India has mask mandates
The Mystery Of India's Plummeting COVID-19 Cases
February 1, 20213:29 PM ET
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 unprecedented recession.
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."
Scientists say it's a mystery. They're probing why India's coronavirus numbers have declined so dramatically — and so suddenly, in September and October, months before any vaccinations began.
They're trying to figure out what Indians may be doing right and how to mimic that in other countries that are still suffering.
"It's the million-dollar question. Obviously, the classic public health measures are working: Testing has increased, people are going to hospitals earlier and deaths have dropped," says Genevie Fernandes, a public health researcher with the Global Health Governance Programme at the University of Edinburgh. "But it's really still a mystery. It's very easy to get complacent, especially because many parts of the world are going through second and third waves. We need to be on our guard."
Scholars are examining India's mask mandates and public compliance, as well as its climate, its demographics and patterns of diseases that typically circulate in the country.
Mask and mandates
India is one of several countries — mostly in Asia, Africa and South America — that have mandated masks in public spaces. Prime Minister Narendra Modi appeared on TV wearing a mask very early in the coronavirus pandemic. The messaging was clear.
In many Indian municipalities, including the megacity Mumbai, police hand out tickets — fines of 200 rupees ($2.75) — to violators. Mumbai's mask mandate even applies outdoors, to joggers on the beach and passengers in open-air rickshaws.
"Every time they fine a person 200 rupees, they also give them a mask to wear," explains Fernandes, a Mumbai native. "Very stereotypically, we [Indians] are known to break rules! You see traffic rules being broken all the time," she says, laughing.
But in the pandemic, when it comes to masks, "the police, the monitoring, enforcement — all that was ramped up," she says.
Authorities reportedly collected the equivalent of $37,000 in mask fines in Mumbai on New Year's Eve alone.
But the fines and mandates appear to have worked: In a survey published in July, 95% of respondents said they wore a mask the last time they went out. The survey was conducted by phone in June by the National Council of Applied Economic Research, India's biggest independent economic policy group.
Awareness is widespread. Whenever you make a phone call in India — on landlines and mobiles — instead of a ring tone, you hear government-sponsored messages warning you to wash your hands and wear a mask. One message was recorded by Bollywood legend Amitabh Bachchan, 78, who battled and recovered from COVID-19 last summer.
The mask and hand-washing messages have now been replaced with new ones urging people to get vaccinated; India began vaccinations on Jan. 16.
Heat and humidity
Aside from mask compliance, there's also India's climate: Most of the country is hot and humid. That too has deepened the mystery. There's some evidence that India's climate may help reduce the spread of respiratory viruses. But there's also some evidence to the contrary.
A review of hundreds of scientific articles, published in September in the journal PLOS One, found that warm and wet climates seem to reduce the spread of COVID-19. Heat and humidity combine to render coronaviruses less active — though the certainty of that conclusion, the review says, is low. Previous research has also found that droplets of the virus may stay afloat longer in air that's cold and dry.
"When the air is humid and warm, [the droplets] fall to the ground more quickly, and it makes transmission harder," Elizabeth McGraw, director of the Center for Infectious Disease Dynamics at Pennsylvania State University, told NPR last year. (However, the science of transmission is still evolving.)
In a survey of COVID-19 cases in India's Punjab state, Das, the health economist at Georgetown, found that 76% of patients there did not infect a single other person — though it's unclear why. He and his colleagues examined data collected from contact tracing and found that most patients who did infect others infected only a few other people, while a few patients infected many. Overall, 10% of cases accounted for 80% of infections. One implication, which Das says he's investigating further, is the possibility of making contact tracing more efficient by first testing a patient's immediate family members. If no one at all is infected, the process can end there.
"The temperature, of course, is in our favor. We do not have too cold of a climate," says Dr. Daksha Shah, an epidemiologist and deputy executive health officer for the city of Mumbai. "So many viruses are known to multiply more in colder regions."
But there's also some scientific evidence to the contrary, that India might actually be more conducive to the coronavirus: Research published in December in the journal GeoHealth says that urban India's severe air pollution might exacerbate COVID-19. Not only does pollution weaken the body's immune system, but when air is thick with pollutants, those particles may help buoy the virus, allowing it to stay airborne longer.
A paper published in July in The Lancet says extreme heat may also force people indoors, into air-conditioned spaces — and thus might contribute to the virus's spread. The Natural Resources Defense Council has warned that extreme heat can lead to a spike in other illnesses — dehydration, diarrhea — that might lead to overcrowding in hospitals and clinics already struggling to treat victims of COVID-19.
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