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

Facing a sudden increase in coronavirus infections, India is once again home to the second largest outbreak in the world, surpassing Brazil after the country continued in March. But behind the gloomy statistical jokelook is an epidemiological mystery as to why the country in Latin America was much more devastated by the pathogen.

In terms of the extent of infections, the two countries are similarly similar, with cases hanging close to 14 million and hospitals from Mumbai to Sao Paulo under increasing pressure as admissions continue to increase. But it is the difference in deaths that has surprised scientists. Brazil, home of almost 214 million, more than 361,800 people have died from Covid-19, more than double the number of deaths in India, with a much larger population of 1.4 billion.

While deaths began in India climbs and threatens to get worse, the difference remains at the macro level and is indicative of different ways in which the pandemic is spreading across regions. Experts believe it needs to be better understood and decoded, to curb this global outbreak and avoid future public health crises.

Covid’s mortality rate in South Asia, including India, is consistently lower than the world average, just as it is consistently higher in Latin America, forcing virologists to present a number of theories as to why Covid is a more deadly strip of Brazil. to Argentina.

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

Brazil has been hit by several waves that kill an alarming number of them young and it reported a record jump to one day of 4,000 Covid-19 deaths last week. Meanwhile, India’s daily increase in casualties was around 1,000 and lower than last week. Deaths in the country in Asia as a percentage of confirmed cases 1.2 versus 2.6 in Brazil, shows the data compiled by Bloomberg.

Age variation

Several factors can play into the deadly gap, including the differences in average age – 26 years in India to Brazil’s 33.5.

Experts have long criticized India’s broader death statistics, especially in the rural interior. According to Mukherjee, one in five deaths was not reported at all before the pandemic. But that does not explain why Brazil’s death toll is higher than the aging Western countries that were also hit hard by the pandemic.

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

The increasing number of infections and deaths comes as the rate of vaccination in each country accelerates over the past month after an initial sluggish start. India has managed to more than 114 million vaccine doses, compared to Brazil 32 million – although the latter injected a larger proportion of the population.

Cross-immunity

Other theories behind the diversity between Brazil and India are around the different countries’ different environments and experience of diseases.

Some scientists believe that the wide exposure to a variety of diseases in India has helped the citizens to build up natural resilience against coronaviruses like Covid-19.

Shekhar Mande, Head of India The Council for Scientific and Industrial Research is one of those who investigated this trend and was the co-author of a publication study on this. His research found correlations where citizens of low-hygiene countries tended to handle Covid-19 better.

“Our hypothesis, and this is strictly a hypothesis, is that because our population is constantly exposed to many types of pathogens, including viruses, our immune system does not respond to any new variation that comes in,” Mande said in an interview. .

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

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

Mutant strain

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

“The P.1 variant spread simultaneously through many Brazil’s cities and states, leading to a collapse of the health care system, leading to a very high mortality rate,” said Chebabo of the Brazilian Society of Infectious Diseases. Brazil is in a “perfect storm, ”He added, with the lack of political leadership in implementing effective measures such as closures, which exacerbates the Covid crisis.

The rapid and sustained spread of the variant in Brazil also gave its healthcare system no respite, unlike a silence between waves during the last months of 2020 in India, which helped hospitals and frontline workers to recover and plan ahead .

“We are much better prepared to handle this wave than we used to be in many, many ways,” said Suneeta Reddy, managing director of Apollo Hospitals Enterprises Ltd., said in an interview. ‘We learned the clinical protocols to treat Covid. We can use our assets and beds in a much stricter way. ”

With poor data on mutants, India’s viral disorder remains a mystery

India may now be facing a mutant tension-driven upsurge that is worse than its first outbreak, though it is hard to see as the Asian country has done genome sequencing for less than 1% of its Covid-positive samples.

Complacency, Second Wave

Covid’s mismanagement and fatigue are also blamed for the rampant distribution and rising death rates in both countries. Brazilian President Jair Bolsonaro has a long history of controversy, clashes with local governments over pandemic mitigation measures and mockery of the mask.

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

“Brazil is an overall disaster in terms of political leadership, and India has become complacent after the initial decline in business,” he 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 avoid the more deadly fate of Brazil. Some parts of the country imposed targeted closures, elections are being held in five states – while thousands of voters are campaigning – along with a month long Hindu pilgrimage that brings crowds to the banks of the Ganges River.

It threatens to undo the benefits that can come from the increased vaccination system. Daily deaths in the South Asian country have more than doubled in the past week to more than 1,000 per day, with crematoria in many areas that run incessantly and accumulate bodies.

“Both countries need to significantly increase their vaccination coverage and work harder to introduce other public health measures,” Pai said. “What is important is that each country must work much harder to curb the epidemic.”