India's 'Double Mutant,' What's Driving The COVID-19 Outbreak There : Consider This from NPR Things have gone from bad to worse in the pandemic's global epicenter. India reported nearly 400,000 new COVID-19 cases on Friday — and the death count is likely higher than current estimates. Lauren Frayer, NPR's correspondent in Mumbai, explains why. Follow more of her work here or on Twitter @lfrayer.

The surge in India may be due, in part, to new coronavirus variants circulating in the country. NPR's Michaeleen Doucleff reports on one that's been referred to as a "double mutant."

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How India's COVID-19 Outbreak Got So Bad, And Why It May Be Even Worse Than We Know

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How India's COVID-19 Outbreak Got So Bad, And Why It May Be Even Worse Than We Know

How India's COVID-19 Outbreak Got So Bad, And Why It May Be Even Worse Than We Know

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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In parts of India, everyone knows someone who's in isolation or worse.

ANKIT BHUTANI: Our close family, my cousins, friends, office friends - anyone you talk to, at least one or two of the people in their network or immediate family is affected and their home isolated or searching for hospitals.

CORNISH: Ankit Bhutani (ph) can hear the ambulances outside his apartment building near Delhi, an apartment building, by the way, with its own online COVID dashboard.

A BHUTANI: I could see in the last three days there were three deaths - that's at least.

CORNISH: Ankit's father got sick with the virus back in March. After five days in the ICU, he was sent home. But he never fully recovered and, weeks later, took a turn for the worse.

A BHUTANI: The situation was totally different by that time, and the hospitals were already flooded. And that point of time, the whole, you know, kind of panic crept in.

CORNISH: There was no ICU space for Ankit's dad, only an ER bed, where they had to beg for him to get basic care.

GARIMA BHUTANI: So that period was very, very tough.

CORNISH: Ankit's wife, Garima (ph).

G BHUTANI: He was unconscious. He had bedsores. He was a diabetes patient, and his sugar needed to be monitored, and he needed those medicines. And...

CORNISH: The family spent two sleepless nights calling the overwhelmed ER every hour to ask them to check his father's insulin. At the same time, they were desperately searching for another hospital with ICU space. And they finally found one on April 15.

A BHUTANI: Of course, his body and the infection and all that took a toll on his body, and he was quite weak, quite weak. So the next hospital which took us in, he could live only one day there. And on 16th, he passed on.


CORNISH: Pradeep Bhutani (ph), a 71-year-old retired professor and school principal, now among the hundreds of thousands dead in India. Things have only deteriorated further in the weeks since, with the country on Friday setting a new record - nearly 400,000 cases in a single day.

G BHUTANI: All of us - right? - have gone through this physical and mental pain in the period of last month. God knows what else is there to come.


CORNISH: CONSIDER THIS - the situation in what is now the global epicenter of the pandemic is getting worse, why experts can only guess how bad things really are.

From NPR, I'm Audie Cornish. It's Friday, April 30.


CORNISH: It's CONSIDER THIS from NPR. In India, oxygen tankers are traveling under police guard to fend off looters. The black market trade in medical equipment has soared, and crematoriums are running 24/7.

A BHUTANI: Yes, it is actually quite grim as of now.

CORNISH: Just days ago, when Ankit Bhutani went to pick up his father's remains...

A BHUTANI: We could see that they had a flood of, you know, bodies to cremate. And they were, you know, kind of, you know, waiting to find places, new places to kind of, you know, cremate the bodies. So there was a huge inflow of the bodies. I think...

CORNISH: The situation in India is so bad that on Friday, the Biden administration announced it would ban noncitizens traveling from India from coming to the U.S. And Americans traveling home from India have to test negative before they can do so.


PRIME MINISTER NARENDRA MODI: (Non-English language spoken).

CORNISH: "This wave hit us like a storm," Prime Minister Narendra Modi said in an address to the nation last week. It's a storm the country simply was not prepared for.


BHRAMAR MUKHERJEE: Deaths have been increasing by a factor of, like, 10 in the last one month, and cases have skyrocketed seven times.

CORNISH: Bhramar Mukherjee is a statistical modeler at the University of Michigan. She told NPR the spike is partly because when cases fell earlier this year, some people stopped social distancing and weren't as diligent about mask wearing. It may also have to do with new coronavirus variants.


MUKHERJEE: Many multiple unknown variants emerging in the Indian landscape, and we really are very concerned because we need more data. Where are they emerging, and how rapidly are they replacing the original strain?

CORNISH: Now, we'll hear more about those variants in a bit. But first, a story from our correspondent Lauren Frayer, who's based in India's largest city, Mumbai. She's been looking into why the true extent of the outbreak in the country may be even worse than we think.


LAUREN FRAYER: Santosh Pandey's wife is the head of their village near the holy city of Varanasi in northern India, so he hears everything that goes on there. And what's going on now, he told NPR on a crackly phone line, is horrific.

SANTOSH PANDEY: (Non-English language spoken).

FRAYER: Fifty of their neighbors have died in the past two weeks, he says. Many of them have died at home with fevers, unable to breathe. Their bodies get cremated on the banks of the Ganges River nearby. But only five or six of them were counted as COVID-19 deaths, he says.

PANDEY: (Non-English language spoken).

