By Juan Jose Chamie
The whole world has eyes on India. Just months ago, India’s cases and fatalities were few. What happened? We know what we’re hearing in the media: lack of preparation, lack of following social-distancing protocol, and lack of willingness to wear a mask are blamed for the spike in cases and fatalities. But is there more to the story than this? Maybe there’s opportunity to uncover some more candor if we focus on what we see rather than what we hear. Data and trends are a good place to start. If we take a close look at what we see from data, it is possible to better understand the outbreak and to answer questions about the origin and spread of the wave and possible courses for successful treatment. The data also reveals an observation, but most certainly not a established correlation, that a new, highly contagious variant mutation of COVID-19 manifests in locations where the AstraZeneca vaccine has been administered. However, this very well could just be coincidence. This data showcases the consideration that mass vaccination programs should be carefully rolled out to regions and populations where infection rates are stabilized and more under control. Unfortunately, the realities of the market, geopolitical dynamics, and production and supply chain considerations, among other business and socioeconomic factors, render mass vaccination program in the midst of a pandemic challenging. Although India is one of the most prolific vaccine producers in the world as of this writing, only 32 million have received their second vaccination or about 2% of the population. The high level findings in this preliminary report first serve to question the dominant narrative about what’s going on in India. Second, the author argues that India appears to be implementing a population-level treatment regimen, adopted on a state by state basis, as evidenced by recent announcements by the Indian government. This protocol includes Ivermectin and Budesonide, yet this fact appears to be blacked out by all major media in India and elsewhere. Based on the unfolding observation here, India is embracing treatment and prophylaxis, in addition to vaccination and prevention, in order to tackle the global pandemic. According to this high level, population-wide analysis, the trigger for this wave was the emergence of the variant, apparently spread by migrant workers fleeing a major metropolitan center for fear of lockdowns. Moreover, its suspected, but cannot be proven, that the lack of a nationwide early onset COVID-19 care regimen protocol could be a factor contributing to the severity as the new nationwide protocol was just recently declared.
Where did the outbreak start?
Looking at case incidence per state, it’s clear that India’s second wave is mainly spreading from two distinct areas: The State of Maharashtra and The Punjab region, by way of Lahore in Pakistan.
In The State of Maharashtra, case incidence per district shows strong indication that the virus has spread week by week from the districts of Nagpur and Amravati to the rest of the state, including Mumbai. In The Punjab region, data shows that the outbreak actually originated in Lahore, Pakistan, and has spread into India by way of Delhi, India’s capital territory.
What triggered the outbreak?
Data shows a startling connection between the Indian outbreak and the new strain of the virus with E484K mutation.
Let’s take a look at The State of Maharashtra. On February 18, [link] a random sample of COVID-19 positive tests taken in the district of Amravati detected the presence of the new coronavirus variant with E484K mutation. This is the same variation that has been quickly spreading through South Africa, the UK and Brazil.” “E484K is called an escape mutation because it helps the virus slip past the body’s immune defenses” [link].
The evidence suggests the new variant outbreak started in Amravati, grew in Nagpur, and from there spread through the state and soon after to the entire country.
The outbreak in The Punjab region escalated in mid-March, but can actually be traced one month back, originating in the Pakistani Punjab province.
The outbreak was triggered by travelers coming into Lahore, the capital city of the Punjab province of Pakistan and the closest city to the border with India [link]. There are reports from late January 2021 documenting the return of several travelers from the UK and South Africa, areas where the new mutant variant had run rampant. These travelers likely brought the variation of the strain with them into Lahore. In early March, cases were growing in Punjab, India. Throughout March, the virus spread from Punjab to Haryana and into Delhi.
E484K Mutation and AstraZeneca: An Observation
We have already seen data to suggest that the outbreak in India is, in fact, the new coronavirus variant with E484K mutation, the very same mutant that ravaged Brazil, the UK, and South Africa. What is even more unusual is that there seems to be a pattern, which could just be coincidental, between the E484K mutation variant and the AstraZeneca vaccination.
First, let’s take a look at the correlation between the vaccination and the appearance of the mutated strain in the UK, South Africa, and Brazil. Outbreaks occurred in these three locations when the highly-infected populations were introduced to the new vaccine. At the end of August 2020, the AstraZeneca phase 3 trial began in the UK, South Africa and Brazil (link 1), and the E484K mutation was detected in South Africa in September, 2020, in the UK in December, 2020, and in Brazil in December, 2020.
Now, let’s look at the Indian outbreak.
The State of Maharashtra:
On January 16, vaccinations started in the district of Amravati. Citizens were receiving Covidshield, which is the Indian brand name for the AstraZeneca vaccine. This version of the product is manufactured by Serum Institute of India (SII). Amravati was recognized among the state by their diligence in vaccinating the population [link]. The region had one of the highest levels of infections in the country, and the vaccination program reached 18K people in Amravati before the mutated E484K variant was detected. Following suit, the Nagpur region also had a high level of infections and was introduced to the novel vaccine when the E484K spike emerged.
