Water Transmission Increases the Intensity of COVID-19 Outbreaks.

ABSTRACT

India suffered from a devastating 2021 spring outbreak of coronavirus disease 2019 (COVID-19), surpassing any other outbreaks before. However, the reason for the acceleration of the outbreak in India is still unknown. We describe the statistical characteristics of infected patients from the first case in India to June 2021, and trace the causes of the two outbreaks in a complete way, combined with data on natural disasters, environmental pollution and population movements etc. We found that water-to-human transmission accelerates COVID-19 spreading. The transmission rate is 382% higher than the human-to-human transmission rate during the 2020 summer outbreak in India. When syndrome coronavirus 2 (SARS-CoV-2) enters the human body directly through the water-oral transmission pathway, virus particles and nitrogen salt in the water accelerate viral infection and mutation rates in the gastrointestinal tract. Based on the results of the attribution analysis, without the current effective interventions, India could have experienced a third outbreak during the monsoon season this year, which would have increased the severity of the disaster and led to a South Asian economic crisis.