The Mystery Of India's Plummeting COVID-19 Cases

Last September, India was confirming nearly 100,000 new coronavirus cases a day. It was on track to overtake the United States to become the country with the highest reported COVID-19 caseload in the world. Hospitals were full. The Indian economy nosedived into an unprecedentedrecession.

But four months later, India’s coronavirus numbers have plummeted. Late last month, on Jan. 26, the country’s Health Ministry confirmed a record low of about 9,100 new daily cases — in a country of nearly 1.4 billion people. It was India’s lowest daily tally in eight months. On Monday, India confirmed about 11,000 cases.

“It’s not that India is testing less or things are going underreported,” says Jishnu Das, a health economist at Georgetown University. “It’s been rising, rising — and now suddenly, it’s vanished! I mean, hospital ICU utilization has gone down. Every indicator says the numbers are down.”

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Just saw in the news that here in Denmark, child hospitalizations due to infection (from diseases other than corona) appear to have virtually disappeared during the pandemic. Children that normally get hospitalized with fever-cramps, pneumonia, life-threatening dehydration due to vomiting and diarrhea, serious respiratory infections, and inflammation of the brain due to viral infections, have all effectively disappeared from pediatric departments all over the country.

Masks, handwashing, and social distancing works .


If masks, hand washing and social distancing work so well, why has sars-cov2 continued to circulate so easily in countries such as France or Belgium where these measures have been in place for many months now?

How well do people in those places follow the rules? There can be all sorts of cultural and sociological reasons why people in one country, or county, or other cohort generally do much better or worse than another. In the town where I live it is no secret that many young people have behaved irresponsibly. You’d have to look deeper into the behavior of the peoples in these countries and compare them not only across borders but also across generations and classes.

If a sieve will catch rocks, why won’t it catch sand?

Covid is more infectious than the other diseases.


I had read that as the percentage of the population that has antibodies gets closer to herd immunity, the disease will continue to circulate but much more slowly, as it can’t find hosts. I couldn’t find the article back. But the focus on completely stopping the disease is a bit misleading, as even 40-50% would be quite beneficial. Anyone else read anything about that?

In part, this depends on the variants. New mutants could (and already may have) arisen that can escape control by the vaccine.

Yes, obviously :slight_smile:

I just think that slower circulation because of a large population with immunity is probably a leading candidate for plummeting cases. So if they go up dramatically in the future and variants are found, that would be important.

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It might be beneficial, but that likely would not be enough. I don’t think that level of vaccination would be enough to reduce R0 below 1.

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It may be related to the high prevalence of other infections there. Early on, there were some vague negative country-level associations with BCG and Japanese encephalitis vaccinations.

Our campus physician always resisted giving my wife and I hepatitis (and some other) vaccinations, saying, “You live in India now. You don’t need them.” Our former campus (NCBS/inStem/C-CAMP) in Bangalore has done a fantastic job of preventing transmission on site, taking measures that would be inconceivable in the US, even in a university town.

This is not what I read originally, and probably a lot of scientists are going to disagree, but this mentions naturally acquired immunity may be much lower than immunity from vaccines because of heterogeneity, which may explain India’s low cases now.

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The US has a much higher percentage of people who have been infected. India has had ~8,000 cases per million people while the US has had ~83,000 cases per million people. If herd immunity is occurring in India then it should have occurred in the US a long time ago. It didn’t.

Apparently you didn’t read the article?

Last week, preliminary findings from a fifth serological study of 28,000 people in India’s capital showed that 56% of residents already have antibodies, though a final report has not yet been published. The figures were higher in more crowded areas. Last summer, another survey by Mumbai’s health department and a government think tank found that 57% of Mumbai slum-dwellers and 16% of people living in other areas had antibodies suggesting prior exposure to the coronavirus.

As you know - but likely a reminder - official counts aren’t actually counts. It is extremely unlikely that many other countries are capturing data like we are - they just don’t have the capacity or the ability to do so. I read a few stories about India last fall I think it was as well. Their official death counts are probably well under actual also. There were a lot of people turned away from multiple hospitals and dying in the streets. Although anecdotes may not describe the real story, it sounded really, really bad.

Then how can we trust the numbers showing a decrease in infections?

The same question I ask myself when I see the daily Covid-19 figures reported by the National Center for Disease Control in my country. For most parameters, I suspect they are serious underestimates for two major reasons:

First, testing capacity has certainly improved (in a few states though) but it is no where near that of your country (and I hear that US citizens still complain they aren’t getting enough tests). Its been a year since we got neck deep into this pandemic but the number of collected samples tested for Covid-19 falls short of 2 million. Of course, that 2 million figure represents the total number of samples tested, implying the number of newly tested samples is lower. With a population of over 200 million I think that is just terribly inadequate to get a good picture of the infection rate trajectory.

Second, the general disregard for Covid-19 guidelines in my country is disheartening. Most people over here don’t wear masks and when they do (in public), its to avoid being punished. There are handwashing facilities setup everywhere but people barely use them unless they are forced to. In some places, after getting a high temperature reading from a thermal scan you are still let in to mix with other people. Nationwide poor compliance with disease prevention guidelines will certainly engender spread of the virus.


From what I have seen, deaths caused by Covid-19 might be the most accurate statistic, at least in retrospect. This can be done by comparing the time period of the pandemic to the same periods from previous years and looking for the number of excess deaths.

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Good question. I assume there’s more capacity over time, but we’d see it in hospital admissions mostly.

You basically have it right. It would be near impossible to stop it entirely, but we can slow it down. Fewer infected people also means fewer opportunities for new mutations.

Nearly a year ago I was posing appeals of Facebook to the importance of doing all we can to slow down the virus spread. Slowing the spread early has a HUGE effect on the number of infections (and deaths) later on. We mostly missed that bus.

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We missed that bus and then got run over by it. Then it backed up and ran over us again.


I allow that thing might be even worse. Still, if we could go back a year when the doubling time was estimated to be about 3 days, and put measures in place to push that back to 6 days or more, we could have avoided ~200,000 deaths.

Note: I’m oversimplifying the problem to stress the importance of avoiding exponential growth in the number of cases. Even small measure taken early make a big difference.

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