H5N1

Branswell: New analysis finds global Covid death toll is double official estimates

Via STAT, Helen Branswell writes: New analysis finds global Covid death toll is double official estimates. Excerpt:

A new analysis of the toll of the Covid-19 pandemic suggests 6.9 million people worldwide have died from the disease, more than twice as many people as has been officially reported. 

In the United States, the analysis estimates, 905,000 people have died of Covid since the start of the pandemic. That is about 38% higher than the current death estimate from the Centers for Disease Control and Prevention, 561,594. The new figure also surpasses the estimated number of U.S. deaths in the 1918 flu pandemic, which was estimated to have killed approximately 675,000 Americans. 

The analysis was conducted by scientists at the University of Washington’s Institute for Health Metrics and Evaluation. 

“We’re probably not yet at the global toll of Spanish flu and certainly not at the death rate from Spanish flu. But given what’s unfolding in India right now, given our expectation of continued deaths, Covid is going to rival Spanish flu at the global level in terms of the count, likely, before we see the end of this epidemic,” the institute’s director, Christopher Murray, told reporters in a briefing. 

Most countries have underreported deaths, Murray said. In many cases, the under-estimates seem to be a result of health systems being overwhelmed, and of insufficient testing. 

But in several cases it appears something else would have to account for the scale of the differences between the deaths countries are reporting and the excess mortality they have experienced during the pandemic, he said, pointing to countries like the Russian Federation and Egypt, where the estimated deaths, 170,000, are 13 times higher than the country’s official death toll, 13,529. 

Murray’s group estimates that by September, the global death toll from Covid-19 will reach 9.4 million, with India at that point surpassing the United States as the country with the highest toll. By September, the group’s models suggest that India’s Covid death toll will be 1.4 million people, and the U.S. toll will be 949,000. 

The estimates are of deaths directly related to Covid, and do not include deaths that resulted from the pandemic’s disruption of health care — for example, people who did not seek care for heart attacks because they were afraid to go to Covid-swamped hospitals.

India is hiding its Covid crisis – and the whole world will suffer for it

Via The Guardian: India is hiding its Covid crisis – and the whole world will suffer for it. Excerpt:

A few years ago, as Narendra Modi came into power, I worked on an investigative report about India hiding its malaria deaths. In traveling from tribal Odisha to the Indian national health ministry in New Delhi, my colleague and I watched thousands of cases disappear: some malaria deaths, first noted in handwritten local health ledgers, never appeared in central government reports; other malaria deaths were magically transformed into deaths of heart attack or fever. The discrepancy was massive: India reported 561 malaria deaths that year. Experts predicted the actual number was as high as 200,000. 

Now, with Covid ravaging the country, desperate Indians have taken to Twitter to ask for oxygen cylinders or beg hospitals for an open bed. The crisis has been exacerbated by the government’s concealment of critical information. Between India’s long history of hiding and undercounting illness deaths and its much more recent history of restraining and suppressing the press, Modi’s administration has made it impossible to find accurate information about the virus’s hold in the country. Blocking that information will only hurt millions within the country. It will also stymie global efforts to stop the Covid-19 pandemic, and new variants of the virus, at India’s border. 

Epidemiologists in India and abroad estimate that the country’s official reported Covid-19 death toll – around 222,000 at time of publication – accounts for only a fraction of the real number. The director of the US-based Institute of Health Metrics and Evaluation has estimated that India is only detecting 3-4% of actual cases. Other experts point to total excess deaths in cities such as Mumbai as proof that there could be 60% to 70% more deaths from Covid-19 than the government is admitting to. 

There are various reasons India could be cooking the books on Covid deaths. For one, the utter failure of the public health system makes it difficult to account for the millions of bodies passing through hospitals, clinics and those dying in their own home. Despite having become one of the largest economies in the world, Indian state and federal governments spend a dismal amount on healthcare, with an investment of less than 1% of its GDP, one of the lowest rates in the world. 

