India is facing a deeper Covid-19 crisis a year after it fell into one of the world’s toughest lockdowns.
But this time, authorities are reluctant to re-impose a nationwide house arrest. Add to that a swinging vaccination campaign and the spread of new virus variants, and India’s near future looks bleak.
For nearly a week, the country has been registering more than 200,000 coronavirus cases daily – one of the highest rates in the world, although probably still an under-number. Shortage of beds and oxygen puts health care systems under pressure, especially in cities like Mumbai and Delhi.
People use social media in an attempt to do this crowdsource concern and to share reports of people who are out hospital to hospital seeking treatment. Daily deaths have also increased, to more than 1,700 on Tuesday, and crematoriums are unable to keep up with the number of bodies.
A jumble of factors likely feeds the wave, making it difficult to pinpoint exactly what’s going on. “Many of us are still scratching about this. There is no concrete evidence, ”said Manoj Mohanan, associate professor of public policy, economics and global health at Duke University. “What we do know are a few pieces of the puzzle.”
The pieces of the puzzle include a drop in the number of cases at the start of the year and the promise of the vaccination campaign, both of which have left the public and even officials with a false sense of security. In addition, there was a general fatigue from the limitations of Covid-19, which felt particularly stressful when things were on a downward spiral.
People started to get lax about things like wearing a mask and social distancing. Many began to resume something like normal life by attending weddings and other celebrations.
“There was a sense of relaxation in both public policymakers and the general public, and there was a noticeable decline in Covid-appropriate behavior,” said Chandrakant Lahariya, an expert on public policy and health systems in Delhi.
Mass rallies have furthered the perception that India has beaten the virus – and likely amplified some of its spread. Millions of pilgrims thronged along the Ganges River as part of Kumbh Mela, a major Hindu festival in India and one of the largest religious gatherings in the world.
A year after the pandemic, some Indian states are also holding local elections, which appear to be a political test for Prime Minister Narendra Modi and his Hindu nationalist Bharatiya Janata party (BJP). Modes and other BJP officials huge political gatherings throughout the campaign, usually with a maskless crowd on top of each other. His opposition didn’t exactly follow the Covid-19 protocols, either.
“The public sentiment is denial, fatigue and fatalistic surrender,” Bhramar Mukherjee, a biostatistician and epidemiologist at the University of Michigan, told me in an email.
Experts are also concerned about the spread of new varieties, although it is not yet known how these new species cause the spike or whether they are more transmissible or deadly.
But as Mukherjee put it, the more the virus spreads, the more it changes. And those changes may make Covid-19 more difficult to control.
The challenge of fighting this second wave: fatigue and frustration
To slow down its first Covid-19 wave last March, India imposed one of the most aggressive lockdowns in the world. A year after the pandemic, it is unlikely that India will follow that course again. “The massive lockdowns are no longer feasible, and it has become politically unsustainable,” Duke’s Mohanan told me. “So it’s just not something they can reasonably do.”
The first lockdown has battered the Indian economy, and political leaders are likely to fear the backlash from more sweeping restrictions. Modi said this week that even states should use lockdowns as a last resort and instead focus on “ micro-containment zones. ”
But as certain states and cities are facing an acute crisis, there are few options left for trying to stop the spread of the virus. In Delhi, where the test positivity rate is nearly a quarter of the population, officials imposed a week-long shutdown with a curfew from 10 p.m. to 5 a.m. Officials said people could be fined if they leave their homes.
The state of Maharashtra, where Mumbai is located, has imposed strict measures for 15 days, including a curfew and curbs for all but essential services. “I’m not saying lockdown now, but strict restrictions,” Maharashtra chief minister Uddhav Thackeray said at a press conference announcing the changes, the BBC reported.
Even without a full lockdown, the new restrictions will cause additional economic pain.
A Pew Research Center study estimates that by 2020 the coronavirus pushed 32 million people in India out of the middle class, and a second wave threatens to cause even more damage. This is especially true in areas that rely heavily on financial services and hospitality – such as Mumbai, where many such businesses are now closed due to the rise of Covid-19.
This is something the authorities are well aware of: “I know bread and butter is important,” Thackeray said at the same press conference, “but saving lives is important.”
India cannot vaccinate itself out of this wave
Starting May 1, anyone over 18 will be eligible for a vaccination, Modi said this week. But expanding eligibility does not solve some of India’s other vaccination issues.
India’s vaccination program got off to a promising start, given the country’s experience with vaccination campaigns and its advantage as one of the most important worldwide manufacturers of the doses themselves.
The Serum Institute of India was already the largest vaccine manufacturer in the world, and its production is now essential to Covid-19’s global vaccination effort. It has been contracted to produce billions of doses of the AstraZeneca vaccine for India and the rest of the world.
When it started its own vaccination campaign, India donated supplies of its vaccine to neighboring countries in a big show of vaccine diplomacy. The Serum Institute also signed a contract with Covax, the multilateral effort to supply vaccine supplies, to make more than 1 billion doses of vaccine.
Many of the world’s poorest countries depend on those shipments, which are now being delayed due to increased demand in India. Problems at AstraZeneca factories in Europe have also led wealthier countries such as the UK and Canada to make deals with the Serum Institute, and they are also seeing delays in vaccine delivery.
But India’s own rollout has been slow, and as Mukherjee said, India really missed the opportunity to speed up vaccinations when the number of cases was low earlier this year. Just over 120 million doses of vaccine have been administered in the country to date. It sounds like a lot, until you consider that the country has set an ambitious goal of vaccinating 330 million people by the summer. Only about 1 percent of the population is fully vaccinated.
And in some parts of India, vaccine stocks are starting to dry up, forcing them to close vaccination sites. The Indian government is now desperately trying to import vaccines to boost supplies. The country gave widespread approval for most foreign vaccines and is expected to receive about 850 million doses of Russia’s Sputnik V vaccine.
However, more doses are not a panacea. It is much more difficult to ramp up a vaccination campaign en masse in a country already struggling due to a health crisis. The same nurses or technicians who are assigned to vaccinate people are often the same staff who have to care for Covid-19 patients or perform testing and contract tracking.
That could amplify the rise of the coronavirus, further delaying the vaccination campaign, creating a dangerous cycle.
“I am concerned that the health care infrastructure must now provide for testing, hospitalization and vaccination,” said Mukherjee.
Even if India can strike a balance between the Covid-19 emergency and vaccinations, it will not be able to simply inoculate itself out of this crisis. That requires the same public health measures that civil servants know from work: masking, social distancing, avoiding mass gatherings, and so on.
“Everyone knew there was going to be a second wave,” said Lahariya, the public health expert in India. “What they didn’t know [is] when this wave would come, and how long would it last, and what would be the effect. “
“We are now in the second wave,” he continued. “So it’s time to do all the things that have been done in the past.”