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How has India managed to avoid a second wave of infection until now?

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PTR 444

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India has just seen a record daily rise of infections. The attached graph from Worldometer shows that cases are now above the first peak in September, but that peak is unique in that it was the only one in the country up until now. Most countries around the world have had at least two waves, partially controlled by lockdowns and seasonal patterns, so what is it about India that has allowed it to have one large wave over the course of a year rather than several smaller waves?

Population density?
Poorer healthcare provision?
Lax social distancing?
All of these?

See the graphs below for a comparison between India and the UK/US.
 

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birchesgreen

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I wonder whether a lot of foreign workers who were stuck abroad during the first wave finally made it home?
 

kristiang85

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Is this a regional thing or country wide? Ie are places not affected by the first wave?

And has testing been ramped up at all?

I can't find any info on this.
 

brad465

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About half of all the surge in cases is linked to one state from reports, Maharashtra, which also happens to be the richest state and the one containing Mumbai. Officials think people not complying and/or campaign rallies for state elections may also be in part driving it. If seasons are having an effect, it's possible that as this India is now in its hottest part of the year ahead of the monsoon season, more people could be indoors more often, but that's not as clear.

What's also noticeable is infection peaks in many places seem to go down as quickly/slowly as they went up; this was the case in India's long wave and in our second wave's second peak, so if this is a common correlation I could see India's second wave/peak going down very quickly once it has peaked.
 

35B

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I have colleagues in both Mumbai and Delhi; the feedback from both places is very much that their experience is that this is both a new wave and that Covid has never disappeared from their consciousness.
 

brad465

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There is no sign of the wave abating yet, with 131k new infections being logged for today which isn't on the below graph yet, but a new high, in a wave that seems to be one of, if not the strongest displays of exponential growth in the whole pandemic:


1617916069053.png1617916104602.png

The current surge in India hasn't stopped a major Hindu festival seeing tens of thousands gathering it seems:


Tens of thousands of people have gathered to take a dip in the holy Ganges river as a deadly second Covid-19 wave continues to sweep India.

The devotees are marking an auspicious bathing day on Monday at the Kumbh Mela in Haridwar city of the Himalayan state of Uttarakhand.

Officials say they are struggling to impose safety norms due to huge crowds.

Hindus believe bathing at the river will cleanse their sins and bring salvation.

The Kumbh Mela takes place every 12 years and the venue is chosen from amongst four cities, including Allahabad, Haridwar, Nasik and Ujjain.

Haridwar's turn to host the gathering came amid a sharp rise in the number of coronavirus infections, with India consistently reporting more than 100,000 cases daily in the past few weeks.

On Monday, India logged more than 168,000 new cases, overtaking Brazil to become the country with the second-highest number of cases globally.

With the total case tally of more than 13.5 million cases, India is now only behind the United States which has reported more than 31 million cases. With 13.4 million cases, Brazil is now at number three.

Health experts had appealed for the Kumbh Mela festival to be cancelled, but the government went ahead saying safety rules would be followed.
 
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brad465

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While I don't support many of the restrictions in place, this move is stupid at the very least, considering the escalating situation in India, and would not be surprised if a U-turn happens in the next 10 days before the trip is meant to go ahead:


Boris Johnson's visit to India will still go ahead later this month despite the country's soaring coronavirus cases and a new variant there, No 10 says.

Public Health England says 73 cases of the variant first identified in India have been found in England and four in Scotland.

Officials have called it a "variant under investigation" rather than "of concern".

The PM had already scaled down his trip due to India's rising number of cases.

The country has reported more than 150,000 Covid cases a day for the past three weeks.

Speaking about the prime minister's visit to India, a No 10 spokesman said the trip was already "slightly shorter than it will have been".

Mr Johnson was due to spend four days in the south Asian country but after talks with Narendra Modi's administration, the "bulk" of meetings will take place on one day - Monday, 26 April.

"As you would expect, safety is obviously important and is a priority for us on this trip, which is why we will make sure that all elements of the visit are Covid-secure," the spokesman said.

