Sunday, August 30, 2020

Is Wudu the Secret of Pakistan's Success Against COVID19?

 الطُّهُورُ شَطْرُ الإِيمَانِ” – “Cleanliness is half the faith [Sahih Muslim Hadith] 

 India is setting new global records in daily COVID19 cases while neighboring Pakistan has seen an unrelenting decline in coronavirus cases in recent weeks. This is happening in spite of the fact that both nations have taken similar measures on paper to contain the spread of the novel coronavirus. Both have imposed lockdowns. Both have required people to wear face masks in public. Both share similar climates, demographics and socioeconomic conditions. Then why this difference? Is it in the implementation of such measures? Or the fact that people in Muslim-majority Pakistan wash their hands before prayers much more often everyday with or without soap, a hygiene practice highly recommended by public health experts during the pandemic? Or could it be that fewer women in Pakistan participate in the work force?  Let's examine this difference.

Muslim Wudu Includes Hand-washing
The best practice to limit transmission of coronavirus is to wash your hands with soap and water. Multiple studies have shown that hand-washing even without soap is quite effective in killing viruses and bacteria. A 2011 study from researchers at the London School of Tropical Hygiene found that washing with water alone reduced bacteria on hands to about one-quarter of their prewash state. A Japanese study reported that Washing your hands under running water — even without soap — is more effective at stopping the spread of flu germs than using ethanol-based hand sanitizers. When a significant percentage of a large population such as Pakistan's does indeed wash their hands under running water even without soap, the collective benefit has the potential to be large. 
As the COVID19 pandemic began, many Muslim scholars began to recommend that people wash their hands for 20 seconds with soap before doing wudu.  While British urban neighborhoods with large ethnic minority populations make up more than three quarters of England's coronavirus hotspots, the numbers coming from Muslim communities in areas which could be expected to be hard-hit are low.

Coronavirus Case Trajectory in India, Pakistan, Bangladesh & United States

In terms of global numbers, there are no major Muslim-majority countries among the most affected by coronavirus, with the possible exception of Iran. As of now, the top 5 nations most affected by COVID19 cases are: United States, Brazil, India, Russia and Peru. Measuring by deaths per million, the top 5 are: Belgium, Spain, UK, Italy and Sweden. Muslims make up a tiny percentage of populations in these countries.

COVID19: Government Response Stringency Index. Source: Our World in Data

Professor Richard Webber of Newcastle University has attributed this phenomenon to cultural habits such as frequent hand washing (wudu) that may be protecting England's Muslims from coronavirus. The Webber Phillips report shows that of 17 coronavirus hotspots in Britain – three quarters of which have large minority populations – Muslim areas are ‘conspicuous by their absence’.
Muslim women, however, may be protected and contribute to lower rates among their communities because so few of them have jobs – a report by the Young Foundation shows just 29 per cent of British Muslim women are employed. Labor force participation rate of women in India and Pakistan is about the same at 22%.
COVID19 Impact. Source: Worldometer August 24 2020

Dr. Syra Madad,  the 34-year-old Pakistani-American head of New York City’s Health and Hospitals System-wide Special Pathogens Program, conveys the importance of personal hygiene in containing the spread of viruses. She takes regular breaks to say her prayers at the Islamic Center of New York University. Before entering the prayer room, Madad stops to perform wudu, and washes her hands, mouth and face as well as her feet, according to a Washington Post report.

Dr. Madad is featured in a 6-part Netflix documentary series "Pandemic: How to Prevent an Outbreak". She had warned of a deadly pandemic in December, 2019, just days before China reported to the World Health Organization that it was treating dozens of patients for a novel virus of unknown origin.  We now know it as coronavirus or Covid-19. The series debuted in January 2020, but recent events have pushed it into Netflix’s “Top 10 in the U.S. Today.”

Dr. Syra Madad is a devout Muslim. The Netflix series shows her praying at her home in Long Island, New York. She says, "I live and breathe being a Muslim. It shapes my daily life. I don't drink I don't meat that's not halal.....I do no harm and help others".

