India's COVID-19 Crisis Is Spiraling Out of Control. It Didn't Have to Be This Way

Naina Bajekal

Scenes of mass death are now unavoidable in what’s often called the world’s largest democracy. Social media is filled with images of body bags and urgent requests for medical aid. Indians gasping for breath are being turned away from overwhelmed hospitals, sometimes simply because they don’t have lab reports confirming COVID-19 infection. Health workers plead for basic supplies. “We feel so angry,” says Kanchan Pandey, a community health worker in Azamgarh, Uttar Pradesh. “At least give us some masks and gloves. Is there no value to our lives?”

Such devastation would have been hard to imagine just a few months ago. Children were back in school, politicians were on the campaign trail, and people were dancing at weddings. “Soon the winter of our discontent will be made glorious summer,” India’s usually staid central bank said in a Jan. 21 bulletin. The next day, Prime Minister Narendra Modi heralded the spirit of atmanirbhar Bharat (self-reliant India) that had helped India secure victories in two major battles: on the cricket field against Australia and in the pandemic.

“A positive mindset always leads to positive results,” he declared. That ebullience did not fade even as epidemiologists noted that cases were starting to rise in a few key states. On Feb. 21, Modi’s ruling Bharatiya Janata Party passed a resolution unequivocally hailing the “visionary leadership of Prime Minister Modi” in turning India into a “victorious nation in the fight against COVID.”

Two months later, India’s crisis has blown well past the scale of anything seen elsewhere during the pandemic. For six of the seven days beginning April 21, India set new global records for daily COVID-19 infections, repeatedly surpassing the 300,000 tally previously set by the U.S. Its total confirmed cases—more than 18 million—are second only to that of the U.S. By official counts, more than 200,000 have now died, and some 3,000 are dying per day. The true daily death toll is at least two times higher, says Bhramar Mukherjee, an epidemiologist at the University of Michigan, from a caseload likely at least 10 times higher, based on modeling of data from the first wave.

India’s health system is on the brink of collapse. Hospitals across the country are running out of oxygen supplies, ventilators and beds. Indians are rushing to buy drugs like remdesivir, causing prices to surge, while labs struggle to process growing backlogs of COVID-19 tests. Its humanitarian crisis will not just be devastating for the country’s nearly 1.4 billion citizens. In the words of the director general of the World Health Organization, the pandemic is a global inferno: “If you hose only one part of it, the rest will keep burning.” In India, where crematoriums have been burning so long that their metal structures have started to melt, the hose isn’t even turned on yet.

When the pandemic swept the world last year, India braced itself. Modi announced a sudden national lockdown in March, sparking an exodus of migrant workers, hundreds of whom died en route from cities to their hometowns. India’s economy was one of the hardest-hit in the pandemic, and lockdown was eased in June to allow businesses to reopen.

Cases peaked around 93,000 per day in September—less than a third of the daily tallies India is reporting this April—and then the curve began to flatten. A narrative emerged that India may have quietly achieved herd immunity, thanks to its comparatively young population—the median age is 27, and just 6.4% of Indians are over 65—and the fact that 66% of its population live in rural areas, spending most of their time outdoors. That optimistic account has since been complicated by two facts: cases are now hitting the young, and also surging in poor, rural states like Bihar and Uttar Pradesh.

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