Public Health England has designated the B.1.617 variant as a "variant under investigation" and said there was currently no evidence to suggest it caused more severe disease or that vaccines were less likely to work against it.

Officials said "all appropriate public health interventions will be undertaken, including enhanced contact tracing" after its detection, with PHE and international partners monitoring the situation "closely".
Surrounding countries are on the red list and one wonders if this planned trip is the main reason India isn't yet on it, as well the new variant there not being "of concern".
 

Cdd89

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one wonders if this planned trip is the main reason India isn't yet on it, as well the new variant there not being "of concern
When I travelled in from the USA a couple of months ago, flights from Mumbai and Delhi were fully loaded (my flight by contrast had a grand total of six people on it). I think there’s a lot of family travel especially from those wishing to access vaccines and I think banning that volume of travel could be both practically (hotel rooms) and politically difficult.
 

brad465

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Thinking about India and Brazil's currently dire covid situations, one common thing these have, that maybe able to explain the covid issues they've had, is not only the rife poverty in these countries, but their respective slums being havens for a virus/pathogen. This report suggests back in July more than half of Mumbai's slum population may have antibodies for it, which will all have been from infections:


More than half of residents living in Mumbai's crowded slums may have contracted coronavirus and are likely being infected at a much higher rate than those not living in slum areas, a new study has found.

The study released Tuesday raises questions over the level of testing in India, which has the third highest number of confirmed cases in the world after the United States and Brazil.

On Wednesday, India reported it had crossed 1.5 million reported coronavirus cases after more than half a million infections were recorded in just 12 days. It took nearly six months for India to reach its first 1 million confirmed cases.

Mumbai, India's financial capital with a population of more than 12 million, has confirmed more than 110,000 cases, including at least 6,180 deaths, according to official statistics. The city is in Maharashtra, the worst-hit state in India with more than 377,000 confirmed cases and at least 14,000 deaths.

The study -- a collaboration between local authorities and medical institutions -- found that 57% of the samples collected from slum residents tested positive for coronavirus antibodies, while only 16% of those living outside of slums tested positive, according to a news release Tuesday.

The researchers used antibody tests -- which are used to test whether a person had coronavirus in the past -- to analyze more than 6,900 random samples collected from participants living in Mumbai in the first half of July.

Antibody tests, often called serologic tests, look for evidence of an immune response to infection. In theory, that should show that the person had coronavirus in the past and has since recovered, but the US Centers for Disease Control and Prevention said in May that antibodies in some people can be detected within the first week of Covid-19 onset.
 

scotrail158713

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While I don't support many of the restrictions in place, this move is stupid at the very least, considering the escalating situation in India, and would not be surprised if a U-turn happens in the next 10 days before the trip is meant to go ahead:



Surrounding countries are on the red list and one wonders if this planned trip is the main reason India isn't yet on it, as well the new variant there not being "of concern".
Sensibly, it is no no longer going ahead.
Boris Johnson has cancelled a trip to India amid rising Covid cases in the country.
No 10 said the Indian PM Narendra Modi and Mr Johnson would instead speak later this month to "launch ambitious plans for the future partnership".
Downing Street said the two men would meet in person later this year.
The trip, billed as the PM's first major overseas visit since taking office, had been due to take place in January.
But it was cancelled when the UK entered a national lockdown.
The UK government had hoped the rescheduled visit in April would boost trade and investment ties, and move the two countries closer to securing a post-Brexit trade agreement.
However, the spread of a Covid variant in India had led some to suggest the trip should not go ahead.
India has been reporting more than 200,000 cases daily since 15 April - and its capital Delhi has been put into lockdown.
Health officials in the UK are investigating whether the variant, first found in India, spreads more easily and is able to resist the vaccine.
Public Health England says 73 cases have been detected in England, and four in Scotland.
India is not currently on the UK government's "red list" - meaning people returning from the country do not have to quarantine in a hotel for 10 days.
The chief medical advisor for NHS Test and Trace, Dr Susan Hopkins, said the UK did not have enough data yet to determine if India should be put on the list.