Related Links:

Haq's Musings

South Asia Investor Review

COVID19 in Pakistan: Test Positivity Rate and Deaths Declining

Pakistan's Pharma Industry Among World's Fastest Growing

Is Pakistan's Response to COVID19 Flawed?

Pakistan's Computer Services Exports Jump 26% Amid COVID19 Lockdown

Coronavirus, Lives and Livelihoods in Pakistan

Vast Majority of Pakistanis Support Imran Khan's Handling of Covid19 Crisis

Pakistani-American Woman Featured in Netflix Documentary "Pandemic"

Coronavirus Antibodies Testing in Pakistan

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Trump Picks Muslim-American to Lead Vaccine Effort

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel


Riaz Haq said...

#India's new grim milestone: India adds 76,456 cases new cases to pass #Brazil for 2nd spot for nations worst hit by #COVID19. Only #Trump's #US now has more #coronavirus cases than #Modi's India. Coronavirus case growth in India now the world's fastest.

Riaz Haq said...

Is COVID re-spiking in Pakistan? #Pakistanis must continue to wear masks & wash hands well with soap/water for wudu to prevent #COVID19 re-spike as the #economy, #businesses, #shopping and #schools reopen. #coronavirus

Riaz Haq said...

#Pakistan records lowest daily death toll of 2 deaths from #COVID19. Pakistan's infection rate has significantly dropped to around 500 per day or less in recent weeks, compared to an average of 5,000 daily cases in May and June. #coronavirus #SouthAsia

Pakistan recorded just two deaths from the coronavirus Sunday, the lowest single-day fatality number since the surge of the pandemic in May, according to health officials.

The number of deaths stand at 6,342, with the additional fatalities.

Another 484 infections were reported, bringing that tally to 298,513.

More than 90% of all patients, or 285,898, have recovered, but 535 are in critical condition.

Pakistan's infection rate has significantly dropped in recent weeks, compared to an average of 5,000 daily cases in May and June.

The highest number of single-day cases was nearly 7,000 last month.

The government is currently following a "mini smart lockdown" strategy. Instead of closing entire streets or shopping centers, only houses or workplaces where infections are reported will be sealed.

The country has conducted more than 2.7 million tests, according to statistics.

Riaz Haq said...

No wonder #Modi's #India has such a serious #COVID19 #pandemic! MP minister Imarti Devi: "Born in cow dung, #coronavirus can't come near me. #Indian #Hindutva politicians have come up with their own version of Covid-19 “cures” #Modi

From injecting disinfectant, drinking alcohol to having papads as immunity booster, politicians of all hues have come up with their own version of Covid-19 “cures”, albeit without any scientific basis. The latest to join the list is Madhya Pradesh minister Imarti Devi, who recently said in Gwalior that she cannot be infected with Covid-19 because she was born in gobar (cow dung) and mitti (mud).

In a viral clip, Devi can be seen telling journalists in Gwalior how wrongly it was reported by the media that she had tested positive for Covid-19.

“Tumahi they, akele tum. Tumey humein corona bata deo. Imarti Devi matti mey paida bhai, gobar mein paida bhai, itte karre kitanu hain ki, Corona ke aas paas nahi aa payein.” (Only you were there and you said that I have corona. I was born in soil and cow dung. There are so many germs there that corona will not come anywhere near me.)

Riaz Haq said...

#Woodward book: #Trump says he knew #coronavirus was ‘deadly’ and worse than the flu while intentionally misleading #Americans. It's based in part on 18 on-the-record interviews Woodward conducted with the president between December and July. #COVID19

Trump shared with Woodward visceral reactions to several prominent Democrats of color. Upon seeing a shot of Sen. Kamala D. Harris of California, now the Democratic vice-presidential nominee, calmly and silently watching him deliver his State of the Union address, Trump remarked: “Hate! See the hate! See the hate!” Trump used the same phrase after an expressionless Rep. Alexandria Ocasio-Cortez (D-N.Y.) appeared in the frame.

Trump was dismissive about former president Barack Obama and told Woodward he was inclined to refer to him by his first and middle names, “Barack Hussein,” but wouldn’t in his company, to be “very nice.”


