# India Tragedy Unfolds- A Grim Reality
As death numbers climbed, India recorded more than 412,000 cases on 5 May 2021. India’s official death numbers were more than 3800 yesterday, a conservative estimate based on various media reports. Today, India has more than 21 million cases, second only to the US. As more than 50 percent of the US population has at least one vaccination jab, President Biden and his team have done an excellent job containing the virus as India explodes as a Global epicenter. Total cases report continue to rise at an alarming rate with an average of more than 350000 in the last six days, according to Worldometer. The recent surge in the COVID19 cases highlights a systemic failure of India, chiefly the Central and selected State governments and institutions. For example, the Election Commission of India did not have the aptitude and the vision to postpone political elections that are today the central tenet for the spread of novel coronavirus.
Based on the analysis of ECDC data on the 14-day notification rate of new COVID-19 cases and deaths for India shared by European Centre for Disease Prevention and Control, an agency of European Union last updated on 29 April, 2021. (Refer to graph above) . There some stunning insights. Week 1 would be sometime in Jan, 2021.
The COVID-19 cases for the period increased by ~1287.7 percent and deaths per million increased by ~665.3 percent from week 1 to week 16, an exponential increase. This period saw numerous political rallies in India esp. West Bengal and religious gathering like Kumbh Mela.
Week 11 is the turning point for both the 14-day notification rate of new COVID-19 cases and deaths in India. Week 11 saw a 52.58 percent rise in the 14-day notification rate of new COVID-19 cases per 100000 population and a 34.82 percent increase in the 14-day notification rate of deaths per million population over the previous week. If you average out the percent increase of the 14-day notification rate of new COVID-19 cases and deaths in the four weeks over the last weeks before Week 11, the numbers are ~ 14.64 percent and ~4.10 percent, respectively. Post week 11, the percent increase for deaths increased substantially, with an 82.5 percent increase in week 16 over week 15. In week 16, the percent of 14-day notification rate of new COVID-19 deaths per million increased by 82.50 percent, the highest for the sixteen weeks of data covered.
# United States Rises
One of the reasons for the rise in cases is a sluggish vaccination program. As the second-most populous country globally, India has ~2.2 percent of the population as fully vaccinated, with more than 158 million jabs administered according to data shared by Our World in Data as of 5 May 2021. The total share of vaccinations either wholly or partly amounts to less than 10 percent of the population. The brilliance of turning around a catastrophic outcome by the Biden administration is by implementing a scientific framework of research, implementing social distancing norms, and rolling out a highly effective and smooth vaccination drive, a fact missing among the steps by the Indian government this year. 
Graph shares a poignant comparison of how scenarios developed in the US and India, countries with the two most numerous COVID19 cases, respectively. Americans negotiated with various companies to discover the virus.
However, the Indian government did not venture aggressively to either scale up the existing capacity of vaccine manufacturers, for example, the Serum Institute of India or Covaxin manufacturers, nor negotiated with other various manufacturers of the vaccines for national rollout like the Americans. Public outrage for stockpiling vaccines as vaccine inequality remains an enabler for universal discontent. The recent announcement of the Biden administration to donate 20 million of AstraZeneca Oxford vaccine helps mitigate some concerns yet far from a panacea for low and medium-income countries.
Healthcare Sector Insights
According to WHO data, India’s healthcare expenditure as a percent of GDP was 3.54 percent in 2018. The Indian government expressed no sense of urgency in implementing radical measures to better respond to the pandemic. In fig, weekly count refers to new cases. In India, the top 10 percent of the population holds 77.4 percent of the total national wealth, making healthcare inequitable, especially in rural areas. Refer to the Davos report 2019, Good or Private Wealth? Oxfam Inequality Report, The India Story.
India had only 0.86 physicians per thousand in 2018 compared to 1.98 in China, 4.25 in Germany, and 2.61 in the US. The figures for China, Germany, and the US are from 2017. 
