The crisis has hospitals around the country past capacity; shortages of medical workers and oxygen have left many sick people to die without ever receiving treatment. The sudden, extreme surge took the world by surprise, and now experts everywhere are trying to understand why this catastrophe happened — and what can be done to stop it. “There’s hope that the second wave has peaked and the number of cases and deaths will begin to drop, but that’s far from certain,” says Anup Malani, JD, PhD, professor at the University of Chicago Law School and lead author on a study published in February 2021 in JAMA that suggests the first wave of COVID-19 in India was vastly underreported. “We didn’t predict this second wave at all, and it hit much more quickly and reached peaks that are way higher than anything seen in wave one. The big concern is what is causing this second wave, and how much longer will it last?” asks Dr. Malani. RELATED: Coronavirus Alert: The Latest News, Data, and Expert Insights on the COVID-19 Pandemic
Experts Fear Cases and Deaths Are Underreported
“The situation in India is just simply heartbreaking,” says Priya Sampathkumar, MD, an infectious disease doctor at Mayo Clinic in Rochester, Minnesota. “The number of cases reported yesterday [April 29] was 380,000, and people on the ground tell us that [the real] number is probably some multiple of that — perhaps 5 to 10 times that number,” she says. “The official death toll stands at around 3,000 people a day — again, it’s probably more like 5 or 10 times that,” says Dr. Sampathkumar. “Many people are dying before they even get to the hospital so they’re not being counted as COVID-19 deaths.”
Hospitals Are Full and Medical Supplies Are Scarce
The medical system in several parts of India has been completely overwhelmed by the huge demand from sick patients, says Sampathkumar. “Hospitals are running out of beds and supplies, including oxygen, and medications are in short supply,” she says. Also dire is the shortage of healthcare workers. “That’s because healthcare personnel are also contracting COVID-19. They’re down at a time when the demand for healthcare is just so great,” says Sampathkumar. RELATED: COVID-19 Vaccines and Treatments: Where We Stand Now
A Feeling of Complacency Contributed to the Surge
In spite of the challenges of socially distancing in the more populated areas of the country and the difficulty of getting any kind of public health message out to its 1.3 billion people, India did a better job controlling the virus in the early part of the pandemic than many other nations, including the United States, says Sampathkumar. “Very strict lockdowns probably played a key part in slowing the spread of COVID-19,” she says. These lockdowns had some negative effects, too. “They were criticized for causing a lot of economic harm to the country and causing unintended consequences, including deaths of migrant workers, who had no way of getting back home because transportation was shut down,” says Sampathkumar. Still, the lockdown’s success, coupled with the shrinking number of cases, led to an overall feeling of complacency and even invincibility. “People thought ‘The worst is behind us, we survived virus,’ and even though there was still supposed to be masking and some degree of social distancing, that really fell by the wayside — no one was doing it,” says Sampathkumar.
Superspreader Events Fueled the Second Wave
In early April, millions of people gathered in India to take a dip in the holiest of rivers, the Ganges, as part of the religious festival Kumbh Mela. “This was a massive superspreader event,” says Sampathkumar. Simultaneously, in multiple other parts of the country, massive political rallies drew extremely large crowds, she adds. This also contributed to the spread of the virus. Many of the incumbents running for reelection wanted to downplay the virus, leading to a major media clampdown on any negative reporting, says Sampathkumar. “As these outbreaks were starting the media was actively being told, ‘This is not important, don’t report on it,’” she says.
