India Alert

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.