'Absurd'​

Last week, Downing Street said Mr Johnson's visit to India would be scaled down - with the bulk of the meetings taking place on Monday 26 April, rather than across four days as originally planned.
But Labour argued the trip should be cancelled entirely, with its shadow communities minister, Steve Reed, telling Sky News he did not understand "why the prime minister can't conduct his business with the Indian government by Zoom".
One senior Conservative also told the BBC it would have been "absurd" for the trip go ahead.
 

nlogax

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It's also expected that India will join the 'red list' for travel corridors in coming hours. Not really a surprise, but you can imagine the faff and indecision at No.10 over recent days that has lead to this moment.
 

scotrail158713

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And would you look at that. Not really surprising though.
India added to “red list” of countries from which most travel to UK is banned amid concerns about coronavirus variant, Health Secretary Matt Hancock says
This breaking news story is being updated and more details will be published shortly.
 

bramling

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It's also expected that India will join the 'red list' for travel corridors in coming hours. Not really a surprise, but you can imagine the faff and indecision at No.10 over recent days that has lead to this moment.

It's yet another example of this government's sheer incompetence. I've lost count of the number of u-turns we've seen through this.
 

brad465

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Add to that Prof Mark Walport thinks adding India to the red list maybe too late now:


India's addition to the UK's "red list" of banned countries due to rising Covid cases and concerns over a new variant may have come too late, the UK's former chief scientific adviser has said.

Prof Mark Walport told the BBC he believed the new variant was "more transmissible" and there were "good reasons" for keeping it out of the UK.

Health officials say it is too early to know whether it is more transmissible.

India has been reporting more than 200,000 cases daily since 15 April.

Its capital Delhi announced a week-long lockdown after a record spike in cases overwhelmed the city's healthcare system.

From 04:00 BST on Friday 23 April, most people who have travelled from India in the last 10 days will be refused entry to the UK.

British or Irish passport holders, or people with UK residence rights, will be allowed in but must quarantine in a government-approved hotel for 10 days.

Meanwhile, Prime Minister Boris Johnson is expected to hold a coronavirus press briefing in Downing Street at 17:00 BST.
 

yorksrob

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I suppose the question is whether this varient is more transmissable than "classic" covid, or whether it's more transmissable than the Kent varient that we have now. That's before you get to the whether it has much effect on the vaccine response to severe illness.
 

philosopher

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I suppose the question is whether this varient is more transmissable than "classic" covid, or whether it's more transmissable than the Kent varient that we have now. That's before you get to the whether it has much effect on the vaccine response to severe illness.
I spoke to a colleague in India today and he said that a lot of people were getting Covid again after having Covid before or getting Covid after being vaccinated in India. However he did say that that those who had Covid for a second time or after being vaccinated were generally only getting mild symptoms.

So that would suggest that with the variant or variants currently prevalent in India the vaccines do not do much to prevent actual illness but they do still prevent severe illness.

He did think it was more transmissible though.
 

778

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Thinking about India and Brazil's currently dire covid situations, one common thing these have, that maybe able to explain the covid issues they've had, is not only the rife poverty in these countries, but their respective slums being havens for a virus/pathogen. This report suggests back in July more than half of Mumbai's slum population may have antibodies for it, which will all have been from infections:

It is interesting that Africa seems to have got off lightly (apart from South Africa). Poverty in Africa, is even worse that both India and Brazil. It could be because of its young population, but both India and Brazil also have young populations, so I am not sure if that explains it?
 

plugwash

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HSTEd

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And yet again our politicians have left a long delay between the announcement and the decision taking effect for people to rush back to the UK.
Trapping photogenic people abroad who can't afford the hotel quarantine is likely to cause more damage than the delay.

If the virus exists, it will eventually slip the cordon anyway.
 

Domh245

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It is interesting that Africa seems to have got off lightly (apart from South Africa). Poverty in Africa, is even worse that both India and Brazil. It could be because of its young population, but both India and Brazil also have young populations, so I am not sure if that explains it?

