Tag: India

True COVID Toll in India Likely in the Millions

Photo by camilo jimenez on Unsplash

Excess deaths in India during the pandemic could be as much as 10 times the official COVID toll, likely making it modern India’s worst human tragedy, according to a new report.

report published by Arvind Subramanian, the Indian government’s former chief economic adviser, and two other researchers at the Center for Global Development and Harvard University, estimates that between 3.4 million and 4.7 million excess deaths have occurred in the country from January 2020 to June 2021.

The report said that the true toll was likely “an order of magnitude higher”, and the official count could have missed deaths with overwhelmed and disrupted healthcare systems, particularly during the devastating virus surge earlier this year. It also has recently come to light that the Indian government did not count any deaths due to a lack of oxygen.

The researchers from used three different data sources to estimate India’s excess all-cause mortality. They extrapolated death registrations from seven states, accounting for half of India’s population, but published data for annual mortality surveys are only available up to 2019. Second, the researchers applied international estimates of age-specific infection fatality rates to data from two countrywide antibody tests, also called sero surveys. Third, they looked at India’s thrice yearly consumer survey of 900 000 individuals, which also records deaths in households.

Taken together, the researchers arrived at an estimate of of 3.4 million to 4.7 million – about 10 times higher than India’s official COVID death toll of 414 000. This was also considerably higher than other estimates by epidemiologists, who estimated excess deaths were between five and seven times higher. Not all these deaths were caused by COVID and an estimation of the actual death toll by the disease would be difficult to give, said Subramanian. 

The data implied that four million people had died in the pandemic in India, according to Dr Subramanian.

“Two of our three estimates measure all-cause mortality and not COVID deaths. Our second measure is a bit closer to a number of [actual] COVID deaths, but it is only one of three estimates,” Dr Subramanian told the BBC.

The researchers also said that the first wave last year appeared to have been more lethal than what was popularly believed. Mortality only seemed to be moderate because it was “spread out in time and space”.

Dr Subramanian said one of the conclusions might be that “India has not been an outlier” and has had “mortality not dissimilar from countries of comparable size and infections”.

The researchers said the most “critical take-away, regardless of the sources and estimates”, was that actual deaths during the pandemic were “likely to be far greater than the official count”.

“The true deaths are likely to be in several millions, not hundreds of thousands, making this arguably India’s worst human tragedy since the partition and independence.” The 1947 Partition of the British-ruled Indian subcontinent into independent India and Pakistan resulted in up to 1 million people being killed in violence between Hindu and Muslim gangs.

Source: BBC News

India Tests Out Drones for Medical Deliveries

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An aviation firm has carried out the first tests in India of drone deliveries at long ranges, in a step towards one day delivering medicines as well as COVID vaccines to remote areas.

India, with a population of 1.3 billion people spread across some 3.2 million square kilometres is the world’s seventh-largest country by land mass. Experts say that widespread use of drones could be a game-changer for medical services in the South Asian nation’s hard-to-reach rural areas with often poor roads and lack of healthcare infrastructure.

Drones are a cost-effective alternative to road transport in difficult terrains. They can be used in the transport of blood from the blood bank to the place of surgery and that of specimens from hard-to-reach areas to the labs in nearby towns. They can deliver essential medicines like anti-venom for snake bite and dog bite and prevent deaths.

Throttle Aerospace Systems is among 20 organisations granted permits by the government since May to conduct experimental flights beyond the current limit of 450 metres.

Two drones were tested in the southern state of Karnataka: one that can carry up to one kilogramme for 20 kilometres for nearly an hour, and another that can lift two kilogrammes for 15 kilometres.

“Medicines was the payload here and… 2.5 kilometres were covered in seven minutes and it delivered the medicines at the designated point and the drone returned,” Throttle’s co-founder, Sebastian Anto, told AFP at the test site.

This month the Indian government also invited bids from drone operators to help set up a pilot project for the delivering of medical supplies as it seeks to bolster its flagging COVID vaccination drive.

