‘To Go Out Is To Get Infected’: In India, A Nightmare

‘To Go Out Is To Get Infected’: In India, A Nightmare

Late last week, I mentioned the pernicious tendency of market participants to give the cold shoulder to the developing world.

Outside of instances when some major financial calamity (often a debt or currency crisis) starts tipping the proverbial dominoes, problems in emerging markets are too often met with shrugs.

This is true, I wrote, even of major emerging markets like Brazil and India. Yes, we pay attention when the word “contagion” starts getting bandied about, but we don’t mean any virus. EM “contagion” only matters when an economic or financial event threatens to spill over into advanced economies. When it comes to biological contagion, it matters only until rich countries are vaccinated.

I try to avoid trafficking in normative statements in these pages, but I make exceptions. We should work to rid ourselves of the mindset described above. Humanity, like markets, is becoming more interdependent and interconnected every day. As I put it a few days ago, 2020 taught us that when someone sneezes in Wuhan, the whole world can literally get the flu.

All of that to say that India is now coping with a veritable nightmare. The figure (below) shows new cases accelerating at an almost unfathomable pace, a development blamed in part on a so-called “double mutant.”

Late last month, the Ministry of Health said that “although variants of concern and a new double mutant variant have been found in India, these have not been detected in numbers sufficient to either establish [a] direct relationship or explain the rapid increase in cases in some states.”

That was on March 24, a day when the country recorded somewhere in the neighborhood of 47,000 new cases and 275 new deaths. Fast forward three weeks and India is now reporting more than 260,000 new daily cases and more than 1,500 deaths every 24 hours.

Late last week, the ministry released another statement. “The double mutation has been found in several countries like Australia, Belgium, Germany, Ireland, Namibia, New Zealand, Singapore, the United Kingdom, and the USA,” it said, noting that “higher transmissibility of this variant is not established as yet.”

It’s becoming more difficult to make the case, though. “The average prevalence of the variant surged to as high as 52% of samples sequenced in April from almost nothing in January,” Bloomberg noted, citing outbreak.info, a site that utilizes data from GISAID.

I suppose this goes without saying, but I can’t personally vouch for the accuracy of this data. That’s why I inoculated myself (sorry) by directing readers to the linked piece from Bloomberg. Simply put: If they cited it, I can cite it. To be as specific as possible, the chart (below) is a visualization which shows the seven-day rolling average of percent of B.1.617-positive sequences, using average daily B.1.617 prevalence data from the same source. The cumulative prevalence in India is 11%, according to outbreak.info, compared to less than 0.5% worldwide.

In the same linked piece, Bloomberg went on to quote a primary source. Anurag Agrawal, director of the state-run Council of Scientific and Industrial Research’s genomics institute which conducts sequencing, said that the variant’s prevalence exceeds 60% in some Maharashtra districts. “It has two critical mutations that make it more likely to transmit and escape prior immunity,” Agrawal remarked.

The situation on the ground is nothing short of macabre. “When new infections started dipping in September, authorities thought the worst of the pandemic was over,” the AP wrote, in a highly disconcerting new piece dated Tuesday. “Health Minister Harsh Vardhan even declared in March that the country had entered the ‘endgame,’ but he was already behind the curve [as] average weekly cases in Maharashtra state, home to the financial capital of Mumbai, had tripled in the previous month,” the same article went on to say. It included some rather harrowing details, a few of which are excerpted below:

Seema Gandotra, sick with the coronavirus, gasped for breath in an ambulance for 10 hours, as it tried unsuccessfully at six hospitals in India’s sprawling capital to find an open bed. By the time she was admitted, it was too late, and the 51-year-old died hours later.

Rajiv Tiwari, whose oxygen levels began falling after he tested positive for the virus, has the opposite problem: He identified an open bed, but the 30-something resident of Lucknow in Uttar Pradesh can’t get to it. “There is no ambulance to take me to hospital,” he said.

