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NEW DELHI – A deadly and rapid second wave of the coronavirus pandemic has brought India’s healthcare systems to the brink of collapse and endangers millions of lives and livelihoods.

On Sunday and Monday, the country recorded more than 270,000 and 259,000 cases, respectively, of Covid-19, a staggering increase from around 11,000 cases per day in the second week of February. Reported coronavirus infections have increased from around 20,000 per day in mid-March to more than 200,000 in mid-April.

Newspapers and social media are the horror and failure rollers of the health care system. There are reports of ambulance queues with patients waiting outside the largest Covid facility in Ahmedabad, western Gujarat, because ventilation beds and oxygen were depleted.

On Friday, in the city of Lucknow, in the north of the country, Vinay Srivastava, a 65-year-old journalist, shared his declining oxygen levels on Twitter, asking government authorities for help. Overcrowded hospitals and laboratories would not take calls from his family. Mr Srivastava’s last handful tweet described his oxygen saturation level at 52, well below 95%, which is considered normal. Nobody helped. He died on Saturday.

At a crematorium in downtown Bhopal, residents said they had not seen so many cremations since 1984, when a gas leak from a Union Carbide pesticide plant in the town killed around 5,000 people. Around 11 a.m. in Delhi, the national capital, with more than 18 million people on Tuesday, only 40 intensive care beds were available for Covid-19 patients.

India has recorded a total of 15.3 million reported coronavirus cases to date, with reported deaths of 180,000 people so far. A survey funded by the government’s leading medical research agency indicated that there were around 30 infections corresponding to each reported case.

Most of the reports of the collapse of the health care system come from major Indian cities. Little is known about the devastation in rural India, where about 70% of India’s 1.3 billion people live and where there are far fewer hospital beds and medical staff. Federal officials have acknowledged that the pandemic is moving to small towns and rural areas.

How did things change so drastically between March and April?

India’s rapid slide into this unprecedented crisis is a direct result of government complacency and lack of preparedness. As the number of cases dropped dramatically by mid-February, the Indian government and various policymakers, encouraged by flexible and triumphant media, prematurely declared victory against the pandemic. In early March, senior government ministers spoke of the end of the pandemic in India.

Cricket matches where tens of thousands of spectators filled the stadiums were allowed and movie theaters were opened. The government has done nothing to prevent huge religious gatherings such as the Kumbh Mela, a festival in Haridwar in the northern state of Uttarakhand, where millions of Hindus have gathered for a dip in the Ganges. Not surprisingly, the cases of Covid-19 in Haridwar have exploded.

India held elections in five states in stages over a month. And one of the busiest political competitions has taken place in West Bengal, where polls take place in eight phases between late March and late April. Despite the increase in cases, numerous public gatherings have taken place, with tens of thousands of people cramped without masks. Although precise data on the correlation between the political campaign and the peak of Covid-19 is not available, the number of cases in West Bengal increased tenfold between the beginning and mid-April – several times the rates in crowded cities from Mumbai and Delhi.

Conversation of opinion
Questions regarding the Covid-19 vaccine and its deployment.

Massive political, religious and sporting events, widely covered by Indian media, have sent mixed messages about the severity of the pandemic. Popular impatience to return to past lives made matters worse. The Indians began to mix widely and minimize the threat too because there is an unfounded feeling among a large number of Indians that exposure to pollution and germs had endowed them with superior immunity.

It was inevitable that the virus would roar. Indians have been shown to be as sensitive to Covid-19 as everyone else. I was one of the researchers in the world’s largest Covid-19 contact tracing study last year, covering more than 660,000 people in two southern Indian states. We found that an early lockdown – it started when there were less than 1,000 reported cases – kept the virus under control.

The risk of getting infected from exposure to someone with coronavirus is no different in India. The proportion of people who die after a diagnosis of Covid-19 is lower in India than in many other countries. But that’s simply because 65% of Indians are under 35.

Indians with Covid-19 aged 40 to 70 were more likely to have died in India due to the high prevalence of comorbidities such as hypertension, diabetes and respiratory disorders. Covid-19 patients in our study in their quarantine in India were twice as likely to die as Covid-19 patients in the corresponding age group in the United States. The rate was 75% higher in India than in the United States when we compared patients in their 50s.

The first wave of Covid was concentrated in poor urban areas, from where it dispersed to rural population centers. Although we do not have reliable data on the socio-economic status of those infected during the second wave, cases now appear to have reached the middle class and rural areas of India.

Immunization rate slowed last week and even shut down in some states due to lack of supply. At the current vaccination rate, it will take until the end of 2022 to fully vaccinate 70 percent of India’s population, the approximate level needed to achieve herd immunity. India is in urgent need of investment to increase its vaccine production capacity to over 12 million doses per day. If the country succeeds, it can immunize 70% of its population in six months.

Finally, there is the uncertainty introduced by the new variants and, with them, the risk of re-infections that might not be stopped by the vaccines. There is anecdotal evidence that the new wave of Covid-19 cases in India is attacking a younger population, including children, and causing the disease to progress faster than before.

Systematic evidence is needed to link the escalation of cases to easier transmissibility and lethality of new variants. A variant, B. 1.617, which may have originated in India is spreading widely and has been found in other countries.

Can India get out of the current situation?

India no longer has the possibility of another national lockdown due to the crushing effect on the economy, but more local and state lockdowns are likely. Indians will need to protect themselves and the Indian government urgently needs to send consistent messages on the severity of the disease.

The Indian government must focus on the compulsory use of masks and act quickly to ban all mass gatherings. Without a consistent message and a scientific approach from the government, India risks returning the hard-earned gains from the nationwide lockdown a year ago.

The ruthless virus must be denied the opportunity to spread.

Ramanan Laxminarayan is an economist and epidemiologist. He is director of the Center for Disease Dynamics, Economics & Policy in Washington and Principal Investigator at Princeton.

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