, Mellado-Sánchez G, et al (2019). Cross-Reaction, Enhancement, and Neutralization Activity of Dengue Virus Antibodies against Zika Virus: A Study in the Mexican Population. J Immunol Res, 2019:7239347.
[12] Warter L, Appanna R, Fink K (2012). Human poly- and cross-reactive anti-viral antibodies and their impact on protection and pathology. Immunol Res, 53(1-3):148-161.
[13] Che XY, Qiu LW, Liao ZY, Wang YD, Wen K, Pan YX, et al (2005). Antigenic cross-reactivity between severe acute respiratory syndrome-associated coronavirus and human coronaviruses 229E and OC43. J Infect Dis, 191(12):2033-2037.
[14] Chan KH, Chan JF, Tse H, Chen H, Lau CC, Cai JP, et al (2013). Cross-reactive antibodies in convalescent SARS patients' sera against the emerging novel human coronavirus EMC (2012) by both immunofluorescent and neutralizing antibody tests. J Infect, 67(2):130-140.
[15] Müller MA, Meyer B, Corman VM, Al-Masri M, Turkestani A, Ritz D, et al (2015). Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study [published correction appears in Lancet Infect Dis, 2015 Jun, 15(6):629]. Lancet Infect Dis, 15(5):559-564.
[16] Shetty AK (2020). Mesenchymal Stem Cell Infusion Shows Promise for Combating Coronavirus (COVID-19)-Induced Pneumonia. Aging Dis, 11(2):462-464.
[17] Clark IA, Alleva LM, Budd AC, Cowden WB (2008). Understanding the role of inflammatory cytokines in malaria and related diseases. Travel Med Infect Di, 6(1-2):67-81.
[18] Leng Z, Zhu R, Hou W, Feng Y, Yang Y, Han Q, et al (2020). Transplantation of ACE2- Mesenchymal Stem Cells Improves the Outcome of Patients with COVID-19 Pneumonia. Aging Dis, 11(2):216-228.
[19] Cao Y, Li L, Feng Z, Wan S, Huang P, Sun X, et al (2020). Comparative genetic analysis of the novel coronavirus (2019-nCoV/SARS-CoV-2) receptor ACE2 in different populations. Cell Discov, 6:11.
[20] Sardar R, Satish D, Birla S, Gupta D. Comparative analyses of SAR-CoV2 genomes from different geographical locations and other coronavirus family genomes reveals unique features potentially consequential to host-virus interaction and pathogenesis. bioRxiv2020.03.21.001586.
[21] Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al (2020). Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA, e203786.
[22] Singh R, Das P, Kaur U, Misra A, Choudhury A, Manna S, et al (2018). Morvan's syndrome-is a pathogen behind the curtain? Neurol Sci, 39(11):1965-1969.
[23] Mourya DT, Yadav PD, Ullas PT, Bhardwaj SD, Sahay RR, Chadha MS, et al (2019). Emerging/re-emerging viral diseases & new viruses on the Indian horizon [published correction appears in Indian J Med Res. 2019 May, 149(5):688]. Indian J Med Res, 149(4):447-467.
[1] Pietro Gentile, Aris Sterodimas. Adipose Stem Cells (ASCs) and Stromal Vascular Fraction (SVF) as a Potential Therapy in Combating (COVID-19)-Disease[J]. Aging and disease, 2020, 11(3): 465-469.
[2] Hong Liu, Shiyan Chen, Min Liu, Hao Nie, Hongyun Lu. Comorbid Chronic Diseases are Strongly Correlated with Disease Severity among COVID-19 Patients: A Systematic Review and Meta-Analysis[J]. Aging and disease, 2020, 11(3): 668-678.
[3] Öztürk Selçuk, Elçin Ayşe Eser, Elçin Yaşar Murat. Mesenchymal Stem Cells for Coronavirus (COVID-19)-Induced Pneumonia: Revisiting the Paracrine Hypothesis with New Hopes?[J]. Aging and disease, 2020, 11(3): 477-479.
[4] Xiaotian Dong, Mengyan Wang, Shuangchun Liu, Jiaqi Zhu, Yanping Xu, Hongcui Cao, Lanjuan Li. Immune Characteristics of Patients with Coronavirus Disease 2019 (COVID-19)[J]. Aging and disease, 2020, 11(3): 642-648.
