Why the World needs to Worry about India’s Covid-19 Surge

The past few weeks have been shocking for Indians around the world. Covid-19 cases skyrocketed drastically, with daily infections breaking past records every single day. Fatalities have surged with the Indian healthcare system buckling under this unfathomable caseload.

As an Indian, I am heartbroken by what is happening in my country. For many, including myself, grief is just a degree of separation away. In contrast, there is a cognitive dissonance with what I see here in the US - restaurants opening up, people booking flights for summer vacations, schools and offices reopening in September. Which leads to the question:

Is the World done with Covid-19 ? And is India just an outlier to this trend ?

As a Data Scientist I am trained to look at numbers to analyze them for patterns and answers. And with most forecasting problems, the past is the best predicted estimate of the future. The Spanish Flu is a close comparison in terms of scale of the pandemic so I started analyzing the trends, and the findings are extremely troubling. With vaccinations underway and case numbers low at most places, the global community might have been lulled into a false sense of security right now.

First the facts:

There are many differences between the Spanish Flu and Covid-19. The Spanish Flu was an Influenza virus belonging to the H1N1 family, while Covid-19 belongs to the SARS-CoV-2 family of viruses. The demographic profile of the high risk population is also different. Unlike Covid-19 which appears to hit hardest the elderly, the Spanish flu struck down primarily young adults.

Yet, there are similarities. The mechanism of spread, virulence and fatality rate are similar. An analysis of excess deaths by investigators at the Brigham and Women’s Hospital suggests the peak of the current pandemic in New York City had a case fatality rate in the same league as the 1918 influenza pandemic.

Now let's look at the Spanish Flu statistics. The data is spotty but there are some clear patterns that emerge.

• There were 3 waves with an estimated 50 million deaths during the 1918-19 pandemic. The 2nd wave was the deadliest, and there was a 3rd wave slightly less fatal than the 2nd wave. 
• The duration between peaks of the 1st, 2nd and 3rd wave was ~4-5 months. I looked up the graphs for the 1957/1958 Asian Flu epidemic, the duration between peak of two waves was also ~4-5 months. 
• The 2nd and third waves of Spanish Flu were attributed to a combination of variants and changes in human behavior - loosening of restrictions and increased travel across borders due to WW-1. Could 4-5 months be the time the virus takes to mutate and come back again ?

Figure 1: Three waves of death during the pandemic: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919. The waves were broadly the same globally. Image from CDC Archives https://wwwnc.cdc.gov/eid/article/12/1/05-0979-f1

If you compare with the current Covid-19 pandemic, here is where the numbers stand. 

Figure 2: Data from Wikipedia as retrieved on Google on 2nd May,2021

• At the global level, the 2nd wave of the pandemic has reached the levels of peak of 1st pandemic in mid-April, quite eerily ~4 months after the peak of the 1st wave 
• Access to medical facilities and vaccinations are better in 2019, however the world population has increased from 1.8 billion in 1918 to 7.8 bil in 2020. This means there are 4X more humans available for the virus to mutate
• The vast improvement in consumer travel makes the spread of the virus much harder to control. Every part of the world can be reached from another within hours compared to barriers in 1918.
• Many countries have experienced the 2nd wave of the pandemic , attributed to new variants . However, as numbers subside around the world India’s numbers are surging exponentially

Experts are puzzled by the surge in India, but the possible causes are quite clear. 

• Four Indian states with a combined population of ~200 mil went to the polls from 27th March to 6 April
• According to Government data , 9.1 million people participated in a religious festival called the Kumbh Mela from January 14 to April 27

The numbers had come down dramatically in India, vaccinations started in Jan/Feb hence the public & government let down its guards with a false sense of security. An argument can be made that when the policy decisions were made to allow for these events in Jan 2021 , the numbers were at their very lowest.

Figure 3: JHU CSSE COVID-19 Data, as retrieved on Google on 2nd May,2021

 Now if you draw comparisons with the Spanish & Asian Flu - the surge of the 2nd wave of the pandemic seems like a disaster waiting to happen. A series of unfortunate events, evolving variants along with the population density in India was like throwing a matchstick on parched tinder. And yet there are many super spreader events which are still in the pipeline like the Tokyo Olympics scheduled for July 2021. If the surge hadn't happened in India , it could easily have happened somewhere else!

 It is true that rare events like this are very hard to predict. Yet, if we do not learn from history we are doomed to repeat it. We are already paying a terrible price for it.

So in conclusion, here are some of the things I learnt from this analysis:

1. Mass vaccinations is the only way to combat this virus - Countries need to ramp up their vaccination drives quickly. Even in countries with ample supplies there is a hesitation to get vaccinated. Vulnerable populations like children are still at risk. An analysis released by Surgo Ventures concluded that the US might hit the wall with vaccinations “before the nation reaches the 70-90% threshold for achieving herd immunity." 
2. The World is not out of the woods yet - If the Spanish flu is a valid example, could a 3rd wave be lurking around the corner?. As offices and schools are planning to open in Sept (4-5 months from now!), we cannot drop our guards yet. Decision makers need to run simulations to assess impact of a possible third wave before things open up
3.  No one is safe until everyone is safe - With a growth in population and increased global connectivity, the virus has ample opportunities to mutate and spread. The developed countries need to ensure that every other country gets the vaccine supply and resources to inoculate their population. If the virus mutates to an immune escape variant ( one that does not respond to vaccinations ) then we could be back to square one in combating this virus
4. Technology and Design enabled innovation needed to vaccinate at scale - For high population density countries like India, mass vaccination even with available supplies are a logistical nightmare. With the rise of the highly infectious variants, vaccination centers drawing large crowds may become super spreaders themselves. Hence combination of methods like online appointments, door-to-door vaccination & public private partnerships along with public health centers should be explored to ensure safe vaccination drives

If you’ve gotten so far, thank you for reading. Like everyone else, I am fervently hoping for the crisis in India to end as soon as possible. And let us do our bit to spread the awareness and ensure we do not make the same mistakes again.