India's Covid-19 outbreak now world's fourth deadliest as developing world bears brunt of pandemic

India's Covid-19 outbreak has become the fourth deadliest on the planet and is also the fastest growing, as developing countries now bear the brunt of the pandemic.

The death toll from the new coronavirus in the world's second most populous country rose 942 according to the latest daily count, overtaking the UK with a total of 47,033 fatalities.

The nation of 1.3bn people lags only behind the US, Brazil and Mexico in the overall number of deaths and its total number of confirmed cases, almost 2.4 million, is the third largest in the world.

India's outbreak is also the fastest growing in the world, with the country reporting a succession of record daily case tallies and now recording around 60,000 or more new infections each day. The country has added its second million cases in only three weeks and is expected to surpass Brazil and America in both caseload and deaths by the Autumn.

Developing and middle income countries now dominate the rankings of countries hardest hit by the virus since it emerged at the end of last year.

Major epicentres in Latin America and parts of Asia and Africa have surpassed former hotspots such as the UK, Italy and Spain, as a worldwide total of 20 million have been infected and almost 750,000 have died.

America still tops a worldwide count of cases and deaths, but the next wealthy nation found in a ranking of cases is Spain, ranked  at number 11 according to figures from John Hopkins University. Badly hit developing countries include Peru, Chile, Colombia, Iran and South Africa.

Public health experts fear the trend is likely to continue, with outbreaks in parts of the developing world proving slow to tame. While European countries saw quickly soaring infection peaks that they were able to quickly reverse by implementing costly lockdown precautions, some developing countries have instead seen a slower rise in cases, but peaks that are longer lived. Countries including Mexico and Brazil have seen both infections and deaths hit stubborn plateaus.

In India, the outbreak has now moved on from the country's densely populated megacities like Delhi and Mumbai and into smaller population centres and rural areas where tracking cases becomes much more difficult.

Narendra Modi, the Indian Prime Minister, placed the entire nation under a draconian lockdown without warning on March 25, which lasted until June 1. The measure triggered a mass migration as now unemployed workers left the cities for their homes.

These desperate labourers often walked for hundreds of miles, but were unwittingly carrying the Covid-19 virus as well as their meagre possessions. As a result, five largely rural states - Andhra Pradesh, Karnataka, Uttar Pradesh, West Bengal and Bihar - accounted for less than 20 percent of India’s first one million cases but have reported over 40 percent of new cases since July 16.

Testing delays and failures, as well as the healthy system's inability to treat patients or protects its own staff have added to the looming crisis.

When Nadeem Qamar, 29, left his Delhi home to begin a 660 mile trek back to his hometown of Robertsganj, he thought he would be safe. Mr Qamar had left the remote town in the northern state of Uttar Pradesh to work as a clerk in a HDFC Bank to support his family but became increasingly concerned about the surging number of Covid-19 cases in India’s 30 million-strong capital.

Several buses and an Uber later, he reached home on June 16 and headed to a local government hospital to get a Covid-19 test done. For three days he quarantined himself at home alone but after he did not receive the results of his test as instructed by June 19, he began to socialise with friends, thinking it would come back negative. To his horror, he received a phone call the next day apologising for the delay, attributed to an administrative error, telling him that he had tested positive for Covid-19. Stories like Mr Qamar’s are increasingly commonplace.

The virus has also hit one of the world's most underfunded and understaffed health systems. Less than £2 is spent per person annually and pre-Covid, India faced a shortage of 600,000 doctors and two million nurses.

One doctor in the western city of Surat told the Telegraph that due to staff shortages, one healthcare professional was having to care for up to thirty critical Covid-19 patients.

Understaffing had been compounded by doctors and nurses contracting Covid-19, due to shortages in protective equipment like, masks, gowns and gloves. Unqualified interns and physiotherapists were being expected to administer ventilators after a one-hour crash course. “These people are expected to intubate patients and then manage these patients on ventilators,” the doctor said on condition of anonymity.

Victoria Hospital, a public facility in the southern city of Bengaluru, has recorded a 97 percent death rate among patients on ventilators, far in excess of comparative figures for the United Kingdom and other developed nations. “A death rate of almost 97 percent for patients on advanced respiratory support suggests something is going wrong in intensive care. Even in Italy at the peak of the Covid-19 incidence, the death rate of people on mechanical ventilation was around 65 percent,” a senior professor at St John’s Medical College and Hospital in Bengaluru told the Indian Express.

*Additional reporting by Mohammad Sartaj Alam