But systemic failure is only one part of the puzzle. The reigning party of the Indian government touted its success in curbing the virus very early in the pandemic, and has never let go of that narrative. As bodies burned in funeral pyres across Uttar Pradesh in April, Yogi Adityanath – the state’s chief minister and a key Modi lackey – claimed that everything was under control and repeatedly refused to announce new lockdown measures, even as he himself contracted Covid-19. 

This denialist rhetoric is occurring at almost every level. Like India’s see-no-evil approach to malaria or tuberculosis, its Covid obfuscation suppresses “bad news” in order to buoy the country’s international image and the government party’s domestic standing. Not all countries with struggling health systems do this. Some actually at times overcount deaths from other viruses in order to get more humanitarian aid. But undercounting disease is, in many ways, far more sinister. Modi’s government had a choice between saving face and saving lives, and has chosen mass death.

How Senegal fought Covid-19 with lessons learned from Ebola and HIV/AIDS prevention

Via Vox.com: How Senegal fought Covid-19 with lessons learned from Ebola and HIV/AIDS prevention. Excerpt:

DAKAR, Senegal — Aissatou Diao talked about Covid-19 a lot. How to socially distance, what to do if you have a cough or a fever. But when the first coronavirus case arrived in Yeumbeul, a village outside Dakar where she does health outreach as a community relay, she couldn’t believe it. 

“I almost died when I heard I was on the list of people who were in contact with the Covid patient,” Diao recalls. 

That single contact brought Diao to Novotel, an upscale hotel in Dakar with Atlantic Ocean views. As part of its pandemic response, Senegal sought to provide a bed to everyone with Covid-19 — including mild or asymptomatic cases — and their direct contacts. In the spring of 2020, for about six months, Red Cross volunteers replaced hotel staff at Novotel, and rooms filled with people like Diao, exposed to Covid-19 and sent away to isolate. 

Her fellow community relays, who did Covid-19 outreach with her, kept calling and calling to check her status. They wanted to know if they’d be next. “We all got ready with our luggage, waiting for the results,” one of them said. 

Diao tested negative, twice, and she left quarantine after just four days. A year later, she calls it a funny story: a short stay in quarantine as she tries to make others aware of the seriousness of Covid-19. 

Diao’s experience captures both sides of Senegal’s Covid-19 response. The West African country used aggressive interventions like this isolation policy to slow transmission. At the same time, community and local health actors bolstered the public health response from the bottom up, relying on longstanding relationships and trust to convince people to wear masks, seek out testing, and get treatment.

“We have what we call a ‘chain of solidarity’: The nation joined hands together,” Moussa Seydi, chief of infectious disease service at Dakar’s University of Fann Hospital Center, said. “Religious leaders came to join the political decision-makers, and also, the community involved themselves in giving this response to Covid-19.”

India’s COVID-19 crisis is the world's crisis

Via The Atlantic: India’s COVID-19 Crisis Is the World's Crisis. Excerpt:

India considered itself to be “in the endgame” of the pandemic just a few weeks ago. Now it is the global epicenter. The country recently surpassed the devastating milestone of more than 345,000 new COVID-19 cases in a single day, the biggest total recorded globally since the pandemic began. 

What is taking place in India isn’t so much a wave as it is a wall: Charts showing the country’s infection rate and death toll, which has also reached record numbers in the country, depict curves that have shot up into vertical lines. Public-health experts aren’t optimistic that they will slope down anytime soon.

India’s outbreak is an enormous tragedy for its own people, but it’s also a catastrophe for the rest of the world. Ninety-two developing nations rely on India, home to the Serum Institute, the world’s largest vaccine maker, for the doses to protect their own populations, a supply now constrained by India’s domestic obligations. 

Meanwhile, the coronavirus is mutating. Reports of double- and even triple-mutant strains of the virus, which experts fear could be driving the country’s latest surge, have prompted concerns that what has started in India won’t end there. Despite efforts to restrict the spread of India’s new COVID-19 variant, called B.1.167, it has already been identified in at least 10 countries, including the United States and Britain.

