NEW DELHI – Two months ago India looked like a coronavirus disaster zone.
Reported infections near 100,000 a day, deaths skyrocketed, and India appeared poised to outperform the United States in total registered cases.
Today the situation in India is very different. Reported infections, deaths, and the percentage of people who test positive have all decreased significantly. In contrast, infections are increasing in Europe and the United States.
However, doubts remain about the reasons for India's decline, and some researchers say the results are at least partially due to a possible change in tests, although researchers say they don't have access to full data to really get the bigger picture know. Experts generally agree that the number of infections has far exceeded efforts to track them in India as elsewhere, and that infections in the country could get significantly worse.
There has also been a shift in collective thinking, and experts fear that India has started to lower its vigilance. After an intense lockdown in the spring and restrictions at social gatherings in the summer, the government has continuously activated the clearance. There is no question of locking again.
The general mood seems to be, "Let's move on."
Mobility data shows that Indians have returned to shopping areas and public spaces. Many do not wear masks. A large part of the population seems to have come to terms with the risk of infection.
People say, 'What the hell, we have to learn to live with it. God knows how long it will take, ”said Dr. Naresh Trehan, cardiologist and head of the Medanta hospital chain near New Delhi.
In many places he added, “People celebrate like there's no tomorrow. So when you do such things, you must suffer. "
Many doctors here believe that it is only a matter of time before cases skyrocket again. Other countries, including the US, France and Germany, believed the worst virus days were behind them only to hit new highs.
Parsing the outbreak history is difficult anywhere, and the next few weeks could complicate the picture. Cooler weather could lead to an increase in infections. The Hindu Christmas season, when millions of people travel to relatives and flock to stores to collect gifts for Diwali, Hinduism's festival of lights, begins.
Air pollution in India's cities is on the rise every fall and winter, and doctors fear that toxic air could lead to more hospitalizations and deaths from Covid-19. There are peaks in some areas, although national numbers are falling. New Delhi, for example, is currently reaching record highs.
"The unexposed, the elderly, the young, who missed the first two waves," said P. Umanath, a doctor and officer who helps deliver test kits in Tamil Nadu state.
The Institute of Health Metrics and Evaluation at the University of Washington predicts India's cases will pick up again soon, exceeding a million daily infections – many of which were never discovered – by the end of the year, even assuming India is wearing not generally accepted by masks.
However, official numbers suggest for the time being that the coronavirus is on the decline. From a peak of nearly 98,000 daily infections on September 16, the average dropped to about 46,000 cases per day for the past week. The daily virus death toll has dropped from 1,200 in mid-September to around 500, and the per capita death toll in India is still much lower than many other countries. According to official figures, India had around 8.5 million infections, followed by the United States by around 1.5 million.
The government has claimed credit and led its spring lockdown and a public awareness campaign despite urging the Indian people to remain vigilant.
"Things are getting better, ”said Harsh Vardhan, India's Minister of Health. "There is no room for complacency, however."
Several prominent scientists and doctors have been reluctant to accept that India's overall infections are falling, saying the lower numbers could be explained by the increased use of less reliable tests and fewer tests.
The number of tests done each day varies, but averages around 1.1 million over the past two and a half months, according to the Indian Council of Medical Research, the top government agency that collects Covid-19 data.
And the council points to a drop in the positivity rate across the country, or the proportion of tests done that detect the coronavirus, to 3.7 percent this week from 8.6 percent in mid-September.
The council also said the country had reduced its reliance on rapid antigen tests, which detect viral proteins called antigens and are considered less sensitive than other tests, from 47 percent in mid-September to 41 percent.
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Things to know about testing
Confused by Coronavirus Testing Conditions? Let us help:
- antibody: A protein produced by the immune system that can recognize and bind to certain types of viruses, bacteria or other invaders.
- Antibody test / serology test: A test that detects antibodies specific to the coronavirus. About a week after the coronavirus infects the body, antibodies start appearing in the blood. Because antibodies take so long to develop, an antibody test cannot reliably diagnose an ongoing infection. However, it can identify people who have been exposed to the coronavirus in the past.
- Antigen test: This test detects parts of coronavirus proteins called antigens. Antigen tests are quick and only take five minutes. However, they are less accurate than tests that detect genetic material from the virus.
- Coronavirus: Any virus that belongs to the Orthocoronavirinae virus family. The coronavirus that causes Covid-19 is known as SARS-CoV-2.
- Covid19: The disease caused by the new coronavirus. The name stands for Coronavirus Disease 2019.
- Isolation and quarantine: Isolation is separating people who know they have a contagious disease from those who are not sick. Quarantine refers to restricting the movement of people who have been exposed to a virus.
- Nasopharyngeal smear: A long, flexible rod with a soft swab that is inserted deep into the nose to collect samples from the space where the nasal cavity meets the throat. Samples for coronavirus tests can also be taken with swabs that don't go as deep into the nose – sometimes called nasal swabs – or with swabs from the mouth or throat.
- Polymerase chain reaction (PCR): Scientists use PCR to make millions of copies of genetic material in a sample. With the help of PCR tests, researchers can detect the coronavirus even when it is scarce.
- Viral load: The amount of virus in a person's body. In people infected with the coronavirus, viral loads can peak before symptoms, if any.
Data from the more reliable tests – called polymerase chain reaction tests or PCR tests – showed a similar decrease in infections, said council director general Balram Bhargava.
"We can clearly see this downward trend," said Bhargava.
Even more generally, scientists believe tests cannot capture the full spread of the disease in India or any other country.
Research on blood samples has shown that at least 15 percent of residents of certain urban areas are already infected with the virus. A new blood test estimated that more than a quarter of the people in Karnataka, a large southern state with more than 60 million people, were already infected.
How many people in India have contracted the disease and may have developed protective antibodies is the big question. A government-backed study, based on mathematical projections and using a model typically used to track disease progression, estimated that nearly a third of the country was already infected with the virus. The scientists estimated the number of undetected cases for each recorded infection using data showing transmission rates in India, the number of people infected and the number of recoveries.
While other scientists question this study, they believe infections have hit 200 million, or at least 15 percent of the population, undetected.
"The government and the public have focused on recovery and the minor deaths and decided to let the virus take its own natural course and work towards herd immunity if that can be achieved," said Bhramar Mukherjee, professor of epidemiology at the University of Michigan's School of Public Health following India closely.
Controlling the outbreak in India would not be difficult under any circumstances. A large part of the population lives in a confined space. The health system is severely underfunded. The government is a free-running democracy that does not exercise the same control over a nation as China.
Like many other countries, India imposed a major lockdown that brought the economy to a standstill. But much of that was lifted after two months when officials concluded the restrictions were killing the economy.
India has room to expand. Although some people work from home, it is a luxury most can only dream of. Countless millions have to circulate on the streets every day to feed their families.
"India could shine like a Christmas tree for the next three or four months," said Michael Osterholm, an epidemiologist at the University of Minnesota. "We welcome the decrease in cases, of course, but we recognize just like any other country that it will come as soon as you let go of the brakes."
Hari Kumar contributes to the reporting.