A familiar scene is taking place across India. In large cities, hospital beds are filling up with Covid-19 patients. Warehouses, unused trains and large public spaces are being converted into makeshift treatment centers. And restrictions are clamping back down, with new lockdowns in place.
India has plunged into its second wave – and this time, with new variants, fatigue setting in among the population, and several massive religious gatherings taking place, it threatens to be worse than the first one.
The country recorded 103,558 new cases on Monday, according to the Indian Ministry of Health – the highest single-day figure since the beginning of the pandemic.
The previous record high had been in September last year, with nearly 98,000 cases in a day during the peak of the first wave. Daily cases had gradually fallen by nearly 90% to reach about 9,000 cases a day in mid-February – which was hailed as a sign that the country had controlled its outbreak.
But cases began rising again in early March. Now, less than two months later, daily cases have jumped more than tenfold.
“There is a shortage of private beds and beds in major government setups,” said Deepak Baid, president of the Association of Medical Consultants in Mumbai. “Because beds aren’t available, actually many patients are still in home quarantine, patients are getting admitted in non-Covid hospitals when they are positive.”
Monday’s figures raise the country’s total since the beginning of the pandemic to more than 12.5 million cases and 165,000 related deaths, according to data from Johns Hopkins University.
“Covid cases in India are rising very sharply at this time, very different from a year ago when the rate of increase seemed a lot less rapid,” said Ramanan Laxminarayan of the Center for Disease Dynamics, Economics and Policy in New Delhi.
One major difference is that when the first wave began rising in late spring last year, the country was just emerging from a months-long lockdown that had closed state borders, shut down national travel, and brought businesses to a halt. The stringent lockdown and gradual, phased easing of restrictions “significantly slowed” the infections, said Laxminarayan – which is “not the case now.”
There are some factors that could help lessen the impact this time around: the medical infrastructure is better prepared now, and staff have experience on their side, which could lower the mortality rate even if the case rate increases. The country’s vaccination program is also underway, with two vaccines approved for use. And in big cities that have been hard hit before, like Delhi and Mumbai, people who have already been infected before may have some natural immunity.
But still, Laxminarayan said, “that is not going to be sufficient to prevent a second wave of cases.”
Lockdowns and curfews
Authorities rushed to reimpose restrictions over the weekend in hard-hit states. The western state of Maharashtra is the main concern, accounting for nearly 60% of all of India’s new cases over the last two weeks, officials said. And eight of the top ten worst-affected districts nationwide are in Maharashtra, including its capital, Mumbai.
The entire state will undergo new restrictions starting Monday, including a daily evening curfew and strict weekend lockdowns, announced state cabinet minister Nawab Malik on Sunday. Public spaces like parks, shopping malls, cinemas and religious centers are closed until further notice, and all restaurants can only serve take-out.
Several other states have also seen the virus spread in recent weeks, including Karnataka, Chhattisgarh, Kerala and Punjab.
Prime Minister Narendra Modi held a high-level meeting on Sunday to discuss the rise in infections, according to a news release by his office. He urged states and authorities to “avoid mortality under all circumstances” by “ramping up” equipment and infrastructure, like oxygen availability and ventilators in hospitals.
Modi also directed a team of public health specialists to be sent to Maharashtra, instructing hard-hit states to take action so that “the collective gains of Covid-19 management in the country in the last 15 months are not squandered,” said the release.
There are several reasons Maharashtra has seen such a dramatic spike, said Randeep Guleria, director at the All India Institute of Medical Sciences. As one of the country most populated cities, with about 18.3 million residents, public spaces are often crowded.
It’s also an industrial and transport hub, home to international businesses and many migrant workers, meaning there is frequent movement in and out of the state.
Maharashtra also has a high level of statewide testing and a good health system, which could mean it’s better at detecting cases than in other parts of the country, said Laxminarayan. “You see this consistently, that states with better health systems and with more urbanized populations will see more Covid cases,” he said.
And across India, the winter success, vaccine rollout and sense of fatigue have culminated in a dangerous complacency, said Oommen Kurian, senior fellow and head of health initiative at the Observer Research Foundation in New Delhi. Authorities became less alert, people went out more, and the public were looser with precautions such as social distancing and mask wearing.
All this comes as the government races to meet its vaccination goals. India began its rollout in January, pledging to administer 600 million shots by August. So far, nearly 76 million doses have been administered, with less than 1% of the country’s 1.3 billion population fully vaccinated, according to Johns Hopkins University.
“With all this discussion of vaccines and India’s role as a major producer, many people think that the virus is losing the battle, and are letting their guard down,” Kurian said. “Unfortunately, that doesn’t seem to be the case.”
Major gatherings and new variants
Experts warn that cases may balloon in the coming weeks, due to a number of large gatherings and congregations in several states.