The world is yet to see the worst of the COVID-19 outbreak in India, a Kiwi expert says, with case numbers spiralling out of control - and deaths soon to follow.
In the past month, the world's second-most populous nation has gone from recording a couple of hundreds deaths a day to nearly 3000, with some estimates that figure could be five to 10 times too small.
Over the same time frame, the daily confirmed number of infections has risen from 50,000 to more than 300,000 - surpassing the US outbreak at its worst, and also likely an underestimate. That figure has doubled in just two weeks, suggesting in two weeks' time the official daily death toll could be twice what it is now.
"It's terrible to watch," University of Auckland disease modeller Shaun Hendy told The AM Show on Tuesday.
"The high case numbers we're seeing now are going to translate into a number of fatalities in the coming weeks, so we've not seen the worst yet."
As recently as February experts were left scratching their heads as to why India - a poor and crowded nation - hadn't been hit hard by the virus. India lifted many of its restrictions around the same time as case numbers fell to about 10,000 a day - the equivalent of New Zealand recording about 36 cases a day.
Implementing a nationwide lockdown as strict as New Zealand's was isn't really an option though, said Dr Hendy.
"They don't have great options there - it is very difficult to manage a lockdown. Many people simply can't stay at home - they live hand-to-mouth, so a lockdown isn't a great option. They're really looking to vaccine suppliers and the world can't make vaccines fast enough at the moment."
While India makes most of the world's vaccines, it simply can't keep up with the virus right now.
"It's going to be very grim to watch things play out over the next few weeks to a month," said Dr Hendy, whose work on the pandemic last year at research centre Te Pūnaha Matatini was honoured with the Prime Minister's Science Prize for 2020.
"It's quite possible we could see India heading towards one of the highest fatality rates in the world."
The Indian variant, B.1.6.7, has been dubbed the 'double mutant' because it contains two key mutations scientists fear could help the virus spread faster, escape vaccines and cause worse illness.
One mutation, E484Q, is similar to those seen in the South African and Brazilian variants of the virus, while the other - L452R - can also be found in the California variant dubbed "the devil" by one of the researchers who uncovered it.
"There's a lot of uncertainty, particularly around the variant that they're dealing with at the moment," said Dr Hendy. "We don't know as much about this variant. It has some of the changes that we've seen in some of the other dangerous variants around the world, but it's unclear to the extent to which that variant is driving the problems, or the way that people are responding to the outbreak."
Dr Hendy expects the ban on arrivals from India, set to expire on Thursday, to be extended. On the day the ban was announced, India reported 126,000 new cases and 685 deaths. The former figure has nearly tripled, and the latter is now more than four times bigger.
"I think we're going to have to extend that travel ban for the time being. We were seeing people getting infected on the way to the airport or getting their test. We were seeing something like 10 percent of arrivals with an infection - that indicates they were probably picking it up during their travel, and so we'd be putting people at risk by opening that travel bubble again."
If the Government doesn't extend the ban, from Thursday people arriving from India will enter specific managed isolation facilities set aside for those coming from high-risk countries, defined as any with positivity rates of 5 percent or higher on arrival.
Only citizens and their immediate family members will be allowed in, which in addition to India will include Brazil, Pakistan and Papua New Guinea at first.