India’s COVID-19 Catastrophe

A second COVID-19 wave that began gathering momentum in March is tearing through India with the force of a tsunami and causing as much, if not more, devastation.

On April 22 India reported 332,503 new coronavirus infections, the highest recorded by any country over a 24-hour period. It then set new records on each following day, for a streak of five days. India has became the global epicenter of the pandemic, taking that unwanted title from the United States.

The mammoth surge in daily infections in India has come at a time when new cases are falling in several other countries.

In a country with a population of around 1.3 billion, India’s total tally of COVID-19 cases was around 17.6 million as of April 27, and growing by over 300,000 cases per day.

Infections are spreading at a far greater pace during this wave. During the first wave, it took 110 days for the COVID-19 daily tally to rise from 8,105 to 97,894 cases. It took just 62 days for the daily tally to spike from 8,365 to 103,558 during the second wave and less than a month after that for the count to top 300,000 a day.

As alarming as the numbers are, they do not capture the magnitude of the human tragedy unfolding in India.

Hospitals are overflowing with patients. In several hospitals, two or more patients share each bed. Thousands are being turned away as there is no space to accommodate patients even on the floor. Long lines of ambulances with gasping patients can be seen outside most hospitals. There is a severe shortage of oxygen, medicines, and ambulances.

Social media is inundated with frantic calls for help.

Hospital authorities have been putting out statements asking for help, too. “Hospital in crisis mode for fourth time in 24 hours,” one of India’s top hospitals, the New Delhi-based Sir Ganga Ram Hospital said in a statement at 11 p.m. on April 24. “Lives of more than 100 patients in risk. Oxygen left which will last for 45 minutes to an hour. Manual ventilation starts. Need urgent refill ASAP.” Just 4 percent of the hospital’s oxygen storage tank was full at that point. The previous day, 25 patients had died in this hospital for want of oxygen.

A disruption of oxygen supply due to leakage from the main storage tank led to the deaths of 24 patients who were on life-support in a government-run hospital in Nashik in central India on April 21.

According to the federal Ministry of Health, 2,771 people died of COVID-19 on April 27, bringing the total tally of fatalities to nearly 198,000.

But this is widely believed to be an under-estimation.

The scene at crematoriums is heart-rending; bodies are lined up in long queues. Furnaces in crematoriums have stopped functioning due to overuse. The dead are being cremated on sidewalks and at what were once parking lots and playgrounds.

India’s first COVID-19 wave was severe; daily infections peaked at 97,894 on September 16 last year. There were shortages of hospital beds, personal protective equipment (PPE) kits, oxygen, and ventilators during the first wave, too.

However, the demand then was far less as the number of cases were a fraction of what is being reported today. For instance, the demand for liquid medical oxygen during the first wave was around 2,800 metric tons per day (MTPD) compared to the current demand of around 5,000 MTPD.

From the peak in mid-September 2020, daily new infections began dropping. In January the numbers fell to fewer than 20,000.

It did seem then that the worst was over. Indeed, on January 28 India’s Prime Minister Narendra Modi declared victory over the pandemic at the World Economic Forum’s Davos Dialogue. “We not only solved our problems but also helped the world fight the pandemic,” he boasted.

Modi’s cheerleaders went into overdrive. The ruling Bharatiya Janata Party (BJP) hailed his “able, sensitive, committed and visionary leadership” during the COVID-19 pandemic.

Meanwhile, the coronavirus was still lurking, preparing to barrel through India with unprecedented ferocity.

On February 1, India recorded 11,427 new cases. The numbers rose to 72,330 new cases by April 1. On April 5, the daily tally surpassed the first wave peak to touch 103,558 cases. That figure more than tripled to 354,531 new cases on April 25.

Experts say that a new double mutant strain is driving this second wave. Sixty-one percent of cases reported in the western state of Maharashtra, which accounts for most of India’s COVID-19 cases, are from the new mutant variant.

The second wave could have been prevented, or at least mitigated, had people worn masks and avoided large social, religious, and political gatherings.

“We completely let down our guard and assumed in January that the pandemic was over — and COVID surveillance and control took a back seat,” K. Srinath Reddy, president of the non-profit Public Health Foundation of India said. Consider this: India’s scientific taskforce on COVID-19 “did not meet even once during February and March.” It met on April 15 and 21, but by then infections were already out of control.

In late February, India's Election Commission announced assembly elections in five states, with voting stretching over a month. Leaders were now in election mode. Capturing power in key states gained precedence over enforcing pandemic protocols.

Although Modi urged people to get themselves vaccinated and to wear masks, he and other leaders participated without masks in election rallies and processions attended by thousands of unmasked supporters.

The government also permitted several other massive gatherings, including cricket matches at the Narendra Modi stadium in Gujarat and the Kumbh Mela, a religious gathering where millions of Hindu pilgrims congregated daily for a fortnight at Haridwar. Pandemic protocols were not enforced at either event. With pilgrims coming from various parts of the country, a super-spreader event like the Kumbh Mela is likely to have hastened the geographic spread of the new coronavirus variant.

When the first COVID-19 wave struck, India was caught unaware like most countries. The pandemic laid bare the fragile condition of its health infrastructure.

This time around, India’s health infrastructure is not just shaking but is on the brink of collapse.

The Modi government had at least six months, if not a year, to ramp up this infrastructure to tackle the pandemic. It made plans, but did not implement them.

According to the federal health ministry, only 33 out of a planned 162 oxygen manufacturing plants had been installed. Eighty plants will be ready by the end of May, it said.

Meanwhile, the government has started acting to augment medical supplies. It has ordered some 10,000 oxygen concentrators from the United States, for instance. Indian Air Force planes are transporting cryogenic oxygen tanks from Singapore.

Experts expect things to worsen. According to Bhramar Mukherjee, professor of epidemiology at the University of Michigan, India’s second wave will peak in mid-May when “India will see 8-10 lakh [800,000 to a million] fresh cases per day.” Daily fatalities are expected to rise to 4,500 deaths per day around May 23.

It is “very plausible” that this will not be the last COVID-19 wave to hit India. More variants of the virus can be expected to strike in the future.

India and the world need to accelerate the vaccination of their populations, else the future is bleak.