For most of the past 11 months, Dr Sushila Kataria has worked 15 hours a day, seven days a week, attending to a rising tide of Covid-19 patients at Medanta Hospital, a large private institution in the outskirts of New Delhi.
Since the first cases in hospital – of Italian tourists who fell ill in March – Medanta has treated more than 11,000 Covid patients in its wards, intensive care units, quarantine facilities in hotels and home care programs. The Covid load peaked in November, with around 450 patients hospitalized and another 50 to 100 on a waiting list for beds.
“It was totally overwhelming,” said Dr Kataria, an infectious disease specialist who heads the service at Medanta. “November was the worst month. We could only see as many patients as we could refer. We were taking care of very, very sick patients in the outpatient clinic because there was no room in the hospital. USI. “
But doctors in the New Delhi area who treat Covid are now experiencing unexpected relief. The daily number of new infections in the capital has fallen sharply in recent weeks. Medanta now has only 25 Covid patients, and other hospitals in the city are also reporting many empty beds in Covid wards.
“To our relief and surprise, the number of cases has started to drop dramatically,” said Dr Kataria.
The trend goes beyond the capital. Nationally, new confirmed coronavirus infections in India have dropped precipitously, from nearly 100,000 new infections per day in mid-September to an average of 13,000 to 14,000 per day last week. At the same time, health research indicates that public exposure to the virus may have been much higher than previously thought.
As many more countries battle waves two and three and alarm new variants of the coronavirus, the drop in infections brings a fascinating perspective: Has the pandemic started to die out in India?
Some doctors and researchers are starting to speculate that populated Indian cities may be approaching the early stages of natural “herd immunity” – even before a vaccine was widely available – causing the spread of the virus to suddenly disappear. the pathogen.
“What we seem to have done is let the virus follow its path,” said virologist T. Jacon John, a retired professor at the Christian College of Medicine in Vellore, Tamil Nadu, in the south of the country. “By not flattening the curve at first, India has broken the herd immunity barrier and the epidemic appears to be easing naturally.”
This, in turn, fuels cautious optimism that India is emerging from the shadows of the pandemic, allowing it to repair an economy hit by a rigid lockdown, subsequent restrictions and public fear.
“I hope the worst is over,” said Dr Randeep Guleria, director of the Indian Institute of Medical Sciences and a member of the Indian government’s Covid-19 task force. “In some areas, like big cities, we may have come close to achieving a good level of immunity – if not the herd, nearby.”
The normally contained Reserve Bank of India was even more effervescent in a recent bulletin, praising the “growing likelihood” of a stronger-than-expected economic recovery as the disease threat recedes.
“India doubled him as Beckham,” the central bank said of the country’s pandemic curve. “Apart from the appearance of a second wave, the worst is behind us. The recovery is strengthening, and soon the winter of our discontent will turn into a glorious summer.”
After India detected its first hundreds of coronavirus infections in March last year, Prime Minister Narendra Modi imposed a draconian lockdown across the country, hoping to break the chain of viral transmission and to contain the pathogen.
With public transport suspended for months and consumers limited to buying food, medicine and cleaning supplies, India’s economy contracted 24% on an annual basis between April and June.
But the lockdown has failed to stem the spread of the virus in a country where millions of people live in clusters, sharing community bathrooms and taps, in overcrowded slums. From cities, the pathogen has apparently been transported inland, as the dismissed migrant workers return to their villages.
In total, India has reported more than 10.7 million confirmed infections with the coronavirus, the second highest count in the world, after the United States. But health experts agree the actual total was much higher, with most infections going unrecognized or recorded.
“The reported cases don’t even remotely reflect actual cases – they only reflect people who have been tested,” said Vikram Patel, professor of global health at Harvard Medical School. “For reasons we are not fully aware of, the virus has spread like wildfire in India – more than in any other country.”
In cities like Delhi, Mumbai and Puna, seroprevalence studies – which measure antibodies suggesting previous exposure to the virus – have indicated that more than half of residents have been exposed to the virus. One of those studies in Karnataka state estimated that there were 31 million infections there as of mid-August, including 44% of the rural population and 54% of the urban population.
