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Jvarasura's Time : The Rise of SARS-Cov-2 in India

A few days prior, over a work-related video conference, an engineer based in India opened to those present their feelings on the state of their country. It was a depressing story, of death and many more infections on the campus (some of which must result in more deaths). He mentioned the incredible sadness that is affecting so many in their country, the frustration at the lack of resources the country has as the pandemic's infections and fatality rates continue their accelerating and upwards trend. This is obviously not just one individual story; as the death toll mounts and city crematoriums cannot cope with the number of death, makeshift pyres are build parking lots. Hospitals are unable to find beds, there is insufficient access to tests, even oxygen is in impossibly short supply.

Aggregate data understates the seriousness of the situation. It is certainly true, with a large population that India could be expected to have a large number of cases. How does it fare on a pro-rata basis? Certainly, when measured against confirmed cases per million, India's aggregate score of 13,487 per million is below the global average of 19,393 per million. From this perspective, at first glance, India is doing much better than, for example, the United States (99,349 cases per million), the United Kingdom (64,743 cases), France, (85,520), Germany (40,228), and so forth. But this misses out that such advanced economies have much higher testing rates; the US 1,338,318 per million, the United Kingdom (2,274,438), France (1,156,160), Germany (660,557), compare quite strongly to India's 204,480 tests. In other words, India's real infection rate is almost certainly much higher than what the confirmed case figures indicate (the Victorian Chief Health Officer tweeted the daily figure is "probably over two million".

But what is truly terrifying in India is not just the aggregate values or the relatively low level of testing, but rather that extremely rapid expansion of the number of infected and dead. Every epidemiologist worth their salt at the very start of this pandemic was calling for the need to flatten the curve. Now we are beginning to see what happens when the curve overwhelms the capacity of a medical system to cope. Whilst India did manage to keep the virus under some semblance of control for most of last year, coupled with some very strong movement restrictions, as recent as March this year the Indian health minister Harsh Vardhan declared the country was "in the endgame" of the Covid-19 pandemic. Reality has a habit of contradicting political marketing, and now what we are witnessing is the collapse of a medical system in a country of 1.366 billion people.

The United States and the United Kingdom both may have more cases per capita, but since January the number of new cases has declined rapidly. France has a slow increase in numbers through mid-Nov to mid-April, but now with some signs of decline. Germany had a rapid increase in November, a decline in January, and now has a flatter number of cases through April. The reality is that the medical system in the advanced economies, combined with sensible public policy on mask-wearing, movement restrictions, and availability of vaccines, is gradually keeping the curve down. This is not the case in India. We are witnessing a disaster unfolding in front of our very eyes. The tough reality is that wealthy countries need to look beyond their own borders and their managed control of the pandemic with generosity to a place that it is out-of-control. It is to some credit that the new Biden government in the United States has just brought in oxygen cylinders and test kits. Much more will need to be done and our politicians must be lobbied and cajoled to provide the necessary aid, as they are unlikely to do out of their own generosity. We individuals can make our contributions - organisations like Médecins Sans Frontières are already engaged in direct and practical hospital work. If we cannot do anything in person, we can always provide the money for organisations that do. Donate to MSF; help save lives.

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