The Punjab region:
Two mutant variants detected in the UK and South Africa were likely brought to the Punjab region by infected individuals returning from these areas. The bases for this observation are a survey of local media, however this premise cannot be proven.
How has the virus spread so quickly?
The State of Maharashtra:
The outbreak that started in the east of Maharashtra in early February moved slowly to neighboring states. But once it arrived in Mumbai and cases exploded, the virus rapidly spread to other states. At the end of March, only Maharashtra had an incidence over 150 cases per 100,000 – but by April 10, more than 10 other states crossed this threshold.
What happened? Well, Mumbai plays a huge role here. Mumbai actually has the highest percentage of “migrant workers” in India. Nearly 50% of the whole population lives in Mumbai temporarily or seasonally for work. When cases here surged, people fled, fearing an imminent lockdown and losing their jobs. When they fled the Covid hotspot, they traveled in packed trains and buses, bringing the virus with them to their hometowns.
Take a look at Lucknow, the capital city of Uttar Pradesh. This city is the principal source of migrant workers traveling to Mumbai for temporary or seasonal work. Cases in the city and surrounding area exploded suddenly in the last week of March; no other city in close vicinity had an outbreak before this time. But the virus didn’t develop locally; it’s more likely that the new outbreak started when the hundreds of thousands of migrant workers [link] fled from Mumbai back home, bringing the new variant of the virus with them.
The Punjab Region:
The initial spread from Lahore to Punjab and into Delhi was “by the book” – in other words, a traditional town-to-town spread. What is now most concerning is Delhi: the city is experiencing the worst outbreak in the country, with death-per-population 50% higher than its nearest neighboring city. With the announcement of a lockdown, migrant workers began fleeing the city in the last week of April, likely carrying the virus with them to their hometowns.
Treatments and Media Influence
Since the outbreak of Covid, three treatments have been battling for attention all over India. Until mid-June 2020, the clear favorite was hydroxychloroquine (HCQ). Remdesivir was in the spotlight from mid-June until early August 2020. From August 2020, the number one was Ivermectin, and it remained at the top of the list until the end of March 2021. And now?
On April 22nd, the Ministry of health, AIIMS and ICMR updated the national COVID-19 treatment protocol. The new protocol includes recommending Ivermectin and Budesonide for all patients with a mild case of COVID. On April 28th a new more detailed document was released, in which the Ministry of Health advised patients who are asymptomatic or have mild symptoms to use Ivermectin and Budesonide and not to use Remdesivir outside hospital facilities. And on April 29th in a press conference, the ministry of health once again confirmed the new protocol. These updates were presented in a media update on April 30, 2021 and can be viewed here. Also, see the link for the official protocol including Ivermectin and Budesonide.
However, despite the government’s persistence in promoting Ivermectin and Budesonide, the media hasn’t shown interest in sharing this news. The comments continue to promote Remdesivir as an effective drug, and the few media outlets that even bother mentioning Ivermectin refer to it as “the unproven medicine” or an “outdated treatment.” It’s as if there are two different realities—on the ground and in the local health systems, millions of patients are now receiving ivermectin yet one would never know by the media topics—its as if there is a blackout on the topic. When the topic does surface, it’s mentioned as “outdated” or “inappropriate.”
Ivermectin Intervention and Conclusion
At the national level, the massive surge that overtook the country at the beginning of April slowed exponentially after the new COVID-19 protocol was introduced, including the use of Ivermectin and Budesonide. COVID-related deaths plateaued on April 28, and cases seem to have followed the same pattern where the regimen is at work. Cases in Uttar Pradesh, hometown to many migrant workers who fled Mumbai, have been dropping since April 24, and deaths have dropped since April 30, this author suspects likely to the aforementioned regimen.
To conclude, data reveals that the new outbreak and rapid spread of COVID-19 in India hasn’t necessarily been caused by general pandemic mismanagement. Rather, the data reveals that the suspected culprit here is E484K, the new mutant strain. Again, this study reveals the observation that the variant has surfaced where the AstraZeneca vaccine has also been used; however, there is lack of sufficient data to claim any correlation or even definitive pattern. Furthermore, analysis of the data indicates that the traditional spread from area to area was accelerated by migrant workers fleeing hotspots, in an effort to avoid city lockdowns. And while the implementation of Ivermectin and Budesonide as a protocol appear to represent a population-wide early care regimen, the media is hesitant to report on this topic. This analysis covers high level population data and an important subsequent topic of study would be to compare the transmission rates, disease progression rates and death rates among population exposed to the current Ivermectin and Budesonide regimen versus remdesivir and other course of action for more granular insight into care strategies.