I have no deep thoughts on this subject, but I want to put it on the radar, because there are all indications that it will end up as the worst outbreak of COVID on Earth since the pandemic began. This distinction now belongs to Brazil, I think, but India’s population is smaller than that country. And India is poorer per capita, which means that many people in dire need of hospital care may not be able to get them.
Only God knows where the death toll could go in this regard.
The epidemic curve there has become vertical. And it must be emphasized: in a poor nation that does not do too many tests (India ranks 116th in per capita tests), the number of confirmed cases only scratches the surface of the actual number of infections.
The schedule of daily cases is terrifying
Family / friends in India say it is as bad as it sounds
Oxygen-free hospitals
A large number of doctors and nurses with COVID
Vaccines hard to find
And no clear purpose in sight pic.twitter.com/XVc4TNNecK
– Ashish K. Jha, MD, MPH (@ashishkjha) April 21, 2021
Three hundred thousand cases a day is a lot, needless to say, but the US approached this number in the worst winter and we only have a quarter of India’s population. If 300,000 were an exact measure of what they are facing now, it would not be devastating. But IHME estimates that the actual number of infections in India is about 29 times the number of confirmed cases, which, if true, would mean close seven million new cases. Every day. With each of those people able to infect several others.
What does this look like on the ground? Take 10 minutes to read the new reports on the crisis in India from the Financial Times and CNN. These correspond to the key details: the health system is collapsing, people in need of hospital beds cannot find them, extra oxygen is scarce, cemeteries and crematoria are slipping under the load and vaccinations are only being dragged.
Yesterday India registered 2,000 official deaths caused by COVID, a small number given the size of their population. (Equivalent to about 500 in the US) But no one has the slightest idea of the true number of dead. Financial Times provides these data:
The Times notes that in some Indian states, the ratio of known deaths from the disease to officially reported deaths is about nine to one. Quote: “In the Jamnagar district of Gujarat, 100 people died of Covid-19, but only one Covid death was reported.” And what is happening in the poorest rural areas of India, where there is little medical care and even less reporting? Again, God only knows. Compare the use of ICU in India lately with the use of ICU in some of the worst previous outbreaks on the planet, however:
The crisis in India is much more serious than these data indicate @FT Today’s review clearly shows. Here the occupation of the ICU vs the most affected regions at the beginning of the pandemic
The role of variant B.1.617 is still uncertain
Links and threads 👇https: //t.co/p7tb2KjHGK pic.twitter.com/CfIoAq7cPC– Eric Topol (@EricTopol) April 21, 2021
How did a country that endured a relatively mild pandemic for 12 months suddenly turn into a furious hell? There are two theories. One, in Chile, is that India thought it licked COVID after a few months of few infections, so it left its guard and restrictions relaxed. The cinemas opened at full capacity on February 1. The Prime Minister, Narendra Modi, started organizing mass rallies again and did not bother to wear a mask. (Which sounds familiar.) Last month, the health minister arrogantly said the country was in the “final game of the COVID-19 pandemic.” An epidemiologist writes today that “mass political, religious and sporting events, which are widely covered by the Indian media, have sent mixed messages about the severity of the pandemic” and that “there is an unfounded sense among a large number of Indians that pollution and endowed the microbes with superior immunity. ”
Worst of all, I am in the middle of an Indian religious festival that will take place all month:
The largest gathering by far is 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 make holy dives in the Ganges River …
“Kumbh Mela could come down as one of the biggest super-mass events ever, simply because of the size of the number of people who show up there for ritual bathing in the Ganges, ”said Laxminarayan.
Of course, much of the festival takes place outdoors, where transmission is less likely. But participants must eat, sleep and use the bathroom. Sometimes I’m inside. And as they infect each other and return home after Kumbh Mela, they will sow outbreaks everywhere. It seems that Modi urged the Indians to stay home and celebrate the “symbolic” festival, but not after it was already underway. And why would people fear infections in the Ganges if Modi himself doesn’t care about his infected supporters at his rallies?
The other factor in India’s outbreak is that they now have their own version. A “double-mutant”, in fact, so-called, because it has not one, but two key mutations on the spike protein:
As the Covid epidemic in India worsens, the prevalence of a “double mutation” variant, which has E484Q (such as E484K) and L452R mutations (found in the CA variant). Now classified as B.1.617 – it went from 24% of the samples sequenced in February to 80% on April 1. Https://t.co/tgCYu540MT
– Scott Gottlieb, MD (@ScottGottliebMD) April 16, 2021
Scientists are not yet sure if it is significantly more contagious than the common coronavirus, but the growing prevalence of the strain is an indication that it is. Doctors are understandably concerned that the variant could theoretically break the immunity offered by vaccines:
Both mutations are known to decreases – although does not completely eliminate – the binding of antibodies created by infection and vaccination, according to Jesse Bloom, associate professor of genome and microbiology at the University of Washington …
“We’ve done the math – we think a lot of the increase in breeding numbers can be explained by these mutations,” Nithya Balasubramanian, head of health research at Bernstein India, told Bloomberg TV this week. “So, yes, 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. This one increases viral transmission by approximately 20% and reduces the effectiveness of antibodies by more than 50%, he said…
“Variant B.1.617 has all the characteristics of a very dangerous virus” William A. Haseltine, a former professor at Harvard Medical School, wrote to Forbes on April 12. “We must do everything possible to identify its spread and contain it.”
Even though vaccines work to subdue B.1.617, a major outbreak in India is fertile ground for the emergence of several variants. Every infected person is a laboratory for the virus to move into something more dangerous, and India has more “laboratories” than any country on Earth except China. The virus is running millions of “experiments” right there – every day. The fact that until recently the country has suffered only slight peaks in cases compared to Western countries should also logically mean that there is little natural immunity in the population to help slow the current spread. How much could get worse, everyone assumes, but the outlook is awful, given that their health care system is already on the verge of breaking down. If you are the type of prayer, now is the time.