Samiran Panda,  epidemiology chief of the Indian Council of Medical Research, told The Hindu daily newspaper that the technology could help innoculate priority groups in hard-to-reach places.

“We need smart vaccination instead of mass vaccination to stem an epidemic,” Panda told the newspaper last week.

However, India lags behind many other nations when it comes to drones both in terms of their uses and the regulatory framework.Under current regulations, they have to be flown in full view, or within 450 metres, of their operators on the ground.

In Germany, it is reported that researchers are testing drone prototypes that can track down disaster victims by their screams. In Australia, drones using artificial intelligence algorithms are being used to spot crocodiles and count koalas in rugged terrain.

“Drone technology would have a huge impact in those areas where emergency medicines and vaccines could be supplied,” co-founder of lobby group the Drone Federation of India, Vipul Singh, told AFP.

“Where it takes a few hours to travel 20-30 kilometres by road, whereas a drone can actually travel that distance in 10 to 15 minutes,” said Singh, also the co-founder of Bangalore-based Aarav Unmanned Systems.

Source: Medical Xpress

Indian Doctors Hit Back at Guru’s Inflammatory Remarks

Image source: Naveed Ahmed on Unsplash

Doctors in India have hit out against yoga guru Baba Ramdev over his controversial statements against modern medicine and mocking of COVID patients.

Recently, the controversial guru said that tens of thousands died of COVID after taking modern medicines, and also mocked patients for trying to get oxygen cylinders. 

The guru subsequently withdrew his statement after being criticised by the country’s health minister. But on Monday he again took a swipe at modern medicine for not having a cure for some diseases.

Despite India’s modern allopathic healthcare system, alternative therapies like ayurveda and homoeopathy are hugely popular in India. This has helped many gurus to launch successful businesses with sales of herbal medicines and products. India also has a Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (Ayush) that promotes traditional medicine systems.

The Indian Medical Association (IMA), which represents allopathy doctors in India, has criticised the guru for his “insensitive” remarks in the middle of the pandemic. Such statements from a guru with millions of followers were “irresponsible and demoralising”, said doctors spoken to by the BBC.
The country has been grappling with a surge of infections caused by a ‘double mutant’ SARS-CoV-2 variant as well as prematurely relaxed social distancing rules.

The controversy
A video of Baba Ramdev mocking patients for trying to find oxygen went viral earlier this month, making references to oxygen shortages in several cities in April and May.

“God has given us free oxygen, why don’t we breathe that? How can there be a shortage when God has filled the atmosphere with oxygen? Fools are looking for oxygen cylinders. Just breathe the free oxygen. Why are you complaining about shortage of oxygen and beds and crematoriums?” he said.

The statement drew sharp criticism from doctors and families of COVID patients who demanded an apology.

Just two weeks later, another video surfaced in which he criticises doctors, blaming COVID deaths on them. Many doctors expressed their anger over Twitter, some went so far as to demand his arrest. In the face of mounting pressures, India’s Health Minister Dr Harsh Vardhan issued a statement asking the guru to withdraw his remarks.

“Allopathy and the doctors attached to it have given new lives to millions of people. It’s very unfortunate for you to say that people died from consuming allopathic medicines.

“We should not forget that this battle can only be won through united efforts. In this war, our doctors, nurses and other health workers are risking their lives to save people’s lives. Their dedication towards serving mankind in this crisis is unparalleled and exemplary,” Dr Vardhan said.

Baba Ramdev withdrew his controversial statement in a Sunday tweet — only to issue a letter the next day asking the IMA why modern medicine had no cure for 25 diseases, including diabetes and hypertension.

This has again infuriated doctors. Prominent pulmonologist Dr A Fathahudeen, who has treated thousands of COVID patients, told the BBC that such statements cause lasting damage.

“For more than a year, healthcare workers like me have been in a war-like situation. We have saved tens of thousand of lives. It’s really unfortunate, insulting and hurtful to read such statements,” he said.

