I don’t have any deep thoughts on this topic, but I want to put it on your radar because there is every indication that it will end up as the worst COVID outbreak on Earth since the start of the pandemic. That distinction currently belongs to Brazil, I think, but India’s population is smaller than that of that country. And India is poorer per capita, which means that more people in urgent need of hospital care may not be able to get it.
Where the death toll could go only God knows.
The epidemic curve there has turned vertical. And it should be emphasized: In a poor nation that doesn’t run many tests (India ranks 116th in tests per capita), the number of confirmed cases just scratches the surface of the actual number of infections.
The graph of the daily cases is terrifying
Family / friends in India say it is as bad as it seems
Hospitals without oxygen
Large numbers of doctors and nurses who are sick with COVID
Vaccines are hard to come by
And no clear end in sight pic.twitter.com/XVc4TNNecK
– Ashish K. Jha, MD, MPH (@ashishkjha) April 21, 2021
Three hundred thousand cases a day is a lot, of course, but the US was approaching that number during the worst part of the winter and we only have a quarter of India’s population. If 300,000 were an accurate measure of what they are dealing with now, it wouldn’t be devastating. But the IHME estimates that the actual number of infections in India is about 29 times the number of confirmed cases, which if true would mean almost seven million new cases. Every day. With each of those people capable of infecting several others.
What does that look like on the ground? Take 10 minutes to read the new reports on the crisis in India from the Financial Times and CNN. They agree on important points: the health system is collapsing, people who need hospital beds cannot find them, supplemental oxygen is scarce, cemeteries and crematoriums are getting heavy under pressure, and vaccinations just keep creeping up.
Yesterday, India registered 2,000 officially deaths from COVID, a small number given the size of their population. (Equivalent to about 500 in the US) But nobody has the slightest idea what the real death toll is. The Financial Times provides this data:
The Times notes that in some Indian states, the ratio of known deaths from the disease to officially reported deaths is around nine to one. Quote: “In the Jamnagar district of Gujarat, 100 people died from Covid-19, but only one Covid death was reported.” And what is happening in the poorest rural regions of India, where there is little medical care and even less reporting? Again, only God knows. However, compare ICU use in India lately to ICU use in some of the planet’s previous worst outbreaks:
The crisis in India is much worse than these data indicate @FT assessment today makes clear. Here ICU occupation versus worst affected regions at the start of a pandemic
Role of variant B.1.617 still uncertain
Links and thread 👇https: //t.co/p7tb2KjHGK pic.twitter.com/CfIoAq7cPC– Eric Topol (@EricTopol) April 21, 2021
How did a country that had endured a relatively mild pandemic for 12 months suddenly turned into a raging inferno? There are two theories. One, a la Chile, is that India believed it licked COVID after many months of few infections, so it dropped its guard and relaxed restrictions. Cinemas opened at full speed on February 1. The Prime Minister, Narendra Modi, started holding mass rallies again and did not bother wearing a mask. (That sounds familiar.) Last month, the health minister arrogantly stated that the country was in the “endgame of the COVID-19 pandemic.” An epidemiologist writes today that “the massive political, religious and sporting events, which are extensively covered by the Indian media, have sent mixed reports about the severity of the pandemic” and that “there is an unfounded feeling among a large number of Indians against pollution. and microbes had given them superior immunity. “
Worst of all, they are in the middle of an Indian religious festival that goes on throughout the month:
By far the largest gathering is the Kumbh Mela, an important Hindu festival and one of the largest pilgrimages on earth. Millions of Indians travel from all over the country to Haridwar, an ancient city in the state of Uttarakhand, to attend ceremonies and prayers and take holy dip in the Ganges River …
“The Kumbh Mela could go down as one of the largest mass-surveillance events eversimply because of the large number of people who show up there for the ritual bathing in the Ganges, ”said Laxminarayan.
Admittedly, much of the festival takes place outdoors, where handover is less likely. But those present have to eat, sleep and use the bathroom. They are sometimes inside. And as they infect each other and return home after the Kumbh Mela, they will spread outbreaks everywhere. Modi apparently urged the Indians to stay at home and celebrate the festival “symbolically” instead, but only after it was already underway. And why should people in the Ganges fear infection if Modi himself doesn’t care that his supporters get infected at his gatherings?
The other factor in the outbreak in India is that they now have their own variant. Basically a “double mutant,” so called because it has not one but two key mutations on the spike protein:
As the Covid epidemic in India worsens, so is the prevalence of a “double mutation” variant, which has the mutations E484Q (such as E484K) and L452R (found in CA variant). Now classified as B.1.617 – it has gone from 24% of sequenced samples in February to 80% on April 1. Https://t.co/tgCYu540MT
– Scott Gottlieb, MD (@ScottGottliebMD) April 16, 2021
Scientists aren’t yet sure if it is meaningfully more contagious than the common coronavirus, but the growing prevalence of the species is an indication that it is. Doctors are understandably concerned that the variant could theoretically breach vaccine immunity:
Both mutations are known reduce – although not completely eliminate – the binding of the antibodies created by infection and vaccination, according to Jesse Bloom, an associate professor of genome sciences and microbiology at the University of Washington …
“We’ve done the math – we believe that much of the increase in reproductive numbers can be explained by these mutations,” Nithya Balasubramanian, the head of health research at Bernstein India, told Bloomberg TV this week. “So yes, the mutations are a major cause for concern.”
The characteristics of the double mutant variant are under investigation, but the L452R mutation is well characterized in US studies, according to Agrawal. It increases viral transmission by approximately 20% and decreases antibody efficacy by more than 50%, he said…
“The B.1.617 variant has all the characteristics of a very dangerous virus”, William A. Haseltine, a former professor at Harvard Medical School, wrote in Forbes April 12, “We must do everything possible to identify and contain its spread.”
Even if the vaccines work to contain B.1.617, a major outbreak in India is fertile ground for the emergence of more variants. Every infected person is a laboratory to mutate the virus into something more dangerous, and India has more “laboratories” than any country on Earth except China. The virus is now conducting millions of “experiments” there – every day. The fact that until recently the country had seen only mild spikes in cases relative to Western countries should logically also mean that there is little natural immunity in the population to help slow the current spread. How much worse it could get no one can suspect, but the prospect is terrifying given that their healthcare system is already at the breaking point. If you’re the praying type, now is the time.