But many people with antibodies don’t remember they were sick. “It is estimated that 30% to 40% of people may have had asymptomatic or mild infections and have not been tested,” Dr Guleria said. “Many of those who have developed moderate symptoms may have had Covid-19 without realizing it.”
India has reported more than 154,000 deaths from Covid-19. But, like the real number of infections, the real number of deaths will never be known, as most Indians still die at home, without the cause of death being formally determined. “We’ll never know how many people have died – no one counts,” Dr John said.
Even taking this into account, some researchers claim that the Covid death rate in India was probably not as high as in other regions.
One of the reasons for this could be the relative youth of the Indian population. Only 6.5% of them are over 65, compared to 20% in Europe.
Some experts also point to environmental factors that affect the immune system – although scientists point out that this hypothesis needs further study. “We have much less severe disease than the rest of the world, and much more asymptomatic infections,” said microbiologist Gagandeep Kang, who was involved in the production of the coronavirus vaccine in the country. “Part of the reason may be previous exposure to many other pathogens.”
“We live in an environment where we are constantly exposed to all kinds of pathogens and we learn not to overreact,” she added.
India does very little viral sequencing, which would allow scientists to monitor the particular variant of the disease prevailing in the country, which the government is currently trying to correct. But Kerala-based health economist Rijo John suggests India has so far had a much less virulent strain than elsewhere.
“It is generally accepted that we have a very mild form of the virus in India,” he said. “But it’s hard to predict the future.”
The daily number of new cases reported is certainly lower than the actual total of new infections – especially in rural areas, where testing infrastructure is weakest – but experts say there is no doubt that the pandemic is down sharply in India.
“It looks like the virus has really spread across the country,” Dr Kang said. “Maybe the reason the numbers are dropping is that most people have already been infected and the infection gives them at least 80% protection for months.”
‘Space to increase the crates’
With public anxiety over the disease now subsiding, India’s economy is recovering and, HSBC estimates, the economy is at 94% of its pre-pandemic level. But the recovery remains uneven, with demand for goods returning to pre-pandemic levels, but demand for services continues to decline by 30%.
Life also remains seriously disrupted by other means. Most of the country’s 270 million schoolchildren have not attended school since March, although some states have allowed the return of limited numbers of older students. White-collar workers have mainly worked from home for 11 months, while many older people have barely left home, due to the possibility of them remaining susceptible to infection.
Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policies, warns that further steps towards normalcy – such as reopening schools and workplaces – could be accompanied by a further increase in cases as people without immunity will be exposed to the virus.
“A lot of it is being left behind, but that doesn’t mean it’s over for good,” he said. “We have an artificial situation where we strike a balance, but if we go back to normal life there will still be a lot of room for the increase in cases.”
India has launched an ambitious vaccination campaign, aiming to immunize 300 million people by the end of August, including health workers and the elderly. But with only 3 million people vaccinated since the campaign began two weeks ago, reaching that goal will likely be a slow and protracted process.
In the meantime, localized coronavirus outbreaks are likely – like what’s happening in Kerala, the southern state that was once praised for its successful control of the virus. “If you look at the sites that performed well in the initial check, they are the ones that have the high level of infection today,” said Dr Kang. “And if there is a variant that escapes immune reactions, everyone will be back in the game.
At Delhi’s Medanta Hospital, Dr Kataria says the constant pressure of the past year – along with the physical isolation of her husband and two teenage children to keep them safe – has come at a price. “I was like, ‘I did everything I could do,’” she said. “We can’t think of ourselves as gods. We are human after all.”
While she is cautiously optimistic that the worst is over, she warns against complacency, given the potential for further outbreaks of cases, especially if a more virulent variant spreads across the country. “If the situation continues like this for a month, we can say that we have reached low numbers supported by immunity and vaccination,” she said. “But we have to keep our fingers crossed. These good times may not last forever.”