Dr Fathahudeen added that modern medicine had evolved over the years with constant research and studies. “We follow evidence-based practice. At any given time, thousands of researchers are working to come up with cures. Look at the progress we have made in cancer treatment. We have to constantly evolve and learn. It’s hard to trust any branch of medicine that offers absolute cure for every disease.”

Dr Fathahudeen also said that such statements manifest doubts in the minds of people when trust in medicines and vaccines is most needed in the middle of a raging pandemic.

Baba Ramdev’s rise to fame
Televised yoga classes were Baba Ramdev’s ticket to fame; he had a following of millions and he received worldwide praise for promoting yoga and healthy living.

He successfully leveraged his fame to create a business empire. In 2006, he helped launch a company called Patanjali Ayurveda to sell herbal medicines and a few years later, the business expanded to sell almost any product. Since last year, the company has been selling a product called Coronil that it has made a number of false claims over, including that it was a WHO-approved COVID treatment.

Source: BBC News

Indian States Turn to Ivermectin Amid COVID Crisis

Image by Steve Buissinne from Pixabay

Two Indian states have decided to distribute the controversial anti-parasitic drug ivermectin as a preventative measure, MedPage Today reports.

Goa, on the west coast, and Uttarakhand, a northern state in the Himalayas, will give the anti-parasitic to wide swaths of their population as a preventative measure in hopes of preventing future outbreaks.

Leaders of both states insisted that their recommendations were evidence-based. “An expert medical panel has recommended this,” Om Prakash, chief secretary of Uttarakhand, told Reuters. Vishwajit Rane, health minister of Goa, also said an expert panel from Europe found the drug shortened recovery time and reduced the risk of death, the news agency reported.

Yet no large randomised controlled trial has proven the drug’s efficacy against COVID, and no prominent health group — the NIH and the WHO among them — has recommended the drug in treatment or prophylaxis.

The use of ivermectin for COVID has been the subject of bitter debate in South Africa, and human administration of ivermectin was approved for compassionate use with guidelines released in January. Following a court order, pharmacists and doctors in South Africa are allowed to make up small batches of medicines containing Ivermectin on prescription by a doctor and in small quantities, and can be used.

Madhu Pai, MD, PhD, professor of epidemiology and global health at McGill University in Montreal, tweeted a link to guidelines developed by collaborators in the UK and India, led by Cochrane and Christian Medical College Vellore in the southern state of Tamil Nadu.

On May 15, the group updated their guidance to state that it recommends “against using ivermectin for treatment of patients with any severity of COVID-19. Ivermectin should only be used in the context of a randomized controlled trial.”

Officials in Goa said the state will give ivermectin tablets to anyone aged 18 or over. Through most of the recent COVID surge, the popular tourist destination has remained open to holidaymakers, only imposing a 15-day lockdown last week.

Meanwhile, Uttarakhand plans to distribute the drug even more widely, giving it to anyone over age 2, with the exception of pregnant and lactating women, according. The state has been struggling with high caseloads, which rose from under 300 a day in early April to more than 7000 a day last week, Reuters reported.

The state recently hosted Kumbh Mela, a huge festival which drew millions of people from across the country for a two week long celebration including bathing in the river Ganges. Reports indicated many people did not wear masks and were closely packed. This became a massive superspreader event, with cases all over India being traced to it. Some districts of Madhya Pradesh reported that 20% of cases were festival returnees.

Goa and Uttarakhand’s moves have not gone unnoticed by ivermectin advocates. The Front Line COVID-19 Critical Care Alliance, a long time champion of the drug, paid scant attention to the difference between causation and correlation in a recent tweet on the issue: “Case counts and deaths are falling in India! A close look … shows that the declines occurred as the Health Ministry [sic] began its widespread distribution of #ivermectin.”

Source: MedPage Today

Indian COVID Variant ‘of Global Concern’ Says WHO

The World Health Organization said on Monday that a SARS-CoV-2 variant circulating in India is of global concern.

“We classify it as a variant of concern at a global level,” Maria Van Kerkhove, WHO technical lead on COVID, told a briefing. “There is some available information to suggest increased transmissibility.”

