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

Faced with a sharp rise in coronavirus infections, India is once again hosting the second outbreak in the world, overtaking Brazil after the latter advanced in March. But behind the gloomy statistical jockeying it is an epidemiological enigma about why the Latin American country was much more devastated by the pathogen.

When it comes to the extent of the infections, the two nations are similarly similar, with cases hovering nearly 14 million and hospitals in Mumbai as far as Sao Paulo under increasing pressure as admissions continue to rise. But scientists have been puzzled by the divergence in deaths. Brazil, close to home 214 million have seen more than 361,800 people die from Covid-19, more than double the death toll in India, which has a population of more than 1.4 billion.

While deaths in India have begun rising and threatening to worsen, the macro-level disparity remains and is emblematic of the different ways in which the pandemic unfolds in different regions. Experts say this needs to be better understood and decoded to contain this global outbreak, as well as to avoid future public health crises.

The Covid mortality rate in South Asia, including India, is consistently lower than global averages, just as those in Latin America are consistently higher, forcing virologists to provide a number of theories as to why Covid cut a more deadly portion of Brazil in Argentina.

“We don’t compare apples to apples here, we compare apples to oranges,” he said Bhramar Mukherjee, president of biostatistics at the University of Michigan School of Public Health. For now, both countries have an “interesting puzzle – an epidemiological mystery that needs a Sherlock Holmes or Miss Marple in action.”

Brazil has been hit by several waves that have killed an alarming number young people and reported a record jump in a day of 4,000 Covid-19-related deaths last week. Meanwhile, the daily increase in casualties in India was about 1,000 and well below last week. Deaths in the Asian country as a percentage of confirmed cases are 1.2 versus 2.6 in Brazil, data compiled by Bloomberg shows.

Age variation

Several factors could be involved in the fatality gap, including differences in the average age – 26 years in India compared to 33.5 years in Brazil.

Experts have long criticized India’s broader death statistics, especially in its rural interior. Prior to the pandemic, about one in five deaths were not reported at all, according to Mukherjee. But that doesn’t explain why Brazil’s death rate is higher than the older Western nations, which have also been hit hard by the pandemic.

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

The increased rate of infection and mortality comes as the rate of inoculation has increased in each country in the last month, after a slow initial onset. India has managed to manage more than 114 million doses of vaccine compared to Brazil 32 million – although the latter injected a larger proportion of its population.

Cross immunity

Other theories behind the divergence between Brazil and India focus around the different environments and experiences of diseases in the two countries.

Some scientists say that widespread exposure to a number of diseases in India could have helped citizens build their natural resistance to coronaviruses such as Covid-19.

Shekhar Mande, the head of India The Council for Scientific and Industrial Research is among those who have examined this trend and co-authored a publication study this. His research found correlations in which citizens in countries with poor hygiene tended to cope better with Covid-19.

“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 react hyper to any new variation that occurs,” Mande said in -an interview .

Many experts acknowledge that genetics or cross-immunity may be at stake, as other South Asian countries, including Bangladesh and Pakistan, have also reported far fewer deaths than Brazil.

That 87% of Brazilians live Urban areas, but two-thirds of Indians live in rural areas with more space and ventilation could be another reason, according to Mukherjee of the University of Michigan.

Mutant strains

Then there is the fact that Brazil is where one of the most potentially deadly coronavirus mutations, variant P.1, was identified in December. Together with the variants first observed in South Africa and the United Kingdom, studies suggest that these strains are more contagious.

“Variant P.1 has spread simultaneously through many cities and states in Brazil, leading to a collapse of the health system, which has led to a very high mortality rate,” said Chebabo of the Brazilian Society of Infectious Diseases. Brazil is in a “perfect storm“, He added, with his lack of political leadership in the implementation of effective measures, such as the blockade, which aggravates the Covid crisis.

The rapid and sustained spread of the variant in Brazil has not provided its health care system with any breathing space, as opposed to a break between waves in the last months of 2020 in India, which has helped hospitals and front-line workers recover. and plan ahead.

“We are much better prepared to handle this wave than we were earlier in many, many ways,” said Suneeta Reddy, CEO of Apollo Hospitals Enterprises Ltd., said in an interview. “I learned the clinical protocols to treat Covid. We can use our assets and beds in a much more rigorous way. ”

With poor data on mutants, virus overvoltage in India remains a mystery

India could now face the prospect of mutant strain growth that is more severe than the first outbreak, although it is difficult to say, given that the Asian nation has sequenced the genome for less than 1% of its Covid-positive samples. .

Compatibility, the second wave

Improper management and Covid fatigue have also been blamed for rampant spreads and rising death rates in both countries. Brazilian President Jair Bolsonaro has long opposed blockades, clashing with local governments over pandemic mitigation measures and ridiculing the wearing of a mask.

For India, a month-long drop in daily infections since the first peak in September – along with officials lifting restrictions on public gatherings – has encouraged people to lower their guard. Many also became indifferent to the dangers of Covid after seeing their friends and family with mild symptoms recover and politicians failing to follow safety protocols.

“Brazil is a complete disaster in terms of political leadership, and India has become satisfied after the initial decline in cases,” he said. Madhukar Pai, Canada Research Department of Epidemiology and Global Health at McGill University in Montreal.

It is too early to say whether India can continue to avoid the more lethal fate of Brazil. While some parts of the country have imposed themselves targeted blockades, elections are being held in five states – seeing thousands of voters pack campaign rallies – along with a monthly Hindu pilgrimage that brings crowds on the banks of the river Ganges.

They threaten to nullify the benefits that can come from the accelerated impulse of vaccination. The daily deaths in the South Asian country have already doubled to over 1,000 a day in the last week, with crematoria in many areas that operate non-stop and bodies pile up.

“Both countries need to greatly increase their vaccination coverage and work harder to implement other public health measures,” Pai said. “What matters is that each country has to work much harder to counter the epidemic.”