In just three weeks, India went from the world’s sixth-worst affected country by the coronavirus to the third, according to a tally by Johns Hopkins University.
The South Asian country’s fragile health system was bolstered during a stringent months-long lockdown but could still be overwhelmed by an exponential rise in infections.
India has tallied 878,254 infections and more than 23,174 deaths, with cases doubling every three weeks. On Sunday, the country reported its highest single-day tally of more than 28,600 cases.
More than 250,000 samples are being tested daily after months of sluggishness, but experts say this is insufficient for a country of nearly 1.4 billion people.
“This whole thing about the ‘peak’ is a false bogey because we won’t have one peak in India, but a series of peaks,” said Dr Anant Bhan, bioethics and global health researcher.
He pointed out that the capital New Delhi and India’s financial capital, Mumbai, had already seen surges, while infections had now begun spreading to smaller cities as governments eased restrictions. The actual toll would be unknown, he said, unless India made testing more accessible.
The Ministry of Health said on Thursday India was doing “relatively well” managing COVID-19, pointing to 13 deaths per million people, compared with about 400 in the United States and 320 in Brazil.
But knowing the actual toll in India is “absolutely impossible” because there is no reporting mechanism in most places for any kind of death, said Dr Jayaprakash Muliyil, an epidemiologist at the Christian Medical College in Vellore who has been advising the government.
Official data shows 43 percent of the people who have died from the coronavirus were between the ages of 30 and 60, but research globally indicates that the disease is particularly fatal to the elderly, suggesting to Muliyil that many virus deaths among older Indians “don’t get picked up” or counted in the virus death numbers.
‘No central coordination’
In India, public health is managed at a state level, and some have managed better than others. The southern state of Kerala, where India’s first three COVID-19 cases were reported, has been held up as a model.
It isolated patients early, traced and quarantined contacts and tested aggressively.
By contrast, Delhi, the state that includes the national capital, has been sharply criticised for failing to anticipate a surge of cases in recent weeks as lockdown measures eased.
Patients have died after being turned away from COVID-19-designated hospitals that said they were at capacity. It led the Ministry of Home Affairs to intervene and allocate 500 railway cars as makeshift hospital wards.
But as the capital rushes to conjure new beds, officials admit that they are worried about the lack of trained and experienced healthcare workers.
According to Jishnu Das, a professor of economics at Georgetown University, there is “no central coordination” to move healthcare staff from one state to another, exposing India’s relative inability to use data to guide policy decisions.
“The one big thing that we’re learning from this pandemic is it takes any cracks in our systems and it drives a chisel to them. So, it’s no longer a crack, it’s a huge chasm,” Das said.
India’s role in global fight
India has seven vaccines in various stages of clinical trial, including one by Bharat Biotech that the Indian Council on Medical Research pledged would have results from human trials by August 15, the country’s Independence Day.
The top medical research body quickly backtracked, but regardless of whether India comes out on top in the global race for a vaccine, the country will play a critical role in the world’s inoculation against COVID-19.
The Serum Institute of India in the western Indian city of Pune is the world’s largest vaccine manufacturer.
India makes about 1,000 ventilators and 600,000 personal protective equipment (PPE) kits per day, according to government think-tank Niti Aayog, making it the second-largest kit maker in the world after China.
The economic curve
Although Indian airspace remains closed to commercial airlines from abroad, the country’s economy has largely reopened.
Consumer activity has rebounded to pre-pandemic levels, government data showed, and factory workers who fled cities when India imposed its lockdown on March 24 have begun to return, enticed, in some cases, by employers offering free room and board.
Prime Minister Narendra Modi has used the health crisis along with a military standoff with China over a disputed border region to rally the country around the idea of a “self-reliant India” whose home-grown industries will emerge stronger.
Modi’s approval ratings remain high, despite the hasty lockdown triggered a humanitarian crisis, with thousands of migrant workers fleeing on foot towards their natal villages, and as two top government scientists on the front lines of the coronavirus fight stepped down in recent weeks.