Is the sharp decline in India’s coronavirus cases as dramatic and curious as some believe?
Is the epidemic receding strongly in a country where many early modelers predicted millions of deaths due to Covid-19?
In October, I wrote extensively about the fact that the epidemic in India is slowing down. Business peaked in mid-September – there were more than a million active businesses. Thereafter, daily deaths and case studies began to decline despite constant testing and some short and severe infections in cities like Delhi.
The situation has improved significantly since then.
By last week, India had barely averaged 10,000 cases of Covid every day. The seven-day average daily deaths due to the disease have dropped to below 100. More than half of India’s states report no Covid deaths. On Tuesday, Delhi, which was once an infection hotspot, did not record a single Covid death for the first time in ten months.
So far, India has recorded more than 10 million infections – the second highest in the world after the US. More than 150,000 deaths have been reported as a result of the disease. The number of deaths per million people is 112, much lower than reported in Europe or North America. It is also clear that the decrease in cases is not due to lower tests.
Most pandemics usually rise and fall in a bell-shaped curve. India was no exception. There is also a large percentage of cases and deaths among people over the age of 65 living in densely populated cities, depending on infection trends around the world.
“There is nothing unusual about infections falling in India. There is no miracle here,” says Dr Shahid Jameel, a leading virologist.
Experts believe that there is no shortage of possible causes, as set out below, due to the relatively low severity of the disease and its toll.
“We still do not have causal explanations. But we know that India is not a people that offers herd immunity,” said Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, who closely watched the pandemic . Herd immunity occurs when a large part of a community becomes immune to a disease through vaccination or through the massive spread of the disease.
Why is India far from herd immunity?
The latest sero-survey – studies that pick up antibodies – indicate that 21% of adults and 25% of children are already infected with the virus.
It was also found that 31% of the people living in slums, 26% of the urban population who are not slums and 19% living in rural areas are exposed to the virus. This is well below 50% – a figure reported by some of the larger cities, such as Pune and Delhi. Here is evidence of much higher exposure to the virus, suggesting that these sites are likely to be closer to herd immunity.
But experts say the numbers are still too low.
“There is no region in the country that can be considered herd immunity, although there may be small pockets,” Dr K Srinath Reddy, president of the Public Health Foundation of India, a think tank in Delhi, told me .
People who are still not exposed to the virus in places with a high incidence of infection can be protected in their communities, but will be vulnerable if they travel to areas where transmission levels are lower.
Why then does business go downhill?
Experts believe there may be different reasons.
In the first place, India has seen a “patchwork” pandemic with cases declining and declining at different times in different parts of the country.
More people are infected in cities – especially in slums – and in developed, urbanized districts than in smaller towns or villages. In all these places, the exposure to the virus varied considerably. Business has now declined in most urban areas, but rural India still remains a bit of a mystery.
“My feeling is that the exposure to the infection is much higher than the surveys indicate. We should not take India as one either. In some cities like Delhi, Mumbai, Pune and Bangalore up to 60% of the people were found with antibodies. against the virus. So it’s all unequal, “says Dr Shahid Jameel, a leading virologist.
The other explanation is that India has many cases and still misses, mainly because a large number of infected people have no symptoms at all or have a very mild infection.
“If we had a large number of very mild or asymptomatic cases, we might have already reached a threshold of herd immunity. If that is the case, we still have to explain why so many Indian cases were so mild?” asks Partha Mukhopadhyay, a senior fellow at Delhi’s Center for Policy Research, who studied the pandemic.
Is the low mortality rate a mystery?
Most scientists believe that far more Indians died from the infection than the official figures reveal. India has a bad record of death certification and a large number of people are dying at home.
But even such a scale of under-reporting did not cause public panic or overwhelming hospitals. Consider it. India has about 600,000 villages. Even one undiagnosed and unreported death of Covid in every village would not overwhelm the public health system.
India launched a rapid, early strike in late March to halt the spread of the virus. Scientists believe the closure, which lasted up to nearly 70 days, prevented many infections and deaths.
In the cities hit hard, shipping was delayed due to the widespread use of face masks, physical distance, school and office closures, and people working from home.
Scientists have also attributed fewer deaths to a young population, protective immunity, a large rural population with insignificant links with cities, genetics, poor hygiene and adequate lung protection proteins.
A number of studies have said that the infection is largely spread by the virus that floats inside, small droplets that hang in stagnant air in poorly ventilated rooms.
But more than 65% of Indians live and work in the countryside. Brazil, for example, is nearly three times more urban than India, and that may partly explain the large number of cases and deaths there, scientists say.
In cities, the vast majority of India’s workforce is engaged in the informal economy. This means that many of them, such as construction workers or street vendors, do not work in enclosed spaces. “The transmission risks are lower for people working in open or semi-enclosed ventilated spaces,” says Dr. Reddy.
Did India avoid a second wave?
It’s too early to tell.
Some experts fear that India may see a spate of infections with the onset of the monsoon, which is also the start of the country’s flu season. It lasts from June to September and causes devastation in South Asia every year.
“The start of the coming monsoon season is going to be critical. We can only make an informed assessment whether the pandemic is really taking its course in India after the season is over,” said an epidemiologist who preferred to remain anonymous.
The real elephants in the room, scientists say, are the new variants of the virus that have been identified in South Africa, Brazil and the United Kingdom.
Since a large number of Indians are still not exposed to Covid-19, a dominant strain can easily move to relatively uninfected areas and cause new outbreaks.
By the end of January, India had reported more than 160 cases of the British variant. It is not clear whether the other variants are already spreading in the country. India can also easily have homemade varieties.
The British variant was spotted in Kent in September, but only became the reason for a full-fledged second wave two months later. Since then it has been found in more than 50 countries and is now the world’s dominant tribe.
India has enough scientific laboratories, but genome sequences are still full, scientists say.
“The variety story is the biggest. It can upset all our calculations. We have to be very vigilant, and our laboratories have to increase genome order to pay attention to variants,” says Dr Jameel.
Clearly, India needs to speed up its vaccination journey – about six million jabs have been given in just under a month. The government aims to vaccinate 300 million people by August to make sure a second wave does not result in widespread infections.
And there is still no room for complacency – doctors and scientists are appealing to people to avoid mass gatherings and overcrowded areas and continue to use face masks and practice hand hygiene.
Graphs by Shadab Nazmi