Why the Story About India's April COVID-19 Spike is All Wrong

The Chloroquine Wars Part XVII

You've probably seen the recent news out of India: Pandemonium. All the important media outlets are talking about it, and since they're telling the exact same story, you can be sure they checked in with the exact same gatekeeper.

• The NYT: India sets a global record for daily infections.

• BBC: COVID in Uttar Pradesh: Coronavirus overwhelms India's most populous state.

• NPR: How India Went From A Ray of Hope To A World Record For Most COVID Cases In A Day.

• Reuters: Oxygen gets armed escort in India as supplies run low in COVID crisis

There is something about phrases like "world record" and "unprecedented" that seem inappropriate for such a solemn topic, but right now I'm having a hard time getting the image of focus group testing out of my head. What kind of newsroom goes with a "It was a dark and stormy night" narrative as opposed to direct fact reporting?

Death is always with us. It is also important that we search for appropriate perspective. On the order of 60,000,000 people died last year around the world, and each was a light in the world. We do our best to serve human health to search for the best ways to suppose human health.

Now, let us look a little more closely at the portrayal of the story of India's COVID-19 spike. Let us begin with some of the tweets (here and here) raising the alarm so that all of the [English speaking] world knows what is happening in parts of India. There is a focus on the quickly depleting oxygen supply. We might guess this is the primary variable in the equation.

We can see the spike in India's aggregate cases here and here.

The CDC advises American citizens to avoid all travel to India.

Here is a gut-wrenching quote from Reuters news service:

Earlier in the day, the hospital's chief executive, Sunil Saggar, choked back tears as he described the decision to discharge some patients because the lack of oxygen meant there was nothing his hospital could do to help.

Another Reuters article reminds us that any time an outbreak occurs, a lack of authoritarian measures is to blame.

Prime Minister Narendra Modi, whose government has been criticised for relaxing virus curbs too soon, met chief ministers of the worst-affected states, including the capital Delhi, Maharashtra and Modi's home state of Gujarat, to discuss the crisis.

Health Minister Harsh Vardhan said this week people had largely given up COVID precautions and "became very careless" before the surge.

Now, let's take a look at the concentration of cases around India.

The large Central-Western state of Maharashtra has a population of around 125 million people, which is around 9% of India's massive 1.4 billion people. The second largest number of active COVID-19 cases is in Uttar Pradesh in the north, which has nearly twice as many people (240 million) and less than 40% as many cases. These state populations would qualify as large nations on their own, and we see wildly different results. The total number of deaths per million in Maharashtra is right around 500 per million. There have been only 44 deaths per million residents of Uttar Pradesh. These numbers are different by kind. Of the 221 nations listed in worldometers, India ranks 120th in deaths per million, Maharashtra would alone rank 72nd, and Uttar Pradesh would alone rank 148th. Of the handful of large nations that have suffered lower mortality (per million) than India, nearly all are near neighbors with similar statistics, African nations with low elderly populations, or island nations with less international traffic (and likely protective exposure to other coronaviruses).

In fact, Maharashtra and also Dehli are relatively unique in all of South Asia with such high COVID-19 caseloads relative to population size. It makes sense to focus in on why that might be the case. This leads us immediately to the story that the Western media refuses to talk about---and we have seen it before. One or the other of two drugs are used widely across South Asia: hydroxychloroquine (HCQ) and ivermectin (IVM).

Okay, so I can make that claim. I do so after many conversations, emails, and electronic messages with doctors and researchers in India. But I will back it up here with a few sources.

Let us start with covexit.com, which has faithfully covered topics ignored by the larger media during the pandemic. Covexit invited a team of Indian doctors to tell the story of HCQ/IVM use as prophylaxis and medical therapy in India. While many doctors have recently moved to IVM usage, HCQ has been used broadly across most of India during the pandemic.

Similarly, Pakistan chose to use HCQ early on during the pandemic and is one of the nations that has produced several studies on treatment results. The rest of South Asia made the same decision, acquiring stocks of the drug from large manufacturers India and Pakistan: Sri Lanka, Nepal, Bhutan, Bangladesh, and Myanmar all use HCQ to treat COVID-19. Let's take a look at how all these nations are doing relative to both the U.S. and the entire world:

So, what's different between Maharashtra and Delhi with respect to the rest of India and South Asia? Instead of relying on HCQ and IVM, many doctors and health officials in Maharashtra and Delhi pushed the expensive and profitable remdesivir drug. Due to its cost and recommended time of usage, remdesivir is not used either as a prophylaxis or for early outpatient treatment. And unlike the cheap and easy-to-produce HCQ and IVM, remdesivir is difficult to replace when it runs out. During this wave in India, many hospitals in Maharashtra and Delhi ran out of the stocks of remdesivir. Perhaps...just perhaps...these contrasts in treatment philosophy make the difference between a substantial viral breakout, and one that is highly manageable. Where HCQ and IVM are used widely as prophylaxis and to treat COVID-19 early, the outbreaks and deaths are far more manageable. The oxygen doesn't run out. It's much like a typical flu season, in fact.

It becomes harder and harder by the day to believe that health officials, pharmaceutical companies, and the media haven't noticed.

On a positive note, the number of active cases in Maharashtra has begun to recede. Let us hope the trend continues or accelerates.