Covid in India: why the pandemic tragedy in the Asian country threatens the whole world
The size of the population in India and the dramatic increase in cases and deaths cause a lot of concern
"I have never seen such a frightening situation. I cannot believe that we are in the capital of India," Jayant Malhotra tells the BBC. "People are not receiving oxygen and are dying like animals."
Malhotra has helped in a crematorium in India's capital, Delhi, where hospitals are suffering from an unprecedented wave of coronavirus infections.
The country recorded a global record of new cases for the fifth consecutive day. There were 320 thousand new cases of infection on Tuesday (27) and the death toll is close to 200 thousand.
While India suffers from this outbreak - similar to what Brazil has been and still is -, China, the United States, much of Western Europe and parts of Africa and Southeast Asia recorded declining deaths in the two weeks preceding April 25.
How big is the covid crisis in India?
In February, with deaths per day in the hundreds and cases of around 12,000, many in India were hopeful that the country had escaped the worst of the pandemic.
Crematoriums have resorted to mass funeral pyres as the number of bodies of covid victims continues to increase
But the country has reported more than 200,000 new cases of covid-19 daily since April 17 - well beyond the previous peak of 93,000 cases per day in September last year.
Deaths have also been on the rise - an average of 2,336 people died in India per day for the week until April 25 - double the number during the peak of the first wave. In Brazil, with a population smaller than that of India, the daily average of the same week was 2,465, according to data from Conass (National Council of Health Secretaries).
For BBC science and health reporter James Gallagher, India is "battling". "The palpable fear reminds me of the beginning of the pandemic, when the coronavirus was still an unknown entity. The covid can be lethal even with perfect medical care, but when hospitals are overwhelmed, the lives that could have been saved are lost."
The situation is particularly dire in Delhi, where there are no more ICU beds.
Many hospitals are refusing new patients and at least two have seen patients die after the oxygen supply has run out.
The number of Covid deaths in India is likely to be underreported
Relatives of sick people are calling on social media for vacancies in hospitals, oxygen supplies and mechanical ventilation machines.
To complicate the response to the outbreak, laboratories are also overloaded and are taking up to three days to return the results of the covid tests.
The crematoriums, in turn, are open 24 hours a day.
Similar scenes are taking place in other large cities. In total, India confirmed almost 17 million infections and 192,000 deaths.
Graph shows number of confirmed cases and deaths per day in India
But these numbers are highly likely to underestimate infections and deaths.
The country's huge population and logistical problems make it very difficult to take the covid test or accurately record deaths, making it much more challenging to know the exact scale of the crisis in India than in Europe or the USA, for example.
How bad can it get?
"Unfortunately, in the coming weeks the situation is going to get significantly worse," warns Gallagher.
India expects to vaccinate 250 million people by July
"One lesson, learned over and over again, is that an increase in cases leads to an increase in deaths a few weeks later," he says.
"Even if India could prevent the spread of the virus, deaths would continue to increase exponentially, as many people have already been infected. Of course, there is no sign that infections are stabilizing - how far the cases will continue to rise will depend on the success of lockdowns and the pace of immunization. "
It is important to note that India does not yet have the highest number of cases or deaths - the US has so far had 32 million cases and 572,000 deaths, according to data compiled by the Johns Hopkins Coronavirus Resource Center on Monday (26 April). Brazil has more than 14 million cases and 391 thousand deaths.
Nor is India at the top of the list of cases or deaths per million inhabitants - much of Europe and Latin America are reporting much higher numbers.
But it is the size of the population in India and the dramatic increase in cases and deaths that are causing so much concern.
"We have never seen a situation like this, in which the health system is not able to cope with the weight of current figures and there is, at bottom, a sharp and continuous increase in new cases," Gautam Menon, professor of physics and biology and specialist in modeling infectious diseases, he told the BBC.
Chronic oxygen scarcity means that many people who could be saved are dying
When health services collapse, people die from all causes in far greater numbers - deaths that are not reflected in the coronavirus statistics.
In addition, healthcare operators in India also face far greater challenges in covering their vast population and many Indians have no access to any healthcare services.
What does this mean for the rest of the world?
The pandemic is a global threat.
From the earliest days, scientists and health experts have tracked coronavirus infection moving from country to country, driven by air travel and a highly globalized world economy.