“Trump never did seem willing to fully mobilize the federal government and continually seemed to push problems off on the states,” Woodward writes. “There was no real management theory of the case or how to organize a massive enterprise to deal with one of the most complex emergencies the United States had ever faced.”

Woodward questioned Trump repeatedly about the national reckoning on racial injustice. On June 3, two days after federal agents forcibly removed peaceful protesters from Lafayette Square to make way for Trump to stage a photo opportunity outside St. John’s Church, Trump called Woodward to boast about his “law and order” stance.

“We’re going to get ready to send in the military slash National Guard to some of these poor bastards that don’t know what they’re doing, these poor radical lefts,” Trump said.

In another conversation, on June 19, Woodward asked the president about White privilege, noting that they were both White men of the same generation who had privileged upbringings. Woodward suggested that they had a responsibility to better “understand the anger and pain” felt by Black Americans.

“No,” Trump replied, his voice described by Woodward as mocking and incredulous. “You really drank the Kool-Aid, didn’t you? Just listen to you. Wow. No, I don’t feel that at all.”

As Woodward pressed Trump to understand the plight of Black Americans after generations of discrimination, inequality and other atrocities, the president kept answering by pointing to economic numbers such as the pre-pandemic unemployment rate for Blacks and claiming, as he often has publicly, that he has done more for Blacks than any president except perhaps Abraham Lincoln.

In another conversation about race, on July 8, Trump complained about his lack of support among Black voters. “I’ve done a tremendous amount for the Black community,” he told Woodward. “And, honestly, I’m not feeling any love.”

Riaz Haq said...

Coronavirus: What explains Pakistan doing so much better than India?

Was it India’s botched lockdown?

By Shoaib Daniyal

With this (smart lockdown), not only did Pakistan avoid the hardship India’s economy went through but Pakistani economist Anjum Altaf argues that this lax lockdown might have, paradoxically, helped Pakistan better contain Covid-19.

India’s total lockdown tried to trap workers in the cities. The attempt, however, failed spectacularly. So massive was the migration from the cities, that some described it as the biggest movement of people on foot since Partition. ”With no work, in India workers trickled back to the villages,” said Altaf. “But in Pakistan, the lockdown was so lax, workers still found work. And so there was barely any movement back to the villages.”

Altaf therefore argues that when the virus came to the big cities in Pakistan, it stayed there. But in India the policy response inadvertently pushed it out into the villages. “There is, therefore, a chance that Pakistani cities reached herd immunity locally – which would explain the curve bending – but in India, this will take a long time, since the virus has been pushed out all across the country,” he said.

Indian economist Kaushik Basu also proposed a similar theory where India’s lockdown “itself became the source of the virus’s spread”. “By having people huddle together, infecting one another, and then having the same people travel hundreds of miles, the pandemic has been made much worse than it need have been,” wrote Basu.

Calling it a “lockdown-and-scatter” policy, Basu argues that “some 4 or 5% of India’s population were literally sent off like sprinklers across the nation”.
The fact that India’s lockdown saw cases surge – rather than drop – as well the spread of the pandemic into rural India tend to back up Basu and Atlaf’s point

Riaz Haq said...

WHO Director-General's opening remarks at the media briefing on COVID-19 - 7 September 2020

Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children for polio have been utilized for surveillance, contact tracing and care.

There are many other examples we could give, including Cambodia, Japan, New Zealand, the Republic of Korea, Rwanda, Senegal, Spain, Viet Nam and more.

Many of these countries have done well because they learned lessons from previous outbreaks of SARS, MERS, measles, polio, Ebola, flu and other diseases.

That’s why it’s vital that we all learn the lessons this pandemic is teaching us.

Although Germany’s response was strong, it is also learning lessons.

I welcome the announcement by Chancellor Angela Merkel over the weekend that her government will invest 4 billion euros by 2026 to strengthen Germany’s public health system.

I call on all countries to invest in public health, and especially in primary health care, and follow Germany’s example.

Riaz Haq said...

#Coronavirus: #India reports record daily jump of almost 100,000 new cases for 2nd consecutive day. India has more than 4.65 million infections, with only #UnitedStates recording a higher figure, with more than 6.4 million. #COVID19 #Modi #BJP #Hindutva

The western state of Maharashtra has been particularly hard-hit, with total confirmed cases of coronavirus passing one million late on Friday, the first place anywhere in the world to cross that mark.

