Does India have enough medical infrastructure for its vast population

The harrowing scenes from India have shocked the world, as the country struggles with soaring cases of Covid.

But the outbreak isn't just a crisis for India - it's a crisis for everyone.

"The virus doesn't respect borders, or nationalities, or age, or sex or religion," says Dr Soumya Swaminathan, the World Health Organization's chief scientist.

https://connect.informs.org/network/members/profile?UserKey=91bb3322-6ef0-444e-9993-d3f8bf5e9b7b
https://connect.informs.org/network/members/profile?UserKey=64f9059e-0b28-475c-8112-21e39931e936
https://connect.informs.org/network/members/profile?UserKey=d4aecc95-23eb-4538-aa56-748382f84d64
https://connect.informs.org/network/members/profile?UserKey=6795a9c5-fb4e-4673-a9a5-0155f96185b5
https://connect.informs.org/network/members/profile?UserKey=e72d463d-2566-45f3-bca4-84d9b0e7da52

"And what's playing out in India now unfortunately has been played out in other countries."

The pandemic has revealed just how interconnected the world is. And if a country has very high levels of infection, then it's likely to spread to other countries.

Even with travel restrictions, multiple tests and quarantine, infections can still leak out; and if a traveller has come from somewhere where the virus is very prevalent, they have a higher chance of taking the virus with them. On a recent flight from New Delhi to Hong Kong about 50 passengers tested positive for Covid-19.

But there's another concern with India's high infection rates: variants.

A new variant has emerged in India called B.1.617. It's been dubbed by some as the "double mutant" because of two key mutations on the spike of the virus. There's some lab evidence that suggests it's slightly more transmissible and that antibodies may find it harder to block the virus, but scientists are still assessing how much immunity is lost.

"I don't think there's any evidence that it's an escape mutation [which would mean] it fundamentally can't be stopped by the vaccines," Dr Jeff Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute, told BBC News.

https://connect.informs.org/network/members/profile?UserKey=13456159-fd19-4395-ad04-248674600428
https://connect.informs.org/network/members/profile?UserKey=9b43b651-c38b-493d-8851-9c21f8247568
https://connect.informs.org/network/members/profile?UserKey=37872eca-40fc-4af6-bce6-309a1baf3aac
https://connect.informs.org/network/members/profile?UserKey=dd60bb69-453b-4028-a347-57161aa3d10f
https://connect.informs.org/network/members/profile?UserKey=fef5c060-54c4-4e74-a8f2-308119014993
https://connect.informs.org/network/members/profile?UserKey=7d664359-56e6-4460-8505-700f2d0a53fc
https://www.nsacct.org/network/members/profile?UserKey=bef5897e-b784-48b4-a31c-6208c606d84e
https://ragbrai.com/groups/hd-watch-the-girl-who-believes-in-miracles-2021-online-full-and-free-1987092620/
https://ragbrai.com/groups/hd-watch-the-courier-2021-movie-online-full-and-free/
https://ragbrai.com/groups/hd-watch-nobody-2021-movie-online-full-and-free/

"I think we have to obviously watch carefully, but there's at present no reason to panic about it."

But the higher the number of Covid cases a country has, the more likely it is that new variants will emerge. That's because every single infection gives the virus a chance to evolve and a major concern is that mutations could arise that render vaccines ineffective.

"The way to limit viral variants emerging in the first place is to prevent the virus replicating in us… so the best way to control variants is actually to control the global amount of disease that we have at the moment," explains Prof Sharon Peacock, Director of the Covid-19 Genomics UK consortium (Cog-UK).

Lockdowns and social distancing measures will do this - but vaccination is also vital.

This is happening slowly in India: so far less than 10% of its population have had the first dose of the vaccine and less than 2% are fully vaccinated.

This is despite the fact that it's home to the world's biggest vaccine manufacturer - the Serum Institute of India. And this is another reason why India's surge in cases has a knock-on effect for the rest of the world.

In March, as infections in India started to surge, authorities there halted large exports of the Oxford-AstraZeneca vaccine.

That included vaccines for the UN-backed Covax scheme to provide doses to low and middle-income countries. On Monday, the Global Vaccine Alliance (Gavi), which is a partner in the scheme, said it was waiting to hear when supplies from India would resume.

This will certainly impact on vaccination roll-outs in many countries. But it means more of India's vaccines are diverted for domestic use, while it tries to ramp up production.

And with India's dire situation, scientists say this is a priority.

"We really need to double down on vaccination as quickly as possible or the virus is going to try and do everything it can to keep on spreading from person to person," says Swaminathan.

Globally, the pandemic shows no sign of easing, with the virus devastating country after country.

The situation in India is a bleak reminder that none of us will be safe until everyone is safe.

India has had more Covid-19 cases in the last seven days than anywhere else in the world. Experts believe the real death toll may be higher than the official numbers.

https://www.guest-articles.com/news/indias-covid-crisis-your-questions-answered-02-05-2021
https://www.guest-articles.com/news/india-has-had-more-covid-19-cases-in-the-last-seven-days-02-05-2021
https://www.guest-articles.com/news/why-is-indias-second-wave-devastating-jabran-ali-khan-02-05-2021
https://www.guest-articles.com/news/experts-believe-the-real-death-toll-may-be-higher-than-the-official-numbers-02-05-2021
https://www.guest-articles.com/news/does-india-have-enough-medical-infrastructure-for-its-vast-population-02-05-2021
https://www.guest-articles.com/news/the-harrowing-scenes-from-india-have-shocked-the-world-02-05-2021
https://www.thewyco.com/general/the-pandemic-has-revealed-just-how-interconnected-the-world-is-02-05-2021

Many of you have been sending us questions regarding the current situation and we asked experts inside and outside the BBC to answer them.
Why is India's second wave devastating? Jabran Ali Khan

Dr Om Srivastava, consultant and visiting professor, infectious diseases, Mumbai, answers: We were very careful in the first wave. The story of the Dharavi slum in Mumbai is a fantastic example of how infections can be contained. It was a model replicated across the world.Over a period of time, from about November of last year, we probably became a little bit complacent, thinking it was out of our lives.

In doing that, we probably did not keep the social distancing we should have. And then there were a number of events after that where social distancing was not possible - election campaigns and the Kumbh Mela.

That kind of situation, where we don't keep social distancing, will usually keep coming back to hurt you. There are other reasons. If you look at second waves historically, they've always been more aggressive and bigger in number than the first. The intensity this time round, though, is more about the overbearing requirement for people to have two things. Firstly, the need to get into a hospital and have a bed with oxygen where they can feel a bit secure. And secondly, the amount of anxiety that comes from not getting a bed.

That has been the overwhelming sentiment of most people who may or may not need hospitalisation, but feel it is the most secure place for them.
Does India have enough medical infrastructure for its vast population? Ealias in Singapore

Yogita Limaye, BBC India correspondent, answers: In 2018, India's spending on healthcare was 1.28% of its Gross Domestic Product (GDP). By comparison, in the US it was 17%.

From numbers published by the Indian government in 2019-20, there is one doctor per 1,456 people in the country.

This underinvestment in public healthcare is a long-running issue. Successive governments have not made it a priority.

In smaller cities, towns and rural areas, the situation is particularly bad. Hospitals have inadequate equipment and staff. In some parts of the country, people have to travel miles to get to any kind of medical services.