COVID in India

Photograph Source: Ninian Reid – CC BY 2.0

In March last year I was in New Delhi for a conference at one of the several universities there– it was my last trip anywhere since the pandemic took hold in increasing parts of the world that spring.

Delhi’s notorious pollution relented, and there were blue skies during my week there.

But the pandemic was looming. A conference participant from Tokyo took ill with what turned out to be Delhi Belly (aka traveller’s diarrhoea). However, since Covid-19 has already taken hold in Japan, and some of its symptoms overlap with Delhi Belly, the organizers took him to a nearby clinic. They were not equipped to administer a Covid test, so he was sent on to a hospital with this capacity. To the relief of all at the conference, his test result was negative.

India did relatively well at the start of the pandemic, prompting the Hindu nationalist government of Narendra Modi to claim at the beginning of March that the country was in Covid-19’s “endgame”.

Today, however, the Covid situation in India, and Delhi in particular, is absolutely dire. State governments in Delhi and Mumbai are now scrambling to reconstruct the temporary Covid facilities they had decommissioned earlier, in the belief that the pandemic had been brought under control.

However, in the space of just 12 days, India’s Covid infection rate doubled to 17%, reaching 30% in Delhi. Hospitals have filled to capacity, with most beds occupied by the young; in Delhi, 65% of cases are under 40 years old.

Six hospitals in Delhi have run out of oxygen completely and medical authorities say other hospitals have just a few hours of supplementary oxygen supply left.

A crematorium east of Delhi had to build funeral pyres in its parking lot to deal with demand. Mortuaries are at full capacity and bodies are left to decompose at home.

A number of people have died while waiting for oxygen, and more than 99% of all intensive care beds are full. The New Delhi High Court has ordered the government to divert oxygen from industrial use to hospitals treating Covid patients.

Indian railways said it now has special trains specifically designed to carry liquid oxygen and oxygen cylinders, named the “Oxygen Express”. Thousands of Covid beds are also being created in train carriages.

India reported a global record of 349,691 new cases on Sunday April 22nd, a record increase for the fourth consecutive day, and 2,767 people dead, as the surge hit the world’s second-most populous country (India has nearly 1.4 billion people). The country’s brittle health care system is now in a state of collapse, lacking the ICU beds and supplementary oxygen needed for seriously ill patients.

The following chart depicts the gravity of India’s Covid situation, where new cases now exceed those of the US during the latter’s peak:

Source: Johns Hopkins University Coronavirus Resource Center.

Modi’s government had ordered a wide-ranging lockdown last year, in the early stages of the pandemic, but has since become cagey over the economic consequences of the continued imposition of strict restrictions.

Modi’s version of Indian/Hindu exceptionalism stoked his complacency.

The totally unwarranted belief in national greatness led to the country being unprepared for the severity of the crisis, especially in vaccine production.

Western countries had encouraged India to become the engine of global pharmaceutical manufacturing, but last week German Chancellor Angela Merkel said this approach was possibly mistaken. China and the US are now manufacturing more Covid-19 vaccines than India, which is now having to import Russia’s Sputnik-5 vaccine.

India has launched a vaccination drive but only a tiny fraction of the population has been administered a vaccine, as indicated by the following chart:

The US has vaccinated 26.7% of its population against the virus, the UK 16.5%, while India (admittedly with its massive, mostly rural, population) is at 1.4%.

The government announced that vaccines will be available for those over the age of 18 from May 1 but experts say India won’t have enough doses for the 600 million people who will qualify for a jab.

Like his American friend “Dolan Trum”, the smug Modi would not pause campaigning while the pandemic was in full flow. India proceeded to hold 5 state elections in April, and an unmasked Modi presided over huge political rallies, with crowds not social distancing and without masks like their leader.

Modi was also criticized for allowing millions of Hindus to take a dip in the Ganges during the Kumbh Mela festival, again without social distancing and without masks.

In addition to shortages of hospital beds, oxygen, and vaccines; plasma and Remdesivir (the promising experimental drug used to treat Donald Trump when he contracted Covid), also remain in short supply in hospitals across the country.

The prospect of stemming India’s second wave of Covid remains dim for now. Apart from the incompetence of political leaders prone to magical thinking (the chief minister of Uttarakhand, TS Rawat, claimed that oxygen is not necessary since the ancient Brahmin sages survived without breathing), 3 exacerbating factors have to be taken into account.

India’s medical experts say new and more virulent Covid variants, in particular a “double mutant” strain that originated there, have contributed to the surge in infections, affecting people in their 20s and 30s in particular.

In addition, an over-relaxed government did not use the lull after the first surge to build-up stockpiles of drugs and vaccines, as well as enhancing Covid- care provision. Modi’s government fell asleep at the proverbial steering wheel.

Another still imponderable factor is the transmission of the virus to rural areas, as workers who migrated to the now highly infected cities in search of work, flee these cities (having lost their jobs due to lockdowns) and return to their villages, bringing the virus with them.

To quote The Guardian:

“Scenes of migrant workers massing at bus and train stations, fleeing lockdowns in Indian cities for their villages, are ominous to doctors in the country’s hinterlands.

They know that many of those in the crowds will be returning with Covid-19 strains that are ravaging urban India, leading to record numbers of daily infections this week and the country’s highest daily death tolls since the virus emerged. In parts of rural West Bengal state, where politicians were holding mass election rallies until late this week, the surge has already started”.

India’s rural areas are of course even more disadvantaged with regard to health and medical resources than its cities.

Moreover, deaths in rural areas, from whatever cause, are less likely to be registered than in bigger towns and cities, as more rural dwellers die at home without reaching a hospital, where the requisite bureaucracy can record their deaths.

The result is an almost certain discrepancy between confirmed (i.e., officially registered) deaths and actual deaths.

Modi’s response to a wave of criticism? Censor such criticism– Twitter confirmed it had blocked dozens of critical tweets following a legal demand from the government.

Kenneth Surin teaches at Duke University, North Carolina.  He lives in Blacksburg, Virginia.