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India's Second COVID Crisis

Posted on May 14 2021

India's Second COVID Crisis


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By Larry Marotta

In the United States, COVID seems to be on the decline. According to Johns Hopkins University in Baltimore, Maryland, the number of new cases in the U.S. fell to an average of 38,000 per day as of Monday, May 10. While still a large number, it is the first time the number of daily new cases dropped below 40,000 since September 2020. It is also good news since the U.S. was reporting about 70,000 new cases each day in mid-April 2021—just a few weeks ago.

Sadly, the country of India is not faring nearly as well. Pandemics like COVID are said to occur in waves. Similar to a wave in the ocean, the number of cases rises to a peak. Then, after the crest of the wave passes, there is a drop in cases as the virus dies down. For example, the Spanish flu of 1918 had several surges of new cases before the pandemic ended.

In India, during the first wave of the COVID pandemic, in September 2000, the country of 1.3 billion people hit highs of about 90,000 new cases and 1,100 deaths per day. By February 2021, as the first wave passed, those numbers had dropped significantly. For example, on February 10, 2021, India had a much smaller 11,000 new COVID cases and 94 deaths daily.

However, the current surge in COVID cases is surprising because India’s leaders and medical professionals seemed to have managed the first wave successfully. Even though India’s population is about four times larger than that of the United States, to date, India has had 40 percent fewer COVID-related deaths than the U.S. Currently, India is now experiencing more than 400,000 new daily COVID cases—and hospital space is very limited. The situation in India is dire and getting worse.

Not that long ago, in Delhi, the city and territory which contains India’s capital, New Delhi, life had seemed to be returning to normal after the first wave had passed. By December of 2020, temples re-opened for worship, weddings could be planned, and large political rallies were permitted. Even with fewer social distancing restrictions, by February 2021, India’s daily cases fell nearly 90 percent from their September peak.

Then, in March, cases started rising in Maharashtra, the state which is home to Mumbai, India’s most populous city. By the month’s end, daily cases were six times higher than they were at the start. In May, Maharashtra responded with weekend lockdowns and limiting the size of public gatherings. Other states followed its example. As of May 11, 24 of India's 36 states and territories had instituted new COVID restrictions.

“We thought it would be like the first wave,” said Rajat Arora. Dr. Arora is a cardiologist and director of a hospital in New Delhi. “We thought things would pick up but pretty much be manageable. You always reason from your past experience.”

Arora and other medical professionals proved to be incorrect. India is now experiencing a surge in COVID cases, taxing the nation’s hospitals. Arora says that while his hospital can admit 30 new COVID patients each day, it is not enough to meet the 1,000 requests he gets for treatment daily. “There’s nothing we can do until someone gets better or someone dies,” Arora explains. “If I put up a thousand-bed hospital today, it would be full in an hour.”

With hospitals unable to take on more COVID patients, some families have found themselves driving from hospital to hospital, hoping to find one with an empty bed. However, finding one is not necessarily the end of the story. Overburdened hospitals are running out of urgent medical supplies like oxygen, which the sickest patients need in order to keep breathing. For example, on May 1, eight people died at a New Delhi hospital after it ran out of oxygen supplies.

It is still too early to say whether the worst of the second wave is over. "There are some epidemiological estimates that say we are closing in on a peak, but these are all projections," explains Chandrika Bahadur, chair of the Lancet COVID-19 Commission India Task Force. "So it's hard to tell whether the peak will come in the middle of
May . . . or whether it will take a little bit longer."

After managing a first wave of the virus, how did things get so out of hand for the second? Dr. Krishna Udayakumar, a professor of global health and medicine at Duke University in Durham, North Carolina, says much of the blame should be directed towards the country’s leaders.

“What we’ve seen is really a massive failure of leadership across multiple parts and systems in India,” Dr. Udayakumar argues. “This was a foreseeable and foreseen second wave. Rather than using the time after the first wave that peaked in September to be better prepared, we saw many political leaders actually become complacent, declare victory and allow the loosening of public health tools and policies that we saw lead to exactly where we are now. It’s a tragic set of events that we’ve seen happen.”

For example, in March 2021, India’s health minister publicly proclaimed that the country was nearing the end of the pandemic. Citizens then became less vigilant in maintaining social distancing guidelines while authorities relaxed the safety measures. "No one saw the extent of the surge," says K. Vijay Raghavan, an Indian government science adviser. "As the previous wave came down, there was in all of us a feeling that this was something which had been dealt with substantially. We saw signs of a next surge, but the scale and the intensity of it was not clear."

Another concern is potential COVID variants. When a virus like COVID makes copies of itself, it sometimes changes a little. These small changes are called mutations. When a virus has one or more mutations, it is considered a variant of the original virus. When a virus spreads in highly populated cities like New Delhi or Mumbai, it has many more opportunities to mutate. Sometimes mutations allow a virus to spread more easily or make its symptoms worse.

Some scientists are linking the rise of a COVID variant called B.1.61 to this recent crisis. "In Maharashtra we saw (the Indian variant) go up, we saw an outbreak. We are seeing it go up in Delhi, we are seeing an outbreak," said Anurag Agrawal, director of India’s Institute of Genomics and Integrative Biology.

However, India’s National Center for Disease Control (NCDC) advises that more research is needed to confirm whether this variant is responsible for the surge in COVID cases. "We have not been able to establish the epidemiological and clinical correlation completely yet," says NCDC Director Sujeet Singh. "This correlation is the main aspect, and without it we cannot link a particular surge to the variant."

Some are linking the surge to problems with India’s COVID vaccination program. Although the program started in January, leaders have faced hurdles delivering vaccines to clinics that administer them. In addition, worries about the safety of the vaccine have led some people away from receiving them. As of May 11, India had administered more than 168 million vaccine doses, with 34 million citizens now fully vaccinated. Even though those numbers are large, with a population of 1.3 billion people, only about 2.5 percent of the nation currently has full immunity.

According to Duke University’s Krishna Udayakumar, these vaccines are likely to have no immediate effect on the pandemic. “Vaccines are an incredibly important component of the global response, including the response in India, but unfortunately it won’t make much of a difference in the coming weeks,” he says. “Much of the death and illness that we will see in the coming weeks is already built in. This number of 400,000 cases a day . . . 4,000 deaths a day . . . will continue to go up for weeks, unfortunately, no matter what we do today.”

Some citizens are directing their frustration towards India’s government. They blame Prime Minister Narendra Modi for refusing to institute a nationwide lockdown. Modi has argued that a national lockdown should only be considered a last option. Others accuse Indian health officials of understating the severity of the recent COVID surge until it was too late. In some cases, India’s government has removed posts from social media websites that are critical of how it has handled the crisis. This has led some citizens to conclude that the government is more concerned with protecting its own image than the lives of its people.

Thankfully, several countries around the world have provided aid to India in its time of need. The United States has promised to send medicine, ventilators, test kits, and other supplies doctors need to treat COVID patients.

Although grateful for aid, India’s doctors and nurses still have the unwelcome task of turning away sick patients and treating people whose chances of surviving COVID are frequently slim.

“Our staff is struggling,” confesses Rajat Arora of New Delhi’s Yashoda Hospital and Research Centre. “Many are on the brink of a complete breakdown. Every day, they come to work and see nothing but death. They go home, and their own family has gotten COVID and can’t breathe or have died. This is the situation. There’s no end in sight.”


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