India's devastating second COVID wave

India is in the grip of a devastating second wave of COVID-19. The number of documented new cases is currently exceeding 300,000 people per day, and main hospitals, even in Delhi, are running out of oxygen; and that’s assuming patients can get a bed in a hospital in the first place, because there are none left. The tragedy echoes the on-going situation in Brazil, thought to be fuelled there by the “P1” variant and leading some to speculate that the emergence of an Indian variant might be to blame. Murad Banaji is a Middlesex University mathematician who has been tracking the outbreak from Mumbai. He told Phil Sansom what’s happening...

Murad - Things are very, very bad. It's a devastating situation in many parts of the country. And part of the problem is that because it's all happening so fast, health systems haven't managed to keep up. So many health systems are getting overwhelmed. And even those parts of the country, where perhaps the surge hasn't reached in full force yet, the worry is that it's on its way.

Phil - How has this happened?

Murad - The speed and the size of this wave has taken people aback, including myself. Places, which were previously very badly hit, cities like Mumbai and Delhi are being hit again. And the fact that these places have been hit again, so badly, forces one to wonder whether this is connected, perhaps with the spread of new variants.

Phil - Are people being infected again, who have had it before?

Murad - It's hard not to conclude that people are being infected again. I'm saying this based on seroprevalence studies, which check for antibodies to SARS-CoV-2, and those surveys have indicated that the great majority of people have been infected, 75%, for example, in some of the slums. And yet you're finding high levels of infection happening again. So in a sense, we are really forced to conclude that at least some of that must be reinfection, but we don't know how much. There is some sequencing going on. And I would really like to be able to say, yes, I understand Mumbai's story. I understand Delhi's story because it coincides with the arrival of the following variant, but really we're kind of speculating a lot of the time.

Phil - I wonder how would you compare the situation in India to somewhere like Brazil, which seems to be experiencing kind of a similar looking surge?

Murad - There are many parallels, the most important one being that Brazil appeared to have an improving situation. And then everything got very bad, again, very quickly. There was a story of variants there, obviously. So the lesson should have been, Oh, we need to be keeping a very close eye on what variants might be developing. If in India, people making public health policy had been watching what was going on around the world, including for example, the B.1.1.7. variant taking over in the UK, then people in India would have said we need to be incredibly careful. And one of the things that I think people would have said is that we need to vaccinate as a matter of urgency, because India actually started vaccinating right at the start of the year, but it proceeded very, very slowly. There was not a sense that this is something we need to do as fast as we can. As far as I'm aware, there've been 130 million vaccine doses. That's roughly one dose so far for every 10 people in the country. For me, that reflected the way that policymakers were not tracking what was happening in other parts of the world.