India’s daily COVID statistics are down slightly but remain high. The health ministry said Monday there were 366 161 new cases and 3754 deaths from the virus in the previous 24-hour period. Public health experts believe the new cases and deaths to be an underestimate of the true picture.

India has 22.6 million COVID cases so far, according to the Johns Hopkins Coronavirus Resource Center. India’s case load is surpassed only by the US, with 32.7 million COVID cases.   

There is also growing concern in India about ‘black fungus’ or mucormycosis, an opportunistic fungal infection which is affecting COVID patients and also those who have recovered from the disease. It typically only appears in immunocompromised patients. COVID patients with diabetes are particularly susceptible to mucormycosis, medical experts said.
 Meanwhile, struggling to contain its own COVID outbreak, Nepal is running short of oxygen and oxygen tanks and has asked Mount Everest climbers and guides not to abandon their oxygen cylinders on the mountain, rather bringing them back down so that medical facilities can fill them to give to COVID patients.  

Kul Bahadur Gurung, a senior official with the Nepal Mountaineering Association, told Reuters, “We appeal to climbers and Sherpas [Himalayan people living around Nepal and Tibet, well known for climbing mountains] to bring back their empty bottles wherever possible as they can be refilled and used for the treatment of the coronavirus patients who are in dire needs.”  

A Nepal health ministry official speaking to Reuters said the country needs 25 000 oxygen tanks immediately.

Source: Voice of America

Indian Medical Trainee Exams Postponed to Boost Personnel

Indian flag. Photo by Naveed Ahmed on Unsplash

India postponed exams for trainee doctors and nurses on Monday, freeing them up to fight the world’s biggest surge in COVID infections, as the health system buckles under the weight of new cases, and a lack of beds and oxygen.

The total number of infections so far rose to just short of 20 million, propelled by a 12th straight day of more than 300 000 new cases.

Actual numbers in India could be five to 10 times higher than those reported, according to medical exports.

Hospitals have been overloaded, oxygen has run short, and morgues and crematoriums have struggled with the number of corpses. 
“Every time we have to struggle to get our quota of our oxygen cylinders,” said BH Narayan Rao, a district official in the southern town of Chamarajanagar, where 24 COVID patients died, some suspected from lack of oxygen.

“It’s a day-to-day fight,” added Rao, describing the struggle for supplies.

In many cases, volunteer groups have come to the rescue. Outside a temple in India’s capital, New Delhi, Sikh volunteers provided oxygen to patients lying on benches inside makeshift tents, hooked up to a giant cylinder. A new patient would come in every 20 minutes.

“No one should die because of a lack of oxygen. It’s a small thing otherwise, but nowadays, it is the one thing every one needs,” Gurpreet Singh Rummy, who runs the service, told Reuters.

Offering a glimmer of hope, the country’s health ministry said that positive cases relative to the number of tests fell on Monday for the first time since at least April 15, and modelling shows that the virus could peak on Wednesday.

While 11 states and regions have put movement curbs in place to stem transmissions, Prime Minister Narendra Modi’s government, widely criticised for allowing the crisis to spin out of control, is reluctant to announce a national lockdown, concerned about the economic impact.

“In my opinion, only a national stay at home order and declaring medical emergency will help to address the current healthcare needs,” Bhramar Mukherjee, an epidemiologist with the University of Michigan, said on Twitter.

As medical facilities near collapse, the government postponed an exam for doctors and nurses to free up some to join in the COVID fight, it said in a statement.

Prime Minister Modi has provoked criticism for not acting earlier to limit the spread and for allowing millions of people, mostly without masks, to attend religious festivals and political rallies during March and April.

In early March, a forum of government scientific advisers warned officials of a new and more contagious variant of the coronavirus taking hold, five of its members told Reuters.

Four of the scientists said in spite of the warning, the federal government did not try and impose strict curbs.

Meanwhile, in response to India’s crisis, aid has poured in. On Sunday, the UK government said it will send another 1000 ventilators to India. 

