Covid is much deadlier in Brazil than India and no one knows why

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A quarantine center converted into hospitals crippled by viruses


Faced with a sudden surge in coronavirus infections, India is once again home to the world’s second largest outbreak, overtaking Brazil after the latter advanced in March. But behind the dark statistical jockwatch is an epidemiological conundrum as to why the Latin American country has been so much more devastated by the pathogen.
When it comes to the scale of infections, the two countries are the same, with cases hovering around 14 million and hospitals from Mumbai to Sao Paulo under increasing pressure as admissions continue to rise. But it is the divergence in deaths that leaves scientists perplexed. Brazil, home to almost 214 million, has seen more than 361,800 people die from Covid-19, more than double the number of deaths in India, which has a much larger population of 1.4 billion.

People pray while attending a funeral service for a Covid-19 death at a cemetery in New Delhi on April 13.

Photographer: T. Narayan / Bloomberg

While deaths in India have started climbing and threatening to worsen, the macro-level disparity remains and is emblematic of the different ways the pandemic is unfolding in the regions. Experts say this needs to be better understood and decoded, to contain this global epidemic and prevent future public health crises.

Covid death rates in South Asia, including India, are consistently lower than global averages, just as those in Latin America are consistently higher, forcing virologists to come up with a number of theories as to why Covid cut a Brazil’s deadliest band to Argentina.

“We’re not comparing apples to apples here, we’re comparing apples to oranges,” said Bhramar Mukherjee, chair of biostatistics at the School of Public Health at the University of Michigan. So far, the two countries present an “intriguing puzzle – an epidemiological mystery that requires a Sherlock Holmes or Miss Marple in action.”

Brazil has been hit by multiple waves killing an alarming number of its young people and it reported a record one-day jump of 4,000 Covid-19-related deaths last week. Meanwhile, the daily increase in casualties in India has been around 1,000 and well below that of last week. Deaths in the Asian country as a percentage of confirmed cases are 1.2 compared to 2.6 in Brazil, data compiled by Bloomberg shows.

Inside a makeshift Covid-19 quarantine facility in New Delhi on April 13.
Photographer: T. Narayan / Bloomberg

Age variation

Several factors could be at play in the mortality gap, including the average age differences – 26 years in India against 33.5 years for Brazil.

Experts have long criticized India’s general mortality statistics, especially in its rural hinterland. Before the pandemic, about one in five deaths had not been reported at all, according to Mukherjee. But that doesn’t explain why Brazil’s death rate is higher than that of aging Western countries that have also been hit hard by the pandemic.

“Brazil’s death rate is even more shocking because the population is much younger than other countries, such as European countries,” said Alberto Chebabo, vice president of the Brazilian Society of Infectious Diseases.

The rising infection and death rates come as the pace of immunization campaigns in each country has picked up over the past month after an initially slow start. India has managed to administer more than 114 million doses of the vaccine, compared to Brazil’s 32 million – although the latter injected a higher proportion of its population.

Lines to receive vaccine as Brazil registers 12.5 million Covid-19 infections
A healthcare worker administers a dose of CoronaVac Covid-19 vaccine from Sinovac Biotech Ltd. in a clinic in Rio de Janeiro on March 31.
Photographer: Andre Coelho / Bloomberg

Cross immunity

Other theories behind the divergence between Brazil and India center on the different environments and disease experience of the two countries.

Some scientists claim that widespread exposure to a range of diseases in India may have helped its citizens build their natural resilience against coronaviruses such as Covid-19.

Shekhar Mande, the head of India’s Scientific and Industrial Research Council, is among those who have examined this trend and have co-authored a study publication on it. His research revealed correlations in which citizens of countries with poor hygiene tended to cope better with Covid-19.

“Our hypothesis, and this is strictly an hypothesis, is that, because our populations are continually exposed to many types of pathogens, including viruses, our immune system does not over-react to any new variation that is coming, ”Mande said in an interview. .

Many experts recognize that genetics or cross-immunity could be at stake, as other South Asian countries, notably Bangladesh and Pakistan, have also seen far fewer deaths than Brazil.

That 87% of Brazilians live in urban areas, but two-thirds of Indians live in rural areas with more space and ventilation could be another reason, according to Mukherjee of the University of Michigan.

Mutant strains

Then there’s the fact that Brazil is where one of the most potentially deadly coronavirus mutations, the P.1 variant, was identified in December. Along with the variants first seen in South Africa and the UK, studies suggest these strains are more contagious.

“The P.1 variant spread simultaneously in many Brazilian cities and states, leading to a collapse of the health system, which led to a very high death rate,” said Chebabo of the Brazilian Society of Infectious Diseases. . Brazil is in a ” perfect stormHe added, with his lack of political leadership in implementing effective measures such as lockdowns, exacerbating the Covid crisis.

Brazil nears grim milestone of 300,000 coronavirus deaths
Mourners watch workers bury the coffin of a Covid-19 victim at a cemetery in Sao Paulo, Brazil, earlier in March.
Photographer: Victor Moriyama / Bloomberg

The rapid and sustained spread of the variant in Brazil has also given its health care system no leeway, unlike a lull between waves in the last months of 2020 in India, which has helped hospitals and frontline workers to recover and plan ahead.

“We are much better prepared to handle this wave than we were previously in many ways,” said Suneeta Reddy, managing director of Apollo Hospitals Enterprises Ltd., said in an interview. “We have learned the clinical protocols for treating Covid. We are able to use our assets and our beds much more rigorously. “

With weak mutant data, virus wave in India remains a mystery

India could now face the prospect of a surge of the mutant strain worse than its first outbreak, though it’s hard to say given that the Asian nation has performed genome sequencing for less than 1% of its positive samples for Covid.

Complacency, second wave

Covid mismanagement and fatigue have also been blamed on the rampant spread and skyrocketing death rates in both countries. Brazilian President Jair Bolsonaro has long opposed lockdowns, clashed with local governments over pandemic mitigation measures and ridiculed the wearing of masks.

For India, a months-long drop in daily infections since the first peak in September – along with authorities lifting restrictions on public gatherings – have encouraged people to let their guard down. Many have also become indifferent to the dangers of Covid after seeing friends and family with mild symptoms recover and politicians fail to follow safety protocols.

Covid-19 field hospital in Sao Paulo's largest favela as intensive care beds reach capacity
Photographer: Jonne Roriz / Bloomberg

“Brazil is a complete disaster in terms of political leadership, and India has become complacent after the initial decline in cases,” said Madhukar Pai, Canada Research Chair in Epidemiology and Global Health at McGill University in Montreal. .

It is too early to say whether India can continue to avoid Brazil’s deadliest fate. While parts of the country have imposed targeted lockdowns, elections are being held in five states – with thousands of voters rallying for the election campaign – with a for a month Hindu pilgrimage that brings crowds to the banks of the Ganges.

These threaten to nullify the benefits that may flow from the intensification of the vaccination campaign. Daily deaths in the South Asian country have already more than doubled to more than 1,000 a day last week, with crematoriums in many areas running non-stop and bodies piling up.

“Both countries need to dramatically increase immunization coverage and work harder to implement other public health measures,” Pai said. “What matters is that each country has to work much harder to contain the epidemic.”

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