National borders have so far represented a very limited barrier to propagation, and it is impractical - if not impossible - to impose travel bans and to close borders indefinitely.
Some hospitals in Delhi have seen patients die after the oxygen supply has run out
Therefore, what happens in India will certainly have repercussions for other countries, especially since the country has the largest diaspora in the world. In addition, uncontrolled infections can lead to the emergence of variants that can potentially resist vaccines.
"The pandemic has taught us that one country's problem is everyone's problem," adds James Gallagher.
"Coronavirus was first detected in a city in China, it is now everywhere. The record number of cases in India can spread to other countries, which is why many have introduced travel restrictions, and high levels of infection are a breeding ground for new variants of the virus. "
Was a new threat born in India?
And conditions in India can be very bad news for the global fight against covid-19.
"India's high population and density is a perfect incubator for this virus to experience mutations," says Ravi Gupta, professor of clinical microbiology at the University of Cambridge.
Medical staff mourning coronavirus deaths in Kuvadava, a village in Gujarat
If the virus has time to mutate in such ideal conditions, it could prolong and increase the severity of the pandemic worldwide.
"The more opportunities the virus has to mutate, the more likely it is to find a way to infect even the people who were vaccinated," adds James Gallagher.
New variants of the virus from the UK, Brazil and South Africa have already caused problems during this pandemic, spreading around the world, and Professor Menon warns of new variants in India.
"Some of them are known to be associated with regions of the spike protein that allow viruses to attach themselves better to cells and reduce the binding of antibodies," he said.
"It is impossible to limit the spread of variants. Variant B.1.617 (which was first identified in India) has already been seen in several countries outside India, probably as a result of the import."
Professor Menon warns that the viruses will continue to mutate and evolve to escape the immunity that a previous infection or vaccination can provide.
Some hospitals in New Delhi are not accepting new admissions from patients with covid
The question now is how fast this can happen.
"We know that SARS-CoV-2 can mutate to achieve more transmissibility, from our observation of multiple variants worldwide. So far, we believe that vaccines must still remain effective against these new variants, but that could change in the future."
How can India (and the rest of the world) prevent this spread?
International efforts are underway to help India manage its critical oxygen shortage and the devastating increase in covid-19 cases.
The United Kingdom has started sending ventilators and oxygen concentrating devices and the United States is lifting the ban on sending raw materials abroad, allowing India to produce more of the AstraZeneca vaccine.
Several countries are also offering to send medical teams and PPE to help.
The size and density of India's population makes it particularly vulnerable to outbreaks
The Indian government has approved plans for more than 500 oxygen generation plants across the country to increase supplies.
But these are measures to try to prevent deaths, not infections. What the world needs is a dramatic increase in India's ability to vaccinate its population and prevent the spread of the virus.
The country may have had reason to hope for the start of the pandemic - when it comes to vaccine manufacturing, the country is a powerhouse.
He runs a massive immunization program, manufactures 60% of the world's vaccines and is home to half a dozen major manufacturers.
But "a large-scale adult vaccination program against a virulent pathogen like SARS-Cov2, the virus that causes covid-19, is presenting unprecedented challenges," according to BBC India correspondent Soutik Biswas.
India's vaccination campaign, the largest in the world, began on January 16 and aims to reach 250 million people by July. So far, it is believed that "only" about 118 million people have received the first dose. This represents less than 9% of the population.
Initially limited to health professionals and frontline staff, vaccination was extended in stages to people over 45 years of age.
But the scale of the task of immunizing such a large population and the country's logistical and infrastructure problems are complicating implementation.
Experts say the vaccination campaign needs to accelerate much more to achieve its goal.
"It is not clear whether the country has sufficient vaccines and state capacity to accelerate movement and expand coverage to include young people," says Biswas.
Until such a large population is successfully vaccinated, infections in the country will pose a risk to the entire world.
"The problem of infectious diseases like covid-19 is not a problem for a single nation or even a small group of nations. It is truly global in its implications," says Professor Menon.
"We need more international cooperation in testing, vaccines and research for the world's greatest good."
As public health officials and politicians have said since the early days of the pandemic, "no one is safe until everyone is safe".
No comments:
Post a Comment