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MUMBAI : After giving up on a costly lockdown, India is projected to see its coronavirus outbreak nearly triple over the next month to more than 800,000 cases as the country’s leaders tell citizens to learn to live with the virus.

The forecast from a team of data scientists at the University of Michigan would put India just below Brazil, the world’s second worst-hit country right now, and on track to surpass the Latin American country given its massive population of 1.3 billion people and the ongoing relaxation of virus containment measures.

“You cannot see the peak, it’s been pushed further in time," said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan who is part of the team that’s modeling India’s epidemic.

Mukherjee removed longer term projections from the team’s website because they were causing people to panic. “I wish I could be more positive but I think it’s going to be really hard over the next couple of months."

India tried a nationwide lockdown at the end of March, at a relatively early stage of its detected outbreak. While the measures slowed transmission somewhat, they didn’t flatten India’s infection curve as they have in other, developed nations.

Steadily worse

In fact, the lockdown pushed India toward its first full-year economic contraction in over four decades, leaving millions jobless and forcing the government to ease curbs this month. Daily cases have since spiked to over 10,000, taking the total tally past 343,000, trailing only the US, Brazil and Russia.

With lockdowns too costly to continue and the surge of new cases each day too overwhelming to implement the kind of test-and-trace strategy used in South Korea and Germany, India must now focus on limiting casualties while hoping people practice social distancing on their own.

But as day laborers put out of work by the lockdown continue to flee India’s megacities for their villages in the hinterland, infections have begun to multiply in poorer, more rural parts of the country that have even less health-care infrastructure.

Spokespeople for the Ministry of Health and the Indian Council of Medical Research (ICMR) did not respond to calls and emails requesting comment.

“India can’t afford to have any more lockdowns and, therefore, the strategy is to open up and deal with the virus -- I think the slogan is live with the corona," said Ramanan Laxminarayan, director of the New Delhi and Washington D.C.-based Center for Disease Dynamics, Economics and Policy. “You basically have to live with it until the vaccine arrives or there is herd immunity."

Both those milestones are far off. Herd immunity occurs when at least 60% of a population develops antibodies naturally after infection.

Years to inoculate

Though there are about 100 vaccines in development globally, it could be years before there’s viable and widely-available inoculation.

As India’s infection numbers have climbed, the government has taken to pointing to the country’s reported fatality rate -- among the lowest in the world at 2.9% -- as evidence its approach to the virus is paying off.

But a low death rate may also be a function of India’s young population, who are less likely to fall seriously ill from Covid-19. Doubts also remain over whether official data shows the full picture.

The health care system is already becoming overwhelmed in the cities hardest hit by the virus. In New Delhi, the country’s capital, and Mumbai, its financial center, bodies are piling up in hospitals and crematoria and stories of patients being denied treatment for lack of beds have become common.

Record fatalities

New Delhi reported a record 129 casualties on June 12, and Maharashtra, the state where Mumbai is located, logged a record 178 deaths on June 15, according to coronavirus.app, a data aggregation platform.

While other countries used lockdowns to bring the rate of daily new cases down to low enough levels to break large chains of transmission, India’s population density and multi-generation households pose a different set of challenges.

Despite some bright spots in virus containment -- the southern state of Kerala and the Dharavi slums in Mumbai have brought case growth down through intensive contact tracing and isolation -- these measures may be too hard to implement across India.

Until herd immunity catches up, India can expect a “cascade of peaks" as outbreaks sweep around the country, the University of Michigan’s Mukherjee said.

In experiencing a lockdown that wrought economic suffering without flattening the infection curve, “India had the worst of both worlds," she said.

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