Africa's lack of medical infrastructure, particularly around registering death (for comparing excess mortality) and even diagnosing covid, will also be a significant factor behind their apparent lack of cases. This article is a good read about this

Only eight African countries out of more than 50 have a compulsory system to register deaths, a BBC investigation has found.
This is not just a failure of the state to recognise individual tragedies but has enormous implications for the making of government policy.
All but two countries in Europe - Albania and Monaco - have a universal death registration system, and in Asia, just over half, analysis of UN data shows.
But in Africa it is only Egypt, South Africa, Tunisia, Algeria, Cape Verde, São Tomé and Príncipe, Seychelles and Mauritius that have what are called functioning, compulsory and universal civil registration systems - known as CRVS systems - which record deaths.
All of the countries surveyed by the BBC, working with researchers from the UN's Economic Commission for Africa (UNECA), do have some sort of death registration.
But it is often on paper and not available in a shareable digitised form. The information may be used in a local area but cannot calculate mortality trends on a national level.
Map of Africa showing death registration systems

1px transparent line

In the wake of the Ebola epidemic, and now Covid-19, having an accurate picture of who is dying, from what and where, is crucial when it comes to allocating resources and funding.
This also has implications for tracking maternal and child mortality as there are children whose birth and untimely death go unrecorded.
This not only robs them of a "right to an identity", in the words of William Muhwava - the head of demography at the UNECA based in Addis Ababa - it also means that lessons are not learnt.
"In order to help the living, we need to count the dead," UN Population Fund demographer Romesh Silva told the BBC.
Those who are missed out on the registers are often the poorest and socially excluded, he adds, and the absence of information about their deaths means that measures to deal with the causes are sometimes not taken.
"Despite investments, CRVS systems remain dysfunctional, forcing governments to rely on surveys... which by the time they are published are already outdated," says Irina Dincu, from the Centre of Excellence for CRVS systems.
Relatives observe undertakers moving a casket containing the remains of a COVID-19 coronavirus patient during a funeral at the Avalon cemetery in Soweto, on July 24, 2020.
IMAGE COPYRIGHTAFP
image captionSouth Africa has the highest Covid death toll in Africa - according to official figures
When it comes to coronavirus there is a concern that its true extent in some countries is not fully understood.
It has been widely reported that Africa's Covid-19 death toll is far lower than in other parts of the world.
Expertise in epidemic control, a swift response in some countries, the relatively young population and cross-immunity from other coronaviruses are all thought to have had an impact.
But data scientists say that calculating a key indicator of the pandemic's fallout - known as "excess deaths" - is impossible in most countries because of the lack of CRVS systems.

Measuring the Covid-19 death toll​

Excess deaths is a measure which compares the actual deaths over a period of time with the number of deaths expected based on the same period in previous years. But it relies on the full registration of deaths.
Looking at excess deaths gives a sense of the overall loss of life caused directly by Covid-19.
It also shows deaths caused indirectly by the pandemic because of factors such as overstretched health systems, fear of attending hospital and an economic downturn.
A Lancet study across 118 low-income and middle-income countries estimated that the continued disruption of health systems from Covid-19 could result in 1,157,000 additional child deaths and 56,700 additional maternal deaths.
South Africa and Egypt are among the eight countries which do have functioning death registers, so calculating excess deaths in both countries is possible, and the results are telling.
Graph showing South Africa's excess deaths

1px transparent line

By early February, South Africa had recorded nearly 138,000 excess deaths since the pandemic began - that is almost three times the official figure given for Covid-19 deaths.
To break it down: 46,200 of these people were officially recorded as having died with coronavirus and there are death certificates to prove it.
This means the other 91,500 were either undiagnosed, or died as an indirect consequence of the pandemic such as delayed cancer treatment or fear of going to hospital.
At the height of the pandemic in late last July, South Africa experienced 54% more deaths than was expected for that time period.
Although when the lockdown was first imposed, fewer deaths were recorded than normal, presumably because of fewer cases of alcohol-related violence and road accidents.
Graph showing Egypt's excess deaths

