I was in India ~10 years ago, upon entering the airport i was shocked to see smoke everywhere and assumed there had been some kind of fire. Nope, i was seeing the air, i could see the normal air inside the airport terminal. Pollution is a huge problem in Delhi which surely contributes to bad covid outcomes.

That was my thought, though the whole nutritional aspect of diet may also play a factor.

I wanted to find a map of Indian pollution averages, pull that up and a map of covid deaths - https://aqicn.org/map/india/ does real-time air-quality and does give some idea.

Also other factors that may or may not play a part would be the climate, we know how well virus's do in winter over summer, equally peoples health. Now India climate wise - the only difference that sticks out this time of year would be that on average the humidity is at it's lowest point of the year, as is rainfall. Are they factors, maybe and equally less rain would also mean more particulates in the air and that we can measure with air quality.

[EDIT ADD] AS for nutritional - let us be mindful that the impact of a whole year upon business and income in India may well of seen peoples nutritional intake decline due to trickle down economics being quick to pass on the bad times over the good, and for many income wise this year not been good and not everybody gets paid to stay at home in every country.

A whole year ago early in the pandemic (may2020), dutch pollster / data entrepreneur Maurice De Hond was purged from google indexes, for suggesting there was a link between covid spikes and weather.

His research [1] indicated that brazil (manaus) and ecuador (guayaquil) - both hit early on by the disease- showed a very strong predictive basis for spikes in covid19 deaths/cases, and massive rainfall.

Now, its important to note that this was not referring to classic "rain". The previously mentioned cities lie on a specific latitude which has torrential rainfall, the kind that floods roads, etc. This was moonson-style rain happens near the equator (it was remarkable early on how south America and africa were mostly spared, except for the aforementioned 2 cities)

Fast forward to india.

Would an early moonson season, together with a latent pool of virus already Within the populace, be the driving factor here?

[1] https://www.maurice.nl/2020/05/21/the-blind-spot-with-huge-c...

I'm curious to know, why he was de-indexed from Google?

Early on in the pandemic, information about covid19 not coming from official channels seemed to disappear from search engines quickly.

That was the claim. I dont have information that would point the motives behind any such action, besides pure speculation (govt request, genuine awkward attempt to help, etc)

The air quality was bad for the first wave (H2 2020) as well though, so it can't be helping, but it can't be what's causing this second wave to be such a catastrophe.

You always can tell you're about to land in Delhi because you can smell the air before you touch down.

That said, I don't think this alone is an explanation, since COVID is currently also tearing through Indian cities like Bangalore where air quality is better. (Not good, mind you, but nowhere near as bad.)

> You always can tell you're about to land in Delhi because you can smell the air before you touch down.

What a great description. It sounds like Terry Pratchett describing Ankh-Morpork.

The air pollution was there even the last year. But, the situation was not this bad. Surely the air pollution is a problem, but there must me more to the current crisis which was not there last year.

It was like that 20 years ago. You can see the pollution.

Being infected isn't a binary thing. There is a big difference from swallowing 30 Coronavirus particles from touching your face to breathing in 300,000 from someone coughing in your face.

If you're young the first is probably a mild cold while the latter is a trip to the ICU.

Part of bringing the virus under control is reducing the amount of particles people are exposed to so they have a better chance of fighting off the virus.

How do you know?

It depends on how fast the virus population doubles. And how fast the immune system kicks in.

If the virus population doubles every second then the person who swallowed 30 virus particles will be at 300,000 in just 14 seconds.

If it doubles once per minute, it is 14 minutes. If it doubles once per hour, it is 14 hours.

The question if that is a meaningful headstart depends on how fast the immune system reacts. And if it reacts faster to 300k viruses than to 30.

A very important thing is the topology of the infection. I had COVID last year and it progressed linearly over time, from the back of my nose(probably from a big water droplet I breathed)forwards(towards my nose) and downwards towards my lungs. I could measure the progress day after day.

It progressed linearly because the breathing system is a duct. Like a fire needs a boundary to expand, a frontier. It is not 3D but 2 dimensional.

You just can not do an exponential calculation, without taking into account the physical limits of the environment.

Just before entering the lungs I did beat it. I coughed for a month or so,specially for the irritation in my glottis, but nothing serious.

This year I got it again, the progress rate was very similar but my immune system reacted sooner.

What is interesting is that I did not developed antibodies, my antibodies test were negative but the PCRs positives. This means that my T cells were already fighting the infection.

