How COVID-19 spun out of control in India

The stories from the front lines of India’s COVID-19 outbreak speak louder than numbers. Families drive their sick loved ones from hospital to hospital, turned away at each one because the beds are full. Over a dozen patients die when a leak saps a COVID-19 hospital’s supply of medical oxygen. Workers cremate the dead on open pyres because crematoriums are overwhelmed.

Once seen as a model for fighting the coronavirus, now India’s relaxed public health practices, vaccine distribution problems, and a new virus variant has led to a deadly second wave overwhelming the nation’s fragile healthcare infrastructure.

The spike in COVID-19 cases and deaths comes months after government officials seemed to declare victory over the disease. The nation’s first wave of coronavirus infections, which peaked in September, barely touched the 1.4 billion­–person nation. According to the University of Oxford research project, Our World in Data, India has suffered 165 deaths per 1 million population throughout the pandemic. By comparison, 1,783 per 1 million Americans have died of the disease.

Epidemiologists credited India’s early success to a variety of factors from the quick adoption of public health protocols by the government of Prime Minister Narendra Modi to the nation’s relatively low average age. Some suggested India’s citizens possessed a kind of background immunity due to exposure to similar diseases in the past.

By December, public health restrictions had largely disappeared in the nation’s biggest cities. Political rallies, big weddings, and religious ceremonies returned as before. On March 8, Indian Health Minister Harsh Vardhan proclaimed India was in the “endgame of the novel coronavirus pandemic.” But the euphoria of surviving a global pandemic has given way to the grim reality of India’s second wave. At the same time Vardhan seemed to declare victory, the number of daily new cases in India began to increase. The number topped 400,000 last week—more than four times the country’s September high of about 98,000 daily new cases.

Last year, Modi discouraged large gatherings for Holi, a Hindu springtime religious festival. This year, with Indians largely returning to pre-COVID-19 customs, India saw a 152 percent increase in coronavirus cases two weeks after the March 29 festival, according to the nation’s health ministry. Tens of thousands of Indians made a pilgrimage to bathe in the Ganges River during an April religious festival. Two weeks after elections for legislative assemblies in India in late March and early April, cases rose in Bengal by 530 percent and in Kerala by nearly 350 percent.

Now, researchers investigating cases in India are tracking a new variant of the disease that may explain at least some of the country’s explosive increase in cases. First identified in October in Maharashtra, the B.1.617 variant is called by some a “double mutant.” Though the variant contains more than a dozen mutations from the original novel coronavirus, two are noteworthy. One mutation, also seen in the strain of the virus circulating in California, reportedly makes the virus 20 percent more transmissible, according to a recently published study. The other mutation is common in viral strains originating from Brazil and South Africa. An April 21 study published in Nature says the B.1.617 variant has already become the dominant strain in Maharashtra. The more infectious U.K. variant of the coronavirus is also circulating in India.

Under the weight of record-setting new daily cases, India’s hospitals and medical supply chain have reached a breaking point, said World Vision India health director and infectious disease expert P Carel Joseph.

“The second wave of COVID-19 in India has been like nothing we’ve ever seen before,” he told the New Zealand Herald. “Hospital beds now have waiting lists. Each one has as many as 75 patients waiting for it. That has been the reality for the past two or three weeks all across India. And there’s a massive shortage of oxygen. Hospitals all over the country are crying out for oxygen. Beds with ventilators are a distant dream.”

Meanwhile, India’s vaccination campaign has staggered. Despite being one of the largest producers of coronavirus vaccines, just 2.2 percent of the nation’s residents have been fully vaccinated, according to Our World in Data, and 9.4 percent have received at least one dose. After exporting 60 million AstraZeneca coronavirus shots earlier this year, the country has stopped shipping out doses.

Modeling developed by the University of Washington’s Institute for Health Metrics and Evaluation suggests daily deaths attributable to COVID-19 in India will continue to increase into mid- to late-May before finally decreasing. “There’s a wall of infections that’s about to hit,” Ashish Jha, dean of the School of Public Health at Brown University, told PBS. “It’s going to get meaningfully worse.”