Covid Is Deadlier in Brazil Than India and No One Knows Why - bloomberg.com .
Multiple factors could be at play in the fatality gap, including the differences in mean age -- 26 years in India to Brazil’s more elderly mean age of 33.5.
Facing a sudden surge in coronavirus infections, India is once again home to the world’s second-largest outbreak, overtaking Brazil after the latter moved ahead in March. But behind the bleak statistical jockeying is an epidemiological enigma over why the Latin American country has been far more devastated by the pathogen.
When it comes to the scale of infections, the two nations are similarly matched, with cases hovering around 14 million and hospitals from Mumbai to Sao Paulo under increasing pressure as admissions continue to rise. But it’s the divergence in fatalities that has scientists puzzled. Brazil, home to almost 214 million, has seen more than 365,000 people die from Covid-19, more than double the number of deaths in India, which has a far greater population of 1.4 billion.
While deaths in India have started climbing and threaten to get worse, the macro-level disparity remains and is emblematic of different ways in which the pandemic is playing out across regions. Experts say this needs to be better understood and decoded, to contain this global outbreak as well as avoid future public health crises. Covid death ratios in South Asia, including India, are consistently lower than global averages, just as those in Latin America are consistently higher, forcing virologists to offer a number of theories as to why Covid has cut a more deadly swathe from Brazil to Argentina.
“We’re not comparing apples to apples here, we’re comparing apples to oranges,” said Bhramar Mukherjee, the biostatistics chair at University of Michigan’s 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 multiple waves killing an alarming number of its young and it reported a record one-day jump of 4,000 Covid-19-related deaths last week. Meanwhile, India’s daily surge in casualties have been more than 1,000 in the past few days and was well below that last week. Deaths in the Asian country as a percentage of confirmed cases is 1.2 versus 2.6 in Brazil, data compiled by Bloomberg show.
Age Variation
Multiple factors could be at play in the fatality gap, including the differences in mean age -- 26 years in India to Brazil’s 33.5.
Experts have long criticized India’s broader death statistics, particularly in its rural hinterlands. Before the pandemic about one in five fatalities were not reported at all, according to Mukherjee. But that doesn’t explain why Brazil’s death rate is higher than aging 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 European ones,” said Alberto Chebabo, the vice-president of the Brazilian Society of Infectious Diseases.
The rising infection and death rates come as the pace of the inoculation drives in each country has sped up in the past month after an initially sluggish start. India has managed to administer more than 117 million vaccine doses, compared to Brazil’s almost 33 million -- though the latter has injected a higher proportion of its population.
A healthcare worker administers a dose of the Sinovac Biotech‘s CoronaVac Covid-19 vaccine at a clinic in Rio de Janeiro on March 31.
Cross-ImmunityOther theories behind the divergence between Brazil and India center around the two countries’ differing environments and experience of disease.
Some scientists say widespread exposure to an array of diseases in India may have helped its citizens build natural resilience against coronaviruses such as Covid-19.
Shekhar Mande, the head of India’s Council of Scientific and Industrial Research, is among those who have examined this trend and co-authored a published study on this. His research found correlations where citizens from low-hygiene nations tended to better cope with Covid-19.
“Our hypothesis, and this is strictly a hypothesis, is that because our populations are continuously exposed to many kinds of pathogens, including viruses, our immune system does not hyper-react to any new variation that comes in,” Mande said in an interview.
Many experts acknowledge genetics or cross-immunity could be at play as other South Asian countries including Bangladesh and Pakistan have also seen far fewer deaths than Brazil.
That 87% of Brazilians live in urban areas, but two-thirds of Indians live in rural places with more space and ventilation could be another reason, according to University of Michigan’s Mukherjee.
Mutant StrainsThen there’s the fact that Brazil is where one of the most potentially deadly coronavirus mutations, the P.1 variant, was identified in December. Along with variants first seen in South Africa and the U.K., studies suggest these strains are more contagious.