That probably had something to do with living in China in the past and having developed immunity against SARS.

> That probably had something to do with living in China in the past and having developed immunity against SARS.

Only about 8000 persons have been recorded to come down with SARS. Were you one of them with a diagnosed case of SARS (10% fatality rate)? The vast majority of residents in China would have no exposure to SARS.

Alternative theory: you had something else for at least one of those reported illnesses, and your PCR test was a false positive. The rest is conjecture, anecdote, and speculation.

> Just before entering the lungs I did beat it.

How long it took / how fast it progressed from one drop almost to lungs (with what treatment)?

Do you think this could have helped early in your case:

Use of Povidone Iodine Nasal Spray.. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3563092 (March 2020)

or this: nasal rinse and mouthwash, Listerine Antiseptic https://doi.org/10.1002/jmv.26514 if the virus landed on the throat ?

>If the virus population doubles every second then the person who swallowed 30 virus particles will be at 300,000 in just 14 seconds

That was also my intuitive response at the beginning of the pandemic. I assume one virus was plenty due to exponential growth. Having read every article I could in the past year, it's extremely rare to run across any details but:

1. I've read that scientists believe a coronavirus takes hundreds of viruses to successfully infect us. Not, for example, several dozen like some other viruses.

2. Next obvious question to me is, is this because one has to land on a lucky spot on the body and the rest somehow die before they can reproduce (so it's statistical odds that one virus gets the conditions it needs just like one sperm makes it to the egg)? Or can the body fight off a dozen or two dozen covid19 viruses so quickly that they never take hold? I only see two possibilities here.

3. If it is the latter, an answer I can't find anywhere, why did we need to waste so much time developing a vaccine? Wouldn't it be equally efficacious to introduce one virus to the body on day one, four on day two, and so on until immunity is achieved? Evidence of this possibility would be mixed in with the population they believe are asymptomatic, so unless researchers look for this they won't find it. (Basically a natural immunity hypothesis - based on repeated low viral count exposure.)

A virus that doubled in a second would be perceived as a swarm that dissolved people before our eyes as it quickly ate the biomass of the planet. Think 2^86400 in one day. Fortunately it would need faster than light travel to keep replicating at that rate for long.

Why would it need ftl?

Aren’t all the doublings local?

Anything that keeps replicating exponentially will eventually have its growth limited by the speed of light, because the amount of space you can reach while traveling at a bounded speed only grows polynomially fast. Because the formula for the volume of a sphere is cubic. You’ll run out of space and the things in the inside of the ball won’t have room to replicate.

I'm assuming it would consume all local mass shortly.

> If it is the latter, an answer I can't find anywhere, why did we need to waste so much time developing a vaccine? Wouldn't it be equally efficacious to introduce one virus to the body on day one, four on day two, and so on until immunity is achieved?

Introducing the virus like this, you’ve created a live virus vaccine. The work involved in creating and testing such a vaccine isn’t really any less than creating the vaccines we did make. You still have to develop technology to grow the virus and distribute exactly the right quantity. Moreover, the risk of complications is far greater if someone fails to fight off the small viral load infection.

The vaccines such as Moderna only took a week or two to prototype in January 2020. The entire rest of the time was scaling up production and running tests to prove it worked in the population. We could have skipped running the trials and deployed the untested vaccine instead. A lot of lives would have been saved but no way to know that without doing the trials, I suppose.

What you are referring to is the viral load. How much does it take to make you really ill. It matters because your body can fight a few dozen virus cells more readily that it can a few thousand. Sure it can make more antibodies but they take time, time the virus has to replicate, so now you need more antibodies, and yiu aren't exactly sure which ones work.

https://www.bmj.com/content/371/bmj.m4763

That's called variolation [0], and it was floated early on by some pundits, but not seriously. It faces the same sort of pushback as challenge trials.

[0] https://en.wikipedia.org/wiki/Variolation

Sort of. Variolation also involved intentionally inoculating with a naturally occurring less deadly strain. Also, introducing intentional Covid infections in a naive population would likely infect many contacts of the inoculated patients before they got inoculated, which would defeat the purpose.

to your last question—when we develop a vaccine or treatment, it’s about making sure as many people as possible get the minimum degree of protection with the least amount of risk. giving live virus is a tremendous risk, even if you found a way to just give one particle at a time effectively.