If the state, which is India's richest, were a country, it would rival Russia for the fourth highest number of cases globally.

Russia has now recorded 1,057,362 after a further 5,488 new infections were recorded on Saturday, with authorities saying a further 119 people have died, pushing the total number of deaths to 18,484.

Government officials and experts have claimed the increases in Maharashtra and elsewhere across the country are likely to be down to the economy re-starting, local festivals and lockdown fatigue.

"I am so disappointed with the pandemic situation in India," said Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, who has been tracking India's COVID-19 situation closely.

In a tweet, she continued: "It is getting worse and worse each week, but a large part of the nation seems to have made the choice to ignore this crisis."

Riaz Haq said...

No peak in sight for #India #coronavirus cases with huge daily increases in new cases.

Lav Agarwal, the joint secretary in the Union health ministry assigned to brief the media during the early days of the pandemic, had on several occasions remarked that India’s peak in terms of daily cases “may never come”.

At the time, it seemed like a baffling claim. The conventional epidemiological understanding is that the curve of a pandemic is usually symmetric: a sharp surge of cases is followed by a peak or a plateau after which news cases start declining.

But six months into the pandemic in India, Agarwal’s words seem to have been curiously prophetic – India’s Covid-19 graph continues to shoot up with no peak or plateau in sight.

This is almost singularly unique. Most countries have seen at least one peak or plateau even as some have seen new infections rise again. (India’s graph did momentarily slow down in mid-August raising some hope, but it did not sustain).

What explains this?

India, after all, clamped down one of the world’s harshest and longest lockdowns to contain the spread of the virus.

Six months after the lockdown started, why is the graph still rising?

Multiple pandemics
Observers say the explanation is rather simple: India’s size. This has meant that different places are at different stages of the pandemic.

“While in some of the original high-burden cities, the curve has largely plateaued or even gone down, in some other places growth is picking up,” said health economist Riju M John. “The national average is just an aggregation of what is happening around the country.”

DCS Reddy, who heads the research group on epidemiology and surveillance constituted by the Indian government’s National Task Force for Covid-19, explained: “The pandemic has now entered the rural areas where a larger number of people actually leave, so no wonder the overall numbers are going up because of the sheer size of our population.”

Other countries
But how did other big countries rein in the virus then?

Epidemiologists say India’s situation cannot directly be compared to any other country. “The only country you can maybe think of is the United States,” said Reddy, a former professor and head of community medicine at the Institute of Medical Sciences at Banaras Hindu University.

The United States, Reddy said, experienced two major surges: the first driven by eastern states like New York and New Jersey, and the second largely by Texas and Florida.“These are heavily populated states,” Reddy pointed out. “After they peaked, the virus moved inwards where fewer people live.”

In contrast, in India, rural areas are heavily populated. “In fact, almost 70% of our total population lives there,” said Reddy. To make matters worse, health infrastructure is weak in these areas. “I also doubt how much the messaging of physical distancing and mask wearing has reached those places.”

India’s lockdown did not help, Reddy added, since it led to a mass exodus of itinerant workers, stranded without jobs and money, from urban centres to rural areas, carrying the virus with them.

A lockdown that did not work
T Jacob John, one of India’s leading virologists, agreed that India’s harsh lockdown had made things worse. “I would compare India to Europe,” he said, pointing out that Indian states are as large, if not larger, than European countries. “So, a nationwide lockdown was illogical – what we needed was staggered and localised lockdowns in each state depending on the stage of the pandemic in that place.”

That way, Jacob John said India’s pandemic curve could have been flatter, leading to less pressure on medical facilities and, consequently, possibly fewer deaths. “Over a long period, say a year and a half, the number of infections would be the same anyway, but we would buy time and not have such a high peak as we are now.”

Riaz Haq said...

Millions of Children in #Pakistan Return to School Post-#coronavirus Crisis after a 6-month closure. An Asian Development Bank report praises Pakistan for achieving “notable success in containing the dual health & economic challenge". #education #health

The largest return to school in the world comes as daily infections and deaths from the outbreak in the country of 220 million have steadily declined. Officials reported around 400 new cases and six deaths in the last 24 hours.

