In terms of the scale of infections, the two nations are similar, with cases hovering around 14 million and Bombay hospitals in Sao Paulo under increasing pressure as admissions continue to rise.
But it is the divergence in fatalities that has baffled scientists. Brazil, home to nearly 214 million people, has seen more than 361,800 people die from Covid-19, more than double the death toll in India, which has a much larger population of 1.4 billion.
Although deaths in India have begun to rise and threaten to worsen, the macro-level disparity persists and is emblematic of the different ways in which the pandemic unfolds in different regions. Experts say this needs to be better understood and decoded, to contain this global outbreak and prevent future public health crises.
The rates of covidae deaths in South Asia, including India, are consistently lower than world averages, just as those in Latin America are consistently higher, forcing virologists to offer a range of theories as to why Covid has cut a more deadly strip from Brazil to Argentina.
“We don’t compare apples to apples here, we compare apples to oranges,” said Bhramar Mukherjee, president of biostatistics at the University of Michigan School of Public Health. For now, both countries present an “intriguing puzzle: an epidemiological mystery that needs a Sherlock Holmes or Miss Marple in action.”
Brazil has been hit by several waves that killed an alarming number of young people and reported a record one-day jump of 4,000 Covid-19-related deaths last week. Meanwhile, India’s daily casualty rise has been around 1,000 and well below last week. Deaths in the Asian country as a percentage of confirmed cases are 1.2 versus 2.6 in Brazil, according to data compiled by Bloomberg.
Age variation
Several factors could be at stake in the mortality gap, including the differences in mean age: 26 years in India and 33.5 in Brazil.
Experts have long criticized India’s broader mortality statistics, especially in its rural countries. Prior to the pandemic, approximately one in five fatalities was not reported, according to Mukherjee. But that doesn’t explain why Brazil’s mortality rate is higher than the aging of Western nations that have also been hard hit by the pandemic.
“Brazil’s mortality rate is even more shocking because the population is much younger than other countries, such as Europeans,” said Alberto Chebabo, vice president of the Brazilian Society of Infectious Diseases.
The increase in infection and mortality rates occurs as the rate of inoculation in each country has accelerated in the last month after an initially slow start. India has managed to administer more than 114 million doses of vaccine, compared to Brazil’s 32 million, although the latter has injected a larger proportion of its population.
Cross immunity
Other theories behind the divergence between Brazil and India focus on the different environments and disease experience of the two countries.
Some scientists claim that widespread exposure to a number of diseases in India may have helped its citizens build natural resistance to coronaviruses such as Covid-19.
Shekhar Mande, the head of the Scientific and Industrial Research Council of India, is among those who have examined this trend and have been co-authors of a published study on it. His research found correlations in which citizens of countries with poor hygiene tended to cope better with Covid-19.
“Our hypothesis, and this is strictly a hypothesis, is that because our populations are continuously exposed to many types of pathogens, including viruses, our immune system does not react hyperreactively to any new variation,” Mande said in an interview. .
Many experts acknowledge that genetics or cross-immunity could be at stake, as other South Asian countries, including Bangladesh and Pakistan, have also recorded far fewer deaths than Brazil.
According to Mukherjee of the University of Michigan, 87% of Brazilians live in urban areas, but two-thirds of Indians live in rural areas with more space and ventilation.
Mutant strains
Then there is the fact that in December one of the most life-threatening coronavirus mutations, variant P.1, was identified in Brazil. Along with variants first seen in South Africa and the UK, studies suggest that these strains are more contagious.
“The P.1 variant has spread simultaneously to many cities and states in Brazil, which has led to a collapse of the health system, which has led to a very high mortality rate,” said Chebabo, of the Brazilian Society of Infectious Diseases. Brazil is in a “perfect storm,” he added, with its lack of political leadership in implementing effective measures such as closures, which exacerbated the Covid crisis.
The mourners see workers wearing protective equipment bury the coffin of a Covid-19 victim in Vila Formosa Cemetery in Sao Paulo, Brazil, on Wednesday, March 24, 2021. Brazil reported more than 3,000 killed by Covid-19 for the first time on a Tuesday, a 24-hour period as the pandemic spreads uncontrollably to Latin America’s largest economy and the nation is approaching 300,000 dead lives.
The rapid and sustained spread of the variant in Brazil also gave its healthcare system no breathing space, unlike a calm between waves in the last months of 2020 in India, which helped hospitals and front-line workers. to recover and plan ahead.
“We are much better prepared to handle this wave than before in many, many aspects,” Suneeta Reddy, CEO of Apollo Hospitals Enterprises Ltd., said in an interview. “We have learned the clinical protocols to treat Covid. We can use our assets and beds in a much more rigorous way ”.
Now India could face the prospect of an increase in mutant strain that is worse than its first outbreak, although it is difficult to know given that the Asian nation had sequenced the genome by less than 1% of his positive samples to Covid.
Complacency, second wave
Poor management and coveted fatigue have also been blamed for rampant spread and high mortality rates in both countries. Brazilian President Jair Bolsonaro has long since closed the closures, clashing with local governments over pandemic mitigation measures and for ridiculing the use of masks.
For India, a decline in daily infections during the month since the first peak in September, along with officials lifting restrictions on public meetings, encouraged people to lower their guard. Many were also left indifferent to Covid’s dangers after seeing friends and family recover with mild symptoms and politicians ignoring safety protocols.
“Brazil is a complete disaster in terms of political leadership and India has been pleased after the initial decline in cases,” said Madhukar Pai, Canadian research chair in epidemiology and global health at McGill University in Montreal. .
It is too early to say whether India can continue to avoid Brazil’s most lethal destination. While some parts of the country have imposed specific closures, elections are being held in five states (seeing thousands of voters pack campaign rallies), along with a month-long Hindu pilgrimage carrying crowds along the Ganges River .
These threaten to undo the benefits that can be derived from increasing the vaccine. Daily deaths in the South Asian country have already doubled to over 1,000 a day last week, with crematoria in many areas operating non-stop and bodies piled up.
“Both countries need to significantly increase their vaccination coverage and work harder to implement other public health measures,” Pai said. “The important thing is that each country has to work much harder to contain the epidemic.”