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Migrant workers and their families wait in Delhi for busses back to their home villages. Photo: Yawar Nazir/Getty Images

India opened up restaurants, shopping malls and places of worship today even as it recorded a record-high 9,971 new coronavirus cases, the third-most worldwide behind Brazil and the U.S.

Why it matters: Lockdowns are being lifted in South Asia — home to one-quarter of the world’s population — not because countries are winning the battle against COVID-19, but because they simply can't sustain them any longer.

Flashback: For a time, South Asia was cited as a source of optimism because relatively few cases and deaths were being recorded despite large, dense populations.

  • Lockdowns came relatively early, with varying severity (India’s was considerably stricter than Pakistan’s, for example).
  • Outbreaks have continued to accelerate, however. Pakistan’s daily case count is now on par with the U.K.'s and six times Germany's, adjusted for population.
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios

Limited testing means South Asia's outbreaks could actually be far more severe. India, for example, is testing at one-twentieth the rate of the U.S.

  • John Clemens, an epidemiologist at ICDDR,B (formerly the International Centre for Diarrheal Disease Research, Bangladesh), estimates that Bangladesh's capital, Dhaka, may have up to 750,000 cases — 12 times the official tally, per the Economist.
  • The official numbers still show India, Pakistan and Bangladesh with the third-, seventh- and tenth-most new cases in the world over the past three days, respectively.

Bhramar Mukherjee, a professor at the University of Michigan who has been modeling India's outbreak, tells Axios that while some states have hit initial peaks, she doesn't expect a national peak until late July or August.

  • While the transmission rate has slowed, "you see this steady rise in cases because the population is so large." She expects the numbers to fall slowly after the peak, unlike the trajectory in Europe.
  • The numbers can be unreliable, Mukherjee says, with some states fearing that testing symptomatic people will cause them to "look bad" as cases rise.
  • She also worries that India didn't use the lockdown period to build up testing and hospital capacity.
  • "It's really chaos unfolding in Mumbai and Delhi, and I think unfortunately India is going to be at the top of the list in terms of cases," she says.

Zoom in: Mumbai has launched an app to help people locate hospitals with empty beds, but such is the scarcity that they’re often full by the time patients arrive, WSJ reports. Some die without ever receiving treatment.

  • Morgues are overfull t00. There are reports of patients being treated in rooms that also contain dead bodies.
  • Public hospitals in Delhi, home to 26 million people, are also reportedly full and turning people away.

The coronavirus likely arrived in Mumbai with wealthy people returning from abroad, before spreading among poorer people and to slums where social distancing is hardly an option.

  • That pattern has been seen elsewhere in the developing world, including in cities like Rio de Janeiro.
  • There's an additional complication in India's case, though. After initially failing to account for migrant workers when implementing the lockdown, the government started to transport them to their home villages on special busses and trains.
  • The virus traveled too. 71% of cases recorded in Bihar, a state in eastern India, have been linked to returning workers, Foreign Policy reports.

The bottom line: South Asian governments attempted to balance health and hunger, knowing they could only shut down their largely informal economies for so long.

  • But with health care systems already stretched and case counts continuing to rise, they're opening up with more hope than confidence.

Go deeper

Updated Sep 24, 2021 - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Vaccines: CDC director maintains Pfizer booster recommendation for high-risk workers — CDC director approves Pfizer boosters, adds eligibility for high-risk workers — FDA approves Pfizer boosters for high-risk individuals, people 65 and up.
  2. Health: America's mismatched COVID fears — Some experts see signs of hope as cases fall — WHO: Nearly 1 in 4 Afghan COVID hospitals shut after Taliban takeover — D.C. goes further than area counties with vaccine mandates.
  3. Politics: Bolsonaro isolating after health minister tests positive at UN summit — United Airlines says 97% of U.S. employees fully vaccinated — Mormon Church to mandate masks in temples.
  4. Education: Health care workers and teachers caught up in booster confusion — Asymptomatic Florida students exposed to COVID no longer have to quarantine — Education Department investigating Texas mask mandate ban.
  5. Variant tracker: Where different strains are spreading.
Bryan Walsh, author of Future
Sep 16, 2020 - Health

Exclusive: First full at-home COVID-19 test

The Gauss/Cellex rapid at-home COVID-19 test. Credit: Gauss

Gauss, a computer vision startup, and Cellex, a biotech company that works on diagnostics, are announcing the first rapid COVID-19 test that can be fully performed by people at home without involving a laboratory.

Why it matters: Experts agree that the U.S. still needs far more widespread testing to help contain the coronavirus pandemic. An antigen test that could be performed and provide results rapidly at home could help reduce testing delays and allow people to quickly find out whether they need to isolate because of a COVID-19 infection.

Sep 16, 2020 - Health

CDC director suggests face masks offer more COVID-19 protection than vaccine would

CDC director Robert Redfield suggested in a Senate Appropriations subcommittee hearing on Wednesday that face masks are "more guaranteed" to protect against the coronavirus than a vaccine, citing the potential for some people to not become immune to the virus after receiving the shot.

What he's saying: "These face masks are the most important, powerful public health tool we have. And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings. I've said if we did it for 6, 8, 10, 12 weeks, we'd bring this pandemic under control," he said.

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