Prime Minister Imran Khan’s government had closed more than 300,000 educational institutions in mid-March as part of a nationwide lockdown to contain the spread of the virus that causes the COVID-19 disease.

Authorities have since gradually lifted all curbs on businesses across Pakistan and opened public places, including gyms, tourist destinations and restaurants, but schools remained closed.

The restriction confined more than 50 million school and university-going Pakistanis to their homes in the South Asian country where officials estimate nearly 23 million children already have no access to education.

“Let us welcome our children and students on the first day of opening of educational institutions,” tweeted Faisal Sultan, a special assistant to the prime minister on national health services.

“Please don't forget basic protective steps. Masks, reduced density in classes, hand hygiene. Parents, school administrators, teachers, students — all together,” Sultan cautioned.

Officials have recorded more than 302,000 cases, including close to 6,400 deaths, while 96% of the patients have recovered.

Pakistan’s countermeasures and supply of emergency assistance to millions of poverty-stricken families directly affected by ensuring economic lockdowns have been widely lauded.

An Asian Development Bank report released Tuesday praised Pakistan for achieving “notable success in containing the dual health and economic challenge" presented by the infection.

The government’s rapid mobilization of a $7 billion relief package comprising emergency financial support to daily wage earners, cash transfers to low-income families, accelerated procurement of wheat, support for health and food supplies and financial support for small and media enterprises helped shield the poor and most vulnerable during the pandemic, the report said.

"As the curve flattens and business activity resumes, the economy is showing signs of resilience and recovery, said ADB country director Xiaohong Yang.

The head of the World Health Organization (WHO) last week included Pakistan among seven countries that he said the world can learn from about how to fight future pandemics.

“Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children for polio have been utilized for surveillance, contact tracing and care,” Tedros Adhanom Ghebreyesus said.

Riaz Haq said...

Your #Coronavirus Test Is Positive. Maybe It Shouldn’t Be. In 3 sets of data in #Massachusetts , #NewYork and #Nevada , up to 90% of people testing positive for #COVID19 carried barely any virus. Low virus load may not be contagious.- The New York Times

Some of the nation’s leading public health experts are raising a new concern in the endless debate over coronavirus testing in the United States: The standard tests are diagnosing huge numbers of people who may be carrying relatively insignificant amounts of the virus.

Most of these people are not likely to be contagious, and identifying them may contribute to bottlenecks that prevent those who are contagious from being found in time. But researchers say the solution is not to test less, or to skip testing people without symptoms, as recently suggested by the Centers for Disease Control and Prevention.


The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.

This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.

In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.

On Thursday, the United States recorded 45,604 new coronavirus cases, according to a database maintained by The Times. If the rates of contagiousness in Massachusetts and New York were to apply nationwide, then perhaps only 4,500 of those people may actually need to isolate and submit to contact tracing.

One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.

Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.

Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.

A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.


Instead, new data underscore the need for more widespread use of rapid tests, even if they are less sensitive.

“The decision not to test asymptomatic people is just really backward,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, referring to the C.D.C. recommendation.

“In fact, we should be ramping up testing of all different people,” he said, “but we have to do it through whole different mechanisms.”

In what may be a step in this direction, the Trump administration announced on Thursday that it would purchase 150 million rapid tests.

The most widely used diagnostic test for the new coronavirus, called a PCR test, provides a simple yes-no answer to the question of whether a patient is infected.


But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.

Riaz Haq said...

#India's #Economy Heads for Double-Digit Plunge as #CoronaVirus Spikes. Goldman Sachs estimates a 14.8% contraction in #GDP for fiscal 2020-21, while #ADB is forecasting -9%. OECD sees the #Indian economy shrinking by 10.2%. #COVID19 #Modi #BJP #Hindutva

India’s economic recovery prospects have gone from bad to worse after the nation emerged as a new global hotspot for the coronavirus pandemic with more than 5 million infections.