Viral reproduction rate is not that fast. It's about 8 to 72 hours depending on the type of virus. This is why low viral load is generally associated with milder disease outcomes, the body has a significantly longer time to generate an immune response before the viral load becomes significant.

Parent was referring to the doubling rate.

Cells produce more than one additional particule per reproduction cycle, so the doubling rate is lower than 8 to 72h.

It doesn't only react faster, it will react differently. Up to a reaction called "sepsis" that can kill you even without the virus doing anything anymore. Research points to most covid complications being such (there are lots more, the immune system is the worst kind of spaghetti code you can imagine) massive immune reactions gone haywire.

I'm not saying you are right or wrong. I'm saying that immune reactions aren't linear, straightforward, harmless or predictable. And that "more virus" usually isn't better.

As a type1 diabetic, I love the 'spagetticode' reference. Our biology is amazingly complex. And in a somewhat constant broken state. My immune system decided that crucial pieces of my own body, are dangerous invaders, and it then decided to attack it. The attack is ongoing, and successful: a crucial subroutine of me is being destroyed faster than another part of me can rewrite it.

This isn’t really accurate because it fails to take into account how infections work. Viruses don’t replicate like bacteria, so they don’t just double every X amount of time. They infect a cell and hijack the cell to produce copies (sometimes millions) of the virus until the cell exhausts itself and dies, bursting open and releasing all those copies of the virus. While this is happening, the body is attempting to fight this. What is particularly relevant are several of the varieties of T-cells, or killer cells. They are attempting to find cells infected with the virus and destroy them before they burst. While some copies of viruses escape cells as they are producing them, the overwhelming majority escape when it dies and bursts.

What this means is that 30 viral particles do not become 300,000 in 14 seconds. Say that all 30 find cells and infect them, and T-cells destroy 50% before they burst. You have 15 cells that burst and release viruses to infect nearby cells. If you start with 300,000 infected cells, and T-cells destroy 50% before they burst, you have 150,000 cells that burst and release viruses to infect nearby cells.

Low initial infections can often be well controlled and managed by the immune system in this way until antibodies are produced. High load infections can often spiral out of control due to so many initial cells being infected, the physical damage of higher numbers of killed cells, either burst or destroyed, and the high numbers outpacing the body’s ability. Of course this is also a simplification, but I think it demonstrates how initial viral load can have a big effect on outcome.

Won't the immune system acts better when it gets infected by 30 (say) virus particles than swamped by 300k viruses (say).So my guess (as layman) is when infected with 30 viruses the growth might not be as uncontrollable (doubling per second). I think the virus load indeed matters too.

You absolutely don't know that. Disease severity vs. contaminant load correlation is unknown.

You are right, but in the early phase of the pandemic this was raised by medics in the UK as a reason why some of them were dying. The pathology mentioned then was that a cytokine storm got kicked off in people with strong immune systems exposed to high load. This prompted changes in PPE for hospital staff - from light gear that would be worn in the face of flu patients (of whom, as we know some 1000's are hospitalised and die every year) to the space suit style gear that is now used in ICUs with COVID. If you are young and nursing a bunch of relatives at home it's reasonable to say that you are effectively exposed to ICU risks without ICU gear.

I work in an ICU. Bedside staff is equipped with PPE2. No space suit. I've spent months of my life wearing only a surgical mask in what is basically a COVID aquarium, with patients on non-invasive ventilation in open-space units spraying virus everywhere. Our staff case count of hospital-acquired infection is currently zero. So, I don't know what the ground truth is but it certainly seems like exposure is not the only factor.

So - that's amazing to me. In the beginning of the pandemic the stats seemed to show that hospital staff were at significant risk. I think that this has faded from the numbers in the UK and my assumption was that this was because staff were now able to protect themselves with good PPE and vaccination.

It makes logical sense, is there any study to support this

I mean, the current accounts suggest the entire reason hospital care is being denied to some is because there is no room.

When we have seen total healthcare breakdowns (Wuhan, Italy, NYC, etc.) the efficiency of hospital care drops like a rock due to both overstressed medical staff and the staff themselves also catching COVID. I would expect India to follow the same pattern, but exacerbated by the lack of capacity.

Let me add one data point: Hungary has currently the highest mortality for covid-19 in the world, and still currently higher than India, for apparently the same reason, healthcare over capacity.