1px transparent line

Thanks to Egypt's comprehensive registration system, it is possible to calculate that there were more than 68,000 excess deaths between May and August last year.
In June, the number of recorded deaths was almost double what would usually be expected.
On average, official Covid-19 deaths made up under 10% of those additional losses.
But for most countries on the continent there is no way to reach any conclusions like this as the data is so sparse.
In 14 countries a maximum of only one in 10 deaths are recorded, including in Nigeria, the Democratic Republic of Congo and Cameroon.
Over half of the countries in sub-Saharan Africa only keep handwritten death records.
Certain states, such as Eritrea and Burundi, have no legal requirement to register or collate deaths at all.
Eritrea has recorded only seven Covid-19 death to date and Burundi, just three, although there was speculation that the virus was a contributing factor in the unexpected death of Burundi's former President Pierre Nkurunziza last year.

media captionFake news and mistrust in the government mean a lot of Nigeria's population thinks the pandemic is a hoax.
Nigeria, Africa's most populous country, recorded only 10% of all deaths in 2017.
The pandemic further "paralysed all the civil registration activities" in the country, which were not deemed an essential service, according to a UN report in April 2020.
This could explain why the number of Covid-19 deaths per million people remains relatively low there.
Nigeria has recorded nine Covid-19 deaths per million, compared to the global average of 316.
Meanwhile, South Africa has recorded 827 Covid-19 deaths per million and Tunisia 659 - the two highest in Africa.
But it is important to take into account that these countries have good registers that capture most deaths - 92% and 95% of the population, respectively.

What is being done?​

The BBC and UNECA's research has created the most up to date and comprehensive assessments of the death registration systems on the continent.
It was also discovered that many countries are making progress in bridging the data gap.
The Central African Republic (CAR) has one of the lowest performing CRVS systems on the continent following years of conflict, which is still ongoing.
In 2017 only 2% of estimated deaths were registered in the country. Twice as many male deaths were recorded as female - and then only in the capital, Bangui, and its outskirts.
Elvis Franck Matkoss, head of the statistics department at the Ministry of Economy, Planning and Co-operation, told the BBC that "the government attaches particular importance to CRVS and its fundamental role in promoting good governance".
He added that the CAR was making great efforts to improve on its 2% coverage through the modernisation of registration centres and the creation of a more centralised system.
Mr Matkoss said the government was also providing funding to help communities register their dead, as well as promoting free birth certificates for all children.
Senegal and Rwanda are both working with a US non-profit organisation, Vital Strategies, to put together historic mortality data that can be compared to deaths during the pandemic - using a method called "rapid mortality surveillance".
Five other countries - Togo, Burkina Faso, Sierra Leone, Liberia and Ghana - are working with the African Field Epidemiology Network to do the same.

'Verbal autopsies'​

Chad and Liberia are asking community health workers to notify the authorities about deaths that occur outside of hospitals.
They are using "verbal autopsies" - interviewing next of kin about the deceased - a low-cost solution to understand major causes of death in a specific region.
Some countries are using mobile technology to collect, manage and archive data about deaths.
In Rwanda and Mozambique, people can use smartphones to register deaths on an electronic system, allowing relatives to report deaths while socially distancing.
In Uganda, the Civil Registration Office has set up the Mobile Vital Records System for the registration of births and deaths in health centres and at a community level.
Over the next decade, data scientists hope this kind of innovation will help more countries on the continent to reach their universal death registration targets.
The BBC's research has highlighted some of the problems and the UNECA's Mr Muhwava said that it had brought "to the fore the challenges that CRVS systems in Africa face in documenting death events".
 

kristiang85

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In Africa, they deal with health emergences far more serious than COVID- I'm getting many anecdotal reports through work the effects diverting resources in already resource-poor settings to COVID is having on some areas. Thus some countries are just ignoring COVID; people suffering from malaria, TB, drought, other neglected tropical diseases, are more of a priority.

Unforutnately, given the West's obsession with COVID, it is sucking up funding that would normally be going to these countries to help their health systems, so this is a silent crisis that will only become apparent far too late (like our own cancer crisis).
 

HSTEd

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It is interesting that Africa seems to have got off lightly (apart from South Africa). Poverty in Africa, is even worse that both India and Brazil. It could be because of its young population, but both India and Brazil also have young populations, so I am not sure if that explains it?

Nowhere near as young as Africa though.