If ever there were a time for intervention, it would be now. But world leaders, who have so far only paid lip service to the need for global cooperation, have mostly been preoccupied by their own internal situations. Although this approach may have served vaccine-rich countries such as the U.S. so far, India could prove its limits. 

How did India, which merely a month ago thought it had seen the worst of the pandemic, get to this point? Michael Kugelman, the deputy director of the Asia program at the Washington, D.C.–based Wilson Center, told me the answer comes down to a “perfect storm” of factors that includes new and existing variants (and a lack of robust genomic sequencing to track them), a continuous stream of widely attended political rallies and religious gatherings (with no social distancing or mask wearing), and a general complacency on the part of the Indian government, which was slow to respond to a crisis in which it had prematurely claimed victory. 

The result has been overwhelmed hospitals, depleted oxygen supplies, morgues that have run out of space, and crematoria that are melting from near-constant use. The country surpassed 2,000 deaths a day last week—and those are just the cases that have been recorded. This time next month, that figure could rise to as high as 4,500 daily deaths, Bhramar Mukherjee, a biostatician and epidemiologist at the University of Michigan who is tracking the situation in India, told me. Others warn that it could get as high as 5,500. Though the projections vary, the conclusions are largely the same. “All the arrows are pointing to real darkness,” Mukherjee said. 

The situation has become so dire that the Pune-based Serum Institute, the manufacturer of the AstraZeneca vaccine and a major contributor to the COVAX initiative to provide doses to low- and middle-income countries, said it will not be able to meet its international commitments amid India’s domestic shortage. Once considered the pharmacy of the world, India is now being forced to import doses.

Indian hospitals swamped by coronavirus as countries promise aid

Via Reuters: Indian hospitals swamped by coronavirus as countries promise aid. Excerpt:

India ordered its armed forces on Monday to help tackle surging new coronavirus infections that are overwhelming hospitals, as countries including Britain, Germany and the United States pledged to send urgent medical aid. In a meeting with Prime Minister Narendra Modi, the Chief of Defence Staff General Bipin Rawat said oxygen would be released to hospitals from armed forces reserves and retired medical military personnel would join COVID-19 health facilities. 

And where possible, military medical infrastructure will be made available to civilians, a government statement said, as new coronavirus infections hit a record peak for a fifth day. 

"Air, Rail, Road & Sea; Heaven & earth are being moved to overcome challenges thrown up by this wave of COVID19," Health Minister Harsh Vardhan said on Twitter. 

Modi on Sunday urged all citizens to get vaccinated and to exercise caution amid what he called a "storm" of infections, while hospitals and doctors in some northern states posted urgent notices saying they were unable to cope with the influx. 

In some of the worst-hit cities, bodies were being burnt in makeshift facilities offering mass cremations. 

 The southern state of Karnataka, home to the tech city of Bengaluru, ordered a 14-day lockdown from Tuesday, joining the western industrial state of Maharashtra, where lockdowns run until May 1, although some states were also set to lift lockdown measures this week. 

The patchy curbs, complicated by local elections and mass festival gatherings, could prompt breakouts elsewhere, as infections rose by 352,991 in the last 24 hours, with crowded hospitals running out of oxygen supplies and beds. 

"Currently the hospital is in beg-and-borrow mode and it is an extreme crisis situation," said a spokesman for the Sir Ganga Ram Hospital in the capital, New Delhi. 

FIRE 

Following a fire at a hospital in the western diamond industry hub of Surat, five COVID-19 patients died after being moved to other hospitals that lacked space in their intensive care units, a municipal official told Reuters. 

Television channel NDTV broadcast images of three health workers in the eastern state of Bihar pulling a body along the ground on its way to cremation, as stretchers ran short.

India’s Covid death toll at record high, but true figure likely to be worse

Via The Guardian: India’s Covid death toll at record high, but true figure likely to be worse. Excerpt:

India’s daily Covid deaths and infections hit new records on Saturday, but doctors and bereaved families have warned that even these bleak official statistics are seriously underestimating the scale of the country’s tragedy. 

