Monthly Archives: January 2022

Just five days ago I wrote about my fears of what is about to happen in India. The situation is finally getting a little bit of press, but not enough.

The official death toll in India stands at 483,000. However, the actual mortality is considerably higher. In one study, three different methodologies were used to estimate excess deaths in India from COVID up to June 2021, which was in the tail end of that wave. These estimates ranged from 3.4-4.9 million excess deaths due to COVID.

In only five days time, the data paints a frightening picture as the omicron variant begins to spread in the country. One can now easily see this exponential growth of cases currently compared to the graph from five days ago.

The red line in this graph is the slope, or can also be referred to as the first derivative. It’s a measure of how quickly cases are growing or slowing. and the distance from zero as represented on the right axis is directly proportional to the rate of growth or slowing. It was that inflection on the graph a few days ago that caught my attention much more than the epidemic curve itself because the massive scale of the last big wave dwarfed the current incidence of cases.

The next piece to look at is how quickly that 1st derivative is growing. That allows for a comparison between the last wave and the current one to see if there is much difference. Just by eye, it looks as if the current wave is considerably steeper. The 2nd derivative is useful to assess that assumption.

The graph below has that same 1st derivative (the red line) but the scale for it is on the left. The 2nd derivative is in blue and is on the right.

The question that this can answer is whether the rate of the rate of acceleration is even faster this surge. To help understand how this works, look at the red highlighted box on the right. The bottom left corner of it is aligned with the start of the climb of the first derivative. The top right corner is aligned with the current height of the first derivative. The height is what is important for the comparison.

The yellow highlighted box is the same height as the red one. The bottom left corner starts at the corresponding start of the earlier surge on the 1st derivative. The next thing to do was to widen that box to find the point at which the 1st derivative was the same height as seen in the red highlight. It’s obviously quite a bit wider.

Each of those boxes has been placed with their left edge corresponding to Sep 1, 2021 on the date scale at the bottom and they overlap. Think of each as being pushed to the left edge of the dotted line surrounding them.

If you look at the now orange box (from overlapping red and yellow), you can see that this current rate of the rate of acceleration (not a typo) was reached in about two weeks, whereas in the prior surge, it took about 5-6. That is what we would expect with the omicron variant because of it’s much higher rate of spread.

This can also be seen by the higher reproduction rate of cases this surge compared to the prior one.

That could easily spell a major disaster for India. Currently, it’s estimated that 63% of the population has had one dose of vaccine and only 45% has had two. The epidemic curve against vaccinations is in the graph below.

I have already discussed to some extent how this is really bad for not just India, but the entire world. Until we have N95 or equivalent masks, adequate testing, and a fully implemented mass vaccination program globally, this cycle is likely to continue due the much higher chance of new variants arising as the virus has more chances to mutate and replicate. We are YEARS from being out of the woods from COVID.

The official COVID death toll in India currently is 481,770. However, this number is likely many times lower than the actual toll. A paper was published in July last year that estimated the death toll to be between 3.4-4.9 million.

Most people can probably remember some of the awful images of people trying to find oxygen and the massive numbers of funeral pyres in April and May of last year when the country was officially peaking at 400,000 cases/day, although that’s likely a gross underestimate as well. Most of that surge was due to delta, which is also thought to have originated in the country.

Something alarming presented itself in the data from India. When looking at the epidemic curve, it doesn’t appear that there is anything very concerning right now. Part of that is due to the massive scale of the big surge there last year However, I have used the first derivative of the epidemic curve to identify rapid growth or slowing of cases (the red line). It’s also useful to project about 10 days out the rate of case growth or slowing. It may not look like much now, but it matches the rate of growth in the earliest part of the delta surge.

When zooming into the epidemic curve, it becomes readily apparent that there is an exponential curve starting in India.

The proportion of omicron found from sequencing samples in India also suggests that this curve is the start of the impact of omicron there. It should be noted how much faster omicron spreads in other countries causing a much steeper curve, so this is a veery ominous warning sign.

This is also very concerning given how small a proportion of the population has received either one or two doses of vaccine in India.

Not only is this a potential catastrophic disaster for the people of India, but the repercussions of it will be felt throughout the world.

Most Americans are completely unaware the role India plays in supplying generic drugs to the US. In addition, almost 70% of the active ingredients India uses in manufacturing the pharmaceuticals originate in China. At one point, the combination of the supply chain from the two countries was about 80% of the US generic pharmaceutical supply. While that number has come down considerably, the US is still very dependent on the production from both countries.

India is also the major supplier of COVID vaccine to the world, particularly in less developed countries. Any impacts on vaccine production in India will be felt globally.

The more people who become infected with COVID, the more likely the emergence of another variant of concern that could start an entirely new wave of infections which may not have coverage by any vaccine. One only needs to look at the impacts of both the delta and omicron variants to understand the potential scale of impact on India. The population size and density makes this a very significant risk.

One thing that has been very notable is how politically divisive the pandemic has become in many parts of the world. The pandemic is one area where we need to come together not only as a nation, but as a global community to use evidence-based science and medicine to mitigate the impacts of the pandemic. The big test for the US will be starting this month. If we can’t start caring for each other as countrymen, there seems little chance that we will be able to do so as part of global community.

My friend Crystal Evans wrote a personal account of what it is like to have a disability during a pandemic. The notion that has been pushed that we can easily protect those at high risk of disease or with complex medical needs is simply a lie. Our country has not been able to do that with healthy people. How on earth does anyone who supports the Great Barrington Declaration think we can do that well with those who need support?

