Chindia Alert: You’ll be Living in their World Very Soon
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Image copyright GETTY IMAGESImage caption India has more than 150,000 reported infections
On the face of it, things may not look bad.
Since the first case of coronavirus at the end of January, India has reported more than 150,000 Covid-19 infections. More than 4,000 people have died of the infection.
To put this in some context, as of 22 May, India’s testing positivity rate was around 4%, the death rate from the infection around 3% and the doubling rate of infection – or the amount of time it takes for the number of coronavirus cases to double – was 13 days. The recovery rate of infected patients was around 40%.
All this is markedly lower than in the countries badly hit by the pandemic.
Like elsewhere in the world, there are hotspots and clusters of infection.
More than 80% of the active cases are in five states – Maharashtra, Tamil Nadu, Delhi, Gujarat and Madhya Pradesh – and more than 60% of the cases in five cities, including Mumbai, Delhi and Ahmedabad, according to official data.
More than half of people who have died of the disease have been aged 60 and older and many have underlying conditions, hewing to the international data about elderly people being more vulnerable to the disease.
The more than two-month-long grinding lockdown, official data suggests, has prevented the loss of between 37,000 and 78,000 lives. A paper published in Harvard Data Science Review appears to support that – it shows an eight-week lockdown can prevent about two million cases and, at a 3% fatality rate, prevent some 60,000 deaths.
“Infection has remained limited to certain areas. This also gives us confidence to open up other areas. It is so far an urban disease,” says VK Paul, who heads the medical emergency management plan on Covid-19.
This is where such claims enter uncertain territory.
Image copyright GETTY IMAGESImage caption India has conducted some 180,000 tests so far
Infections are rising sharply, up from 536 cases on 25 March when the first phase of the world’s harshest lockdown was imposed. The growth of infections is outpacing growth in testing – tests have doubled since April but cases have leapt fourfold.
Epidemiologists say the increase in reported infections is possibly because of increased testing. India has been testing up to 100,000 samples a day in the past week. Testing criteria has been expanded to include asymptomatic contacts of positive patients.
Yet, India’s testing remains one of the lowest in the world per head of population – 2,198 tests per million people.
The bungled lockdown at the end of March triggered an exodus of millions of informal workers who lost their jobs in the cities and began returning home in droves, first on foot and then by train. Some four million workers have travelled by rail from cities to their villages in more than half a dozen states in the past three weeks.
There is mounting evidence that this has already led to the spread of infection from the cities to the villages. And with the messy easing of the lockdown earlier this month, there are growing fears of infections spreading further in the cities.
Rising infections and a still-low fatality rate possibly points to milder infection in a younger population and a large number of asymptomatic cases. The focus, says Amitabh Kant, CEO of the government think-tank NITI Aayog, should be “bringing down fatalities and improving the recovery rate”.
But if the infection rate continues to grow, “things are going to get pretty grim in a few weeks time,” a leading virologist told me.
Image copyright GETTY IMAGESImage caption Millions of workers have fled the cities and returned to their villages after the lockdown
Doctors in the capital, Delhi, and the western city of Mumbai tell me they are already seeing a steady surge in Covid-19 admissions and worry about a looming shortage of hospital beds, including in critical care.
When the infection peaks in July, as is expected, a spike in infections could easily lead to many avoidable deaths as hospitals run out of beds for, or delay treatment to, infected patients who need timely oxygen support and clinical care to recover.
“That is the real worry. A critical-care bed needs an oxygen line, a ventilator, doctors, nursing staff. Everything will be under pressure,” Dr Ravi Dosi, who is heading a Covid-19 ward at a hospital in Indore, told me. His 50-bed ICU is already full of patients battling the infection.
With the lockdown easing, doctors are feeling jittery. “It’s a tactical nightmare because some people have begun going to work but there is a lot of fear”, says Dr Dosi.
“One co-worker sneezed in the office and 10-15 of his colleagues panicked and came to the hospital and demanded they get tested. These are the pressures that are building up.”
One reason for the confusion is the lack of – or the opacity of – adequate data on the pandemic to help frame a strategic and granular response.
Most experts say a one-size-fits-all strategy to contain the pandemic and impose and lift lockdowns will not work in India where different states will see infection peaks at different times. The reported infection rate – the number of infections for every 100 tests – in Maharashtra state, for example, is three times the national average.
“The infection is not spreading uniformly. India will see staggered waves,” a leading virologist, who insisted on anonymity, told me.
The lack of data means questions abound.
What about some 3,000 cases, which are not being assigned to any state because these people were found infected in places where they don’t live? (To put this into context, nine states in India have more than 3,000 cases.) How many of these cases have died or recovered?
