What makes Israel better than India

Four factors that fueled India's corona wave

  • India is in the middle of a corona crisis: the hospitals are overloaded with patients. The number of corona infections is increasing every day.
  • The rapidly spreading variants and yet taking place social gatherings are what fuel the outbreak, experts say.
  • The slow start to vaccination and a poor health system made the situation even worse.

Just two months ago, the situation in India seemed to have turned. The number of corona infections had fallen to its lowest level since the beginning of the pandemic. In addition, the vaccines were gradually brought to market. However, as early as mid-February, Professor of Epidemiology at the University of Michigan, Bramer Mukherjee, believed that this progress would not last. At that point, she noticed an increase in cases amid an increase in social gatherings such as weddings, family reunions, parties and sporting events.

The professor then called her 81-year-old father and 79-year-old mother, who live in Calcutta. She wanted to know if they would be vaccinated anytime soon. In an interview with Business Insider, Mukherjee said her parents believe there is no rush because there is no widespread spread of the virus at the moment. "I think that shows what happened: the low point in the number of infections would have been the right time for India to speed up vaccinations," she said. "But that didn't happen."

Now the number of daily registered cases in India has increased more than 20-fold in the past two months. On Monday, India reported more than 350,000 new cases, out of a population of 1.38 billion. That is the highest number reported in a day worldwide - but also in an extremely populous country. The number of deaths has also risen sharply in the past two months, by almost 25 times. In Indian hospitals there are long queues with sick people waiting to be treated. The country is lacking oxygen and ventilators, and those who have died from the virus pile up in the crematoriums.

India should have used the "rest break" over the winter

Public health experts point to four factors that have made the outbreak of a new wave so wildly out of control: the more rapidly spreading mutations, an increase in social gatherings, a slow adoption of vaccines, and an ill-equipped one Health system.

India should have used the “rest” over the winter to improve the tests, the observation of the mutations and the supply of medication, say experts. Then the country would have been better prepared to deal with this new wave.

"Unfortunately, the image of how well India has done so far has created a false sense of security," explains Krutika Kuppalli. She works as an assistant professor at the University of South Carolina. "I always had the feeling that India would become the epicenter of this pandemic." Epidemiologist Bramer Mukherjee emphasized that India's "premature victory celebration" should serve as a warning to other countries. "The tricky thing about this virus is that you can't wait for it to work," she said. "All developments, no matter how small, must be observed and followed."

New gene variants may be the main cause of the enormous increase

The faster spreading gene variants of the virus are perhaps the main culprit behind the devastating outbreak in India. One of them, variant B.1.617, has features of two variants - the British and the South African. This could mean that the antibodies produced by the vaccine or previous infections cannot prevent this new variant from developing.

Scientists say the variant is showing the first signs that it is easier to transfer than the original strain. “This new variant seems to be more infectious. It also seems to catch younger people, which has pushed the numbers up significantly, ”said University of Toronto epidemiologist Prabhat Jha.

Scientists in the Indian state of Maharashta first identified the B.1.617 strain in March. First, they stated that the variant could be associated with around 15 to 20 percent of all cases at the time there. In April, the mutation had already made up more than half of all new corona infections in India, according to the global database GISAID, which collects coronavirus genomes. "The double mutation is now in California, it's in the UK, and similar variants will be circulating around the world," Mukherjee said.

Other strains could also be driving the spread of the virus. Scientists only recently identified a variant with three key mutations, variant B.1.618, in the Indian state of West Bengal. Variant B.1.36 was also found in Bangalore. This has already been linked to reinfections.

Experts advise the country to have regional bans in the areas where the variants are widespread. "If India does not get the situation under control, it will affect the whole world," said Kuppalli. "We can put in as many travel restrictions as we want, but that won't prevent these gene variants from getting elsewhere."

Meetings gave the variants more opportunities to spread

In the spring, the mutations had ample opportunity to spread across India. Earlier this month, at least 50 million people crowded the Ganges River for a Hindu religious festival. Over 2,000 corona infections have been linked to the festival. Indian Prime Minister Narendra Modi has also held major campaign events, including one in March, which drew around 800,000 people.

