I have no in-depth thoughts on this topic, but I want to put it on your radar because everything indicates that it will eventually be the worst COVID outbreak on earth since the pandemic began. The distinction currently belongs to Brazil, I think, but India’s population dwarfs the 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.
God knows only where the death toll could go.
The epidemic curve there has become vertical. And it should be emphasized: in a poor country that does not test much (India ranks 116th in tests per capita), the number of confirmed cases only scratches the surface of the actual number of infections.
The chart of daily affairs is frightening
Family / friends in India say it’s as bad as it looks
Hospitals without oxygen
Large number of doctors and nurses who are ill with COVID
Vaccines that are difficult to find
And no clear end in sight pic.twitter.com/XVc4TNNecK
– Ashish K. Jha, MD, MPH (@ashishkjha) 21 April 2021
Three hundred thousand cases a day is a lot, needless to say, but the US approached the number during the worst part of the winter and we have only a quarter of the population doing India. If 300,000 were an accurate measure of what they are currently facing, it would not 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 businesses. Every day. With each of the people who can infect several others.
What does it look like on the ground? Take ten minutes to read the new reports on the crisis in India from the Financial Times and CNN. It matches the key details: the health care system is collapsing, people in need of hospital beds are unable to get it, supplemental oxygen is scarce, cemeteries and crematoria are struggling, and vaccinations are only shrinking.
India scored 2,000 yesterday official deaths due to COVID, a small number given the size of their population. (Equals about 500 in the US) But no one has the slightest idea what the actual death toll is. The Financial Times provides the following information:
The Times notes that the ratio between known deaths due to the disease and officially reported deaths in some Indian states is about nine to one. Quote: “In the Jamnagar district of Gujarat, 100 people died of Covid-19, but only one death of Covid was reported.” And what is happening in the poorest rural regions of India, where there is little medical care and even less reporting? Again, God does not know. Compare ICU usage in India recently with ICU usage in some of the previous worst outbreaks on the planet:
The crisis in India is much worse than these data indicate, as @FT review today makes it clear. Here is ICU occupation against the worst affected areas early in the pandemic
Role of B.1.617 variant still uncertain
Links and thread 👇https: //t.co/p7tb2KjHGK pic.twitter.com/CfIoAq7cPC– Eric Topol (@ EricTopol) 21 April 2021
How did a country that had a relatively mild pandemic for 12 months suddenly turn into a raging inferno? There are two theories. One, a la Chile, is that India believed that he had leaked COVID after many months of few infections, so he lowered his guard and relaxed restrictions. Movie theaters fully opened on February 1st. The Prime Minister, Narendra Modi, started holding mass rallies again and did not wear the mask. (Which sounds familiar.) Last month, the health minister arrogantly declared that the country was in the ‘endgame of the COVID-19 pandemic’. An epidemiologist writes today that ‘the political, religious and sporting events, which are widely discussed by the Indian media, have sent mixed messages about the severity of the pandemic’ and that there is an unfounded sentiment among a large number of Indians who are exposing pollution and microbes gave them excellent immunity. ”
Worst of all, they are in the midst of an Indian religious festival that will last all month:
The largest gathering is by far the Kumbh Mela, an important Hindu festival and one of the largest pilgrimages on earth. Millions of Indians travel from across the country to Haridwar, an ancient city in the state of Uttarakhand, to attend ceremonies and prayers and take sacred dives in the Ganges River …
‘The Kumbh Mela Could Undertake as One of the Largest Mass Spread Events Ever, simply because of the size of the number of people who turn up for the ritual bath in the Ganges, ”Laxminarayan said.
Granted, much of the festival takes place outdoors, where it is less likely to broadcast. But participants must eat, sleep and use the bathroom. They are sometimes indoors. And when they infect each other and return home to the Kumbh Mela, they go seed outbreaks everywhere. Modi apparently encouraged Indians to stay home and rather celebrate the festival “symbolically” but only after it was already underway. And why would people be afraid of infection at the Ganges if Modi himself does not care that his supporters become infected during his rallies?
The other factor in the outbreak of India is that they now have their own variant. A ‘double mutant’, in fact, so named because it has not one, but two key mutations on the ear protein:
As the Covid epidemic in India worsens, the occurrence of a “double mutation” variant, which worsens mutations E484Q (such as E484K) and L452R (found in CA variant). Now classified as B.1.617 – this is from 24% of the samples in sequence in February to 80% on 1 April. Https://t.co/tgCYu540MT
– Scott Gottlieb, Managing Director (@ScottGottliebMD) 16 April 2021
Scientists are not yet sure if it is significantly more contagious than the common coronavirus, but the growing appearance of the strain is an idea that it is. Doctors understand that the variant can theoretically break the immunity through vaccines:
Both mutations are known reduces – although does not completely eliminate – the binding of the antibodies caused by infection and vaccination, according to Jesse Bloom, associate professor of genomics and microbiology at the University of Washington …
“We did math – we believe that much of the increase in reproductive numbers can be explained by these mutations,” Nithya Balasubramanian, head of health research at Bernstein India, told Bloomberg TV this week. “So, yes, the mutations are a big concern.”
The characteristics of the double mutant variant are being investigated, but the L452R mutation is well characterized according to American studies, according to Agrawal. It increases the transmission of the virus by about 20% and reduces the antibody efficiency 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 on April 12. “We must do everything possible to identify and contain its distribution.”
Although the vaccines work to subdue B.1.617, a major outbreak in India is fertile ground for more varieties. Every infected person is a laboratory for the virus to turn into something more dangerous and India has more “laboratories” than any country on earth except China. The virus is currently causing millions of “experiments” – every day. The fact that the country until recently had only slight peaks in cases relative to western countries would logically mean that there is little natural immunity in the population to slow down the current distribution. How much worse it can get, one might guess, but the outlook is frightening as their healthcare system is already at the breaking point. If you are the praying type, now is the time.