Several nations have shut their borders to Indian arrival as the Indian COVID variant has now reached at least 17 countries including the UK, Iran and Switzerland.

Source: Reuters

What is India’s ‘Double Mutant’ COVID Variant?

Artistic rendering of SARS-CoV-2 virus, which causes COVID. Photo by CDC from Pexels

While Indian hospitals buckle under COVID cases and even capacity for cremations runs out, a new ‘double mutant’ variant of the virus has emerged.

First announced just one month ago, scientists are already trying to determine if it is driving the surge in Indian cases — and the implications for the rest of the world.

“We need to keep a close eye on this variant,” Katelyn Jetelina, PhD, MPH, of the University of Texas Health Science Center at Houston, wrote in a recent email newsletter.

What ‘double mutant’ means

Officially named B.1.617, the ‘double mutant’ is a bit of a misnomer, because it actually carries 13 mutations, 7 of which are in the spike protein. The nickname comes from two notable mutations found in other variants that appeared together for the first time in this new strain: the L452R and the E484Q mutations.

The L452R mutation in the spike protein was first found in the COVID variant detected in California, which could be up to 20% more transmissible than wild-type strains.

The E484Q mutation seems very similar to the E484K mutations found in the B.1.351 (South African) and P.1 (Brazilian) variants. These are ‘escape mutations’ because it enables these SARS-CoV-2 variants to evade immune protection with monoclonal antibodies, potentially making vaccines less effective. Thus far, current vaccines appear to be holding up against these variants, according to Jetelina.

The exact significance of these mutations is still being worked out.

“Just because there are two worrisome mutations on one variant doesn’t necessarily mean this is [doubly] contagious or [doubly] deadly. The WHO [World Health Organization] has declared B.1.617 a ‘Variant of Interest’ instead of a ‘Variant of Concern,'” she wrote.

The WHO definition of ‘variant of interest’ is one that has been found to cause community transmission, has been found in numerous COVID cases or clusters, or has been found in multiple countries. A ‘variant of concern’ on the other hand is defined as one that has been associated with or has demonstrated increased transmissibility, increased virulence, a change in clinical disease, or decreased effectiveness in treating or controlling the illness.

What is the significance of this variant?

The B.1.617 variant has spread rapidly in India, becoming the dominant strain in the state of Maharashtra in southwestern India. Maharashtra is India’s second most populous state and also home to India’s financial centre in Mumbai.

In December 2020, 271 million people (about one-fifth of India’s population) were already infected with COVID, and modelling studies suggested that natural infection had already caused India to reach herd immunity. In light of this, India’s health minister announced that the country had successfully contained the spread of the virus.

Yet three months later, the biggest COVID surge yet is happening in India, with a new high of over 340 000 new infections reported daily. Furthermore, experts believe the actual number of infections and deaths may be under-estimated.

Is the new variant possibly to blame for the current surge? Or is it a combination of factors related to people letting their guard down, such as a lack of masking, large gatherings of people mixing and travelling together, and a belief that somehow India was already immune?

No-one has answers to this yet, but a similar situation has already occurred elsewhere in the world.

“We saw the same story in Brazil. The city of [Manaus] had over 70% of people ‘naturally’ infected. But, once P.1. hit, they had a major surge,” Jetelina wrote. “Populations that have high ‘natural’ immunity are getting re-infected. It doesn’t look like natural infection will protect us for long. Get your vaccine.”

The variant has been found in the US and 18 other countries and on all continents, except Africa. Preliminary evidence so far suggests that the Covaxin vaccine, an inactivated virus vaccine made in India, is still protective against the double mutant variant. The trial attracted controversy since it was approved in January without a final phase III clinical trial. Scientists in India have also reported that Covishield, which is a viral vector vaccine like AstraZeneca’s jab, has efficacy against the mutant.

Dr Jetelina nevertheless urged vigilance: “The more this virus jumps from person-to-person (regardless of where it’s at in the globe), the more chances it has to mutate,” she wrote. “The more it mutates, the more chances it has to outsmart our vaccines.”

Source: MedPage Today