COVID Clobbers India
By Nayyer Ali MD
The global pandemic of COVID-19 has hit India with a vengeance. On March 1, India recorded only 11,000 new cases of COVID, and only 80 deaths among its 1.4 billion people. By April 1 those figures had risen to 80,000 cases and 700 deaths, and now by May 1 India is diagnosing 400,000 new cases daily and officially recording 3,700 deaths in a single day. The real numbers are much higher.
India’s health care system has been overwhelmed. It is almost impossible to get decent medical care in the rural areas, much less get tested for COVID. Even in major urban areas, many deaths are not being attributed to COVID due to lack of testing and likely also political pressure to minimize the numbers. Many cases of COVID are with few or no symptoms and those patients often are not diagnosed even in the US.
The US has probably only diagnosed about a half of its actual infections during the course of this pandemic. For India, with its much larger population and much smaller testing capacity, the fraction is likely much smaller. If I had to venture a guess, the true rate of new infections in India is probably more than 2 million per day, and deaths are likely 20,000 or more daily.
The whole world is watching terrible scenes from across India of families desperately searching for empty hospital beds to take their loved ones, and for oxygen cylinders simply to provide oxygen. In the US, despite plenty of oxygen, many patients die from severe COVID pneumonia and shock requiring ICU care with trained specialists. In India, patients are dying with much milder disease because of the lack of simple oxygen. For those even sicker, the options are almost nil.
India’s government bears the blame for this catastrophe. Prime Minister Modi rapidly shut the country down over a year ago when the pandemic began, in a manner that was enormously disruptive, especially for tens of millions of migrant workers who had to return to their villages. The shutdown last year caused India’s economy to contract by 8%, while Pakistan, which did a much more limited shutdown, experienced a relatively flat economy and perhaps actually some growth by end of 2020. Modi was very interested in promoting a triumphalist narrative in 2021 and seeing India recover the lost economic ground with a surge in growth to over 10% for the year.
On January 28th, while addressing the World Economic Forum, Modi went so far as to claim “victory” over COVID. India had weathered the pandemic with much less death than Europe or the US given its population. While the US was still in the middle of a winter COVID surge that was finally abating, India had minimal infections and deaths. With vaccines becoming available, it seemed like common sense to declare the virus history.
But the virus was not gone yet. India simply has too many people and too little vaccine for vaccination to be counted on for containing COVID. The US has at least partially vaccinated almost 85% of its seniors and over half of adults, but that is only about 150 million people. And the US has been vaccinating for over four months. India has only vaccinated 2% of its population.
What created this massive surge was that India simply let down its guard. Modi’s government allowed the population to return to normal life. Masks were discarded. Massive election rallies were held. The religious gathering of Kumbh Mela, which occurs on 6 and 12 year cycles, was allowed to go forward this spring, and this brought crowds in the millions. The end result could have been predicted by anyone with a slight knowledge of biology. A massive wave of infection built and spread throughout India, and the end is not in sight. The total body count may never be known, perhaps only epidemiological or demographic studies in the future will be able to put a number on it. For now, the rest of us see the images of funeral pyres cremating the dead in any available spot.
There is a natural tendency to want to help. Some have suggested the world rush vaccine to India. But when an epidemic like this is totally out of control, vaccines are not the answer. It simply takes way too long to vaccinate enough people to bring this under control. India actually is a major producer of vaccine. What India needs is something Modi is just not willing to do, at least for now. India needs a nationwide lockdown for several weeks to break the cycle of infections. This will dramatically hurt India’s economy, but that short-term pain must be accepted. India does not have enough hospital beds, trained doctors and nurses, and advanced technology to save the tens and perhaps hundreds of thousands that may die in the next two months. The only effective response is to stop new infections as quickly as possible.
While the world watches India’s suffering, is Pakistan next? Pakistan also lacks large scale vaccine supply, though it has acquired a few million doses from China. There are plans to set up domestic production of Chinese vaccine but that will take at least another month to get going. Infections in Pakistan have also risen in the last month, and daily deaths are now above 100, and reached 200 on a single day. For now, spare hospital capacity and oxygen remain. Pakistan has not dropped mask wearing, nor has it carried out mass rallies and religious events that could spread the virus. But this is no time to drop precautions. To vaccinate everyone over age 50, Pakistan would need 30 million vaccinations, and another 20 million for those over age 40. Vaccinating those age groups would likely block any catastrophic outcomes, and would allow the country to move towards normal. That will probably take another 6 months to reach that point. Till then, public health measures remain critical.
The advanced countries are vaccinating their own populations first. But the US is getting close to meeting vaccine demand in the next few weeks, and Europe will be there by July. New vaccines and ramped up production are also coming. Enough vaccine for poorer countries to vaccinate their older populations at a minimum should be available in the next 6 months. After that, will we need to vaccinate everyone, or will we decide to live with a certain amount of virus in the world, as we do with the flu? Given the vaccine hesitancy in some people, the latter is more likely.