In addition, according to the experts, many Indians no longer consider it necessary to adhere to contact restrictions or to wear masks. An investigation in January found that 56 percent of 28,000 people screened in Delhi tested positive for antibodies to the coronavirus. This realization led many people to believe that herd immunity had already been achieved in large cities, according to Mukherjee.

“A lot of people thought, 'Oh, we're all under control,' in December and January,” Jha said. “That turned out to be a mistake. Some colleagues and I had warned that there could be a new wave. ”Even countries like the United States of America, Great Britain and Israel, which have already vaccinated 40 to 65 percent of their population, need to be aware that the virus has not gone away, say the experts. "The real lesson is: respect the virus, respect science," said Jha. "There is no other way out."

The outbreak of the new wave could not be prevented due to the slow start of the vaccination

Since the start of the national vaccination program, India has vaccinated less than nine percent of its population. This is not particularly surprising given the size of the population. "The challenge of vaccinating a billion people is just extraordinary," said Jha. However, the lack of perceived urgency on the part of the population did not help, the experts said. Some residents did not see the need to get vaccinated immediately. Others were skeptical of the vaccine's side effects.

The country approved its own vaccine called Covaxin - even before human clinical trials were completed. It is designed in a similar way to the Chinese Sinovac vaccine. The manufacturers of the vaccine, Bharat Biotech and the Indian Council of Medical Research, state that the active ingredient is at least 78 percent effective. However, epidemiologist Prabhat Jha says there is still uncertainty as to how well the vaccine really works. “We know that a similarly designed Chinese vaccine underperforms in Latin America. It could well be that the same problem is occurring in India, ”he said.

The vaccination efforts also experienced a setback when the number of infections rose dramatically, Kuppalli said. This was because health workers were forced to focus on treating the sick rather than giving the vaccine. “Vaccines are good and important. We have to distribute it and expand it, but you cannot vaccinate yourself out of an outbreak, ”said Kuppalli.

India's health system was unprepared for another wave

Prabhat Jha said the Indian health system is unable to handle another outbreak in addition to the vaccine introduction. "You have to keep in mind that there has been ongoing underinvestment in Indian health care for a long time," he said. "India, like many other countries, unfortunately does not have an adult protection program." The country had a short window of time when infection rates were low that it would have been easier to increase testing and critical drug supplies, Jha added added. However, many government officials mistakenly assumed the threat was over.

Now the situation on the ground is probably even more devastating than the official figures suggest. Testing flaws prevent the nation from quantifying the extent of the outbreak. A handful of doctors as well as journalists and numerous relatives of the sick have reported that the official figures do not show the actual number of deaths. Indian health care providers lack the resources, including beds and medicines, to treat patients. "If you suppress and suppress the data and the number of deaths, you cannot really estimate how many people will show up in the hospital the next day," said Mukherjee. "This massively hinders the possibility of supplying enough people with oxygen and of guaranteeing general health care."

Experts said that some doctors in India - whether due to a lack of training or sheer desperation - have tried to give drugs that do not work for the virus. It is said that drugs such as ivermectin were used: a drug used to treat parasitic infections. "I've heard stories from people who were prescribed three, four, five, six drugs that weren't shown to be effective at all," said Kuppalli. “I think people just reach for anything. But that only makes the chaos and fear even bigger. "

Jha stated that there may also be a financial incentive to offer medication to patients in critical condition. “When a scenario like this arises, a lot of people become desperate,” he said. "Then there are unfortunately always dubious private providers who want to take advantage of this and offer all kinds of treatments - regardless of whether they work or not." Meanwhile, drugs that are effective, such as the antiviral drug Remdesivir, are in great demand, says Kuppalli . There is a huge black market for remdesivir. "I am concerned that the same could happen for vaccines now."

This article was translated from English and edited by Julia Knopf. You can read the original here.