Can it happen here?Deterioration of COVID situation in India

April 28, 2021-COVID-19 Outbreak In India, oxygen is present in record daily cases Ventilator Transmission speed that indicates that there is a lack of execution and that the situation is getting worse before it gets better.

Is it possible that such a scenario will be implemented in the United States in the future?

Experts generally agree that the United States is in a better position due to the recent increase in COVID-19 vaccination. However, there are some unclear points. vaccination Is it effective? How about the variant? Will mitigation of public health measures in some states play a role?

One thing is certain: India reported more than 300,000 new COVID-19 cases on April 27 for the sixth consecutive day. In addition, considering 20% ​​of the total, the official death toll of 198,000 can be underestimated. Coronavirus The tests there are back positive for the infection.

Humanitarian crisis

Ashish Jha, MD, Dean of the Brown University School of Public Health in Providence, Rhode Island, said a new case report from India could be “extremely underestimated” at a media briefing on April 27. Said that was high.

Similarly, the total death toll of about 200,000 is “clearly underestimated,” Jha said. “The best estimate is 10 times that.”

“The virus is swallowing the people of our city like a monster,” said Bhopal city official Mamutesh Sharma. I told the Associated Press.

“There is no doubt that there is a humanitarian emergency in India right now,” said Dr. Michael Head, a senior researcher at Global Health at the University of Southampton in the United Kingdom. “There are many stories about the collapsed health care system, and there are reports of inpatients and the body burning with firewood in the streets lacking oxygen.”

India’s mortality rate has not kept pace with the surge in new cases and is a lonely bright spot in the numbers. Mortality is often several weeks behind infection, which can change the situation.

The United States initially promised to send raw materials vaccine Added to India and later Will ship 60 million doses of AstraZeneca vaccine Overseas to support the catastrophes that are occurring in India and other countries. India has reported 14 million cumulative cases, second only to the 32 million reported so far in the United States.

“The second COVID-19 wave in India, which began on February 11, 2021, is in a difficult situation as it exceeded 200,000 people a day on April 14, 2021,” said Dr. Rajesh Ranjan and colleagues. It is written as follows. Preprint Study published online on April 21 MedRxiv..

The daily rate of 200,000 new cases is more than double what the country experienced at its first peak. “Data now suggest that the virus is much more infectious than the first wave, but the daily death toll per infection is low,” they write.

Limited outbreaks are likely to occur in the United States

When asked if such a surge could unfold in the United States, Kartik Cherabuddi, MD said. Said, “We have recently experienced this in Michigan and Ontario, so we must be vigilant.”

Vaccination is the most effective strategy to prevent future surges, added Cherabuddi, an associate professor of infectious diseases and global medicine at the University of Florida School of Medicine Gainesville. “There has been a great response so far, but there are signs that demand will slow. We must advocate removing all barriers to vaccination.”

The slowdown in US vaccination is not surprising, Jha said. “I think the 7-day moving average of over 3 million is gone. That number will continue to decline.”

He emphasized that delaying vaccination is not a failure. “That’s exactly what we expected. Vaccine enthusiasts are over. Vaccination of everyone else will be delayed.”

Cherabuddi predicted that the United States is likely to see outbreaks in smaller areas compared to another national surge.
“The availability of vaccines in the United States is certainly an advantage, but more than a quarter of the population is fully vaccinated, but unless we succeed in combating false information about vaccines, we Most can remain unvaccinated. This will leave them unvaccinated. Pandemic It will lead to a continuous cluster. ” Tom Frieden, MD, former CDC director, president and CEO of ResolvetoSaveLives, said in an interview.

“The contrast with the United States is almost jarring,” Ja said.

The United States is at the end of the “Miniforce Wave”. For the first time in a month, there are less than 60,000 new cases per day. He expects the overall decline in this new case to continue and welcomes 10,000 people, at least nationwide, who are more manageable per day if the United States fails to reach zero cases.

Jha agreed that a national surge is unlikely. But “I’m worried about US pockets.”

For example, he is particularly concerned about five states, Alabama, Arkansas, Georgia, Louisiana, and Mississippi, where vaccination rates are low and people can see a surge in summer when they move indoors to air conditioning.

View about variants

Ranjan et al., The latest wave in India may have been caused by a B.1.617 mutant of coronavirus, a “highly infectious double mutant”, a population of “faulty behavior”, and mitigation of interventions. It states that there is. They say more research is needed to determine if infections associated with B.1.617 are more or less serious than wild-type viruses.

Jha said the first identified B.1.1.7 mutant in the UK currently plays a greater role than other concerned mutants in India.

“The situation in India shows the need for both masking, distance and strategic closure to keep variants away and to expand vaccine production globally,” Frieden said.

He added that India has “huge capabilities” in vaccine production and could become a vaccine provider in South Asia by creating an mRNA vaccine production hub. Building a regional hub for vaccine production “takes longer than we want, so we must start now.”

Calm outlook

“The second wave in India looks much more volatile than the first wave, and unless strict measures are taken, the situation can quickly get out of control,” Ranjan et al. Wrote. Vaccination is essential, they add, but “given the large population of India and the current spread of viral mutants to remote areas of India, these strategies stop the spread of the virus. May not be enough. “

Frieden said the virus does not respect borders and the global community must work together.

“I’m trying to reach out to the hesitant and at-risk communities, spread vaccinations around the world as quickly as possible, and keep the spread as effective as possible, especially by keeping a distance from masking indoors. It is in the interests of individuals and groups, “says Frieden. Said.

“You can’t be dazzled by the light at the end of a tunnel in the United States,” he said. “The surge in India reminds us that the virus learns about us and adapts faster than we learn about it and adapts, and that COVID-19 is a continuous and increasing risk. I will. “

Interestingly, India is the world’s largest producer of vaccines, but “there was no largest deployment of vaccination, which means that only a relatively small number of 9% have been protected so far.” , Dr. Martin Hibard of Emerging Infectious Diseases said. He told the Science Media Center at the London School of Economics and Tropical Medicine.

In their study, Ranjan et al. Calculated the likelihood that each infected person could infect another person with the virus. This is known as the reproduction number (Rt). If Rt is greater than 1, each person can spread the virus to multiple others. India’s current Rt is around 1.37, up from 1.09 in September 2020.

Another indicator, case fatality rate (CFR), tends to drop from 3.5% at its first peak in India in April 2020 to 1.2% a year later. “The lowering of the CFR curve suggests a silvery lining of the mutant, which is relatively non-fatal,” wrote Ranjan and colleagues. “But given the rapid increase in cases at a very high rate, medical facilities will soon be completely squeezed and hospital beds and ventilators will not be available to people with significant needs. Is expected. This will result in CFR. “

India “not outside the forest”

Based on this model, researchers predict that the current peak of the second wave will occur in mid-May, when new cases are estimated to reach 360,000 people per day.

“Currently, much focus is on cities and large towns, but we must act immediately to prevent accelerated spread to the small towns and villages where the majority of the population lives. No, “said Cherabuddi, who is also affiliated with us. India COVIDSOS, A volunteer group of scientists, clinicians, engineers, policy makers and epidemiologists from around the world to help fight COVID-19 in India.

“The next four to six weeks will be very difficult for India,” Ja said. “India is never outside the forest.”

“It’s really important for us to remember that this is a pandemic,” he added. “The virus is rampant everywhere, but we are all at risk.”

One of the scenarios that is likely to occur next year or two is: “The United States, Europe, and some other countries have put out fires here and there due to outbreaks and are in fairly good shape, and much of the world is high. It’s about burning at the rate of infection, “Ja said. “It’s not the future that all of us want.”