Also, it is not clear whether the current data – sparse, and sporadic – is sufficient to map the future trajectory of the disease.
There is, for example, no robust estimate of carriers of the virus who have no symptoms – last month a senior government scientist said at least “80 out of every 100 Covid-19 patients may be asymptomatic or could be showing mild symptoms”.
Image copyright GETTY IMAGESImage caption More than 4,000 people have died of Covid-19 in India
If that is indeed true, then India’s fatality rate is bound to be lower. Atanu Biswas, a professor of statistics, says the predicted trajectory could change “with the huge inclusion of asymptomatic cases”. But, in the absence of data, India cannot be sure.
Also, epidemiologists say, measures like the doubling time of the infections and the reproduction number or R0 have their limitations. R0, or simply the R value, is a way of rating a disease’s ability to spread. The new coronavirus, Sars-CoV-2, has a reproduction number of about three, but estimates vary.
“These measures are good when we are in the middle of a pandemic, less robust with fewer cases. You do need forecasting models for at least a month’s projection to anticipate healthcare needs. We should always evaluate an aggregate of evidence, not just one measure, but a cascade of measures,” Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, told me.
Others say even calculating the number of recorded infections every day is “not always a good indicator of how an infection is spreading”.
A better option would be to look at the number of new tests and new cases every day that would provide a “degree of standardisation”, K Srinath Reddy, president of the Public Health Foundation of India, told me.
Likewise, he believes, a measure of how many Covid-19 deaths have occurred compared with the size of a country’s population – the numbers of deaths per million people – is a better indicator of the fatality rate. Reason: the denominator – the country’s population – remains stable.
In the absence of robust and expansive data, India appears to be struggling to predict the future trajectory of the infection.
It is not clear yet how many deaths are not being reported, although there is no evidence of large scale “hidden deaths”.
Image copyright GETTY IMAGESImage caption A Covid-19 isolation ward in India
Epidemiologists say they would like to see clearer data on deaths due to pneumonia and influenza-like illnesses at this time over the past few years to quantify excess deaths and help with accurate reporting of Covid-19 deaths.
They would also like to see what racial disparities in infections and deaths there are to help improve containment in specific community areas. (In Louisiana, for example, African Americans accounted for 70% of Covid-19 deaths, while comprising 33% of the population.)
What is clear, say epidemiologists, is that India is as yet unable to get a grip on the extent of the spread of infection because of the still limited testing.
“We need reliable forecasting models with projection for the next few weeks for the country and the states,” says Dr Mukherjee.
Epidemiologists say India needs more testing and contact-tracing for both asymptomatic and symptomatic infections, as well as isolation and quarantine.
There’s also the need to test based on the “contact network” to stop super-spreader events – frontline workers, delivery workers, essential workers, practically anybody who interacts with a large group of people.
“We have to learn how to manage and minimise risk in our daily lives as the virus is going to be with us,” says Dr Mukherjee.
Without knowing the true number of infected cases India is, in the words of an epidemiologist, “flying blindfolded”.
That can seriously jeopardise India’s fight against the virus and hobble its response in reviving the broken economy.
Image copyright GETTY IMAGESImage caption Testing everyone in 10 days would be a huge challenge
China is drawing up ambitious plans to test the entire population of Wuhan, the city where the Covid-19 pandemic began.
The announcement came after the emergence of six new coronavirus cases in the city – the first ones since early April.
The authorities had originally promised to test all 11 million people in 10 days.
But it now appears they might be aiming for a less ambitious timetable.
How long will the testing take?
In late April, the Hubei provincial government reported 63,000 people were being tested in Wuhan every day.
And by 10 May, that figure had dropped to just under 40,000.
There are more than 60 testing centres across the city, according to the official Hubei Daily newspaper.
These have a maximum capacity of 100,000 tests a day at most, making it hard to see how a target of testing the entire population in just 10 days could be met.
So the authorities have indicated the tests will not all start and finish within the same 10-day period.
“Some districts [in the city] will start from 12 May, others from 17 May, for example,” the Wuhan Centre for Disease Control said.
“Each district finishes its tests within 10 days from the date it started.”
The authorities say they have now tested more than three million people in the city.
Wuhan University pathogen biology department deputy director Yang Zhanqiu told the Global Times newspaper he believed up to five million Wuhan residents may have already been tested.
The population of the city – originally 11 million – has also fluctuated over time.
The authorities said up to five million people had left the city for the lunar New Year holiday before it was locked down on 23 January.
The lockdown then lasted until 8 April, but it is unclear how many of these residents have now returned.