(The trend is different though, there's hope)

I would not believe any numbers coming out of India right now. I have family in the medical field and they all agree that deaths are underreported by a factor of 5-10 based on where you are located. The FT did a story on it as well that showed the deaths were grossly undereeported

Yes, correct. The govt reporting of every figure is less by a factor anywhere from 10-50, or maybe even more as well. The ground reality in India is way worse than what even the media is able to show. And, at present no light in the tunnel. Heart cries at this but it is us at fault only for putting such incompetent people at the helm.

The cases are being under-reported too. The question is whether deaths are being under-reported to a greater degree than cases. Even the test-positivity rates vary from state to state not only because of the extent of infection in different states but also because some states contact-trace and test while others don't. Its a mess. And to see people try to fit models to this data and fight amongst each other is darkly hilarious.

Plus, at least in the first wave in Bangalore (where I grew up), there were no instances of crematoriums melting down and such. So the under-reporting of deaths was likely not as bad in the first wave as it is right now, but the under-reporting of cases was certainly quite large as testing capacity took a while to come online.

India reports 155 deaths per million. Hungary is at 2,874.

NYC didn't have a healthcare breakdown, it did send covid positive people to nursing homes.

WSJ, March 26 2020: https://www.wsj.com/articles/hospital-capacity-crosses-tippi...

> New York, home to the nation’s largest outbreak of Covid-19, the illness caused by the new coronavirus, is rushing to build a temporary hospital in a Manhattan conference center in the hope of staying ahead of the fast-spreading disease.

> Hospitals in parts of New York City have become so full of critically ill patients that they have steered ambulances elsewhere. The full-to-capacity morgue at Elmhurst Hospital in Queens is using a refrigerated truck to hold some of the dead. Thirteen people died in the hospital in the last 24 hours, said NYC Health + Hospitals, which operates Elmhurst.

Having some hospitals be full is not a system-wide breakdown. Even before COVID emergency rooms would be "on diversion" when particularly busy, and ambulances would go elsewhere.

For about 4-5 hours at a time,max, and believe you me it wreaked utter hell on my nights in the back of the ambulance when it happened.

Mine too!

No patients were ever turned away at NYC hospitals. There is a highly sophisticated patient transfer system in NYC.

Morgue capacity makes sense simply because of the population who was coming down with COVID at the time.

This makes it seem like not the case: https://www.nytimes.com/2020/04/19/nyregion/new-york-new-jer...

It very much depends on the definition of breakdown. Some people see a breakdown if hospitals run out of beds, others will pretty much never accept there is a breakdown in health care because it’s contrary to their conviction that COVID-19 is ‘just a flu’. To be fair, it’s a continuum, there’s not going to be an easily agreed fine line between broken down and not broken down. So the real question is, what constitutes the health care system breaking down, and did that happen in NY.

Without agreement on that though, we’re just shouting at each other.

NYC sent the elderly, covid positive people to nursing homes, where they died. Is that not a breakdown?

The order by Governor Cuomo sending infected patients into nursing homes was preemptive, which then led to strain on the health care system.

https://en.m.wikipedia.org/wiki/New_York_COVID-19_nursing_ho...

It’s worse because then they go and infect the rest of that vulnerable group.

I can understand not being able to treat them but at least isolate them…

This is the first I’ve heard of this. If it’s true they were sending known-covid positive cases into nursing homes, whoever gave the order should be tried for mass murder.

Unbelievable!

It is true, and Cuomo ordered it. Fully agreed that he should be tried for some serious crime. https://www.empirecenter.org/publications/the-hospital-lobby...

According to...well, everyone, that was a NYS thing, not NYC specifically.

More broadly it was a nationwide CDC advisory and not only that, the same shuffling of elderly infected back into nursing facilities happened in countries across the (mostly western) world. Probably based on shared implementations of policy briefing/ pandemic planning documents.

I am from India and this is just a personal theory based on interactions with my doctor and pharmacist friends. Most Indians are dying because of lack of medicines and oxygen, and it’s due to the inept Indian government.

I am hearing the same. Cases that would have been treated with O2 and dex are otherwise turning into fatalities. There was very little health-system to begin with. Now it’s just a humanitarian disaster.

I heard once someone needs oxygen, their chances aren't all that great anyway. Something like 65% I think?

Are you sure that statistic wasn't for ventilators, not oxygen?

Yes, you're right - my bad!

FWIW, just anecdotally I know of quite a number of people whose saturation levels dropped below 80 and then recovered after being hospitalized and given oxygen.