“The P.1 variant has spread through a lot of Brazil’s cities and states simultaneously, leading to a collapse of the health system, which has lead to a very high mortality rate,” said Chebabo from the Brazilian Society of Infectious Diseases. Brazil is in a “ perfect storm,” he added, with its lack of political leadership in implementing effective measures like lockdowns, compounding the Covid crisis.
Mourners watch as workers bury the casket of a Covid-19 victim at a cemetery in Sao Paulo, Brazil, earlier in March.
The rapid and sustained spread of the variant in Brazil also gave its health-care system no breathing room, unlike a lull between waves over the last months of 2020 in India, which helped hospitals and frontline workers recover and plan ahead.
“We’re far better prepared for handling this wave than we were earlier in many, many ways,” Suneeta Reddy, managing director of Apollo Hospitals Enterprises Ltd., said in an interview. “We’ve learned the clinical protocols to treat Covid. We’re able to use our assets and beds in a much more rigorous manner.”
With Poor Data on Mutants, India’s Virus Surge Remains a Mystery
India could now be facing the prospect of a mutant strain-driven surge that’s worse than its first outbreak, though it’s hard to tell given the Asian nation had done genome sequencing for less than 1% of its Covid-positive samples.
India is studying the new virus variant but it wasn’t immediately clear if it was triggering the current wave of Covid-19 infections, Aparna Mukherjee, a scientist at the Indian Council for Medical Research told Bloomberg TV.
Complacency, Second WaveMismanagement and Covid fatigue have also been blamed for the rampant spread and soaring death rates in both countries. Brazilian President Jair Bolsonaro has long-opposed lockdowns, clashing with local governments over pandemic mitigation measures and ridiculing mask wearing.
For India, a months-long decline in daily infections from the first peak in September -- along with officials lifting restrictions on public gatherings -- encouraged people to lower their guard. Many also became indifferent to the dangers of Covid after seeing friends and family with mild symptoms recover and politicians disregard safety protocols.
“Brazil is a complete disaster in terms of the political leadership, and India has become complacent after the initial decline in cases,” said Madhukar Pai, the Canada research chair in epidemiology and global health at McGill University in Montreal.
It’s too early to say if India can continue to avoid the more lethal fate of Brazil. While some parts of the country have imposed targeted lockdowns, elections are being held in five states -- seeing thousands of voters pack campaign rallies -- along with a month long Hindu pilgrimage that brings throngs to the banks of Ganges river.
These threaten to undo the benefits that can come from the ramped up vaccination drive. Daily deaths in the South Asian country have already more than doubled to over 1,000 a day in the past week, with crematoriums in many areas running non-stop and bodies piling up.
“Both countries need to greatly increase their vaccination coverage and work harder to implement other public health measures,” said Pai. “What matters is each country needs to work much harder to contain the epidemic.”
People in their 20s and 30s are leaving hospitals in body bags
Some have to work, others don’t grasp the depth of the risk
Rodolpho Sousa, a 28-year-old Brazilian lawyer, had been working from home near Rio de Janeiro when, in late February, one of his clients was jailed. Covid was hitting the prison and he was worried about her, less about himself. He went there to get her out.
His cough started a few days later and wouldn’t quit. He went to an emergency clinic where, his lungs down to half their capacity, he was diagnosed with Covid. In the two days he waited for a hospital transfer, he was witness to an infernal scene -- patients his age dying on either side of him.
“There was a woman who was 23 next to me and we spoke,” he recalled. “She started coughing and coughing, and the doctors closed the curtain between us. Later they took her out in a black body bag. I was completely terrified.”
Like in most countries, the pandemic in Brazil hit the elderly and immuno-compromised first and hardest. But in the past couple of months, the nation that has stood out as nearly a worst-case-scenario for caseloads, deaths and public policy, has shown where the global plague may be headed: for the young.
