The photos emerging from India are horrendous – bodies piling up in the street, funeral pyres everywhere, hospitals inundated with sick people – as the country battles its worst Covid crisis to date and doctors warn of an imminent collapse of the health system. On May 1, the country recorded in one day over 400,000 cases, while averaging some 3,000 deaths per day. By all accounts these figures are greatly underestimated.
What went wrong? Earlier this year, India seemed to have achieved what every other country dreamt of – it had greatly reduced the number of infections per day and its Covid wards lay almost empty.
What happened to create so dramatic a turnaround in such a short period of time?
Some say it is the result of complacency on the part of the government which recently allowed large gatherings and political rallies. Some point the finger at a new homegrown variant called B.1.617. Others attack the country’s slow pace of vaccination: India began its vaccination campaign on January 16 and, to date, has vaccinated just 3.6% of its population. And there could also be a reverse explanation. The first vaccine shot is often followed by a peak in the infection rate (as witnessed in Israel, the UAR, the UK and Chile) and this could be due to the phenomenon known as ADE (antibody dependent enhancement), a phenomenon that occurs when a vaccine stimulates the production of antibodies that facilitate, rather than block, the entry of a virus. Although India’s vaccine drive has been limited, it still tots up to a great number of people: to date 124 million have received one dose of the vaccine and 24 million 2 doses. Could these figures be in any way responsible for the current epidemic? The data coming out of India does not state what percentage of cases comprise partially or fully vaccinated people. This is called the “breakthrough infection rate.” The New York Times, however, reported on Friday that 37 fully vaccinated doctors at Sir Ganga Ram Hospital in New Delhi came down with Covid in April. The doctors had been vaccinated with the AstraZeneca vaccine.
With its 1.3 billion population, densely populated cities and rudimentary health services, India could have suffered devastating consequences from the Covid epidemic. And this indeed was the fear when, after a slow takeoff, the virus spread like wildfire across the Indian continent. But, as the West grapples with a super-contagious second wave, India seems to have achieved what every country aspires to – it has flattened the curve dramatically, falling from a peak of 90,000 cases per day in September 2020 to 12,000 per day at the end of January 2021.
And it has done this without numerous lockdowns and without vaccines. India imposed one two-month lockdown last year and its vaccination program began only in mid-January. The curve, in the meantime, had begun to dip sharply already in November 2020.
Two main reasons have been put forward for this surprising situation. It could be that India achieved herd immunity relatively quickly. According to a recent survey, half the population in major cities such as Delhi, Mumbai and Pune have antibodies, meaning they were exposed to the virus and are now protected. The other reason for the low level of the epidemic is India’s young population. More than half the country’s population is under 25 and just 6.5% are over 65. Dr. Randeep Guleria, Director of the All India Institute of Medical Sciences seemed to confirm this theory: “In certain areas, like large cities, we have come close to achieving a good amount of immunity – if not herd immunity, close to it.”