NEW DELHI (AP) – When the coronavirus pandemic took hold in India, it was feared that it would sink the fragile health system of the world’s second most populous country. Infections climbed dramatically for several months and at one point India seemed to be able to overtake the United States as the country with the highest case tax.
But infections began to plummet in September, and now the country reports 11,000 new cases a day compared to a peak of nearly 100,000, leaving experts confused.
They have suggested many possible explanations for the sudden decline – seen in almost all regions – including that some areas of the country may have reached herd immunity, or that Indians may have some pre-existing protection against the virus.
The Indian government has also partially attributed the decline in cases to masking, which is mandatory publicly in India, and violations draw large fines in some cities. But experts have noted that the situation is more complicated, as the decline is uniform, although mask compliance is highlighted in some areas.
It’s more than just an exciting puzzle; Determining what lies behind the decline in infections can help authorities control the virus in the country, which has reported nearly 11 million cases and over 155,000 deaths. About 2.4 million people have died worldwide.
“If we do not know the cause, you can unknowingly do things that could lead to a flare-up,” said Dr. Shahid Jameel, who studies viruses at India’s Ashoka University.
India, like other countries, misses many infections and there are questions about how it counts viral deaths. But the load on the country’s hospitals has also fallen in recent weeks, which is a further indication that the virus is spreading more slowly. When registered cases crossed 9 million in November, official figures showed almost 90% of all critical nursing beds with fans in New Delhi were full. On Thursday, 16% of these beds were occupied.
This success can not be attributed to vaccinations, as India first began administering shots in January – but as more people get a vaccine, the prospects should look even better, although experts are also concerned about variants identified in many countries which appear to be more contagious and make some treatments and vaccines less effective.
Among the possible explanations for the decline in cases is that some large areas have reached herd immunity – the threshold at which enough people have developed immunity to the virus by becoming ill or being vaccinated that the spread begins to slacken, said Vineeta Bal, who studies immune systems at the National Institute of Immunology of India.
But experts have warned that although herd immunity is partly responsible for the decline in some places, the population as a whole remains vulnerable – and must continue to take precautions.
This is especially true because new research suggests that people who became ill with some form of virus may be re-infected with a new version. Bal pointed to, for example a recent study in Manaus, Brazil, it is estimated that over 75% of the population had antibodies to the virus in October – before cases rose again in January.
“I do not think anyone has the final answer,” she said.
And in India, the data is not that dramatic. A nationwide screening for antibodies conducted by Indian health agencies estimated that approx. 270 million or one in five Indians had been infected with the virus before vaccinations started – well below the rate of 70% or higher, which experts say may be the threshold for coronavirus, though it is not safe.
“The message is that a large part of the population remains vulnerable,” said Dr. Balram Bhargava, who heads India’s leading medical research body, the Indian Council of Medical Research.
But the study offered another insight into why India’s infections might be declining. It showed that more people had been infected in the cities of India than in the villages and that the virus was moving more slowly through the rural areas.
“Rural areas have less crowds, people work more in open spaces, and homes are much more ventilated,” said Dr. K. Srinath Reddy, President of the Public Health Foundation of India.
If some urban areas move closer to herd immunity – no matter where this threshold is – and also limit transmission through masks and physical distance and thus see declining cases, the low speed at which the virus passes through rural India may help explain declining numbers , suggested Reddy.
Another possibility is that many Indians are exposed to a number of diseases throughout their lives – for example, cholera, typhoid and tuberculosis are widespread – and this exposure can give the body a stronger, initial immune response to a new virus.
“If the COVID virus can be controlled in the nose and throat before it reaches the lungs, it will not be so serious. Congenital immunity works at this level by trying to reduce the viral infection and prevent it from reaching the lungs, ”said Jameel from Ashoka University.
Despite the good news in India, the rise in new varieties has added yet another challenge to efforts here and around the world to bring the pandemic under control. Researchers have identified several variants in India, including some that have been accused of causing new infections in people who already had an earlier version of the virus. But they are still studying the implications for public health.
Experts are considering whether variants could lead to a sharp rise in cases in southern Kerala, which was previously hailed as a plan to tackle the virus. Kerala now accounts for almost half of India’s current COVID-19 cases. Government-funded research has suggested that a more contagious version of the virus may be at stake, and efforts to sequence its genome are underway.
As the reasons behind India’s success are unclear, experts are worried that people will fail their guard. Large parts of India have already returned to normal life. In many cities the markets fluctuate, roads are crowded and restaurants almost full.
“With the reducing number, I feel like the worst of COVID is over,” said MB Ravikumar, an architect who was hospitalized last year and recovered. “And we can all breathe.”
Maybe not yet, said Jishnu Das, a health economist at Georgetown University who advises the state of West Bengal on dealing with the pandemic.
“We do not know if this will return after three to four months,” he warned.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. AP is solely responsible for all content.
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