The epidemic in India continues to spiral out of control, with the numbers reaching record highs. Yesterday (6th), the number of confirmed cases exceeded 410,000 and the number of deaths reached 3,980, while experts say that the actual number of confirmed cases and deaths may be even higher. Why did the epidemic suddenly break out in India without warning? When exactly will it reach its peak? European virologist and chief scientist of Biotech, Yuhong Dong, explains in detail 7 major questions about the Indian epidemic. The following is the essence of the interview with Yuhong Dong.
I. When will the Indian outbreak reach its peak?
Since the outbreak in March, the epidemic in India has been soaring almost linearly, with unprecedented momentum, so it has been described as a “tsunami” and a “rocket”. It has slowed down in recent days, but the numbers are still at record highs.
Experts currently disagree on when the epidemic will reach its peak.
Some epidemiologists estimate that the Indian epidemic is nearing its peak. M Vidyasagar, director of the New Crown Outbreak Modelling Committee, believes it could start to decline in a week or two, according to model projections.
In contrast, Chandrika Bahadur, head of the India team of The Lancet New Crown Outbreak Commission, said it is difficult to determine whether the peak will be reached in mid-May or not, and the rise in the outbreak curve may last longer.
Second, what is the actual number of infections and deaths in India?
Since the outbreak of the epidemic in India, scientists and medical professionals have consistently warned that the actual number of infections in India may be grossly underestimated.
Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in New Delhi, India, said, “According to last year’s estimates, only 1 out of 30 infections was detected.” WHO chief scientist Dr. Soumya Swaminathan, on the other hand, said the actual number of infections could be 20 to 30 times higher.
A few days ago, I called a former Indian colleague and asked him how the situation was on the ground. He replied, “It’s very bad indeed, much worse than what is being reported.”
The actual number of deaths in India, according to epidemiologist Bhramar Mukherjee, is probably two to five times higher than the current figure.
Why is the number of confirmed, deaths in India underestimated? There are mainly the following reasons.
- India’s medical resources are grossly inadequate to cope with the current ferocious epidemic. In this situation, many patients cannot be admitted to hospitals and have to stay at home. Therefore, a large number of patients were missed.
What is the extent of the lack of medical resources in India? This can be seen by comparing the following data.
The number of diagnoses and deaths in India is severely underestimated and related to the lack of medical resources.
According to an analysis published in the British Medical Journal (BMJ) on April 30, the doctor-to-population ratio in India is 1:1445 (compared to 2.6:1000 in the U.S.); the bed-to-population ratio is 0.7:1000 (13:1000 in Japan); and the ventilator-to-population ratio is 40,000:1.3 billion (160,000:300 million in the U.S.).
India currently has only 90,000 ICU beds, but 500,000 ICU beds are needed to deal with the current epidemic.
Moreover, India currently has only 90,000 ICU beds, but 500,000 ICU beds are needed to deal with the current epidemic. However, ICUs are not built in a day and need to be equipped with sophisticated resuscitation facilities, so ICU beds also represent a country’s level of medical care.
- Nucleic acid testing capacity is clearly inadequate. Although India has been upgrading its testing capacity, it is still far from being able to meet the soaring demand for cases.
- The number of asymptomatic infected patients is huge.
- Patients are increasingly dying at home, in ambulances, waiting rooms and clinics, with no way to assign a cause of death. Some patients who are able to go to the hospital may die before being tested if their disease is severe and cannot be diagnosed.
Third, why did the outbreak in India occur without warning?
After the first wave of the epidemic in India, the curve of confirmed cases had dropped to a low point in January this year, but there was a sudden outbreak in March. This is reminiscent of the outbreaks in the UK and the US, both of which were sudden and unexpected.
The main reason behind the outbreak in India is the Indian variant of the virus B.1.617.
The Indian variant appeared in India as early as October last year, but the percentage has been quite low. In fact, the same is true for the UK variant and the California variant. When a variant virus first appears, people often do not notice its threat; by the time they do, it may have caused an outbreak to erupt.
In fact, many epidemics have no signs before they break out. The human eye cannot see the microscopic virus, so it is often ignored as a threat. But viruses mutate and spread all the time.
Today, the Indian variant has become the dominant strain in India.
The Indian variant’s power to spread, its ability to evade vaccines, and its ability to cause secondary infections may all increase. Why?
The Indian variant has mutations at two important sites in the “key head”: E484Q and L452R.
If we compare the virus to a key and the human cell to a lock, the Indian variant has two important mutations in the “keyhead” site: E484Q (similar to E484K in the South African and Brazilian variants) and the L452R (found in the California variant) locus. These two changes make it easier for the key to enter the lock and also increase the immune escape ability.
The “key handle” is also mutated, although not as much as the key head, but also allows the virus to invade cells more easily.
Since the Indian variant has only recently been noticed, there is no definitive data on its specific spread and increased lethality, but a comparison with other variants reveals the following.
Comparison of the important mutation L452R in the Indian variant of the virus and N501Y in the British variant.
The current infectivity and lethality of the three major variants of the virus.
The variants are prone to secondary infections. The first wave of the epidemic peaked in September last year, and now, six months later, many of those infected at the time have declining antibodies and may become infected again in the second wave.
In addition, the severity of the epidemic in India is related to its fragile healthcare system and large population base. The Indian health care system is unable to cope with the growth rate of patients and cannot treat them, leading to an accelerated spread of the virus in the community, creating a vicious cycle.
IV. What vaccines are being administered in India?
Currently, 9.4% of the population in India has received one dose of the vaccine; 2.2% have received the full two doses. Both of these rates are in the top 15 globally.