Should everyone be tested?
Wuhan University’s Yang Zhanqiu said there was no need to test everyone living in neighbourhoods with no reported cases.
Image copyright GETTY IMAGESImage caption There are worries about asymptomatic coronavirus cases
The authorities have said they will begin with people considered most at risk – for example in the older, more densely populated areas, as well as those in key jobs such as healthcare.
Also, people who have been tested in the previous seven days will not need to be tested again.
But Chinese Center for Disease Control and Prevention chief epidemiologist Wu Zunyou told state TV: “The virus could take longer to manifest itself in patients with weak immunity and these people are also prone to ‘on’ and ‘off’ symptoms.”
Yang Zhanqiu adds: “You’ll never know if people were infected after testing negative.”
And US-based Council for Foreign Affairs senior fellow for global health Yanzhong Huang said: “There would still be the possibility of isolated outbreaks in the future, which even large-scale testing will not address.”
City at centre of outbreak finally able to declare itself clear of disease after months in lockdown and thousands of deaths
Risk of infection remains, however, with some patients testing positive for coronavirus that causes disease without showing symptoms
Ferries and other public transport services resumed in Wuhan last week. Photo: Xinhua
The city of Wuhan, the initial epicentre of the coronavirus pandemic, no longer has any Covid-19 patients in hospital after the last 12 were discharged on Sunday.
Their release ended a four-month nightmare for the city, where the disease was first detected in December. The number of patients being treated for Covid-19, the disease caused by a new coronavirus, peaked on February 18 at 38,020 – nearly 10,000 of whom were in severe or critical condition.
“With the joint efforts of Wuhan and the national medical aid given to Hubei province, all cases of Covid-19 in Wuhan were cleared as of April 26,” Mi Feng, a spokesman for the National Health Commission said on Sunday afternoon.
The announcement came only one day after the city discharged the last patient who had been in a severe condition. That patient also was the last severe case in Hubei province.
The last patient discharged from Wuhan Chest Hospital, a 77-year-old man surnamed Ding, twice tested negative for Sars-CoV-2, the virus that causes Covid-19, and was released at noon on Sunday.
“I missed my family so much!” Ding told Changjing Daily.
Another unidentified patient exclaimed as he left the hospital: “The air outside is so fresh! The weather is so good today!”
Wuhan faced a long journey to bring its patient count down to zero.
The city of 11 million, the capital of Hubei province and a transport hub for central China, was put under a strict lockdown on January 23 that barred anyone from entering or exiting the city without official approval for 76 days until it was officially lifted on April 8.
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Residents were ordered to stay in their apartments as the city stopped public transport and banned private cars from city streets. As the epidemic worsened, more than 42,000 medical staff from across the country were sent to the city and to Hubei province to help ease the burden on the local health care system.
Wuhan was the hardest hit city in China, accounting for 50,333 of the 82,827 locally transmitted Covid-19 cases recorded in China. More than 4,600 died in the country from the disease.
On March 13, the city reported for the first time that there were no new suspected cases of the infection, and five days later there were no confirmed cases.
The number of discharged patients bottomed out at 39.1 per cent at the end of February, gradually climbing to 92.2 per cent by last Thursday.
“Having the patients in the hospital cleared on April 26 marks a major achievement for the city’s Covid-19 treatment,” the Wuhan Health Commission said in a statement.
However, having no severe cases in hospital does not mean all the discharged patients will require no further treatment as they may still need further care.
“Clearing all the severe cases marks a decisive victory for the battle to safeguard Wuhan,” health minister Ma Xiaowei told state broadcaster China Central Television on Saturday.
“Some patients who have other conditions are being treated in specialised hospitals. It has been properly arranged.”
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Ten patients aged between 42 and 85 who have been declared coronavirus-free are still in intensive care at the city’s Tongji Hospital where they are being treated for kidney problems and other complications arising from Covid-19. Some still need ventilators to help them breathe.
These 10 patients are under 24-hour care, with 190 nurses on four-hour rotations. There are other patients in a similar condition in two other hospitals in Wuhan, according to the Hubei Broadcasting and Television Network.
However, the discharge of the last batch of Covid-19 patients does not mean that the risk of infection is gone.
The city reported 20 new cases of people testing positive for Sars-CoV-2, the official name for the coronavirus that causes the disease, but who do not yet show symptoms.
There are 535 such carriers under medical observation. Past data shows some of these asymptomatic carriers will develop symptoms, and so will be counted as Covid-19 patients under China’s diagnosis and treatment plan.
