The COVID-19 Pandemic: What Is Happening in India

Author: Ivana Mišová, PhD.

Published at: 05/23/2021

India has recorded a sharp spike in coronavirus cases this month. At its worst, the country reported about 400,000 cases a day, with several thousands of deaths1. The sheer number of patients requiring immediate help has quickly surpassed the available hospital beds, oxygen, and medicine. We have been bombarded with tragic stories of hospitals out of oxygen, sick people dying before being admitted, and too many bodies to cremate2. Fortunately, the situation is getting better, and the numbers are dropping. 

What does it mean for the world? Can India be left to fend for itself, or must we take immediate action to help them? The coronavirus spread knows no boundaries, and the more it spreads, the more chances it has to mutate and create variants that could potentially resist current vaccines. This would threaten the vaccination progress in other countries and have dire consequences, underlying the importance of a coordinated response to the global problem of India’s COVID-19 outbreak. Many countries send supplies, such as medicine and oxygen generators, to help India deal with the situation. 

What was the cause of the surge in COVID-19 cases? One factor can be that the vaccination progress in India is not as fast as expected. By now, about 10% of India’s population has received at least the first dose of the COVID-19 vaccine, which is already several percent more than at the time of the peak3. That is a far cry from the vaccination progress in countries like the UK, USA, or the EU, where the first dose has been administered to about 54%, 47%, and 32% of the population, respectively3. Environmental and behavioral factors can also play a significant role in the spread of COVID-19. India is a large, densely populated country, with an unusually drier climate in some parts, together with large gatherings of people during the holidays, which could have facilitated the spread of the virus. 

What is more, India has been plagued by novel coronavirus variants designated B.1.617 and B.1.618. These variants contain mutations within the spike protein that may contribute to their increased transmissibility and potentially result in reinfection or resistance to vaccine-elicited antibodies. The spike protein of B.1.617 has L452R, E484Q, D614G, and P681R mutations, while that of B.1.618 contains mutations Δ145-146, E484K, and D614G. Preliminary data from in vitro tests show that convalescent serum, vaccine-elicited antibodies, or the Regeneron antibody cocktail show decreased neutralization of these virus variants4. However, these tests do not monitor other parts of the immune system, such as T cells, so it does not mean that the current vaccines won’t work. In fact, it is believed that the immunity offered by the Moderna and Pfizer vaccines will be likely retained also against the India variant5. That is great news for the tens of countries that have since reported these coronavirus variants6. 

To make matters worse, India’s doctors are now reporting the occurrence of mucormycosis among the recovering and recovered COVID-19 patients7. Mucormycosis, also called the “black fungus”, is a very rare infection caused by exposure to mucor mold commonly found in soil, plants, manure, and rotting fruits and vegetables. It affects the sinuses, brain, and lungs, and can be life-threatening in diabetic or severely immunocompromised individuals, with an overall mortality rate of 50%. Doctors believe that it might be triggered by the use of steroids in severely ill COVID-19 patients. The steroids help to fight off the coronavirus, but at the same time, they reduce immunity and elevate blood sugar levels - which could be triggering the cases of mucormycosis7. 

India is also a massive COVID-19 vaccine producer. Its Serum Institute of India faced accusations of exporting the much-needed COVID-19 vaccines abroad while the local population suffered. However, they claim that the export has never been at the cost of the people of India - at that time, the number of cases was at an all-time low, and many other countries were facing crisis and in desperate need of help8. The situation in India significantly delayed the production of COVID-19 vaccines to the global initiative COVAX to supply coronavirus vaccines to nations around the world (read more). By the end of June, there is a predicted shortfall of 190 million doses to COVAX9. The Serum Institute of India has expressed hope to start delivering to COVAX and other countries by the end of this year10. Once the COVID-19 outbreak in India recedes, the world’s biggest vaccine manufacturer will need to get back on track and catch up on its delivery commitments to COVAX. 

References

  1. https://ourworldindata.org/covid-cases
  2. https://eu.usatoday.com/in-depth/news/world/2021/04/30/india-covid-19-crisis-oxygen-scarce-bodies-burning-through-night/7410583002/
  3. https://ourworldindata.org/covid-vaccinations?country=IND
  4. Zhou, B. M. Dcosta, M. I. Samanovic, M. J. Mulligan, and N. R. Landau, “The Spike Proteins of SARS-CoV-2 B.1.617 and B.1.618 Variants Identified in India Provide Partial Resistance to Vaccine-elicited and Therapeutic Monoclonal Antibodies.,” bioRxiv, p. 2021.05.14.444076, May 2021.
  5. Lai et al., “Infection and vaccine-induced neutralizing antibody responses to the SARS-CoV-2 B.1.617.1 variant Venkata-Viswanadh Edara,” bioRxiv, p. 2021.05.09.443299, May 2021.
  6. https://www.nature.com/articles/d41586-021-01329-9#ref-CR1
  7. https://www.bbc.com/news/world-asia-india-57027829
  8. https://www.thehindu.com/news/national/never-exported-vaccines-at-the-cost-of-people-of-india-says-serum-institute-of-india/article34588715.ece
  9. https://www.livemint.com/news/india/who-reminds-serum-institute-of-covax-commitments-amidst-soaring-demand-in-india-11621314529243.html
  10. https://twitter.com/SerumInstIndia/status/1394652001573629958/photo/1

Image by D Mz from Pixabay