New confirmed cases of Covid-19 are now running at around 350,000 a day in India, with close to 3,000 people dying daily. However, doctors believe that cases may be being undercounted by a factor of up to five, and daily deaths may be two or three times official figures. Many people, especially in rural areas, are never tested for the virus. The Indian government reportedly expects cases to peak at around 500,000 by mid-May, indicating that the worst may yet be to come.
India’s brutal second wave has dispelled earlier speculation that it might have reached “herd immunity” through natural infection, and, to a lesser extent, vaccination (the country has administered about ten doses per 100 people, according to figures collated by Our World in Data, a project at Oxford University). The outbreak does not appear to be less severe in India’s megacities of Delhi and Mumbai, despite one study conducted in late December and early January indicating that perhaps 40 per cent of their populations had antibodies from prior infection. (It is, however, worth noting that due to the limited sensitivity of testing, the actual prevalence of antibodies could well be lower.)
Across the country, intensive care units are full and oxygen supplies have run out in some cities, leading to heart-wrenching scenes of people rushing their relatives from hospital to hospital, trying to find them a free bed. Some, such as the 65-year-old journalist Vinay Srivastava, have been desperately live-tweeting their low blood oxygen levels, which in healthy people is around 95 per cent or more. On 17 April, Srivastava tweeted: “My oxygen is 31 when some[one] will help me”. He died hours later at his home in the northern state of Uttar Pradesh, having failed to find a hospital bed.
A new variant of Covid-19, known as B.1.617.1, may be contributing to the rise in cases, although due to low levels of genomic sequencing, the prevalence of the strain is largely unknown. The Indian variant, which is thought to have emerged in the western state of Maharashtra, combines two particular mutations which may help it evade antibodies and make it more infectious. Its emergence has led several countries to impose travel restrictions to and from India. The UK put arrivals on the “red list” for mandatory hotel quarantine last week.
A weeklong lockdown imposed in Delhi last Monday has now been extended for at least another seven days. That just seven days of limited social contact could break the chain of transmission in the capital was always doubtful, according to experts. But the options available to the Indian authorities are limited: unlike in rich economies, the government is able to afford only limited economic support to workers in the event of a lockdown.
The Centre for Monitoring the Indian Economy, a business information company, estimated last May that 122 million workers, many of them low-paid migrants, had lost their jobs by April 2020 as a result of India locking down in March that year. In 2020, the economy contracted by about 8 per cent, according to IMF estimates, the largest fall on record.
The high cost of the March 2020 lockdown is one of the key reasons why Prime Minister Narendra Modi appears to be reluctant to impose another one this time. Last week, he insisted the country should be “saved from a lockdown”, which he said should be “a last resort” measure.
But Modi has also been accused of actively encouraging dangerous behaviour likely to contribute to the spread of Covid-19. The Prime Minister, a Hindu nationalist, has permitted mass religious festivals to go ahead with few restrictions. His Bharatiya Janata Party has also held mass rallies for elections currently under way in West Bengal, where it is hoping to unseat the regionalist party that currently rules the state.
“The decisions to allow huge religious festivals such as the Kumbh Mela, where millions of Hindu devotees from across India have converged on the banks of the Ganges to go ahead without any meaningful control measures in place, will undoubtedly have increased transmission and contributed to the current wave of infections,” said Osman Dar, the director of the Global Health Programme’s One Health project at the Chatham House think tank.
India’s surge in cases has implications beyond the subcontinent. The Serum Institute of India, a pharmaceutical company headquartered in Maharashtra, is contracted to produce the bulk of vaccine doses for the developing world via Covax, the vaccine-sharing scheme spearheaded by the World Health Organisation. But the Indian government, confronted by the wave of cases at home, has banned the export of most of the doses meant for other countries, leaving swathes of the Global South facing a shortfall. On Sunday, the US said it would permit the export of raw materials needed to manufacture the Oxford vaccine to India, a key demand of the Modi government.
Several African countries, including Rwanda and Nigeria, have received less than a third of the number of doses they were expecting from Covax. Pakistan and Bangladesh, which border India, have received none. The effects of India’s catastrophic second wave are being felt around the world.