Covid is much more deadly in Brazil than India and no one knows why

India is facing a sudden surge in coronavirus infections and is once again home to the world’s second largest outbreak, overtaking Brazil after the country moved forward in March. But behind the bleak statistical jockeying is an epidemiological mystery as to why the Latin American country has been much more devastated by the pathogen.

When it comes to the magnitude of infections, the two countries are similarly linked, with cases hovering around 14 million and hospitals from Mumbai to Sao Paulo is under increasing pressure as the number of admissions continues to rise. But it’s the difference in fatalities that confuses scientists. Brazil, home to almost 214 million, have seen more than 361,800 people die from Covid-19, more than double the number of deaths in India, which has a much larger population of 1.4 billion.

While the deaths have started in India climbing and at risk of getting worse, macro inequality persists and is characteristic of the different ways in which the pandemic is unfolding in different regions. Experts say this needs to be better understood and decoded to contain this global outbreak and prevent future public health crises.

Covid’s death rates in South Asia, including India, are consistently lower than the global averages, just as those in Latin America are consistently higher, forcing virologists to give some theories as to why Covid cut a deadlier strip from Brazil to Argentina.

“We’re not comparing apples to apples here, we’re comparing apples to pears,” he said Bhramar Mukherjee, chair of biostatistics at the University of Michigan School of Public Health. For now, both countries present an “intriguing puzzle – an epidemiological mystery that needs a Sherlock Holmes or Miss Marple in action.”

Brazil has been hit by multiple waves that have killed an alarming number of its dead young and it reported a record jump of 4,000 Covid-19-related deaths in one day last week. Meanwhile, the daily rise in the number of victims in India was around 1,000, well below last week. Deaths in the Asian country as a percentage of confirmed cases 1.2 versus 2.6 in Brazil, data collected by Bloomberg show.

Age variation

Several factors may play a role in the death gap, including differences in mean age – 26 years in India to 33.5 years in Brazil.

Experts have long criticized India’s wider death rates, especially in the rural hinterland. According to Mukherjee, about one in five fatalities was not reported at all before the pandemic. But that doesn’t explain why the death rate in Brazil is higher than in the aging Western countries that have also been hit hard by the pandemic.

“The death rate in Brazil is even more shocking because the population is much younger than in other countries, such as European,” said Alberto Chebabo, vice president of the Brazilian Association of Infectious Diseases.

The rising infection and death rates are because the pace of vaccinations in each country has accelerated over the past month after an initially slow start. India has managed to over 114 million vaccine doses, compared to those in Brazil 32 million – although the latter has injected a larger portion of the population.

Cross immunity

Other theories behind the divergence between Brazil and India center around the two countries’ different environments and experiences with disease.

Some scientists say the widespread exposure to a range of diseases in India has helped citizens build a natural resilience against coronaviruses such as Covid-19.

Shekhar Mande, the head of India Council for Scientific and Industrial Research, is one of those who have researched this trend and co-authored one published study on this. His research found correlations where citizens from low-hygiene countries tended to handle Covid-19 better.

“Our hypothesis, and this is strictly a hypothesis, is that because our populations are continuously exposed to many types of pathogens, including viruses, our immune system does not hyper-respond to new variations that come in,” Mande said in an interview. .

Many experts recognize that genetics or cross-immunity may play a role, as other South Asian countries, including Bangladesh and Pakistan, have also had far fewer deaths than Brazil.

That 87% of Brazilians live in According to the University of Michigan’s Mukherjee, two-thirds of Indians would live in rural areas with more space and ventilation.

Mutant Strains

Then there’s the fact that Brazil is where one of the most potentially deadly coronavirus mutations, the P.1 variant, was identified in December. Along with variants first seen in South Africa and the UK, studies suggest these species are more contagious.

“The P.1 variant has simultaneously spread through many Brazilian cities and states, leading to a collapse of the health system, leading to a very high death rate,” said Chebabo of the Brazilian Association of Infectious Diseases. Brazil is in a “perfect storm, He added, with his lack of political leadership in implementing effective measures such as lockdowns, which exacerbate the Covid crisis.

The rapid and sustained spread of the variant in Brazil also gave the healthcare system no breathing room, unlike a break between waves in the closing months of 2020 in India, which helped hospitals and frontline workers recover and plan ahead.

“We are much better prepared to deal with this wave than before in many, many ways,” Suneeta Reddy, CEO of Apollo Hospitals Enterprises Ltd., said in an interview. “We learned the clinical protocols to treat Covid. We can use our resources and beds much more rigorously. “

With poor data on mutants, the viral strain in India remains a mystery

India could now face the prospect of a mutant strain-driven wave worse than the first outbreak, although it’s hard to say given that the Asian nation had genome sequenced for less than 1% of its Covid-positive samples.

Complacency, second wave

Mismanagement and Covid fatigue are also responsible for the rampant spread and rising death rates in both countries. Brazilian President Jair Bolsonaro has long been opposed to lockdowns, clash with local authorities over measures to mitigate pandemics and ridicule the wearing of masks.

For India, a month-long drop in the number of daily infections from the first peak in September – along with the lifting of restrictions on public gatherings – encouraged people to lower their guardianship. Many also became indifferent to Covid’s dangers after seeing friends and family recover with mild symptoms and politicians ignoring safety protocols.

“Brazil is a complete disaster in terms of political leadership, and India has become complacent after the initial decline in the number of cases,” said Madhukar Pai, the Canadian research chair in epidemiology and global health at McGill University in Montreal.

It is too early to say whether India can continue to avoid Brazil’s deadlier fate. While some parts of the country have imposed targeted lockdowns, elections are held in five states – seeing thousands of voters organize campaign rallies – along with a month long Hindu pilgrimage that brings crowds to the banks of the Ganges River.

These threaten to undo the benefits that may arise from the increased urge to vaccinate. Daily deaths in the South Asian country have already more than doubled in the past week to more than 1,000 a day crematoriums in many areas operate non-stop and bodies pile up.

“Both countries need to significantly increase their vaccination coverage and work harder to implement other public health measures,” Pai said. “The point is that every country has to work much harder to contain the epidemic.”