FRAYER: "There's a shortage of tests. Nobody's getting tested. So the government's numbers for our district are totally wrong," he says. Across India, funeral pyres light up the night sky. Playgrounds and parking lots have been turned into mass cremation grounds.

ANIKET SIROHI: We are just doing the best we can, but the situation is very grim here.

FRAYER: Dr. Aniket Sirohi has the unenviable job of counting bodies. He's a public health official in the capital, New Delhi, whose job was supposed to be malaria prevention. Every day, he visits every crematorium and graveyard in his municipality. Of his 11 staff, five currently have COVID.

SIROHI: You know, it's pretty shaken up, the morale. I have not taken even a single day off.

FRAYER: Last year, at the height of the pandemic's first wave, he was counting 220 COVID deaths a day. Yesterday, he counted more than 700. He passes those numbers up, but what the government ultimately publishes for his region has been at least 20% lower, he says. He attributes it to administrative chaos, people registered in one district but dying in another.

SIROHI: Somehow, the numbers are not getting recorded or not shown or getting missed. India had always a poor record of, you know, maintaining this thing. We have a lot of population, so there's a bit of a problem with coordination.

FRAYER: There is another reason why India's coronavirus numbers may be skewed - hubris. In early March, India's health minister declared the pandemic over, but cases were actually creeping up, and some politicians didn't want to ruin the narrative. Dr. A. Velumani runs a nationwide chain of medical labs. He told local media his labs have come under pressure from local politicians to manipulate coronavirus tests and report fewer positive results.


A VELUMANI: We are told, you shouldn't be doing more than this much. In fact, in good number of cases, the question asked - why your laboratories reporting more positive than other local laboratories?

FRAYER: Fewer positives mean fewer deaths attributed to the coronavirus. India's total deaths this week crossed the 200,000 mark, but that's still lower than the toll in the U.S., Brazil and Mexico. There are valid reasons why fewer Indians might die from COVID-19. More than half of the country is under 25. They're more likely to survive the disease. But even considering India's demographics, experts say the real death toll here compared to reported figures...

CHRIS MURRAY: Roughly, we would expect it to be about double.

FRAYER: Chris Murray heads the Institute for Health Metrics and Evaluation at the University of Washington. He says it's not just deaths that are undercounted. India may also be detecting only about 3 or 4% of its daily infections.

MURRAY: We're talking about maybe 5 million infections a day in India right now, which is just a huge number.

FRAYER: And so pretty soon, Murray says, the coronavirus may run out of people to infect here, even in India, a country of 1.4 billion.

MURRAY: We think that infections would be peaking probably next week. And then in our model, we think that deaths will probably peak about the third week of May.

FRAYER: But unfortunately, he says India may see 10,000 or even 12,000 deaths a day by then.


CORNISH: NPR's Lauren Frayer in Mumbai. She's been covering the outbreak in India extensively, and we've got links in our episode notes where you can follow her work. Now, we mentioned the idea that new variants may be fueling the spread in India. One variant scientists are looking into has been called a double mutant. NPR science correspondent Michaeleen Doucleff explains what it is and why it has researchers concerned.


MICHAELEEN DOUCLEFF: Let's start with the name - double mutant. Kristian Andersen is an infectious disease expert at Scripps Research Institute. He says that name doesn't make any sense scientifically.

KRISTIAN ANDERSEN: That's a dumb word. I mean, there are double mutants all over the place, right? I mean, SARS-COV-2 mutate all the time. And in fact, this one has more mutations than two.

DOUCLEFF: In fact, the variant in India has more than a dozen mutations, just like all the other variants of concern, such as the one from the U.K. and the one from Brazil. Andersen says the term double mutant came about because the variant in India has two important mutations that are known to change the behavior of the virus. They help the virus escape detection by the immune system.

ANDERSEN: This particular variant in India here has two of those mutations that have been linked to these kinds of immune-evasion mechanisms.

DOUCLEFF: So there's concern that this variant, which is officially called B.1.617, may be able to sneak past the immune system like other variants and more easily reinfect a person who's already had COVID. Shahid Jameel is a virologist near Delhi. I spoke to him on Skype. He says both of these key mutations have cropped up in other variants before, including ones in South Africa, Brazil and here in the U.S.

SHAHID JAMEEL: One mutation was detected in California, and it was responsible for the big surge in Southern California.

DOUCLEFF: That mutation has been shown in the lab to help the virus enter and infect human cells.

JAMEEL: So it's supposed to be more infectious.

DOUCLEFF: Scientists haven't published any studies confirming the variant in India is more contagious, but Jameel says he sees signs of it.

JAMEEL: So for example, in the first wave, we often saw one member of a family getting infected, and rest of the family were all right. This time, it's not like that. This time, before you know it, entire family is infected. So it's far more infectious...

DOUCLEFF: Than the strains they previously had in India. But is it more infectious than the variants already circulating in the U.S.? Kristian Andersen at Scripps says, we just don't know yet.

ANDERSEN: We just don't have any data yet. And of course, it's very important that we get that data.

DOUCLEFF: Right now, B.1.617 is the dominant virus in parts of India. But as Andersen points out, it's not the only variant circulating in the country. There's also ones from the U.K. and South Africa. All three of these are spreading very quickly and fueling what has become the world's worst coronavirus crisis.


CORNISH: That's NPR's Michaeleen Doucleff. It's CONSIDER THIS FROM NPR. I'm Audie Cornish.

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