Why daily infections in India already exceed those in Brazil and the United States

India is immersed in a second massive wave of covid-19 infections, surpassing even the United States and Brazil in terms of new infections daily. The current peak came after a brief hiatus: daily new cases had dropped from 97,000 a day in September 2020 to around 10,000 in January 2021.

However, from the end of February, new daily cases began to increase again, exceeding the 100 000 up to date. Now, rise above 200,000.

Night curfews and weekend closings have been reinstated in some states, such as Maharasthra (including the financial capital, Mumbai). The Health services and the crematoria are overwhelmed, the covid-19 test kits are scarce Y waiting times for results are increasing.

How has the pandemic spread?

Residents in shacks and those who don’t have their own domestic toilet they have been the most affected, implying that poor sanitation and density have contributed to the spread.

One word that has dominated debates about why cases have increased again is laaparavaahee (negligence in Hindi). I know blame the citizens that they don’t wear masks or adhere to social distancing, but that’s only part of the story.

The negligence can be seen in the almost total lack of regulation and its application where regulations existed, in workplaces and other public spaces. Religious, social and political groups contributed directly through the blockbuster events, but this still does not explain the huge increase in cases.

The second wave in India also coincides with the spread of the British variant. A recent report found that 81% of the last 401 samples submitted by the state of Punjab for genome sequencing were of the British variant.

Various studies have discovered that this variant could better evade our immune systems. This means that there is a greater chance that previously infected people will be re-infected and that immunized people will become infected.

Furthermore, a new double mutation is circulating in India, and this could also be contributing to the increase in cases.

Low mortality rate?

In the first phase of the pandemic, India was lauded for its low death rate from covid-19, about 1.5%. However, The Lancet he warned of the “dangers of false optimism” in his September 26 editorial on the Indian situation.

In a pandemic context, the public health approach is often to attribute a death from complex causes to the disease in question. In April 2020, the World Health Organization clarified how deaths from covid-19 should be counted:

A death due to covid-19 is defined for surveillance purposes as a death resulting from a clinically compatible disease, in a probable or confirmed case of covid-19, unless there is a clear alternative cause of death that cannot be related to the disease. covid-19 (for example, trauma).

It is not clear to what extent the health authorities of the Indian states complied with this.

Many States have created expert committees to reexamine and verify Covid-19 deaths after being criticized because reported death rates were not accurate. Many territories made corrections to mortality figures, and it is actively researching the full extent of imperfect records.

The mortality data at the district level, both in the first wave and in the current wave, confirm that the 3.4% overall fatality rate it was surpassed in various districts such as Maharashtra, Punjab, and Gujarat. The fatality rates in some of the worst affected districts were greater than 5%, similar to 5% mortality rate in the United States

What are the challenges this time?

The most cases and deaths (81%) are being reported in 10 out of 28 states, including Punjab and Maharashtra. Five States (Maharashtra, Chhattisgarh, Karnataka, Uttar Pradesh and Kerala) account for more than 70% of active cases. But the infection seems to have moved from the big cities to smaller towns and suburbs with less sanitary infrastructure.

Last year, the The Government’s pandemic control strategy included Government personnel from all departments (including non-health ones) who contributed to Covid-19 control activities, but these workers have been transferred back to their departments. This is likely to have an effect on testing, tracing, and treating covid-19 cases. And health personnel now have to deal with the deployment of the vaccine, in addition to caring for the sick.

And now that?

In early March, the Government declared that we were at the end of the pandemic in India. But his optimism was clearly premature.

Despite the impressive number of more than 100 million immunizations, just the 1% of the country’s population she is currently protected with two doses of the vaccine. The Indian Task Force fears that the monthly supply of vaccines, with a current capacity of between 70 and 80 million doses per month, will “not reach half” the target of 150 million doses per month.

The strict and widespread closures that we have seen in other parts of the world are not possible for all parts of India given their effect on the working poor. Until greater vaccination coverage is achieved, local containment measures will have to be strengthened. This includes strict perimeter control to ensure that there are no movements out of or into areas with local outbreaks, intensive house-to-house surveillance to ensure compliance with stay-at-home orders where they are in effect, contact tracing and conducting generalized testing.

It goes without saying that large human congregations, such as the political rallies and the religious festivals they should not take place and yet they have not been suspended.

What we need is strong leadership and decentralized strategies focused on restrictions until we can get more vaccines to the population.

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