The physicians per thousand figures share an insightful take as are the most critical enablers in fighting the pandemic apart from caregivers and other health workers. The comparative figure for middle-income countries in 2017 is 1.38, highlighting the pain within the healthcare system in India. The Indian government must build make-shift hospitals, invest in ancillary healthcare industries, and boost investment in manufacturing vaccines and medical oxygen before the power of compounding makes the problem intractable. The curve in India is much steeper than in the US, a problematic feature as vaccinations are the most significant aspect in the uphill fight against the virus. The United Kingdom is another remarkable story on how smooth vaccinations can drastically change the scenario. In the fig below, United Kingdom’s fantastic dip in new cases. The data covered for the graph is from 1 Jan 2021 to 5 May 2021.
A brief national lockdown is critical to flattening the curve as India grapples with the possibility of a third wave.
The answer is in plan sight —Vaccination, vaccination, and vaccination backed by social distancing norms. The graph of the UK, Sweden, and Canada has been removed from the original article as it doesn’t highlight the trend in COVID-19 cases meaningfully.
Convalescent plasma therapy A Policy Enabler
Convalescent Plasma Therapy, simply plasma therapy, is a passive antibody therapy to fight the novel SARS virus. It’s a unique way of treating people suffering from COVID19 who are either early in their illness or have a weak immune system. In India, people within 28 days and two months of being tested positive for SARS-Cov2-2 and have recovered can donate provided their SARS-Cov2-2 Ig Antibodies are above a permissible limit. A 500ml dose of plasma can be administered to three patients to help people recover from the infection or, in extreme cases, death. The drawback of this method is that not much evidence is available of its direct effect against the virus; however, the U.S. Food and Drug Administration (FDA) has given emergency authorization for convalescent plasma therapy. In this process, blood is filtered for antibodies and plasma, keeping red cells intact within the body. This is not the first time serum therapy has been used to cure people for diseases caused by viruses, such as Ebola and hepatitis. Still, according to a report published by Lancet in May 2021 – Convalescent plasma from people vaccinated after COVID-19 infection, the efficacy of plasma therapy remains a suspect against the novel coronavirus. Only 20 percent of plasma donations meet the criteria as antibodies deplete fast. The study states that plasma therapy might help people previously infected by the virus who have had one jab of RNA-based vaccine against reinfection. As infections continue to rise globally, especially in countries like India and Brazil, there is a high probability of the third wave as the virus mutates; plasma donation is a noble way to contain the pandemic. With more than 21 million COVID19 cases reported in India with actual cases much higher, a random sampling across cities could shed light on the population affected; this therapy helps fight COVID19 as it does not require a radical shift in technology and investment in research and development.
Convalescent Plasma Therapy, simply plasma therapy, is a passive antibody therapy to fight the novel SARS virus. It’s a unique way of treating people suffering from COVID19 who are either early in their illness or have a weak immune system. In India, people within 28 days and two months of being tested positive for SARS-Cov2-2 and have recovered can donate provided their SARS-Cov2-2 Ig Antibodies are above a permissible limit. This is not the first time serum therapy has been used to cure people for diseases caused by viruses, such as Ebola and hepatitis. Still, according to a report published by Lancet in May 2021 – Convalescent plasma from people vaccinated after COVID-19 infection, the efficacy of plasma therapy remains a suspect against the novel coronavirus. Only 20 percent of plasma donations meet the criteria as antibodies deplete fast. The study states that plasma therapy might help people previously infected by the virus who have had one jab of RNA-based vaccine against reinfection. As infections continue to rise globally, especially in countries like India and Brazil, there is a high probability of the third wave as the virus mutates; plasma donation is a noble way to contain the pandemic. With more than 21 million COVID19 cases reported in India but actual cases much higher, a random sampling across cities could shed light on the population affected; this therapy helps fight COVID19 as it does not require a radical shift in technology and investment in research and development. Suppose between 5 to 10 percent of SARS-Cov2-2 recovered patients donated plasma in India and consider managing efficiency of 20 percent. In this case, it could lead to a database of ~105000 to 2100000, with a multiplier of 3, a potent force to fight COVID19. Extrapolate it globally, and the numbers increase substantially. The middle road spearheads a plasma therapy drive; contact nishant@themiddleroad.org, a plasma donor, for more details. This piece is under the global COVID19 special series.
For any discrepancy in data, write to nishant@themiddleroad.org.