As a court in Delhi said India is facing not just a second wave but a “tsunami”, and hospitals had to turn patients away as they ran out of both beds and oxygen, people in many parts of India are still avoiding testing or struggling to access it. 

“The figures on Covid infections that the government is releasing are actually an underestimate,” Dr Manas Gumta, general secretary of the Association of Health Service Doctors in West Bengal, told the Observer. 

“A huge suspected Covid-positive population is certainly staying away from the tests. I believe the actual number of people dying of Covid is two to three times higher than what the government is reporting. And the number of infections could be up to five times than what is being reported by the Indian authorities.” 

Saturday’s official toll recorded another 2,600 deaths and 340,000 new infections, bringing the total number of cases to 16.5 million, second only to the US. There have been 190,000 deaths attributed to Covid in India since the start of the pandemic. 

But those figures don’t capture casualties like Nurul Amin, who ran a pharmacy in his village of Rajgram. He knew the warning signs for Covid, but when he developed fever and a cough as a second wave of the pandemic was crashing across India earlier this month, he refused to get tested. 

“He insisted it was just an ordinary fever and he would get better with some medication,” his sister-in-law Zainab Begum said. “He told me the hospital was full of Covid patients and he would catch the disease if he went there.” 

Five days later, when the 58-year-old began struggling to breathe, his family raced him to a hospital but he died before he could be admitted, and was buried without ever being tested for the disease. 

He is one of 10 people in the village suspected to have been killed by the disease, but never tested, while five people died after testing positive. Those figures suggest official data will be missing up to two thirds of Rajgram’s Covid losses. 

“It appeared from their symptoms that those 10 were infected with Covid,” said Begum, a school teacher. “However in the official records, none of those deaths was identified as a Covid death.” 

That rate of undetected Covid deaths is likely to be repeated across urban slums and poor rural areas, where the risks from Covid have not been well communicated, Gumta said. 

Suspected cases could be counted in official statistics, under guidelines from the Indian Council of Medical Research, which allow diagnosis just by symptoms, Gumta said. But that discretion is rarely used to register cases, and there are also many who fall ill and don’t go to see a doctor. 

“A small section of these people have access to proper health facilities or hospitals. But most patients with Covid-like symptoms here, and that is a huge number right now, just stay at home and try to treat themselves,” he said. “They are not reflected in any official figures.” 

Rajgram is one of those places. The village was spared in the first wave of the pandemic, and did not lose any residents, which may also have contributed to complacency

While Begum’s family have been scarred by their loss, and now wear masks and practise social distancing, that is unusual. “There is no awareness about Covid in our area. Villagers are not taking precautions, even in the crowded village market around 80% of people just roam around without masks,” she said. Those behaviour patterns, and the scale of the current outbreak, mean both the official and hidden daily toll from Covid is likely to get worse before it gets better, experts say. The current wave is not expected to peak for two to three weeks.

Indian hospitals turn away patients in COVID-19 ‘tsunami’

Via Reuters: Indian hospitals turn away patients in COVID-19 ‘tsunami’. Excerpt:

Overwhelmed hospitals in India begged for oxygen supplies on Saturday as the country’s coronavirus infections soared again overnight in a “tsunami” of disease, setting a new world record for cases for the third consecutive day. 

Max Healthcare, which runs a network of hospitals in north India, tweeted that it had less than two hours of oxygen left while Fortis Healthcare, another big chain, said it was suspending new admissions in Delhi. 

"We are running on backup, waiting for supplies since morning," Fortis said. 

India is in the grip of a rampaging second wave of the pandemic, hitting a rate of one COVID-19 death in just under every four minutes in Delhi as the capital's underfunded health system buckles. 

The government has deployed military planes and trains to get oxygen to Delhi from the far corners of the country and overseas including Singapore. 

The number of cases across the country of around 1.3 billion rose overnight by 346,786, the Health Ministry said, for a total of 16.6 million cases, including 189,544 deaths. 

