India’s second wave of COVID-19 is far more aggressive and deadly than the first. Here’s what went wrong

Original article here.

It took only a few weeks for COVID-19 complacency to turn into an overwhelming sense of despair, anguish and anger. Now India, drowning under a surge of cases, “feels like a country that is broken”.

The country has smashed global records with more than 330,000 daily infections and a daily death toll of more than 2,000.

Countless stories of desperate people unable to get medical treatment and people dying after being turned away from hospitals have engulfed the nation.

Not only is the surge far more aggressive and deadly than the one India endured last year, but there is a much stronger belief that this catastrophe could have, and should have, been easily avoided.0100200300400Days since 100th case0.010.1110100Daily known new cases per million people since 100th case India

“Across the world, we have found that a second wave is always more dangerous and more powerful and more virulent than the first wave,” Dr Deepak Baid, from the Association of Medical Consultants, said.

“We always ask the question: have we been prepared? And the answer is definitely no.”

So how did India get here?

There are three key factors behind what went wrong: government response, public behaviour and variants.

Dozens of people crowd a busy marketplace in India. Some people are wearing face masks.
 India is being overrun by hundreds of thousands of new coronavirus cases, bringing a new reality for daily life in its main cities and towns.(Reuters: Niharika Kulkarni)

First, there was a slower response to the second wave. India took swift action when the pandemic first took hold last year, imposing one of the most aggressive lockdowns in the world

The measures forced millions of economic migrants to walk vast distances to their hometowns and villages.

“Last year, people were a lot more willing to forgive the government for their mistakes and helplessness,” journalist Barkha Dutt, from the online publication Mojo Story, said.

“People were not angry with the government at the time, despite the pain, because there was a sense the whole world was snowed under a pandemic that science did not understand.”

The economic scars from the lockdown have run deep and governments across India have been reluctant to deploy similar methods to control the spread.

This year, mass gatherings — including the world’s largest religious festival of Kumbh Mela — were allowed to continue virtually unabated, even when the second surge was already well underway.

Complacency, even arrogance, after overcoming the first surge primed the country for disaster.

Earlier this week, Prime Minister Narendra Modi was boasting about the size of a crowd at a political rally in West Bengal for his party, the BJP.

It wasn’t the only party to host large rallies.

A group of people holding flags and wearing colourful clothes stand in a crowd
India’s second wave and similar surges elsewhere in the world raised new fears about the virus.(AP: Bikas Das)

A severe lack of masks and social distancing has made the optics of such events so alarming.

South Asia expert Michael Kugelman from the US think tank The Wilson Centre described the government’s response as “a tale of opposites”.

“Previously there was this immediate, bold response [in] which the whole country was locked down,” Mr Kugelman said.

“Whereas in this case, the response has appeared to be complacent at best and catastrophic at worst.”

Hardline Hindu nationalist politics also played a part, he added.

“The BJP has applied a very sharp political lens to its handling of the pandemic,” he said.

“There is a very sharp and disturbing contrast in the way in which the government has reacted to large gatherings of Muslims [last year] and large gatherings of Hindus.”

Families torn apart and a ‘country that is broken’

The human disaster in India is all-consuming, with an overwhelming feeling that every single person in this massive country has been directly affected.

Woman is consoled in India
The Prime Minister has asked people to stay indoors and said the government was working to expand oxygen and vaccine supplies.(Reuters: Amit Dave)

Cremations have spilled out onto the streets and into car parks as the official death toll, which is widely believed to be under-reported, hits staggering heights.

“I describe it as a country that is broken,” Dutt said.

“Everywhere I sense a cocktail of rage, despair, devastation, loss and helplessness.”

Social media feeds have become flooded with pleas for help and journalists have used their clout to amplify such calls.

Dutt has continued reporting from hospitals and crematoriums, even after her elderly, diabetic father was this week admitted to an intensive care ward due to contracting coronavirus.

“What’s happening is larger than us,” she said.

“It’s a calamity. It’s like being at war. And I just feel like I have to keep telling this story. I have to keep holding power to account.

“It’s the only way I know how to cope.”0100200300400Days since 100th case1001k10k100k1M10MCumulative known casessince 100th caseNumber ofcases doublesevery 2 days…doublesevery 3 days…doublesevery weekChinaIndiaJapanUS

The rise of variants

While mass gatherings and poor behaviour is blamed for igniting the surge, the rise of the more infectious variants is widely believed to be fanning the flames.

Last month, the UK strain was found in 80 per cent of samples in Punjab, while India’s so-called double mutant variety — officially known as B1617 — has been found in more than half the samples in Maharashtra.

But overall, genomic sequencing is low in India and the government has only been able to meet 20 per cent of its targets.

Oxygen has become so scarce that several hospitals in the capital, Delhi, have run out, the state government reported.

Dr Baid said the states failed to prime their healthcare systems in case of a second surge, leading to the chronic shortfall of medical supplies, including the anti-viral drug remdesivir, oxygen and beds.

Man prepares a funeral pyre in India
Several major cities are reporting far larger numbers of cremations and burials under coronavirus protocols than official COVID-19 death tolls.(Reuters: Danish Siddiqui)

“The virus is very virulent, the virus is very infectious,” Dr Baid said.

“It’s a strong belief that this virus is different, it’s a mutant virus, because now we’re finding it in children and young people are getting infected, which was not so common earlier.

“We have found immense complications in the young people also.”

But epidemiologist Dr Jayaprakash Muliyil cautioned against over-emphasising the role of the variants.

“What we are seeing anecdotally suggests that probably [the variants] are a bit more infectious,” he said.

“It is not purely because of the double mutant, there are other variations also. Everywhere, some common factor is the behaviour of the people.”

The variants are also believed to have immune-evading qualities and can reinfect recovered patients.

But government data shows breakthrough infections, which is when people become infected after receiving two jabs of vaccine, is incredibly low.

Only 0.03 per cent of people who have received two doses of the AstraZeneca jab have become infected and for those who received the Indian made Covaxin vaccine, it’s 0.04 per cent.

Where are all the vaccines?

So, if the vaccines are proving so effective in stopping infections, why didn’t they prevent this latest surge?

What was touted as the largest and fastest vaccine rollout has consistently underperformed, leaving much of the population exposed.

A masked man and woman tape signs to a fence saying "Vaccine out of stock".
India launched its vaccination drive on 16 January, at first restricting it to healthcare workers and frontline staff.(Reuters: Francis Mascarenhas)

The government also took a controlled approach in allocating its vaccine to states and targeting what it considered the most vulnerable: healthcare and frontline workers, the elderly, and those with comorbidities.

The program was more about stopping deaths than stopping the spread.

Pfizer withdrew its request for emergency approval citing red tape, while the Indian-made Covaxin was granted emergency approvals despite final trials being incomplete, a decision which doctors say fuelled vaccine hesitancy.

The current crisis prompted the government this week to open its vaccination program to all adults from May while foreign-approved vaccines will no longer need to conduct local trials before being granted emergency approval.

It’s a move doctors and some states have long called for. But for many, the vaccine turnaround is too little, too late.

“We have vaccines, we had time to put oxygen in place, we had time to put systems in place,” Dutt said.

“It is mystifying. The complacency, the triumphalism, the callousness, the carelessness.

“I think there’s almost a sense in people that we’ve been left to look after ourselves.”

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