H5N1

Inside India’s COVID-19 surge

Via The New Yorker, another excellent report by Dhruv Khullar: Inside India’s COVID-19 Surge. Excerpt:

The tale of the Indian pandemic is both mysterious and familiar. For much of the past year, the world’s largest democracy—with a population of some 1.4 billion living on a landmass a third the size of the U.S.—escaped the worst. 

Researchers have advanced all sorts of theories to explain this outcome. They point out that India is a young country, with a median age of twenty-eight; that it instituted an early and strict lockdown; that it has undercounted cases and deaths; and that Indians may have had some level of preëxisting immunity to the novel coronavirus, owing to exposure to similar viruses in the past. Studies have indicated, perplexingly, that more than half of the residents in some dense urban centers had previously been infected, even though their hospitals hadn't filled up. 

None of these explanations have been fully proved, and, separately or in combination, they may not account for why India was spared last year. That debate will likely continue for a long time to come.

The reasons for the country’s current surge, on the other hand, appear straightforward. Since the New Year, there’s been a substantial relaxing of public-health precautions. Mask-wearing declined; sporting events, political rallies, and religious festivals brought large numbers of people close together. Lacking a sense of urgency, the country’s vaccination campaign proceeded slowly: India is the world’s leading manufacturer of vaccines for a wide range of diseases, but has fully immunized roughly two per cent of its population against covid-19. 

Many assume that the rise of more contagious variants is accelerating the damage. Almost certainly, B.1.1.7—originally identified in the U.K. and now dominant in many countries, including the U.S.—is contributing to India’s viral spread. But a new variant, known as B.1.617, has also captured headlines and the attention of scientists and the general public. The predominant form of the variant, misleadingly referred to as the “double-mutant”—it has at least thirteen mutations—was first detected in December. B.1.617 has several mutations on its spike protein, including E484Q and L452R, which seem to increase the virus’s ability to bind to and enter human cells, and which may improve its capacity for evading the immune system. Some scientists have hypothesized that another mutation, P681R, could improve the variant’s ability to infect cells. 

Still, the role played by B.1.617 in India’s crisis is uncertain. India has sequenced only about one per cent of positive coronavirus tests, rendering claims about the relative contribution of variants hard to disentangle from other factors, such as a rise in unrestricted gatherings in a densely populated country with limited health-system capacity. In any case, Covaxin—India’s domestically developed covid-19 vaccine—appears to work against both B.1.1.7 and B.1.617. Arora told me that, although several fully vaccinated clinicians at his hospital have recently contracted the virus, none went on to develop severe disease—exactly the kind of protection the vaccines are designed to deliver. 

Last week, the Biden Administration announced that the U.S. would send a hundred-million-dollar aid package to India, including testing kits, ventilators, oxygen cylinders, and P.P.E. The U.S. has also removed restrictions on exporting raw materials for vaccines so that India can increase its production. Last weekend, syringes, oxygen generators, and ventilators poured in from across Europe, and a hundred and fifty thousand doses of Sputnik V, Russia’s vaccine, landed in Hyderabad. The Indian diaspora has committed tens of millions of dollars in aid. 

Whether these interventions will be enough remains to be seen. In a country as large, diverse, and bureaucratically complex as India, the logistical challenges of converting aid into impact cannot be overestimated. Meanwhile, the Indian experience holds a deeper lesson for the world—especially for wealthy countries that have hoarded vaccines and supplies. The constellation of forces that led to India’s crisis—pandemic fatigue, the premature relaxation of precautions, more transmissible variants, limited vaccine supplies, weak health-care infrastructure—is not unique; it’s the default in most of the world. Absent a paradigm shift in our approach, there’s no reason to believe that what’s happening in India today won’t happen somewhere else tomorrow.

While India is desperate for oxygen, its politicians deny there’s even a problem

Via The Guardian: While India is desperate for oxygen, its politicians deny there’s even a problem. Excerpt:

In India’s capital city, citizens are dying in their hospital beds because they can’t breathe. Their lungs, clotted with Covid-induced pneumonia, need oxygen to function. Overwhelmed by India’s tsunami-like second wave and undermined by the smug inertia of the state, hospitals run out of oxygen and patients choke to death in front of their horrified families. 