Even so, what would be their chances without oxygen? You might easily be doubling the overall death rate without it

Chris Christie spoke about when he got Covid prepping for the debate. 7 people contracted Covid during that prep session. He got it the worst, the second worst was Donald Trump, the next worse was Hope Hicks who was in her early 30s and a daily runner.

http://tal.fm/736 about 49 minutes in

Exactly - the enormous population of India means that there are definitely going to be huge numbers of younger people who scum to the disease. Straightforward arithmetic.

*succumb

> What I am seeing in Delhi is people from all walks of life without any comorbidites succumbing to the disease - peoples in 30s, 40s, and even 20s.

Roughly 10% of people need hospitalization when infected with COVID, and when hospitals are full, some of those people are going to die when they wouldn't have had they received care.

I think the 10% ratio against all infections will turn out to be a significant overestimate.

It's off, but maybe not as much as I'd have guessed.

CDC estimates for the USA is 4.9%.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

Psychologically average Indian young person is more unhappy and unstatisfied than ever, this is both because of lack of new opportunities and employment and now Indians are able to see on YouTube and compare living standards to people in foreign countries, psychologically most Indians are devastated because of this new found info.

When you are in doom and gloom state, probably immune system also doesn't perform quite as well and it doesn't help that even basic medicines and healthcare facilities are not available to many of us in India now.

I don't know why you're being downvoted, but what you said applies to everywhere not only India, of course chronic stress means higher cortisol, which lowers immunity.

Because that's a constant and would have been present the entire time and would not adequately explain why a second wave would have more young people succumbing to the disease.

There have been numerous headlines in media about the psychiatric illness epidemic resulting from social distancing measures, and all the downstream effects of the whole situation, including continuing uncertainty. Common sense alone would tell you that mental health has worsened since last year, particularly in those who were already on the edge.

During first wave, many people would have savings. After that they expected recovery but now stuck in 2nd wave.

Price of things that people want have shot up considerably while for most income source has dried up.

The CFR in Mumbai is half that of earlier waves.

See https://postimg.cc/Xpn7hthc

-----

Delhi looks more severely affected, likely due to its air pollution. See https://aqicn.org/city/delhi/

I'm from India. I extremely doubt that the air pollution has anything to do with this. Our healthcare system has completely collapsed. People are struggling to find medical oxygen and are dying outside hospitals without getting any care. Hospital are literally begging for oxygen on Twitter every single day. Significant number of these could've been saved if the Government had prepared for this by improving the healthcare infra. Instead they overconfidently declared victory, kept on hiding data, organized religious and political rallies. The worst is that it has just gotten started and would keep getting worse in the coming days.

At this stage, it's evident that the primary mode of SARS-Cov-2 transmission is through aerosols, not droplets nor fomites.

The level of air pollution affects the duration of suspension of bioaerosols as well as the performance of the innate immune system. Low humidity is also linked to higher transmission.

See

https://www.medrxiv.org/content/10.1101/2021.01.04.21249249v... https://www.medrxiv.org/content/10.1101/2020.10.19.20215236v... https://www.medrxiv.org/content/10.1101/2020.04.07.20057216v...

The level of air pollution is relatively the same now as it was last year for the first wave though. The air pollution isn't helping things but if it were that one thing, why would the second wave look any different from the first?

> The level of air pollution is relatively the same now as it was last year for the first wave though.

No, they are not. See table 1 of https://www.orfonline.org/research/air-pollution-delhi-filli... - it hit a low point in October, but was much better during lockdown and relatively better post-lockdown although trending towards worse levels.

A disease that affects peoples' breathing and you don't think air pollution has anything to do with how severely the outbreak has affected people?

Delhi has screwed up badly. In the South Indian states, in Karnataka and especially Kerala, Oxygen is well provisioned. Karnataka is also ramping up further everyday. Looks like someone in the Delhi state govt forgot capacity planning.

At least 2 car factories stopped to let oxygen to hosiptal.

The Maruti Suzuki plant shutdown is from May 1 to 9. Which means it's starting from today and hasn't provided any of their oxygen to hospitals so far. Too little, too late.

Delhi weather is also extremely hot right now, with highs of over 40degC, and lows of at least 30degC, six out of seven days a week. While it's a dry heat, heat stroke might still be a factor in the higher death rates.

Maybe better healthcare. Kerala case fatality ratio is around 0.3 that is many times better than other states.

