India Faces a Health Crisis As COVID-19 Cases Soar

Government and public complacency have turned India into a global epicenter of rising COVID-19 cases.

NEW DELHI – Earlier this year, it seemed that India had beat COVID-19. "India has successfully contained the pandemic," Health Minister Harsh Vardhan said in late January. The country had reported just 12,000 cases in the previous 24 hours, he said, down from 100,000 cases in mid-September.

But now India is recording more new infections than any other country, raising questions about whether it was resting on its laurels too soon.

"When the first wave began to abate, we had the opportunity to learn lessons and devise policy to respond to a possible second wave," said Yamini Aiyar, president and chief executive of Center for Policy Research, a think tank in New Delhi. "Instead, we got policy complacency and now a repeat of history."

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Places With No COVID-19 Cases
Passengers undergo temperature checks as a preventative measure against the COVID-19 coronavirus as they enter the Pyongyang Railway Station in Pyongyang on August 13, 2020. (Photo by KIM Won Jin / AFP) (Photo by KIM WON JIN/AFP via Getty Images)

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Since March infections have ratcheted up, setting new case records on a near-daily basis, with more than 152,000 cases recorded on April 11, the largest single-day tally for the country. The government earlier this week banned the export of the Remdesivir due to surging public demand for the antiviral drug. Some hospitals in cities such as Pune and Mumbai are running out of beds, and some vaccination centers said they've run out of vaccines.

Meanwhile, migrant workers have started leaving their jobs in the cities to return to their villages, fearing a national lockdown like the one in 2020 that left hundreds of thousands of migrant workers jobless and without public transport to go back home.

While some states have imposed mini-lockdowns and night curfews, Prime Minister Narendra Modi has said a national lockdown is out of the question. Rather, Modi and other politicians were addressing large election rallies in West Bengal and other states where elections got underway on April 6. Videos show these rallies being attended by throngs of people, standing shoulder to shoulder, with apparently few wearing masks.

"The government thinks it can handle the situation," says Jayaprakash Muliyil, chairman of the Scientific Advisory Committee of the National Institute of Epidemiology, a research institute in Chennai.

The belief that the pandemic was under control may be because the recent spurt is limited to a few areas; just eight states account for 80% of the new infections. More importantly, over the last year, COVID-19 hasn't wreaked the kind of havoc in India as some had initially feared.

The country's recorded death toll is around 170,000, less than 2% of its 1.3 billion population. By comparison, Brazil, which has a population of more than 200 million, has reported twice the number of deaths. The United States, with a population of about 330 million, leads the world in both the number of reported cases (31.2 million) and deaths (more than 560,000).

Several theories explain why COVID-19 hasn't led to millions of deaths in India, starting with the belief by some health experts that the official record underestimates the real death count. "In India, even in the best of times, 1 in 5 deaths is medically recorded," says Ramanan Laxminarayan, founder and director of Center for Disease Dynamics, Economics & Policy, a research house in Washington, D.C. Laxminarayan estimates actual deaths attributed to COVID-19 are between 1 million and 2 million.

A health care worker administers the COVISHIELD vaccine for COVID-19 at a Government Fever Hospital in Hyderabad, India, Thursday, April 1, 2021. India is accelerating its vaccination drive by opening it up for everyone above 45 years just as cases spike sharply after several months. (AP Photo/Mahesh Kumar A.)
A health worker administers the COVISHIELD vaccine for COVID-19 at a Government Fever Hospital in Hyderabad, India, on April 1, 2021. India is accelerating its vaccination drive by opening it up to everyone over 45 years old just as cases sharply spike.(MAHESH KUMAR A./AP)

Other experts say the death rate is lower because the virus typically kills older people, whereas more than two-thirds of people in India are under 35 years old. Also, more than half of Indians live in open rural areas, where the transmission is lower.

"All of that forms the background against which policymakers think, 'Let life go on for now. We will clamp down in May if needed,' " after state elections end, says K. Srinath Reddy, president of the Public Health Foundation of India, an academic and research institute.

In this backdrop, the government also permitted holding the Kumbh Mela festival, recognized by UNESCO as the world's largest gathering of pilgrims thanks to millions of Hindu devotees who typically attend it. This time, the festival is being held in the north Indian city of Haridwar, through which runs the holy river Ganga. In deference to COVID-19, the festival's duration has been shortened from three or four months to just the one month of April, and attendees have been asked to get themselves tested before coming to Haridwar. The city has recorded fewer than 500 infections a day.

Fewer devotees have come this year compared to previous years. Still more than 2 million came on April 12, an auspicious day for taking a bath in the Ganga river. Deepak Kamboj, who runs a tour agency in Haridwar, says social distancing is not possible with such crowds in the small city. Still, faith brings people there. "Once you take a dip in the Ganga, everything will be alright."

Meanwhile, health experts are increasingly worried about the current wave, and are asking that people take it more seriously. Events like the Kumbh and election rallies can potentially become super-spreader events and should be avoided, they say.

Experts have attributed the recent rise to a lax attitude among people, especially after cases fell between mid-September and early February. "What I'm seeing anecdotally is that the second wave is among people who had managed to protect themselves in the first phase," says Oommen Kurian, head of the health initiative at Observer Research Foundation, a think tank in Delhi.

A new Indian variant of the virus is also behind many of the new cases.

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Health care workers say policymakers should have stepped up education and messaging on COVID-19 protocols weeks ago. That messaging "should have been multiplied two-three times during this second wave," says Sharad Garg, a general practitioner in Delhi. "Social influencers should lead by example."

Calls for speeding up the vaccination process have increased from health experts and state governments.

India is the world's largest producer of vaccines, and for COVID-19, it is manufacturing a domestically produced vaccine as well as the University of Oxford-AstraZeneca jab. However, hesitancy among people to get inoculated, as shown by surveys and health experts, is holding back the pace of vaccination.

India had administered 100 million doses of the vaccine as of April 11, which it said is faster than any other country. Earlier, country officials had said its target was to administer 400 million to 500 million doses by July 2021.

Starting on April 1, India began allowing everyone above the age of 45 to get vaccinated, which has boosted the overall vaccination number. Some states which have had large infections have asked the federal government to let them inoculate even younger people, to get maximum coverage.

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"India will have to step up vaccines in the high burden districts," says Kurian. "In the short run, what we can do is to prevent people from dying."

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