COVID-19 deaths rose by 2,624 over the past 24 hours, the highest daily rate for the country so far. Crematoriums across Delhi said they were full up and asked grieving families to wait. 

 Hospitals in Delhi have gone to the city's high court this week seeking it to order the state and federal governments to make emergency arrangements for medical supplies, mainly oxygen. 

"It's a tsunami. How are we trying to build capacity?" the Delhi high court asked the state and federal governments in response to this plea. 

Television showed families tending to the sick in hospital corridors and streets as they waited for medical attention. 

One man identified as Amit who was grieving for his brother at Delhi's Jaipur Golden hospital said he had seen families running around with oxygen cylinders trying to get them refilled. 

"You can't leave me in the lurch," a lawyer appearing for the Jaipur Golden hospital told the high court on Saturday, seeking its intervention. 

The court asked the government to ensure supplies, as well to make security arrangements for medical centres amid people's desperation. "We know how people react, let's not have a law and order situation," the court said in its direction to the authorities.

India records world’s biggest single-day rise in coronavirus cases

Via Reuters: India records world’s biggest single-day rise in coronavirus cases. Excerpt:

India recorded the world's highest daily tally of 314,835 COVID-19 infections on Thursday as a second wave of the pandemic raised new fears about the ability of crumbling health services to cope. 

Health officials across northern and western India, including the capital, New Delhi, said they were in crisis, with most hospitals full and running out of oxygen. 

Some doctors advised patients to stay at home, while a crematorium in the eastern city of Muzaffarpur said it was being overwhelmed with bodies, and grieving families had to wait their turn. A crematorium east of Delhi built funeral pyres in its parking lot. 

"Right now there are no beds, no oxygen. Everything else is secondary," said Shahid Jameel, a virologist and director of the Trivedi School of Biosciences at Ashoka University. 

"The infrastructure is crumbling." 

Six hospitals in New Delhi had run out of oxygen, according to a tally shared by the city government, and the city's deputy chief minister said neighbouring states were holding back supplies for their own needs. 

"It might become difficult for hospitals here to save lives," Manish Sisodia said in a televised address. 

Another 2,104 people died in the space of a day, taking India's cumulative toll to 184,657, according to the health ministry data. The previous record rise in cases was in the United States, which had 297,430 new cases on one day in January, though its infection rate has since fallen sharply. 

"INDIA WEEPS" 

Television showed images of people with empty oxygen cylinders crowding refilling facilities, hoping to save relatives in hospital. 

In the western city of Ahmedabad, a man strapped to an oxygen cylinder lay in the back of a car outside a hospital as he waited for a bed. 

"Helplessness," tweeted former foreign secretary Nirupama Menon Rao. "India weeps." 

"We never thought a second wave would hit us so hard," Kiran Mazumdar Shaw, executive chairman of the healthcare firm Biocon, wrote in the Economic Times. "Complacency led to unanticipated shortages of medicines, medical supplies and hospital beds." 

Delhi Health Minister Satyendar Jain said the city needed about 5,000 more intensive care beds.

The Swedish COVID-19 strategy revisited

A letter in The Lancet: The Swedish COVID-19 strategy revisited.

In December, 2020, we wrote about the Swedish response to the COVID-19 pandemic. Our hope was that our Comment, together with hundreds of other fact-based articles, would gain the attention of the Swedish Public Health Agency (Folkhälsomyndigheten [FHM]), that they would revisit and change the national strategy that they had designed so that it would be more aligned with global best practice, and that the political decision makers would act on it. They did not. 

Since then, the FHM has recorded more than 5600 deaths from COVID-19 in Sweden, and cases and deaths continue to rise as we face the third wave without any widespread sense of gravity or urgency. 