I've lived in Kerala for twenty years. Can attest to this being due to better healthcare. There's also very little underreporting of deaths happening (my sister's a doctor directly involved with the government effort).

It's a bit like Cuba, with the Communist past and healthcare/life-expectancy that stands out (compared to say, per-capita income which is average).

Kerala setup 23 Oxygen plants - most of them setup in the last year. It is now exporting oxygen to the other Covid-hit states. The vast majority of beds now have oxygen supply - even all medical colleges.

People actually planned and did things right in Kerala. No one did so at the capital.

But if the number of cases increases its very difficult to manage. Recent reports indicate Kerala might face shortage. Karnataka which also had enough oxygen can face a deficit in coming days if the cases keep up.

There is so much focus on oxygen, but is scaling healthcare facilities actually a solution?

It seems that even in rich countries hospital capacity is overwhelmed as soon as infection rate is out of control.

No, because a significant proportion of people who enter the hospital (and especially intensive care) will still die, even with proper care.

The biggest problem is that it is a really tough sell if you run out of capacity. Even if it would be better to use that capacity for other cases.

Someone who is from UP and lived in Kerala for few months, that state is world apart in terms of basic facilities. I mean computers in primary school (not to mention Linux)!!! In U.P., you won't find teachers teaching in most scholls.

How were they able to achieve this?

96% literacy rate. It is one of the two states with strong socialist presence/governance.

One feature of the Kerala case, which does not get discussed much, is that the load is more or less evenly distributed throughout all the districts. This makes it easier to handle critical cases well.

And we used the calm times to ramp up the infrastructure. But if cases are rising beyond control, this will fail too.

There was a report today in the news here (Netherlands) that more younger people are hospitalized as a percentage of the total. This could mean many things, my guess here would be the elderly are more and more vaccinated and thus less likely to need ICU/Hospital care, but maybe there is more happening on a global scale.

Obviously if one group is hospitalized less, another group will be hospitalized more, as a percentage of the total.

You have to be careful not to end up with one old guy in the hospital and stating ‘wow 100% is male and old’. That’s not a useful statistic.

Absolutely true, but the question remains if that is the only cause which also muddies the numbers a bit if there are different factors at play. I mentioned it as it is seen elsewhere too and I think adds to the discussion.

You can’t solve that question using these statistics. You need to carefully define your question and then look up the data. A lot of it actually is available!

In Belgium too. Younger people in ICU, don't remember about comorbidities.

second wave of Spanish flu was also shifted toward younger ages (W-shape). May be some evolutionary dynamics - the second wave is the strains which successfully outcompeted others. May be also the protective measures like lockdowns/quarantines during the first wave provide selection pressure for more virulence.

Not sure what virus (or rather media) you witnessed, but just because the death rate was rather low with younger people never ment the infection rate was too. Long covid is much more evenly distributed between age classes for example

Maybe it's a very mutated strain?

There is no such thing as "very mutated". Something is either mutated or not.

Your comment goes aligned with the governement propaganda that this is happening only due to the more dangerous strain. I would agree with it if people were dying AFTER GETTING proper medical care. You cannot solely blame the mutation as people are dying without any treatment. It's the dismal healthcare system and the governments who should be blamed. We are not seeing a surge of death among patients with this strain in UK, and US.

The central government's hubris, and every government's not listening to the experts, behaving relaxed which are to blame.

It’s certainly possible for one strain to have more mutations than another (relative to the variant that initially spread in China), though that doesn’t necessarily correlate with dangerousness.

The cases spiked after April. If it was not mutation the total number of active cases would have still going up from last October. Active cases suddenly dropped from October with no good factors to indicate why it dropped.

I have been to 3 wedding after the drop. Almost no one was wearing mask. As far i know govt was still asking people to wear mask. There were major Hindu festivals after October and coming winter were everyone was worried the cases would rise. Did the virus simply hide and rose rapidly?

I also observed this - the slow rise from end-Feb to end-Mar and then the sudden very very steep rise in covid positive cases from end-Mar.

In India, people started opening up during Sep/Oct 2020. I too relaxed the strict restrictions/rules that I was, till then, sticking to. Went to restaurants with friends and teammates (with masks wherever possible) and many people were doing inter-state travels, political events started happening, many festivals/gatherings started happening etc. Life was returning to normal. My important observation is that from then (Sep/Oct 2020) onwards, lots and lots of people were not following covid protocols properly. Social distancing was not followed. Many people did not even put on masks. Am not sure why, but even with all these behaviours which should result in increasing covid positive numbers, the covid positive numbers were continuously going down. I think it hit bottom during second half of Feb 2021.

