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COVID-19 forecasters warn India deaths could double in coming weeks

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The coronavirus wave that has plunged India into the world’s biggest health crisis is likely to worsen in the coming weeks, with some research models predicting the death toll could more than double from current levels.

A team from the Indian Institute of Science in Bangalore used a mathematical model to predict that around 404,000 deaths will occur by June 11 if current trends continue. A model from the University of Washington’s Institute for Health Metrics and Evaluation predicted 1,018,879 deaths by the end of July.

Although coronavirus cases can be difficult to predict, especially in a sprawling country like India, the forecast reflects the urgent need for India to strengthen public health measures such as testing and social distancing. Even if the worst estimates are avoided, India could suffer the highest number of COVID-19 deaths in the world. The United States currently has the highest number of deaths with around 578,000 people.

India reported a record 3,780 deaths on Wednesday for a global toll of 226,188, as well as 382,315 new cases, pushing its epidemic beyond 20.6 million infections. In recent weeks, scenes on the ground, with long queues outside crematoria and hospitals refusing ambulances, have painted a picture of a nation beset by crisis.

“The next four to six weeks are going to be very, very difficult for India,” said Ashish Jha, Dean of Brown University School of Public Health. “The challenge is going to be to do things now that make it four weeks, not six or eight, and that we minimize how bad things are going to turn out. But India is by no means close to the woods. “

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A spokesperson for the Ministry of Health could not be contacted immediately. The ministry said on Monday that in a dozen states, including Delhi, Chhattisgarh and Maharashtra, there were early signs that the number of new daily infections was starting to level off.

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Economic impact

The Indian rupee fell around 1% this quarter in Asia’s worst performance as investors became cautious ahead of an unscheduled speech by India’s central bank governor on Wednesday. The benchmark S&P BSE Sensex is down about 2%, with foreign funds selling about $ 1.7 billion of the country’s stocks.

A protracted crisis can hurt Prime Minister Narendra Modi’s popularity and slow or reverse India’s recovery from last year’s economic recession. Bloomberg Economics has lowered its growth projection for the year ending March 2022 to 10.7% from 12.6%, and even those numbers are flattered by a weak base as activity has halted due to ‘a strict blockage last year.

For public health researchers, a major concern is the relative dearth of coronavirus testing, which many scientists say results in a significant undercoverage of cases.

“Honestly, it just might get worse, which is hard to imagine considering how staggering the impacts have already been when you see 400,000 new cases every day and you know that’s probably an underestimate,” he said. said Jennifer Nuzzo, principal investigator at Johns. Hopkins Center for Health Safety in Baltimore, Maryland.

The main metric that officials monitor is the test positivity rate, which is the percentage of people with positive test results. The overall positivity rate is 20% in India right now, and in parts of the country it exceeds 40%, an incredibly high figure that indicates that up to three-quarters of infections are missed, Jha said.

The World Health Organization considers anything above 5% too high, saying governments should implement social distancing measures until positivity rates are below that level for at least two weeks.

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“Despite the vast increase in testing, it is still not enough to capture all those infected,” said Soumya Swaminathan, chief scientist at the World Health Organization, speaking on Bloomberg TV. “So the numbers, while very high, are probably an underestimate of the true number of infections,” she said. “It’s a grim situation.”

A bustling market in Mumbai on April 12 | ATUL LOKE / NEW YORK TIMES

Social distancing

The goal is to run enough tests that a large number of infected people will go undiagnosed. If only the sickest patients are tested, many people with milder disease or no symptoms may continue to unintentionally spread the disease.

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“There are reports of significantly delayed testing and patients delaying as much as they may have to get to hospital, given the strain on the healthcare system,” said Gautam Menon, professor of physics. and biology at Ashoka University, which is also working on outbreak modeling. “We don’t know enough about the COVID-19 spread far from big cities, in the rural heart of India, although reports from there suggest the situation is dire.”

The US government, as part of a supply package for India, pledged last week to send one million rapid tests to India. There are several other things that could be done quickly to try to help stem the outbreak. Wearing masks tops the list, a crucial part of disease control, said Catherine Blish, infectious disease specialist and global health expert at Stanford Medicine in California.

Big cities in India already require people to wear masks, but such rules can be more difficult to enforce in overcrowded slums and rural areas. Several states have introduced lockdowns, although Modi has resisted a national effort after one imposed by him last year fueled a humanitarian crisis with migrant workers fleeing cities on foot and in some cases bringing the virus with them. them.

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Locks

The Indian Institute of Science has estimated that with a 15-day lockdown, deaths could be less than 300,000, falling to 285,000 with a 30-day lockdown. IMHE estimates a death toll of around 940,000 at the end of July with the wearing of a universal mask.

Vaccines will be the primary means of eliminating risks, although it will take time to get there, public health experts say.

It takes several weeks for immunity to build up after someone has been vaccinated. The process is even longer with those requiring two injections, extending the process from six weeks to two months.

“Vaccines work,” said Kim Mulholland, an Australian pediatrician and head of the infection and immunity group at the Murdoch Children’s Research Institute in Melbourne. “They just don’t have the capacity.”

Ultimately, cases will fall, it’s just a matter of when, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and adviser to US President Joe Biden. Scientists still don’t fully understand why COVID-19 is causing sudden rollercoaster-like changes, he said.

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“He will eventually get burned through the population,” Osterholm said. “In a few weeks to a month and a half, you will see that peak come down again, and it is likely to decrease quickly.”

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