The COVID-19 pandemic is not over, and the world needs to be looking at India

Hospital beds and fatality rates

Almost all healthcare is local. It may work to have a regional heart transplant center, but no region can mount the helicopter fleet necessary to deal with patients during a pandemic (though Kristi Noem can certainly try). When someone walks into an emergency room gasping for breath, they either get treatment immediately, or they don’t get treatment. 

In the United States, there are 2.9 hospital beds per 1,000 people. Those beds are by no means distributed evenly, with both rural and urban areas seriously lacking for available beds in some areas, while others are graced by a higher level of availability. Throughout the pandemic, various regions have been stressed by the sudden onslaught of rapidly increasing cases. That’s been seen by surges that halted cancer treatment in Salt Lake City, field hospitals erected in Wisconsin, and by convention centers converted to handle pandemic overflow coast to coast. 

The same story has played out around the world. Even countries like Germany, which has over twice as many hospital beds per person as the United States, have seen the system stressed on a local level by sudden surges of new cases. It’s no mystery why not just the number of deaths, but the percentage of cases ending in death, has tended to go up whenever there was a prolonged peak in new cases. Hospitals are built to meet the needs in ordinary times. No city, state, or nation is prepared to handle an sustained influx of patients who need intensive care just to survive.

Mexico has just 1 hospital bed per each 1,000 people and, like everywhere else, those beds tend to be in the wealthier, better-served areas. When COVID-19 peaked in that nation around the first of the year, it responded as many other nations have, by attempting to expand capacity through emergency overflow facilities and by handing off cases to thousands of private clinics.

But for Mexico, the basic math was against them. With almost three times fewer hospital beds per capita than the United States, they ended up with a rate of death five times that of the United States (though it took a long time before the government there admitted to this astounding death toll). When hospital beds aren’t available, death rates from COVID-19 climb toward the number of patients who need to be hospitalized. In Mexico, that seems to mean that something close to half of those who required oxygen or ventilation, didn’t get that treatment.

Something similar was seen in the Brazilian city of Manaus in February. As a new, more contagious variant overwhelmed the isolated city, oxygen was in such short supply that a thriving black market emerged. Local producers warned the government of a shortage that had gone on for months, and more-Trump-than-Trump President Jair Bolsonaro eventually dispatched some cylinders of oxygen using the nation’s air force, but it was far from an adequate response. Manuaus, which had already been the first city in Brazil to start digging mass graves, hit staggering levels in January and February, as cheery predictions that the region had “already reached herd immunity” proved devastatingly wrong. As of Monday, Brazil reported 375,000 deaths from COVID-19, giving the nation a fatality rate of under 3%. How many people have actually died in Brazil is unknown, 

India is a crisis for the world

By most scales, India has done remarkably well when it comes to COVID-19. The government appeared to recognize the seriousness of the threat early on and got out in front of the pandemic with measures that were sometimes shockingly harsh. Like police furiously beating a man for failing to wear a mask in public. 

At this point, 1.1% of people in India have tested positive for COVID-19. The relatively low level of testing—193 tests per 1000 people puts India 115th in terms of testing per capital—and the 6% rate of positive tests indicate that a real number is likely considerably higher. Even so, India ranks 121 out of 195 nations when it comes to the rate of COVID-19 infections per capita. It’s got a better rate than nations like Norway or Greece that have been held up as exemplars of nations that have taken proper actions and handled the pandemic well.

So why worry about India? There are four reasons:

• In the last month, the daily count of new cases in India is up by 1,500%.
• That rise coincides with a new “double mutant” variant.
• India has just 0.5 hospital beds per 1,000 people.
• India’s population is nearly 1.4 billion.

At a current 7-day moving average of 232,000 cases per day, the number of new cases in India is currently just under the 250,000 cases a day that the United States experienced for about a week in January. But what’s especially frightening about India is how it got to those numbers:

When it comes to vaccination rates, India is badly lagging. Not only has only 8% of the population been vaccinated, the current rate of vaccination means that its unlikely to reach 70% until somewhere around the end of the year. Add that to the relatively existing low percentage of people who have had COVID-19 in India, and the nation stands as a potential pool of over a billion people with a population a dozen times that of the United States.

Over a year ago, a cursory look at the potential threat from COVID-19 showed some shocking numbers for the United States.

With just under 10% of the population having tested positive, the number of deaths is currently in the middle of that top row, closer to 2% than 1%. Now, here’s what the same chart would look like for India.

If, in the next eight months, India were to see the same kind of growth the United States did over the course of 2020, the number of people infected would be 136 million. That’s roughly the same as the number of people who have tested positive to date everywhere around the world. And if India were to see the same kind of death rates seen in the United States, its death toll could easy approach the 3 million now dead world wide.

India alone, right now, stands on the brink of an epidemic that could match the scale of a the entire global pandemic to date. And that’s without taking into account that 0.5 hospital beds per person. If India were to see case fatality rates like those in Mexico—which has twice the hospital beds per capita—reaching just 10% of the population infected would see over 13 million dead. 

India at this moment represents a unique and massive challenge to global health. As Aljazeera reports, the B.1.617 variant now becoming dominant in India carries a pair of mutations that have been seen separately in variants elsewhere. It has both the “eek” (E484Q) and the L452R changes to the spike proteins. Both of these are thought to make it more evasive of current vaccines and more capable of reinfecting those already infected by past variants of COVID-19.

A failure to address the rapidly growing case count in India doesn’t just stand ready to create an incredible tragedy for that nation, it threatens to provide the world with a new burst of variants that starts from a base that’s already among the most evasive to current vaccines. India could have more cases, more deaths, and more variants than everywhere else in the world combined, and it could have them incredibly quickly, unless the world—definitely including the United States—moves swiftly to provide additional support in dealing with a crisis there that is threatening to spiral out of control.

Case counts in India could begin to level off or fall. They have in other countries, facing other spikes, at multiple points in the pandemic. But there is absolutely no guarantee. 

A weary world that’s eager to put this pandemic to bed, may find that the greatest crisis is actually only now at hand. And it had better lend that hand now, while it’s still possible.