Sometimes hospitals will discharge patients on oxygen support, casually giving their relatives a day or two to find rare air. They set off on frantic odysseys around Delhi, looking for one of two sources of oxygen: a heavy cylinder that weighs 50kg or more and looks like a dented relic from the Industrial Revolution, or a concentrator which extracts oxygen from the air in the room and pipes it into the patient. Delhi is something of a seller’s market. Prices vary. The going rate for a concentrator this week is 160,000 rupees, or slightly more than £1,500. That is a month’s salary for a tenured professor in a public university. 

There is a harrowing video of a traumatised and angry young woman standing in the lobby of a hospital in Lucknow, the capital of India’s most populous state, Uttar Pradesh. She is looking into the camera and raging. Her father’s oxygen levels are dangerously low. The hospital, she says, has run out of oxygen twice. Her father is being given hand-pumped oxygen for which she’s paying 40,000 rupees a day. The chief minister of Uttar Pradesh has threatened legal action against anyone who complains of oxygen shortages because he insists there is no such shortage. She calls him out and dares him to come to the hospital to make good his threat. 

 Yogi Adityanath, the chief minister in question, is a Hindu monk with a vigilante past and a well-earned reputation for being a dangerous man to cross. He has recently threatened to seize the property of people complaining of the unavailability of oxygen because they are lying rumour-mongers, spreading panic. For a young woman to dare a politician of Adityanath’s ilk to do his worst in Lucknow is a measure of her – and the general public’s – desperation. 

A 26-year-old man in Amethi, a town in Uttar Pradesh, tweets out an appeal for an oxygen cylinder for his ailing grandfather. His grandfather then dies of a heart attack. The police press criminal charges against him because his “false tweet” has brought the government into disrepute. For the month of April, newspaper headlines in India read like stage directions for some black farce. 

The principal scientific adviser to the Indian government said in an interview that the government made great efforts to ramp up hospital and health care infrastructure in response to the first wave, “but as that wave declined, so perhaps did the sense of urgency to get this completed”. This distinguished scientist, a fellow of the Royal Society, clearly moonlights as one of the world’s great ironists. The declining sense of urgency he refers to must describe, in its understated way, the government’s concerted efforts to get massive crowds to gather and mingle in the middle of this pandemic.

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 daily Covid death toll hits new record amid oxygen shortages

Via The Guardian: India’s daily Covid death toll hits new record amid oxygen shortages. Excerpt:

India’s daily coronavirus death toll passed a new record Saturday as the government battled to get oxygen supplies to hospitals overwhelmed by the hundreds of thousands of new daily cases. 

Queues of Covid-19 patients and their fearful relatives are building up outside hospitals in major cities across India, the new world pandemic hotspot, which has reported nearly a million new cases in three days. 

Another 2,624 deaths, a new daily record, were reported in 24 hours, taking the official toll to nearly 190,000 since the pandemic started. 

More than 340,000 new cases were also reported, taking India’s total to 16.5 million, second only to the United States. 

But many experts are predicting the current wave will not peak for at least three weeks and that the real death and case numbers are much higher.

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.

Indian coronavirus cases surge to new record as health system staggers

Via Reuters: Indian coronavirus cases surge to new record as health system staggers. Excerpt:

India reported the world's highest daily tally of coronavirus infections for a second day on Friday, surpassing 330,000 new cases, as it struggles with a health system overwhelmed by patients and plagued by accidents. 

Deaths in the past 24 hours also jumped to a record 2,263, the health ministry said, while officials across northern and western India, including the capital, New Delhi, warned most hospitals were full and running out of oxygen. 

The surge in cases came as a fire in a hospital in a suburb of Mumbai treating COVID-19 patients killed 13 people, the latest accident to hit a facility crowded with virus sufferers. 

On Wednesday, 22 patients died at a public hospital in the western state of Maharashtra when their oxygen supply ran out due to a leaking tank, after at least nine had died in a hospital fire last month in the state's capital of Mumbai. 

"It is grim. It is grave ... there is an extreme shortage of ICU beds," T.S. Singh Deo, health minister of the eastern state of Chhattisgarh, told Reuters. 

"We'll need to be very careful in the rural areas. If it spreads there, then it will be out of control." 

Prime Minister Narendra Modi, whose government has been criticised for relaxing virus curbs too quickly, met chief ministers of the worst-affected states. 

 Later he said the government was making a "continuous effort" to increase oxygen supplies, including steps to divert industrial oxygen. 

