The world’s worst COVID-19 outbreak 

In May 2021, India, the world’s second-most populous country, was gripped by a devastating second wave of COVID-19. The surge, larger than any seen before, saw new cases climb past 400,000 a day, breaking the record for the highest single-day figure globally. 

According to the World Health Organisation, as of 21 June 2021 there have been 29,935,221 confirmed cases of COVID-19 in India and 388,135 deaths, since January 2020.   

Even these huge figures are likely to be an underestimation of the true scale of the outbreak, but the human cost of the crisis is clear. Footage shows hospitals with oxygen shortages and family members driving from hospital to hospital, searching for an ITU bed.   

Imperial’s researchers, academics and students have rallied together to try and help with the crisis.  

One challenge is that it has been difficult to get a clear understanding of the scale of the crisis due to a lack of access to reliable testing across parts of the country, a delay in test results, and because fear and social stigma is preventing people from getting tested. 

The Imperial College COVID-19 Response Team have been providing projections of the coronavirus outbreak in India, as well as helping health services with planning. The team are publishing weekly short-term forecasts for the effective reproduction number (the number of people in a population who can be infected by an individual at any specific time) and COVID-19 deaths in the country.  

The researchers use the reported number of deaths due to COVID-19 to make these short-term forecasts as these are likely more reliable and stable over time than reported cases. 

The Imperial team are also providing weekly forecasts of the healthcare burden of COVID-19 in India. The reports aim to provide India and other low- or middle-income countries (LMIC) with an indication of where they are in their epidemic and scenarios of how healthcare demand is likely to vary over the next 28 days. The scenarios help countries understand how strategies today are likely to shape the next phase of the epidemic. 

Researchers Professor Nicholas Grassly, Dr Nimalan Arinaminpathy, and Dr Margarita Pons-Salort have been working with public health institutions in India and the Christian Medical College in Vellore, to help country- and state-level planning of different COVID-19 scenarios. 

They have also helped to estimate the transmission of the virus (R number) and have been examining how contact tracing could be made more efficient. 

India’s devastating second wave is thought to be at least partly caused by a new coronavirus variant, B.1.617.1 – the Delta variant, first detected in India. This variant has now spread across the globe, including to the UK. Early estimates suggest that this variant could be anywhere between 30% and 100% more transmissible than the previously dominant Alpha variant in the UK (first identified in Kent).  

Dr Anne Cori from the School of Public Health said: "Unfortunately the Delta variant is growing fast and has become the dominant variant in the UK. This is due to a combination of two factors that are hard to disentangle; the first is an increase in transmissibility and the second is a reduced vaccine efficacy.  
 
"There is still uncertainty on how much more transmissible Delta is compared to Alpha and there's also emerging evidence that Delta might be more severe. Early studies suggest vaccines would still be relatively effective at preventing symptomatic infection with Delta but we don't know yet how much protection they would give against severe disease and death or against infection and infectiousness." 

According to early data from Public Health England, this variant, now the dominant variant in the UK, is more likely to lead to hospitalisations than the Alpha variant. There are also concerns that it may be more resistant to vaccines, particularly after just one dose. 

Long-standing connections

The College has a long history of collaboration with colleagues in India; a two-way flow of ideas and innovation that has meant colleagues in both countries were able to respond quickly to the current crisis. 

The first partnerships between academics at the College and the Indian Institute of Technology Delhi began in the 1950s and continue to this day. There are currently 300 Indian students studying at the College and over 3,000 Indian alumni. Imperial has published more than 1,200 research papers with 123 partner institutions in India. 

Across all areas of the College, there is world-leading research taking place with Indian partners, such as the world’s largest study on babies with brain injuries, the PREVENT study, which will study around 60,000 women from South India to help prevent epilepsy in babies. At Imperial College Business School, the Gandhi Centre for Inclusive Innovation was established in 2007 to support and promote collaboration with India, working with some of the country’s leading research institutions. 

Imperial’s graduates are also building collaborations with peers in India. Oorja Development Solutions, co-founded by Chemical Engineering graduate Dr Clementine Chambon and Indian social entrepreneur Amit Saraogi, is a social enterprise that is helping small-scale farmers in northern India to switch from using water pumps powered by diesel to a solar-powered system. Oorja has already installed twelve solar-powered pumps, which provide farmers with pay-as-you go access to their greener and more affordable irrigation solution. 

Our researchers and their peers in India have relied on these strong relations in the current crisis. 

Collaborative effort

Fundraising and supporting those in need is a central pillar of Imperial’s student Indian Society, one of the largest in the UK. The society habitually selects a charity to support each academic year, but this crisis required a collaborative effort on a scale not seen before.  

On 19 May, India reported more coronavirus deaths in a single day than any other country at any time during the pandemic. This led to international interest in the unfolding crisis and prompted the Indian Society to act. They started by signposting students to places they could donate and charities they could support, before coming together with several other university societies to maximise their impact. 

Students for COVID-19 Relief in India is a group of university students in the UK, representing a collaborative effort between eight universities and 14 student societies: Imperial, the University of Cambridge, LSE, the University of St Andrews, King’s College London, the University of Warwick, Cardiff University and Loughborough University.  

This collaboration has raised over £5,000 so far which will be used to provide oxygen supplies, sanitation equipment and face masks. The students are working with two charities on the ground in India: Goonj, a non-profit providing essential items such as food ration kits, masks and sanitation to underprivileged groups across India, and Hemkunt Foundation, a pan-India grassroots organisation that provides free oxygen concentrators and sets up oxygen cylinder drive-throughs and oxygen plants (industrial systems designed to generate oxygen). 

More recently, they’re working with Imperial College Business School and the fundraising arm of the Students’ Union, Raising and Giving (RAG), to organise fundraising events including charity yoga and bake sales. 

Starting conversations

Saylee Jangam, a PhD student in Imperial’s Department of Bioengineering, wanted to start a conversation in the College community about the escalating situation in India. As well as raising awareness of the health crisis, Saylee also wanted to highlight the challenges faced by those in the Imperial community with links to India - be that being born there, having family there or being of Indian heritage - who are far from home and unsure what they can do to help.  

In addition to raising awareness of the personal impact of the crisis on the College community, Saylee also launched a fundraising effort, called ‘Help India Beat COVID-19', to send ventilators to India, raising over £4,500 since early May. Saylee and fellow Imperial students are working with the High Commission of India to send medical aid to India, which will be received and distributed by the Indian Red Cross Society in New Delhi, one of the worst-hit cities in the country. 

On 21 June, the number of confirmed cases of COVID-19 in India stands at 29,935,221. While the situation continues to improve, the repercussions of the pandemic will be felt for years to come in India and communities like Imperial’s must continue to come together to provide support.  

In early June, less than 15% of the Indian population has received at least one dose of the vaccination – largely due to severe shortage of doses. These shortages have led to vast access inequalities, with rural areas, the poor and women falling behind. Modelling and projections, from teams such as Imperial’s COVID-19 Response Team, will continue to be needed to ensure authorities can prepare for the next stages of their pandemic as best as possible.