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NEW DELHI: When the COVID-19 pandemic gripped India, there were fears that it would sink the fragile healthcare system of the world’s second most populous country. Infections rose dramatically for months, and at one point, India looked like it could surpass the United States as the country with the highest number of cases.
But infections began to plummet in September, and now the country reports around 11,000 new cases a day, compared with a peak of nearly 100,000, which leaves experts stumped.
They have suggested many possible explanations for the sudden drop, seen in almost every region, including that some areas of the country may have achieved herd immunity or that Indians may have some pre-existing protection against coronavirus.
The Indian government has also partly attributed the drop in cases to the wearing of masks, which is mandatory in public in India, and violations lead to hefty fines in some cities. But experts have pointed out that the situation is more complicated as the decline is uniform even though compliance with masks is declining in some areas.
People wait outside a health center to get tested for COVID-19 in New Delhi, India, on February 11, 2021 (Photo: AP / Manish Swarup).
It is more than an intriguing puzzle; Determining what’s behind the drop in infections could help authorities control the virus in the country, which has reported nearly 11 million cases and more than 155,000 deaths. Around 2.4 million people have died worldwide.
“If we don’t know why, you could unknowingly be doing things that could cause an outbreak,” said Dr. Shahid Jameel, who studies viruses at Ashoka University in India.
India, like other countries, overlooks many infections and there are questions about how it is counting deaths from viruses. But the tension in the country’s hospitals has also eased in recent weeks, one more indication that the spread of the virus is slowing down. When registered cases topped 9 million in November, official figures showed that nearly 90 percent of all intensive care beds with ventilators in New Delhi were full. By Thursday, 16 percent of these beds were occupied.
That success cannot be attributed to vaccines, as India only started giving injections in January, but as more people get vaccinated, the outlook should be even better, although experts are also concerned about the variants identified in many countries that seem to be more contagious and some treatments and vaccines are less effective.
Among the possible explanations for the drop in cases is that some large areas have reached herd immunity, the threshold at which enough people have developed immunity to the virus, by getting sick or getting vaccinated, that the spread begins to slow, Vineeta Bal said. . studying immune systems at the National Institute of Immunology of India.
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But experts cautioned that even if herd immunity in some places is partially responsible for the decline, the population as a whole remains vulnerable and must continue to take precautions.
This is especially true because new research suggests that people who got sick with one form of the virus can be re-infected with a new version. Bal, for example, pointed to a recent survey in Manaus, Brazil, which estimated that more than 75 percent of people had antibodies to the virus in October, before cases spiked again in January.
“I don’t think anyone has the final answer,” he said.
And, in India, the data is not so dramatic. A nationwide antibody screening test by Indian health agencies estimated that around 270 million, or one in five Indians, had been infected by the virus before vaccines began, which is well below the the rate of 70 percent or more that experts say could be the threshold. for the coronavirus, although even that is not certain.
“The message is that a large proportion of the population is still vulnerable,” said Dr. Balram Bhargava, who heads India’s leading medical research body, the Indian Council for Medical Research.
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But the survey offered another perspective on why India’s infections might be declining. It showed that more people had been infected in Indian cities than in their villages, and that the virus was moving more slowly through the rural interior.
“Rural areas are less densely crowded, people work more in open spaces and houses are much more ventilated,” said Dr. K Srinath Reddy, president of the Public Health Foundation of India.
If some urban areas are approaching herd immunity, wherever that threshold lies, and are also limiting transmission through masks and physical distancing and therefore seeing a decline in cases, then maybe The slow speed at which the virus is passing through rural India may help explain sunk numbers, Reddy suggested.
Commuters crowd Churchgate train station in Mumbai, India, on Feb. 12, 2021. (Photo: AP / Rajanish Kakade)
Another possibility is that many Indians are exposed to a variety of diseases throughout their lives (cholera, typhoid fever, and tuberculosis, for example, are prevalent) and this exposure can prepare the body to mount a more initial immune response. strong to a new virus.
“If the COVID virus can be controlled in the nose and throat, before it reaches the lungs, it does not become that serious. Innate immunity works at this level, trying to reduce the viral infection and prevent it from reaching the lungs, ”said Jameel, from Ashoka University.
Despite the good news in India, the emergence of new variants has added another challenge to efforts here and around the world to control the pandemic. Scientists have identified several variants in India, including some that have been blamed for causing new infections in people who already had an older version of the virus. But they are still studying the implications for public health.
Experts are considering whether the variants may be driving an increase in cases in the southern state of Kerala, which had previously been hailed as a plan to fight the virus. Kerala now accounts for almost half of current COVID-19 cases in India. Government-funded research has suggested that a more contagious version of the virus may be at play, and efforts are underway to sequence its genome.
Since the reasons for India’s success are unclear, experts worry that people will let their guard down. Much of India has already returned to normal life. In many cities, the markets are full of people, the roads are crowded, and the restaurants almost full.
“With the numbers reducing, I feel like the worst of COVID is over,” said MB Ravikumar, an architect who was hospitalized last year and recovered. “And we can all breathe a sigh of relief.”
Perhaps not yet, said Jishnu Das, a Georgetown University health economist who advises the state of West Bengal on managing the pandemic.
“We don’t know if this will come back after three or four months,” he warned.
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