Here are Crystal’s words.

As a medically complex individual who relies on medical supplies and the healthcare system to stay alive, I live a side of the pandemic many of you have the privilege NOT to experience.

I have a genetic neuromuscular disease, and for me, infections can result in disease progression. In December 2015, I got what would have been “just a cold” for many – which turned into bronchitis, but because I had underlying neuromuscular disease, I lost remaining respiratory function and have been ventilator dependent ever since. The first 4 years post-tracheostomy were generally manageable, but when COVID hit, the dynamics of being medically complex changed everything.

Since April 2020, I’ve been dealing with ventilator supply shortages and medical supply rationing. I’ve dealt with painful airway infections as a result of prolonged use of ventilator supplies, and have spent months to navigate health insurance battles for covering alternative solutions as supplies are scarce. Tracheostomy tubes are now among medical supplies in a shortage. And tracheostomy groups are full of younger people ending up trached after long ICU stays with COVID.

I’ve spent the past month with barely any home care coverage because everyone is ending up quarantined after getting exposed to COVID. And too many people currently need COVID tests for PCAs to quickly access appointments for them. Many of my friends are in perpetual home care coverage crisis too – having to weigh the risks of exposure vs lack of assistance for basic Activities of Daily Living.

Please don’t assume that at-risk people can simply “stay home” to avoid the virus. While you’re out living your life, you’re also risking exposing healthcare workers many of us depend on. I haven’t left my house at all in over 6 weeks. Yet I’ve had exposures in my home by healthcare workers, without actually going anywhere.

Managing our underlying conditions is harder now than ever. The hospitals we used to turn to when we were sick have become some of the least safe environments for us. As a vent user, the unit that has nurses trained to care for me has become a COVID unit. As a result, many of us need to manage care in our homes for issues that was previously hospital-level care. I had sepsis 3 times early in the pandemic due to supply chain issues, but was the one managing my own round-the-clock IV meds, and medical needs. I’ve drawn my own blood dozens of times in the past 2 years to pass off to community paramedicine to take it to the lab.

Many of my friends with underlying conditions can’t get outpatient care or VNA care for basic disease management because the healthcare system is overwhelmed. I’ve also seen several friends with disabilities die directly because of these home care coverage shortages.

The compassion America had for frontline workers in Spring 2020 is long gone. People who don’t feel they are at risk have long moved on with their lives, with little regard to what the healthcare workers continue to be up against.

I’ve seen the incredible amounts of stress home care nurses and VNA therapists are under throughout the pandemic – trying to keep those who are at-risk stable in the community to protect us, and to save those hospital beds for patients who desperately need them. Home Care Agencies and VNAs are short staffed, the workers are exhausted, and at multiple points of the pandemic several have been in tears in my home.

Some of the ongoing nursing staffing issues I’ve dealt with stem from nurses getting long COVID, leaving them unable to work or having to reduce their hours. I’ve also seen 2 of my home care nurses lose their husbands to COVID.’

While healthy people might see increases in local case numbers, but not feel personally impacted or assume it’s “fear mongering,” those of us who are high-risk depend on that local data as it may mean re-thinking basic daily healthcare.

For us to stay healthy during COVID surges might mean eliminating certain services to reduce our contacts – like physical therapy, homemaking, reducing PCA coverage, avoiding in-person errands altogether, and only accessing care via telemedicine. Those of us like myself with inborn errors of metabolism may have to re-think meal prep and how to access medical diets if our kitchens are inaccessible.

I am one of the 19% of American’s living with a disability. While my ventilator and wheelchair make my disability visible, 10% of American’s are living with an invisible disability, and many of these individuals are also immunocompromised or high-risk with COVID. You can’t tell just by looking at someone what their risk factors are. We are surrounded by high-risk individuals in our community, as well as those who live with or care for high risk family members. They are people of all ages. – our children’s classmates, our colleagues, our neighbors, fellow customers in local businesses.

Not every high risk individual can be effectively vaccinated – some immunocompromised people may never develop antibodies post-vaccination. Others may have drug reactions or other risks with vaccination due to their underlying disability. Dec 8 the FDA announced EvuShield, an antibody for high-risk individuals, but last week stated that the US Government only purchased enough for 10% of the 7 million adults in the US who are eligible.

Over the past 2 years, the COVID-19 pandemic has made it clear how devalued the lives of seniors and people with disabilities are by many in our communities. To dismiss the virus as “only people who are 65+ or with underlying conditions are at risk” is incredibly ableist. We are people too. We have jobs, we have families, we have dreams, accomplishments, and goals – just like anyone else. Our age or disability shouldn’t make us worth less than any other person.

Please remember – statistics aren’t just statistics. There is a person behind each case, a family behind each death, a life changed by each Long-COVID infection. But empathy seems to be gone, because the people statistically impacted the most by the pandemic are disabled, elderly and/or people of color. Too many people are more focused on their “rights” and their “freedom” no matter how it affects those in their community.

When you blow off the virus as “just a cold” or “the flu” it’s dismissive to the families of nearly 850,000 American’s who have died from the virus, to the thousands who have spent weeks in the ICU, as well as those who are living with Long-COVID. It shouldn’t matter what the person’s age was, or if they had underlying conditions. They are people who have lived in our community, whose lives matter.