Modi asked states to work together to meet the needs for medicine and oxygen, and stop hoarding and black marketeering. 

"Every state should ensure that no oxygen tanker, whether it is meant for any state, is stopped or gets stranded," he was quoted as saying in a statement. 

Daily infections hit 332,730, up from 314,835 the previous day, when India set a record that surpassed a U.S. figure of 297,430 new cases set in January. The U.S. tally has since fallen. 

Delhi reported more than 26,000 new cases and 306 deaths, or about one fatality every five minutes, the fastest since the pandemic began. 

Medical oxygen and beds have become scarce, with major hospitals putting up notices saying they have no room for any more patients and police fanning out to secure oxygen supplies.  

"We regret to inform that we are suspending any new patient admissions in all our hospitals in Delhi ... till oxygen supplies stabilise," Max Healthcare, which runs a network of hospitals, said on Twitter as it appealed for oxygen. 

Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan in the United States, said it seemed as if there was no social safety net for Indians. 

"Everyone is fighting for their own survival and trying to protect their loved ones. This is hard to watch," he said.

Oxygen leak kills 22 in Indian hospital as coronavirus infections mount

Via Reuters: Oxygen leak kills 22 in Indian hospital as coronavirus infections mount. Excerpt:

At least 22 patients died on Wednesday in a hospital in western India after a disruption to their oxygen supply caused by a leaking tank, the health minister said, as a nationwide surge in coronavirus cases soaks up supplies of the gas. 

The incident in the city of Nashik, one of India's worst-hit areas, happened after the tank of oxygen leaked, said Rajesh Tope, the health minister of Maharashtra, the richest state, where the city is located. 

"Patients who were on ventilators at the hospital in Nashik have died," Tope said in televised remarks. 

"The leakage was spotted at the tank supplying oxygen to these patients. The interrupted supply could be linked to the deaths of the patients in the hospital." 

The world's second most populous nation reported 295,041 new infections on Wednesday - the biggest daily rise reported in any country - stretching its hospitals to breaking point, officials said. 

Only the United States had a slightly higher one-day rise of 297,430 cases in January, though its tally has since fallen sharply. India's 2,023 deaths were also its highest in the pandemic.

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.

COVID-19 in Brazil: 17 states and Federal District have more than 90% of ICUs occupied, says Fiocruz

Via globo.com: 17 states and DF have more than 90% of ICUs occupied, says Fiocruz. Excerpt from the Google translation:

The Oswaldo Cruz Foundation (Fiocruz) warns that "the general picture of the country remains extremely critical" in the country, with 17 states and the Federal District with more than 90% of occupied ICUs (see below). 

The situation is worse than two weeks ago, when Fiocruz warned that Brazil is going through the "biggest health and hospital collapse in history" . At the time, 15 states had an occupancy of over 90% . 

Tuesday's bulletin (30) highlights that "states reveal difficulties to increase the number of ICU beds Covid-19 in order to meet the sharp growth in demand". 

It also warns that "essential supplies and drugs for patients with Covid-19 and other health problems have also become a major concern in view of the prospect of exhaustion". 

States with Covid-19 ICU bed occupancy rates for adults over 90%: 

•  North: Amapá (100%), Rondônia (98%), Acre (97%) and Tocantins (97%) 

• Northeast: Pernambuco (97%), Piauí (96%), Rio Grande do Norte (95%) and Ceará (94%) 

• Midwest: Mato Grosso do Sul (100%), Mato Grosso (97%), Federal District (97%) and Goiás (94%) 

• Southeast: Minas Gerais (94%), Espírito Santo (94%) and São Paulo (92%) 

• South: Santa Catarina (99%), Rio Grande do Sul (95%) and Paraná (93%) 

Another 7 states have rates above 80% ( critical alert zone ): 

•  North: Pará (85%) 

• Northeast: Maranhão (88%), Alagoas (86%), Sergipe (86%), Bahia (86%) and Paraíba (84%) 

• Southeast : Rio de Janeiro (88%)

The Covid-19 Observatory bulletin on Tuesday (30) warns that only Amazonas (76%) and Roraima (62%) are not in the critical alert zone. 

Despite the less serious situation in the two states, Fiocruz points out that "both have also gone through the critical alert zone for several moments, and Manaus has already had two moments of collapse in the health system".