In March, 3,405 Brazilians aged 30 to 39 died from Covid, almost four times the number in January. Among those in their 40s, there were about 7,170 fatalities, up from 1,840, and for those 20-29, deaths jumped to 880 from 245. Those under 59 now account for more than a third of Covid deaths in Brazil, according to research firm Lagom Data. As the elderly get vaccinated, their deaths have fallen by half.
There are many causes for the alarming shift but one appears to be that the young have trouble accepting they are at risk.
“Because they’re young and the virus first infected the elderly population, they don’t believe or don’t want to believe that it can be serious,” said Dr. Suzana Morais, a cardiologist in Rio de Janeiro. “I’ve seen many young patients who are surprised. Others are aware but take risks.”
It’s also true that after months of government aid and staying home, the money is running out and people have to work again, exposing them to risk in a society that hasn’t done well at imposing masks and distancing.
After Sousa recovered, his mother got Covid bad and survived at home. His father, 63, a marathon runner, was hospitalized. He died last week.
Meanwhile, across the country in Brasilia, Andréia Santana became a widow. The 29-year-old works as a maid and was not excused despite her boss showing Covid symptoms after a trip to the beach in early March.
“I needed the job,” she said. Her husband had been unemployed for two years and was taking care of their three children. He got government aid in 2020 but not this year.
All five were infected, her husband the worst. He went to the hospital. It was crowded, as was the other hospital to which he needed to be transferred. It took a week, and he died there a day later. He was 42.
Coronavirus Newsletter: Brazil’s Worst Days Are Far From Over
In Loco, a platform specialized in monitoring social distancing in Brazil, says that, in most states, the social isolation rate hovered around 40% in March, higher than at the beginning of February but still well below the 70% officials say is needed to slow transmission. Another issue is the Brazilian variant of the virus that appears to be more contagious.
During a virtual meeting of executives from Brazil’s biggest soccer teams, the head of the Soccer Confederation said nobody wants to stop the matches and championships. Days earlier, one of his main players was among 200 arrested in a clandestine casino where the buy-in for a poker game was 40,000 reais ($7,200).
Lago Paranoá, a lake in the center of Brasilia, is seeing crowds filter again onto boats for weekend parties -- their masks around their necks.
Rio de Janeiro lifted most bans earlier this month, when it saw a drop in patients, reopening non-essential business and allowing for dining in bars and restaurants. Sitting on the beach is prohibited, but the Saturday after restrictions were lifted, hundreds had fanned out across the sand in Ipanema, taking in the rays. They kicked around soccer balls and vendors hawked beers as authorities zipped by on 4-wheelers leaving everyone undisturbed.
“People are totally tired,” said Pedro Melo, a 27-year-old lawyer who, with his girlfriend, was among the beach goers. The couple got infected in October but only had mild symptoms, like most of their social circle, and were willing to go out again. The night prior, they went for cocktails in Copacabana.
“What we want are vaccines, but since that’s not possible we’re trying to have something of normal life,” he said.
Further down the beach, Lucas Alcantara, 31, a communications coordinator, sipped beer under a umbrella with a friend. “This is my contradiction,” he said. “I understand the risks, and share the concerns, but I need to find some relief.”
Younger Brazilians Are Dying From Covid in an Alarming New Shift
Elen Geraldes, a sociologist at the University of Brasilia, says a big problem is the lack of guidance from the top, a mishmash of policies that vary from state to state and city to city with little enforcement. President Jair Bolsonaro often minimizes the seriousness of the disease, saying the economic toll will be far worse than that of the virus. Last weekend, like he’s done throughout, Bolsonaro gathered a crowd of supporters, shaking hands and kissing babies.
Cases have stopped rising. Deaths, which still routinely top 3,000 a day, will take longer to stabilize, according to health experts. Vaccinations have picked up, though they remain below the daily rate pledged by the government of one million a day.
“We don’t have a unified message from the government about the real need for social distancing,” said Dr. Morais, the Rio cardiologist. “In the end, young people don’t respect this much. You have an economically active population that needs to work and they simply don’t have many options.”
— With assistance by Isadora Sanches |