Economists and global institutions like the Asian Development Bank have recently cut India’s growth projections from already historic lows as the virus continues to spread. Goldman Sachs Group Inc. now estimates a 14.8% contraction in gross domestic product for the year through March 2021, while the ADB is forecasting -9%. The Organisation for Economic Co-operation and Development sees the economy shrinking by 10.2%.

The failure to get infections under control will set back business activity and consumption -- the bedrock of the economy -- which had been slowly picking up after India began easing one of the world’s strictest and biggest lockdowns that started late March. Local virus cases topped the 5 million mark this week, with the death toll surpassed only by the U.S. and Brazil.

“While a second wave of infections is being witnessed globally, India still has not been able to flatten the first wave of infection curve,” said Sunil Kumar Sinha, principal economist at India Ratings and Research Ltd., a unit of Fitch Ratings Ltd. He now sees India’s economy contracting 11.8% in the fiscal year, far worse than his earlier projection of -5.8%.

Goldman Sachs’s latest growth forecast came last week after data showed gross domestic product plunged 23.9% in the April-June quarter from a year ago, the biggest decline since records began in 1996 and the worst performance of major economies tracked by Bloomberg.

India is “likely to see a shallow and delayed recovery in corporate sector profitability over the next several quarters,” said Kaushik Das, chief economist at Deutsche Bank AG in Mumbai, who has downgraded his fiscal year growth forecast to -8% from -6.2%. That will “reduce the incentive and ability for fresh investments, which in turn will be a drag on credit growth and overall real GDP growth,” he said.

Still, foreign investor sentiment will likely return once the pandemic eases, said Todd Buchholz, a former White House economist and now author.

“The virus is seen as a temporary phenomenon,” he said in an interview. “Those investors who were lining up to invest in India in January 2020 will do so in 2021 also, and deregulation has to continue.”

Riaz Haq said...

'So many bodies,' says ambulance driver as #India struggles to stem #COVID19 death toll. Businesses are reopening, hospitals are full and doctors see no end in sight."The most optimistic scenario is plateauing, but it's not going to end soon."- ABC News -

With the windows of his ambulance rolled down and the siren blaring, Mohsin Khan, 41, told his attendant why he drives ambulances.

"I lost my mother because no ambulance came on time to attend to her," he said. "The helplessness I felt, I don't wish that on my worst enemy."

On COVID-19 duty since the beginning of the pandemic in India, Khan has seen and done it all: from rushing patients to hospitals across Delhi to being the sole witness to last rites being performed. But this particular trip to the cremation ground brought him a sense of complete helplessness, as it involved him shifting the body of a 3-year-old COVID-19 victim, the youngest he has ever carried.

"She just reminds me of my daughter, she is somebody's child," he said tearfully.

"Sometimes I end up spending my entire day in cremation grounds and cemeteries. There are just too many bodies," he said as he waited to hand over the stretcher at the crematorium.

Since April 17, when Khan picked up his first COVID-19 patient, he has seen the numbers in cases and deaths rise consistently.

"My ambulance was the only one in the fleet until then," he said. "But with an increase in the number of cases and deaths, we now have 17 ambulances."

Some days, death is the only thing he sees.

"There are so many bodies and so many patients," he said. "On some days, we don't even have time to eat. There have been times when I have had to take six patients at once."

India this month surpassed Brazil as the country with the world's second-highest number of recorded infections. According to the Johns Hopkins Coronavirus Resource Centre, the country has 5.6 million total cases, putting it not far behind the United States, which has 6.8 million.

Testing in India also includes the rapid antigen tests, which result in a higher portion of false negatives, Dasgupta told ABC News.

"Antigen tests have been there for quite some months now and were meant for special situations like containment zones and people with high probability of illness," Dasgupta said. "But it's being done more generally now. On the plus side, this has pushed up testing numbers, but on the minus side you're picking up less than you would from such a high number of tests."

In March, India instituted a stringent lockdown to curb the crisis and give India's overburdened health care system a shot at dealing with the pandemic. But the lockdown plan did not account for the millions of internal migrants working in cities. Most of them were daily wage laborers who, overnight, found themselves without work and shelter.

They were left with no choice but to undertake arduous journeys, often on foot, to go back to their villages located thousands of miles away. And that contributed to the spread of the virus.