China’s coronavirus infection curve has flattened out with about 694 imported cases of Covid-19 on top of about 800 locally transmitted ones now under treatment.
The national health commission spokesman warned that people still need to be on high alert as the virus is continuing to spread around the globe, with no sign yet of a slowdown.
“[We] must not drop our guard and loosen up. [We] must discover cases in time and deal with them quickly,” Mi said, citing the continued pressure from cases imported by people returning from overseas.
“The next step will be to implement the requirements of the central government and continue to guard against imported cases and a rebound of domestic transmitted cases.”
Indian defence officials have reported a coronavirus outbreak at a key naval base in the western city of Mumbai.
Twenty-one personnel have tested positive for Covid-19 at INS Angre, which is the seat of the force’s western command, the navy said in a statement on Saturday.
It added that there are no infections aboard any ships or submarines.
India has 11,906 active infections and 480 deaths, according to the latest data from the ministry of health.
The Navy said that they had tested a number of personnel who had come into contact with a soldier who had tested positive earlier this month. Many of those who had tested positive for the virus, the statement added, were asymptomatic.
All 21 personnel live in the same residential block, which has been declared a containment zone and has been placed under lockdown.
In a video message to personnel last week, Navy Chief Admiral Karambir Singh stressed the importance of keeping ships and submarines free of the virus.
“The coronavirus pandemic is unprecedented and it has never been seen before. Its impact has been extraordinary across the globe, including India,” he said.
The navy has been playing an active role in India’s response to the Covid-19 outbreak.
It has set up isolation facilities to treat patients at one of its premier hospital units and is also running quarantine camps.
The outbreak aboard the Indian naval base follows reports of outbreaks aboard vessels belonging to other nations.
More than 500 sailors on the USS Roosevelt have tested positive for the virus and one of them died earlier this week. And nearly a third of the sailors serving with France’s aircraft carrier Charles de Gaulle – 668 out of nearly 2,000 – have been infected with coronavirus.
SHANGHAI (Reuters) – China ordered on Saturday that anyone in Wuhan working in certain service-related jobs must take a coronavirus test if they want to leave the city.
The order comes after the central city, where the coronavirus emerged late last year, lifted a 70-day lockdown that all but ended the epidemic there.
People in Wuhan work in nursing, education, security and other sectors with high exposure to the public must take a nucleic acid test before leaving, the National Health Commission said in an order.
The government of Hubei province, of which Wuhan is capital, will pay for the tests, the commission said.
Since the city relaxed its lockdown restrictions people who arrived in there before Chinese New Year, when the virus was peaking in China, are allowed to go back to their homes.
People working in other sectors aiming to leave Wuhan are encouraged to take voluntary tests before going.
Within seven days of arrival at their destinations, people who can present test results showing they do not carry the virus, as well as a clean bill of health on a health app, can go back to work.
Everyone else will have to spend 14 days in quarantine before returning to work.
Authorities have worked with the China’s tech giants to devise a colour-based health code system, retrieved via mobile app, that uses geolocation data and self-reported information to indicate one’s health status.
Wuhan will speed up its efforts to investigate asymptomatic coronavirus cases and confirm the presence of antibodies in people, which might suggest immunity, the commission said.
Wuhan, which accounts for 60% of infections in China and 84% of the death toll as of Saturday, has been testing inhabitants aggressively throughout the virus’ breakout and many companies had already been asking workers from the city to undergo tests before resuming work.
Wuhan revised up its death toll from the coronavirus by 1,290 on Friday, taking the city’s toll to 3,869, because of incorrect reporting, delays and omissions, especially in the chaotic early stages of the outbreak, authorities said.
China national death toll is 4,632 from 82,719 cases.
BEIJING (Reuters) – China reported on Saturday a rise in new coronavirus cases, as authorities try to head off a second wave of infections, particularly from imported and asymptomatic cases, as curbs on cities and travel are lifted.
The National Health Commission said 46 new cases were reported on Friday, including 42 involving travellers from abroad, up from 42 cases a day earlier.
In its statement the commission added that 34 new asymptomatic cases were reported, down from 47 the previous day.
Mainland China’s tally of infections now stands at 81,953. The death toll rose by three to 3,339.
Tough curbs imposed since January helped rein in infections sharply from the height of the pandemic in February. But policymakers fear a second wave triggered by arrivals from overseas or asymptomatic patients.
Northeastern Heilongjiang recently reported a spike in new cases because of Chinese nationals entering the province from Russia, which has seen a surge of cases.
Provincial health officials said it had 22 new imported cases on Friday, all Chinese nationals coming from Russia, and one new local case, in its capital of Harbin.