The main vaccines currently in use in India are the AZ vaccine, and Covaxin, which was developed locally in India, as well as the recently approved Russian vaccine SpunikV. And following the outbreak in India, Pfizer is now working with the Indian government to accelerate the approval of Pfizer vaccines in India.
The main vaccines currently in use in India are the AZ vaccine and the Covaxin vaccine, which was developed locally in India.
India’s indigenous vaccine, Covaxin, is an inactivated vaccine with a protection rate of 81% and 100% protection against severe disease, according to the company’s data.
V. The world’s largest vaccine producer is in India, so why is there still a shortage of vaccines in India?
India continues to face a shortage of vaccines.
In fact, the world’s largest vaccine producer is Serum Institute of India (SII), which produces a huge amount of vaccines. But until May of this year, the World Health Organization (WHO) expected them to provide 100 million doses of vaccine, but so far only about less than one-fifth has been received, far short of the target.
This is mainly because the Indian Serum Institute, which produces raw materials for the AZ vaccine, relies mostly on imports from the United States, but the U.S. has previously restricted exports in order to secure its own vaccine supply. The epidemic is disrupting the global supply chain as a clever woman cannot cook without rice.
That said, the vaccine shortage is one thing. Another is the rate at which India is able to get vaccinated. Even if there is an adequate supply of vaccine, the current medical infrastructure, and medical staffing will not be able to complete vaccinations fast enough.
Sixth, why is there an oxygen shortage in India?
In India today, a large number of newly crowned patients are not being treated because of lack of oxygen. The world is donating oxygen to India. Previously, when the epidemic spiked in the UK and the US, we only heard about the shortage of ventilators, but we did not seem to hear about the shortage of oxygen. Why is there a shortage of oxygen in India?
In fact, oxygen is a more basic medical supply than a ventilator.
Because neocon is a lung lesion that causes hypoxia, the most basic supportive treatment for treating a patient with neocon is oxygen infusion to replenish the insufficient oxygen in the body. At this point, the patient’s lungs still have some function.
When the lung function declines further, only then is the patient put on a ventilator. It is only when the heart and lung function are not working that the membrane lung (Yerk membrane) is used.
So, India is in fact lacking more basic medical facilities than ventilators. Getting enough oxygen first can save the lives of a large number of patients whose conditions have not yet progressed to critical.
The demand for oxygen by Indian patients, as the epidemic worsened, surged to.
The need for oxygen for patients in India.
VII. What are the possible global implications of the Indian outbreak?
- Spread of the Indian variant
The most direct global impact of the Indian epidemic is the spread of the variant virus. The Indian variant has already spread to more than 20 countries, and it is worrying whether it will trigger similar disasters in other countries around the world in the coming months.
Currently, the UK, South African and Brazilian variants have spread globally, accounting for 72%. In particular, there has been a significant increase in the last two weeks, a phenomenon that warrants special vigilance. Variant viruses are usually the driving factor in causing new outbreaks and resurgence of the epidemic. As in the case of the UK variant that broke out late last year, it has since set off second, third and fourth waves of outbreaks in many countries around the world.
- Vaccine supply
Since India is home to the world’s largest vaccine manufacturer, the Indian outbreak has also led to a direct impact on global vaccine supply, so there will be a ripple effect on the rest of the world. Many countries are now counting on vaccinations, and the lack of supply makes it difficult to prevent the epidemic.
“No one will be safe unless every single person is safe.”
A thought-provoking quote from a BBC report on the tsunami outbreak in India reminds us that globally, “unless everyone is safe, no one will be safe.”
The global epidemic of the new coronavirus has been going on for more than a year, and one wave has not yet subsided, but another has. If infection levels are high in one country, it is likely to spread to other countries. Even with travel restrictions, screening and quarantine, the virus can still leak out. For example, on a recent flight from India to Hong Kong, about 50 passengers tested positive for the new coronavirus.
The outbreak of the virus in India is not just a crisis for India, but actually for everyone in the world.
At the same time, the succession of outbreaks is a cause for reflection: despite all the efforts made to develop vaccines, antiviral therapies, social distance, isolation, etc., why does the global pandemic seem to have not been fundamentally resolved and is still on the rise overall as of today? According to the WHO’s outbreak report, the number of confirmed cases worldwide in just one week last week was almost as many as the total number of cases in the first five months of the global outbreak just last year.
In an interview with CNN, Dr. Farah Husain, the head of an intensive care unit in India, said the level of devastation in the Indian wave of the epidemic is “like the coming of the end in the biblical book of Revelation.”
“Patients were rushed into hospitals and almost all wards were filled overnight,” she described, adding, “The second wave of the virus was very infectious, very aggressive. We felt very, very tired. The fact that we couldn’t control the growth in numbers was a shock to us. It’s like … there’s this virus in every house.”
The outbreak in India is certainly an early warning to the world, so no one should take it lightly while it’s not really over.
The global scourge, which has lasted for more than a year, also makes people reflect: there has been rapid development of science and technology and rapid progress of material civilization, but why can a small virus exhaust the whole world? Are there still deficiencies in the prevention and treatment of epidemics in our entire humanity?
The catastrophic moment of an outbreak in every country or region is an opportunity for us humans to return to reason, reflect deeply, and then improve. Personally, I believe that in the face of an epidemic, only by constantly maintaining this humble, self-reflective mindset and correcting all direct and indirect factors that may lead to an epidemic disaster will it be possible to find the real fundamental way to prevent the epidemic and truly and completely overcome it. I hope this day is not too far away.
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