India has 1.3 billion people.
4 times that of the US.

What’s going on is just amazing and needs in depth immunologic studies. These are raw numbers!

When I adjust to population, the differences are even more striking.

You cannot undercount ten times the death rate. That would also mean also undercounting 20 times the hospitalizations.

With friends& reporters I’m in touch with across the country, India has had nowhere near the deaths the US has per capita. Life is normal even in big cities

There are 3 likely factors lowering death rate in India:

-Younger age
-Lower obesity
-Cross reactive immunity from prior corona virus and other infections

The first two alone cannot explain lower severity. There are enough older people to overwhelm the health care system.

There are 4 other factors people have hypothesized but I don’t think they play a big role

-BCG vaccination
-High temperature
-Vitamin D levels
-Use of chloroquine, ivermectin etc

Disease severity not just deaths must be markedly less in India Reflected in the marked drop in number of cases even as social distancing became less. What we hear in big cities is: nearing herd immunity

Delhi & Chennai reached 40-50% seroprevalence months ago!

I just think it would be wise to do in depth scientific studies in India and neighboring countries so we better understand resistance to severe COVID that seems to occur in these parts. Looking at the seroprevalence a huge proportion must have been asymptomatic. Question is how?

My earlier thread on this topic is here. https://twitter.com/VincentRK/status/1356624435730649090

My recommendation to India is inspire of the fall in cases vaccinate the whole population as fast as possible. And with single minded focus.

The vaccines will protect you from variants.

*in spite

Remember countries like China, South Korea, Australia, New Zealand controlled the pandemic by dramatically controlling cases.

In India cases were not controlled & half the country is probably seropositive. The phenomenon I discussed is the striking lower severity & mortality.

Case counts in India have now come down as the number of people who have already had COVID and have become immune has risen. This is different than cases coming down due to lockdowns. Its as expected.

I am linking to this absolutely outstanding article by @DrSidMukherjee @NewYorker that just came out.

It examines all the possible reasons from undercounting to cross reactive immunity. A must read to understand the puzzle better. https://www.newyorker.com/magazine/2021/03/01/why-does-the-pandemic-seem-to-be-hitting-some-countries-harder-than-others

Addendum since some people are tagging me that cases are rising in India. This thread is not about cases. It's about markedly reduced disease severity and deaths compared to number of cases.

Preexisting immunity may not prevent cases. It reduces severity of COVID.

Despite massively more overcrowding & far less resources, COVID deaths are 115 per million in India vs 1650 per million in USA.

Seroprevalence in big cities is higher in India than in big city studies in the US.

And the difference is too large to explain by age and obesity.