And then the numbers started to rise - slowly from end-Feb to end-Mar and then suddenly very very steeply rise from end-Mar 2021. And by mid-Apr 2021, things got very alarming. Most of my circle of friends knew that generally the second wave will hit harder than the first. But we also that because vaccination has been going on for 2 or 2.5 months by then, it can help. The strictest (to follow the restrictions) among my friends also started to loosen up a bit. The previous reports that the second wave will hit us during Jan/Feb did not come true. So, we were hoping that there won't be a second wave. Even the US thought that they can start banning the export of raw materials needed for the production of vaccines in India.

So, I do not know if anyone predicted (with numbers to backup their estimates) that the case load will be this bad during Apr 2021. The second wave caught lots of us by surprise. But I believe, like the US and UK survived their second waves and are doing pretty well now, India too will hopefully emerge better and stronger.

* >> But I believe, like the US and UK survived their second waves and are doing pretty well now, India too will hopefully emerge better and stronger. *

and scarred. Some of the stories I read in newspapers, and heard are gut wrenching; reports like families losing more than one person in quick succession, quite young folks dying.

I returned to Bangalore on April when cases were barely going up, Vaccine drive was the way and all seemed good. And now were are in a lockdown!.

>> There is no such thing as "very mutated". Something is either mutated or not.

Well if there are 1 billion genes and one virus strain has 1 mutated gene while another virus has 1,000,000 mutated genes then the latter is "very mutated".

Like a white human and a black human are somewhat mutated relative to each other but both humans are "very mutated" as compared to a chimpanzee. Although 98% humans and chimpanzees are the same animal, let's call it humpanzee.

> Granted death rate of younger people isn't absolute zero, but in India, it's happening way too often. Could it be because of lack of hospital care

Lower standard of living, if not poverty, seems like the simplest explanation. You're comparing the richest countries with an emerging market country that has an astronomical number of poor people. They'll have worse health outcomes in general. Also, polution in India is terrible drom what I understand.

It has hit upper middle class as well, who otherwise have access to best of food/healthcare.

Is the quality of life and are the health outcomes the same as those of the countries they're being compared to for thier middle class? Is it not a relative term?

"According to The Economist, 78 million of India's population are considered middle class as of 2017, if defined using the cutoff of those making more than $10 per day, a standard used by the India's National Council of Applied Economic Research"

So, apparently no probably not to my first question and yes to the second.

A new variant arose that combines the Californian L452R mutation with an E484Q mutation as well (similar to the E484K mutation in the Brazilian and South African variants). It's not really the same virus that hit India earlier.

It’s not puzzling it’s because the so called “double mutant” variant is common there. It affects younger people more. It is escaped into my city Vancouver and kept death rates high despite our old people being vaccinated. This variant is stronger and more spreadable.

https://www.nationalgeographic.com/science/article/this-doub...

The virus uses our immune system against us. Think Aikido using your opponent's strength, or a gravity assist for interplanetary flight. A modern virus attack is higher order, which is what makes designing vaccines so hard. Screw up, and you're just helping the virus. Early variants of COVID-19 were hardest on the old in part from weakness, but in part because of a well-developed immune system to target.

Anyone who's been to India can see that even the young have robust immune systems. Virus variants have finally dialed this in.

Anyone who's been listening in on research seminars since the pandemic start has heard many versions of this. Here is a recent lay account: https://www.newyorker.com/magazine/2020/11/09/how-the-corona...

Could the mRNA vaccines be used to convince the body to NOT make antibodies?

Could it be some sort of pathogenic priming [1] due to the vaccination? There are more people < 60 vaccinated (58M) than > 60 (53M) [2].

Also, after vaccination the immune system gets quite a hit and needs to recover from it. When being infected during that time, isn’t a person more vulnerable for the virus?

This is just me in layman terms grasping what’s going on. Other arguments aren’t different now opposed to the first wave

1: https://pubmed.ncbi.nlm.nih.gov/32292901/

2: https://en.m.wikipedia.org/wiki/COVID-19_vaccination_in_Indi... see: Vaccine administration by age group

Or simply a lot more young people are exposed.