Median age in Brazil is ~34
Median age in India is ~26
Median age in Nigeria is ~18

Nigeria only has 4 million over 65s, in a population of 200 million
 

Yew

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One again, the farce of last minute reactionisim strikes again, we can't let our legislators to continue to rule by ministerial decree, casting peoples lives into doubt at short notice. Surely Borises knees are tired by now, from all these knee-jerk reactions.
 

35B

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One again, the farce of last minute reactionisim strikes again, we can't let our legislators to continue to rule by ministerial decree, casting peoples lives into doubt at short notice. Surely Borises knees are tired by now, from all these knee-jerk reactions.
So we have a policy that is based on limiting transmission, which applies restrictions to travel from countries that represent a high risk of transmitting Covid, and we kneecap that policy by saying it can't be used quickly when required? My own reaction on hearing it was for Friday was to wonder why the delay.

That's not about the policy itself - I suggest we agree to disagree on the merits of it - but the ability to implement it.
 

Yew

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So we have a policy that is based on limiting transmission, which applies restrictions to travel from countries that represent a high risk of transmitting Covid, and we kneecap that policy by saying it can't be used quickly when required? My own reaction on hearing it was for Friday was to wonder why the delay.

That's not about the policy itself - I suggest we agree to disagree on the merits of it - but the ability to implement it.
Such serious policies should have a prober debate in parliament, with public disclosure of the evidence. Rather than the autocratic decisions made at the behest of Grima Wormtongue Chris Whitty in opposition to epidemiological best practices.
 

yorkie

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Scaremongers like to use hyberbolic terms in relation to the Indian variant, such as "double mutant", but such terms are utterly meaningless and designed purely for dramatic effect.

The Kent variant has 17 mutations for goodness sake, so by the logic of the scaremongers it should be called a "septendecuple mutant" :rolleyes:

The “single mutant” B.1.1.7 has 17 mutations. Variants have emerged from the beginning the pandemic. “Double mutant” in this case means 2 concerning spike mutations. We know about a few things about these. They don’t explain the situation in India

The reality is that the virus is still adapting for humans; mutations that improve the fitness of the virus are occurring independently in multiple lineages all over the world. There is no evidence that any of these mutations enable the virus to evade the T-cell response to any extent, nor do they entirely evade antibodies.

People who claim otherwise are either unintelligent, misinformed, or being disingenous (or some combination of these).


I suppose the question is whether this varient is more transmissable than "classic" covid, or whether it's more transmissable than the Kent varient that we have now. That's before you get to the whether it has much effect on the vaccine response to severe illness.
Virologists I've listened to say that it really isn't helpful to view any of these mutations as making the virus "more transmissible" as this terminology gives the wrong impression. It's much more appropriate to say that they improve the fitness of the virus.

However authoritarian people who support restrictions do not want to use clear and appropriate language, and seek to use hyperbolic language in order to justify restrictions.

It makes no sense to say "classic Covid"; remember that Covid-19 is the name of the disease caused by the Sars-CoV-2 virus. We were never exposed to the wildtype (or "classic") virus in any great volume; the version of the virus that hit Europe had the D614G mutation. But this was before anyone cared about variants or mutations!


I spoke to a colleague in India today and he said that a lot of people were getting Covid again after having Covid before or getting Covid after being vaccinated in India. However he did say that that those who had Covid for a second time or after being vaccinated were generally only getting mild symptoms.
This is exactly what you would expect; the vaccines cannot completely prevent people from an infection, but they are highly effective at inducing excellent immunity in the vast majority of people. This immunity means that we are able to effectively fight the virus and avoid severe symptoms.


So that would suggest that with the variant or variants currently prevalent in India the vaccines do not do much to prevent actual illness but they do still prevent severe illness.
We cannot prevent people having mild symptoms, as is the case with hundreds of viruses which we already have good immunity against. This is how the immune response works.

He did think it was more transmissible though.
See above; it's more accurate to say the virus has improved fitness. Yes, this can effectively translate into being interpreted as "more transmissible", for example if the virus is able to replicate more rapidly, it may result in more people having a higher viral load for a longer period of time; people may be more infectious and/or infectious for longer.
 
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