The debate among critics of the Swedish national approach to the pandemic has been consistent since March, 2020: be strategic, test and trace more, follow the growing evidence base and recommend the use of face masks, and enforce regulations about physical distancing and ventilation, especially in schools if they are open. Some critics have advocated for more government-led legal interventions such as reinforcing quarantine or lockdown. It has been a call for timely implementation of basic principles of pandemic prevention and control to contain the spread and flatten the curves of hospitalisations, deaths, and chronic illness.

Instead of following evolving evidence, the FHM has doubled down and defended its approach without reconsidering the assumptions on which the failed national approach is based. It has downplayed the roles of asymptomatic spread, aerosol transmission, children as potential source of infection, and the use of face masks. It has maintained an approach that mainly builds on recommendations to take voluntary actions, guided (in our view) more by public opinion than by sound public health policy. 

The media has played a crucial role in this pandemic response, mostly lacking in investigative journalism and failing to question or hold the public health agency accountable, with some exceptions. Dagens Nyheter, a major newspaper, recently exposed Sweden's large inequities in COVID-19 deaths across income, education, and origin of birth—data that should have informed the national strategy from its inception. 

As of April 16, 2021, more than 13 700 people have died from COVID-19 in Sweden. The country has one of the highest infection rates in western Europe according to Our World in Data COVID-19 statistics, with 606 new infections per million per day, while its neighbours Denmark, Finland, and Norway reported 115, 62, and 112 new infections per million per day, respectively (April 15, 2021). 

New and more infective and deadly variants have taken over, and by April 15, 2021, the UK SARS-Cov-2 variant was supected to have caused 75–100% of all new cases in all regions. This indicates more rapid spread, more deaths, and that more young people will be affected, with intensive care units already at full capacity in some regions. 

While other countries are closing down in response to this new surge in cases, Sweden is opening up—high schools were opened on April 1, 2021. To continue on the same trajectory in the face of current trends, without timely action by agency and government leadership, raises concerns about governance and accountability, and ultimately about fundamental ethics and values.

COVID-19 surges in Indian capital New Delhi with 30% returning positive tests

Via ABC News: COVID-19 surges in Indian capital New Delhi with 30pc returning positive tests - ABC News.

Fewer than 100 critical care beds are available in New Delhi, a city of more than 20 million people, Chief Minister Arvind Kejriwal has said, as social media is flooded with complaints about lack of beds, oxygen cylinders and drugs in the Indian capital.

"The bigger worry is that in last 24 hours positivity rate has increased to around 30 per cent from 24 per cent … The cases are rising very rapidly. The beds are filling fast," Mr Kejriwal told a news briefing. 

In a separate statement, the city government said it had informed Prime Minister Narendra Modi's government about "the dire need of beds and oxygen" and that beds were now being set up in schools. 

Mr Kejriwal also claimed New Delhi's oxygen supply quota had been cut to be diverted to other states. 

New Delhi, which has imposed a weekend curfew, is among the worst hit cities in India, where a second major wave of coronavirus infections is straining health infrastructure. 

Nationwide, India reported 261,500 new cases on Sunday, taking the total number of cases to nearly 14.8 million, second only to the United States, which has reported more than 31 million infections. 

The country's deaths from COVID-19 rose by a record 1,501 to reach a total of 177,150. 

Over the last week, Twitter in India has been awash with requests for help across the country as several states face shortages of critical supplies. 

Prime Minister under fire 

As cases rise across India, criticism is mounting over how Mr Modi's administration has handled the health crisis, with religious festivals and election rallies attended by thousands allowed to continue. 

India's government relaxed almost all lockdown curbs of last year by the beginning of 2021, although some regions including New Delhi and the state of Maharashtra, home to financial hub Mumbai, have introduced localised restrictions. 

While Mumbai remains under curfew on all days as per state guidelines, New Delhi has allowed cinema halls to operate at 30 per cent capacity and people to move freely during weekdays. 

"There is no option but to lock down Delhi for one to two weeks," said Dr Ambrish Mithal, a top doctor of endocrinology and diabetes at hospital operator Max Healthcare, adding that weekend curfews "won't do".  

"[The] situation is unmanageable at present," he said on Twitter.