[5] Zikuan Leng, Rongjia Zhu, Wei Hou, Yingmei Feng, Yanlei Yang, Qin Han, Guangliang Shan, Fanyan Meng, Dongshu Du, Shihua Wang, Junfen Fan, Wenjing Wang, Luchan Deng, Hongbo Shi, Hongjun Li, Zhongjie Hu, Fengchun Zhang, Jinming Gao, Hongjian Liu, Xiaoxia Li, Yangyang Zhao, Kan Yin, Xijing He, Zhengchao Gao, Yibin Wang, Bo Yang, Ronghua Jin, Ilia Stambler, Lee Wei Lim, Huanxing Su, Alexey Moskalev, Antonio Cano, Sasanka Chakrabarti, Kyung-Jin Min, Georgina Ellison-Hughes, Calogero Caruso, Kunlin Jin, Robert Chunhua Zhao. Transplantation of ACE2- Mesenchymal Stem Cells Improves the Outcome of Patients with COVID-19 Pneumonia[J]. Aging and disease, 2020, 11(2): 216-228.
[6] Jong Bin Bae,Ji Won Han,Kyung Phil Kwak,Bong Jo Kim,Shin Gyeom Kim,Jeong Lan Kim,Tae Hui Kim,Seung-Ho Ryu,Seok Woo Moon,Joon Hyuk Park,Jong Chul Youn,Dong Young Lee,Dong Woo Lee,Seok Bum Lee,Jung Jae Lee,Jin Hyeong Jhoo,Ki Woong Kim. Is Dementia More Fatal Than Previously Estimated? A Population-based Prospective Cohort Study[J]. Aging and disease, 2019, 10(1): 1-11.
[7] Stefano Rizza, Marina Cardellini, Alessio Farcomeni, Pasquale Morabito, Daniele Romanello, Giovanni Di Cola, Maria Paola Canale, Massimo Federici. Low Molecular Weight Adiponectin Increases the Mortality Risk in Very Old Patients[J]. Aging and disease, 2018, 9(5): 946-951.
[8] Lee Tien-Ching, Ho Pei-Shan, Lin Hui-Tzu, Ho Mei-Ling, Huang Hsuan-Ti, Chang Je-Ken. One-Year Readmission Risk and Mortality after Hip Fracture Surgery: A National Population-Based Study in Taiwan[J]. Aging and disease, 2017, 8(4): 402-409.
[9] Chojin Yasuo, Kato Tatsuji, Rikihisa Mariko, Omori Masami, Noguchi Shingo, Akata Kentaro, Ogoshi Takaaki, Yatera Kazuhiro, Mukae Hiroshi. Evaluation of the Mann Assessment of Swallowing Ability in Elderly Patients with Pneumonia[J]. Aging and disease, 2017, 8(4): 420-433.
[10] Pasqualetti Giuseppe, Seghieri Marta, Santini Eleonora, Rossi Chiara, Vitolo Edoardo, Giannini Livia, Malatesta Maria Giovanna, Calsolaro Valeria, Monzani Fabio, Solini Anna. P2X7 Receptor and APOE Polymorphisms and Survival from Heart Failure: A Prospective Study in Frail Patients in a Geriatric Unit[J]. Aging and disease, 2017, 8(4): 434-441.
[11] H Abdelhafiz Ahmed, J Sinclair Alan. Low HbA1c and Increased Mortality Risk-is Frailty a Confounding Factor?[J]. Aging and disease, 2015, 6(4): 262-270.
[12] Martin Burtscher. Effects of Living at Higher Altitudes on Mortality: A Narrative Review[J]. Aging and Disease, 2014, 5(4): 274-280.
[13] Bhavani S. Bagepally,John P. John,Mathew Varghese,Harsha N. Halahalli,Lakshminarayanan Kota,Palanimuthu T. Sivakumar,Srikala Bharath,Sanjeev Jain. Relationship of Clinical and Cognitive Variables with Brain Morphometric Abnormalities in Alzheimer’s Disease: a Voxel Based Morphometric Study Using 3-Tesla MRI[J]. Aging and Disease, 2013, 4(5): 235-243.
Full text



Copyright © 2014 Aging and Disease, All Rights Reserved.
Address: Aging and Disease Editorial Office 3400 Camp Bowie Boulevard Fort Worth, TX76106 USA
Fax: (817) 735-0408 E-mail:
Powered by Beijing Magtech Co. Ltd