Inner Mongolia had a daily tally of 27 new imported cases by Saturday morning, all from Russia, the region’s health authority said.
The central province of Hubei, where the virus emerged late last year, reported no new cases for a seventh successive day.
A rise in virus infections has prompted authorities in Guangzhou to step up scrutiny of foreigners, ordering bars and restaurants not to serve clients who appear to be of African origin, the U.S. consulate in the southern city said.
Anyone with “African contacts” faces mandatory virus tests followed by quarantine, regardless of recent travel history or previous isolation, it said in a statement.
It advised African-Americans or those who feel they might be suspected of contact with nationals of African origin to avoid the city.
Since the epidemic broke out in the provincial capital of Wuhan, it has spread around the world, infecting 1.6 million people and killing more than 100,000.
BEIJING/WUHAN, China (Reuters) – China on Saturday mourned the thousands of “martyrs” who have died in the new coronavirus outbreak, flying the national flag at half mast throughout the country and suspending all forms of entertainment.
The Chinese national flag flies at half-mast at Tiananmen Square in Beijing, as China holds a national mourning for those who died of the coronavirus disease (COVID-19), on the Qingming tomb sweeping festival, April 4, 2020. REUTERS/Carlos Garcia Rawlins
The day of mourning coincided with the start of the annual Qingming tomb-sweeping festival, when millions of Chinese families pay respects to their ancestors.
At 10 a.m. (0200 GMT) Beijing time, the country observed three minutes of silence to mourn those who died, including frontline medical workers and doctors. Cars, trains and ships sounded their horns and air raid sirens wailed.
In Zhongnanhai, the seat of political power in Beijing, President Xi Jinping and other Chinese leaders paid silent tribute in front of the national flag, with white flowers pinned to their chest as a mark of mourning, state media reported.
More than 3,300 people in mainland China have died in the epidemic, which first surfaced in the central province of Hubei late last year, according to statistics published by the National Health Commission.
In Wuhan, the capital of Hubei province and the epicentre of the outbreak, all traffic lights in urban areas turned red at 10 a.m. and all road traffic ceased for three minutes.
Some 2,567 people have died in Wuhan, a megacity of 11 million people located in the middle reaches of the Yangtze river. The Wuhan deaths account for more than 75% of the country’s fatalities.
Among those who died was Li Wenliang, a young doctor who tried to raise the alarm about the disease. Li was honoured by the Hubei government earlier this week, after initially being reprimanded by police in Wuhan for “spreading rumours”.
Gui Yihong, 27, who was among thousands of Wuhan locals who volunteered to deliver food supplies to hospitals during the city’s months-long lockdown, recalled the fear, frustration and pain at Wuhan Central Hospital, where Li worked.
“If you weren’t at the frontlines you wouldn’t be able to experience this,” said Gui, as he laid some flowers next to Wuhan’s 1954 flood memorial by the Yangtze.
“I had to (come) and bear witness. For the last 80 days we had fought between life and death, and finally gained victory. It was not easy at all to come by.”
While the worst was behind Wuhan, the virus has spread to all corners of the globe since January, sickening more than a million people, killing more than 55,000 and paralysing the world economy.
Wuhan banned all tomb-sweeping activities in its cemeteries until at least April 30, curtailing one of the most important dates in the traditional Chinese lunar new year calendar which usually sees millions of families travel to tend to their ancestral graves, offer flowers and burn incense.
They have also told residents, most stuck at home due to lockdown restrictions, to use online streaming services to watch cemetery staff carry out those tasks live.
ASYMPTOMATIC CASES
Online, celebrities including “X-Men: Days of Future Past” star Fan Bingbing swapped their glamorous social media profile pictures for sombre photos in grey or black, garnering millions of “likes” from fans.
Chinese gaming and social media giant Tencent (0700.HK) suspended all online games on Saturday.
As of Friday, the total number of confirmed cases across the country stood at 81,639, including 19 new infections, the National Health Commission said.
Eighteen of the new cases involved travellers arriving from abroad. The remaining one new infection was a local case in Wuhan, a patient who was previously asymptomatic.
Asymptomatic people exhibit few signs of infection such as fevers or coughs, and are not included in the tally of confirmed cases by Chinese authorities until they do.
However, they are still infectious, and the government has warned of possible local transmissions if such asymptomatic cases are not properly monitored.
China reported 64 new asymptomatic cases as of Friday, including 26 travellers arriving in the country from overseas. That takes the total number of asymptomatic people currently under medical observation to 1,030, including 729 in Hubei.
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CHINDIA ALERT: You'll be living in their world, very soon 