Shortages of Supplies and India’s Huge Population Pose Vaccination Hurdles
All things considered, India has actually done a very good job with vaccinations, says Sampathkumar. According to tracking data, the United States began vaccinating in mid-December and has administered 246 million doses of vaccine so far. “India began vaccinating about two months ago and they’ve given 120 million doses of vaccine, a faster pace than the United States,” Sampathkumar points out. The challenge, she explains, is India’s large population. At this point in the pandemic, over 44 percent of people in the United States have received at least one dose of vaccine, whereas in India less than 10 percent of the population has been vaccinated. Part of the issue with India’s inoculation program is that, over the last few weeks, there have been issues with sourcing the raw materials needed to manufacture the vaccine, though the White House recently announced they would release these supplies, says Sampathkumar. RELATED: What You Need to Know About COVID-19 Vaccines
Variant First Found in India Could Be More Transmissible
Scientists are still trying to understand how variants (coronavirus mutations) have contributed to the second wave in India, says Sampathkumar. “There’s at least one variant in India that is different from anywhere in the world and it appears that this variant is more infectious and passes more easily from one person to another,” she says. This variant is known as B.1.617 and is already in 19 different countries, including Bangladesh, Nepal, Sri Lanka, Pakistan, and Afghanistan. The more COVID-19 cases in a country, the more likely it is that new variants will emerge, says Sampathkumar. “Every time the virus enters a person, that’s when it multiplies and is susceptible to mutation,” she explains. This B.1.617 variant may sicken people differently than other variants do, she says. “We traditionally think of COVID-19 as presenting with cough and fever and typically happening in older people or people with underlying health conditions. With this virus we are starting to hear that there are more young people getting infected,” says Sampathkumar.
India’s COVID-19 Surge Could Imperil the World
“The United States is vulnerable,” says Sampathkumar. “Vaccination is definitely going to slow down any surges if variants are imported into the United States, but it’s only a matter of time before the U.S. population is affected by this.” “Because of the way the virus is transmitted, no one is safe until everyone is safe — unless the United States is prepared to lock itself down and pull up the drawbridge and not allow any travel from or to the United States,” says Sampathkumar. Because of economic pressures, any type of lockdown or travel ban is unlikely or would be short-lived, says Malani. “We’re going to have to be faced with what’s going on in the rest of the world,” he adds.
The U.S. Vaccination Strategy Requires a Global Vision
Malani and Sampathkumar agree that while it’s critical for more Americans to be vaccinated, Americans aren’t going to be safe until everybody in the world is vaccinated. “If we want to protect ourselves, a good solution is to protect the rest of the world,” says Malani. No one in the United States predicted the magnitude of the second wavein India, but now that it’s here, we need to learn from it and update our strategy accordingly, says Malani. “We need to plan for a possible third wave with new variants,” he explains. That plan should include developing a vaccine production infrastructure that serves the globe, says Malani. “That means a vaccine supply chain and production facilities that are decentralized so they’re working throughout the world.” “There also needs to be increased surveillance of the virus around the world, just as we do with the flu,” Malani adds. “We need to know what variants are circulating and reformulate the vaccine or give booster shots every year or every other year, whatever is required that will make us safer.”
India’s COVID-19 Surge Could Jeopardize World Supplies of Vaccines and Medication
“India is called the pharmacy of the world because a huge portion of pharmaceuticals are manufactured there,” says Sampathkumar. “Many pharmaceutical companies have plants in India that manufacture lifesaving drugs. If India doesn’t have capacity to continue that production, the medical supply for the entire world would be at risk.” India is also a major manufacturer of all different kinds of vaccines and produces 60 percent of the world’s supply, including the AstraZeneca COVID-19 vaccine.
Additional U.S. Government Support to India Is Critical, Health Experts Say
Contributing to reputable charities that are giving aid to India is appreciated and a big help, but it’s simply not enough, says Sampathkumar. “It’s really government that needs to step up. The American public needs to lobby their elected officials and make sure that the United States government passes legislation to get aid to India. Many of the needs right now are only things that the government can provide,” she says. Actual doses of the COVID-19 vaccine are needed right away. “The release of the supplies to make vaccines is helpful, but producing those vaccines takes four to six weeks, which is too late,” says Sampathkumar. “People also need to let their representatives know that vaccinating the world is a top priority,” says Malani. Widespread vaccination lowers the odds of dangerous new variants, leading to a future in which the virus poses a more manageable risk.