Kamla Devi, a 71-year-old diabetic, was rushed to a hospital in New Delhi when her blood sugar levels fell last week. On returning home, her levels plummeted again but this time, there were no beds. She died before she could be tested for the virus. “If you have corona(virus) or if you don’t, it doesn’t matter. The hospitals have no place for you,” said Dharmendra Kumar, her son.

The situation is so acute that prices for oxygen have doubled, while shares of companies that produce it (or have the word “oxygen” in their name) have jumped. “Bombay Oxygen, National Oxygen and Bhagawati Oxygen have surged 47% or more in April,” Reuters observed this week, on the way to dryly noting that while National and Bhagawati actually do produce oxygen, Bombay stopped two years ago and “is now a non-bank lender” called “Bombay Oxygen Investments Ltd.”

India now has the second-most confirmed cases globally, overtaking Brazil, which is a disaster in its own right. And yet, at “just” 181,000, India’s official death toll is less than half Brazil’s. That may well be an undercount, many fear.

“Several major cities are reporting far larger numbers of cremations and burials under coronavirus protocols than official COVID-19 death tolls,” Reuters said, noting that “gas and firewood furnaces at a crematorium in the western Indian state of Gujarat have been running so long without a break during the COVID-19 pandemic that metal parts have begun to melt.”

“Earlier we used to cremate 20 bodies in a day of which few were cremated on a wood pyre while others were cremated in gas furnaces. The load was limited and each furnace got enough time to cool down,” one official told The Times Of India last week. “But now, we are handling over 80 bodies daily and each furnace is in use around the clock, hence the iron frames have started melting and breaking.” Another official at a separate crematorium said “the frames are melting and the gas burners are getting clogged.”

In remarks to Reuters, the president of a trust that controls a crematorium in Surat said “We are working around the clock at 100% capacity to cremate bodies on time.” The same person told Bloomberg that “we can’t afford to have long queues of people at the crematorium, as that again increases the risk of spreading infection.”

Even worse, some media reports suggest the sheer number of burning bodies is creating an air pollution problem. “People are facing health problems due to smoke coming from crematory in Durg,” a local source said, adding that “around 70 bodies, including COVID and non-COVID, are being burnt every day.”

I have a dear friend in Delhi. I asked her Tuesday if the situation was, in fact, as horrific as it sounds.

“It’s next to impossible even for the hospitals to accommodate people. People are dying at home,” she said. “Since electric cremation is not that common, hospitals aren’t even handing over the bodies. Just cremating them in bulk.”

When I asked whether she planned to be vaccinated, she told me that “to go out is to get infected. I’m going to stay at home.”


4 thoughts on “‘To Go Out Is To Get Infected’: In India, A Nightmare

  1. The basic biology is this: SARS-CoV2 only recently crossed over to humans. We are an adequate, but likely far from optimal, host species. The selection pressure in the early days after a species crossover is strong, and there is a relatively high probability that a mutation will be beneficial (for viral transmission) when your starting point is far from optimum. So it is not at all surprising that we’re seeing the development of multiple mutant strains that are better at infecting humans and better at being transmitted. As the US and selected other countries get to vaccination levels and prior infection levels that reach a combined 60-70+% of the population, there will be significant pressure for SARS-CoV2 to mutate to be better able to infect previously infected or vaccinated people. If we could rapidly get to 90+% immunity, and then cut ourselves off from the rest of the world, where you have millions of active infections going at any one time, we could wipe the virus out locally. But neither of these situations will happen. With a significant unvaccinated population taking few precautions, we will have continued relatively high levels of transmission in the US. Every infection is an opportunity for the virus to mutate to something that happens to be better able to infect vaccinated or previously infected people. And we will have continual exposure to the best and brightest virus strains that develop in other parts of the world. The combination of these two circumstances means that we are likely only at the beginning of our battle with SARS-CoV2 in the US. The US should announce a new Marshall plan with massive investment in vaccine production and deployment for the entire world. The investment would likely pay off 1000x if it meant bringing the global pandemic under control in, say, 3-5 years, instead of letting it fester for a decade or longer, with implications for global economic and political stability, and effects on the US economy (and, obviously, public health).

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