Coronavirus: India's 2nd Wave

I last wrote about India and COVID-19 in January. At the time, an assumption was that 60% of the population might have already come down with COVID-19. I was a touch skeptical of those claims as the deaths per million were just really low and didn't make sense when compared to a 60% infection percentage. Yes, India has a young population of just 28.4, but Mexico has a similarly young population of 29.2 and their official deaths per million were 10x that of India's.

Those of us interested in COVID-19 beyond the borders of the United States know that India is now in a very strong second wave. The articles that I read partially point the finger to the Hindu's Kumbh Mela pilgrimage as being a super-spreader event. This would seem to align with the United States having a major wave occurring after Thanksgiving and Christmas. There is also the fact that India is going through a political campaign season (might sound familiar to Americans) and that society was opening up after the first wave.

What is the current news coming out of India?

Own 'Double Mutant' Variant

NPR (Apr 24) reports:

Officially, the variant is called B.1.617, but many people and media outlets (including NPR) have referred to the variant as the "double mutant." That's because B.1.617 has two key mutations that have cropped up in two other infamous strains.

. . . But, [Kristian Andersen at Scripps Research Institute] says, no one knows for sure if B.1.617 is more transmissible and thus driving India's surge. "We also know the B.1.1.7 [the variant first detected in the U.K.] is circulating in India, and we know that P.1. [the variant first detected in Brazil] is also circulating there, too. So they could also play a role in this surge. We simply don't have the data yet."

. . . There are also signs that people who have already had COVID-19 can be reinfected more easily with this strain, [Cambridge University's Ravi Gupta] wrote, especially over time, as their natural immunity wanes. These reinfections may be driving this second, explosive surge in India.

Even though we've been hearing all about this mutant strain, it looks like it isn't the only variant driving this second wave. The article seems to go with the assumption that there was a high infection rate in the first wave as they appear to push the idea of reinfections. This NPR article might be considered to be a worst case scenario write-up.

The Current Situation

Time (Apr 23) reports:

Every day, more than 2,000 people in India are dying with COVID-19, according to official numbers—and experts believe that number is a dramatic underestimate. Three health officials who asked to remain anonymous told me they believe that the daily number of COVID-19 deaths in India has already crossed the 10,000 figure.

Why was India caught unprepared as the second wave ravaged a cross-section of Indian society? The responsibility lies with a strongman regime that has ignored all caution.

. . . It lies with the sycophantic cabinet ministers who praised Modi for successfully dealing with COVID- 19 in India even as testing slowed down and allowed people to become more complacent about the virus.

The article goes on to also blame the upper-middle class, state ministers and Prime Minister Modi. Honestly, there is a strong blame "Trump" Modi vibe to the article. 

Oxygen Shortage

Associated Press (Apr 23) reports:

Indian authorities scrambled Saturday to get oxygen tanks to hospitals where COVID-19 patients were suffocating amid the world’s worst coronavirus surge, as the government came under increasing criticism for what doctors said was its negligence in the face of a foreseeable public health disaster.

. . . The government ramped up its efforts to get medical oxygen to hospitals using special Oxygen Express trains, air force planes and trucks to transport tankers, and took measures to exempt critical oxygen supplies from customs taxes. But the crisis in the country of nearly 1.4 billion people was only deepening as overburdened hospitals shut admissions and ran out of beds and oxygen supplies.

More Nuanced Take

National Geographic (Apr 23) takes a more nuanced approach versus the NPR and Time articles:

We completely let down our guard and assumed in January that the pandemic was over—and COVID surveillance and control took a back seat,” says K. Srinath Reddy, president of the Public Health Foundation of India. But “there were still a fairly large proportion of people in the big cities, but also in smaller cities and villages, who were not exposed to the virus last year, who were susceptible.”

What I notice in the above quote is the "fairly large proportion" statement. That seems contrary to the 60% estimate that was made in my previous blog post. It also perhaps downplays the idea of reinfection as being a major driver. This, of course, will require some additional research by scientists.

. . . India had increased its oxygen exports to other countries by a whopping 734 percent in January 2021. It also exported around 193 million doses of vaccines.

What are the chances that India now dramatically reduced oxygen and vaccine exports? And is likely trying to import as much as it can? To me, which countries are now going to be negatively impacted by this change in policy? Will infections and deaths start to increase in those impacted countries?  

. . . This second wave in India has been widely attributed to the B.1.1.7 variant—first identified in the U.K.—which had ramped up cases in the state of Punjab. Another possible culprit is a homegrown variant, called B.1.617, with two worrying mutations, that originated in Maharashtra, the worst affected state.

. . . [Hyderabad-based Center for Cellular and Molecular Biology] also found that the double mutant is only responsible for around 10 percent of the cases countrywide. In Maharashtra, where this variant was dominant, it accounted for only 30 percent of the cases. “I would blame this surge on human behavior,” says Mishra.

The NPR article was uncertain about which of the three variants (Brazil, UK and India's own variant) were the main drivers. Though written at the same time, National Geographic is stating that the double mutant isn't the main driver as it is only at 10%.   

Where as Time Magazine puts much of the blame on government officials and the upper-middle class, National Geographic is focusing on human nature.  

How Bad Will It Become?

IHME (Apr 23) has a forecast of 959,561 COVID-19 deaths by August 1st. This basically means that a million figure will be reached sometime in August. I should note that Worldometer as of Apr 23 has official deaths at 189,549 whereas IHME is at 370,898 so IHME is doing some forensic estimates that go beyond official numbers. It should be noted that India has a population that is 4x that of the United States so an adjusted comparison would be for the United States to have 250,000 deaths. We're around 600,000 deaths. That provides some context. It is bad in India, but is it that bad? I don't remember reading about oxygen issues in the United States, but that didn't prevent deaths from piling up. 

How are Vaccinations Going?

CNN (Dec 18) stated that there was a target of 300 to 400 million doses by July 2021. Per Our World In Data, the country was at 117 million doses as of Apr 23rd. (For a comparison, the United States was at 137 million.) It looks like the 400 million target is doable as long as there is the supply. The problem, of course, is that if NPR is correct in their negative assumption that the current vaccines might not work against the new variant, India's targets might not matter.