NEW DELHI – When the coronavirus first hit India last year, the country applied one of the world’s strictest national restrictions. The warning was clear: a rapid spread in a population of 1.3 billion would be devastating.
Although it was damaged and eventually defective, the exclusion and other attempts appeared to work. Infections dropped and deaths remained low. Officials and the public dropped their guard. Experts have fruitlessly warned that the government’s haphazard approach will lead to a crisis when a new wave emerges.
Now the crisis is here.
India on Friday reported a daily record of 131,878 new infections while Covid-19 is out of control. Although mortality is still relatively low, it is increasing. Vaccinations, a huge task in such a large country, are dangerously behind the plan. Hospital beds become scarce.
Parts of the country are strengthening the lockdown. Scientists are rushing to find new strains, including the more dangerous varieties found in Britain and South Africa, which could accelerate the spread. But the authorities have simply declared contact detection in some places impossible.
Disclosure and legal action have helped turn India from an apparent success story to one of the world’s worst places, experts say. And epidemiologists warn that continued failure in India will have global implications.
But politicians in India, still plagued by the pain of the recent national exclusion, have mostly avoided major restrictions and have even returned to major election rallies and sent mixed messages to the public. The deployment of India’s vaccine was late and riddled with setbacks, despite the country’s status as a major pharmaceutical manufacturer.
The large number of infections during the first wave made some believe that the worst was over. India’s youth population, which is less susceptible to symptoms and death, has created misperceptions about how harmful another outbreak can be.
What India needs now, epidemiologists and experts say, is a joint and consistent leadership to contain infections and buy time to make vaccinations wider and faster.
“Public conduct and administrative conduct are important,” said Dr. K Sreenath Reddy, the chairman of the Public Health Foundation in India, said. “If we do something for six or four weeks and then declare victory and open the door wide again, we’re in trouble.”
A haunted India will put back the global effort. The government has restricted the export of vaccines to the country’s own needs. If the vaccination does not accelerate, India will need more than two years to vaccinate 70 percent of its population, said Dr. Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, said with his headquarters in Washington and New Delhi.
“The size of India will dominate world numbers – how the world performs on Covid will depend very much on how India performs on Covid,” said Dr. Laxminarayan said. “If it’s not over in India, it’s not really over in the world.”
Prime Minister Narendra Modi on Thursday ruled out the possibility of another rural lock-in, rather than a micro-control zone. He said India could contain a second wave of ‘testing, tracking, treating and Covid-appropriate behavior’.
Mr. Modi’s officials blamed the mismanagement by state governments, and the population’s security measures such as masks and social distance, for the new wave.
The roots of India’s crisis lie in the previous one. The coronavirus has hit the country hard, and India has long had the second largest number of infections after the United States. (It is now behind the United States and Brazil.) The economic setback of the resulting closure was devastating.
But the numbers at the time actually underestimated the first wave, according to scientists, and deaths in India never matched the levels of the United States or Britain. Leaders began to act as if the problem had been solved.
But improvements in testing ability this time led to more accurate scores. The virus has probably spread through some populations such as urban poor and infected between 300 and 500 million people, estimates dr. Laxminarayan. Although they gained some immunity, it came to a standstill until the virus hit others.
“The sad thing is that in a country like India you can have 400 million infections, but that means 900 million people are not infected yet,” said Dr. Laxminarayan said.
The death data were also misleading. Official figures show about 167,000 deaths, or 0.04 per 100,000 people, a surprisingly low rate compared to other countries. About two-thirds of the population is younger than 35. Among people between the ages of 45 and 75, the death rate could be at the same level as Italy, Brazil and the United States, Drs. Laxminarayan said.
India’s vaccine preparation was also worse than it seemed. For months, the Serum Institute of India, one of the largest vaccine producers in the world, boasted a large stock of Oxford-AstraZeneca vaccine, which makes up the bulk of the country’s driving force. The government has even launched a “vaccination diplomacy” campaign that has sent doses to other countries.
But the initial rollout within India is delayed by complacency and plagued by public skepticism, including questions about the Oxford-AstraZeneca vaccine and lack of disclosure about a dose developed by India. The vaccination program does not match the spread. The Serum Institute said virtually all of its daily production of about two million doses will go to the government over the next two months, which will delay commitments to other countries.
Several Indian states are now worried that their vaccines will run out. Mumbai, India’s largest city, has closed more than half of its vaccination centers, local media reported on Friday. The central government health minister addressed the states and reassured that there would be no shortage and that more supplies were in the offing.
Yet many people shed masks and resumed normal life.
In Pune, one of the worst-hit places in Maharashtra’s troubled state, the relaxed attitude and an overwhelming proportion of the mainly asymptomatic cases exacerbated the spread, said Sudhir Mehta, the response coordinator. The district of about 10 million people reported more than 12,000 new cases on Friday, while the cumulative death toll exceeded 10,000. In a letter to the central government, Mr. Mehta described the transfer as so unbridled that contact detection was almost impossible.
“There are so many mild cases where people do not even realize they have Covid,” he said. Mehta said in an interview. (The positive percentage for tests in Maharashtra during the past week was a quarter, compared to a national average of about 8 percent.)
Some of the relaxed attitude comes from above. India’s senior leaders, who have taken vaccinations in public to support the vaccination effort, have urged people to take precautions even when hitting the campaign track for the state’s election. Prime Minister Modi addressed more than 20 rallies, each with thousands of people often unmasked.
On Wednesday, officials in Delhi said that even a solo driver would be punished for not wearing a mask properly. The same day, Amit Shah, the country’s de facto no. 2-leader, by a campaign crowd in the state of West Bengal, waves without a mask and throws rose petals.
The government also decided on a long Hindu religious festival called Kumbh Mela, which lasts until the end of April. Between one million and five million people attend the festival every day in the city of Hardiwar, on the banks of the Ganges River in the state of Uttarakhand.
State Prime Minister Tirath Singh Rawat said no one would be constrained because “faith in God will overcome the fear of Covid-19.” Days later, Mr. Rawat tested positive for Covid.
The positivity rate of randomized tests is rising at the festival, and more than 300 participants tested positive, said Dr Arjun Singh Senger, a health official at the festival.
The sheer speed of new infections has surprised health officials, who wonder if variants could be a factor. It will be difficult to answer the question. According to Dr. Reddy, of the Public Health Foundation of India, said India used only about 1 percent of its cases through genome-sequence tests, but researchers needed a minimum of 5 percent to determine what was circulating.
So far, the government has found variants from the UK and South Africa, as well as a local mutation. Limited information indicates that infectious variants are also spreading in India, said dr. Reddy said.
Although the variant was not yet an important part of the new wave of infections, it cast a shadow over India’s important vaccination action. The AstraZeneca vaccine has been rejected by South Africa for not being as effective.
“This time the speed is much faster than the last time,” said Dr Vinod K. Paul, head of the Indian Covid response task force. “The next four weeks are very, very important to us.”