Posted by: John Elliott | March 31, 2021

India’s Covid cases surge in a second wave

Maharashtra worst hit with Punjab and Gujarat

Vaccine exports curbed to focus on India’s needs 

India has been hit by a fresh surge of the Covid pandemic in the past month with a 51% weekly increase in new cases. This is the biggest spike since last October, with around 60,000 or more cases being reported daily, five times more than in early February and twice as many as three weeks ago.

It comes at a time when massive crowds are attending political rallies for assembly elections that are running through April in six states, as well as a vast Kumbh Mela festival at Haridwar in north India. Last Monday there was the colourful Holi festival. Leading politicians, who are calling for people to socially distance and wear masks, are often themselves ignoring the measures.

On March 28, over 68,000 new cases were reported, [81,000 on April 1] two-thirds of them in Maharashtra, spreading out from Mumbai, India’s commercial capital, and two other key cities, Nagpur and Pune. Maharashtra is now the worst hit state along with Punjab and Gujarat in what is being described as India’s “second wave” with a rising number of deaths. Delhi has also been hit by a fresh surge along with Bengaluru in Karnataka, reflecting the impact on busy urban conurbations.

Active cases March 20source: https://www.covid19india.org

Hospitals are scarce and are becoming over-loaded. According to last year’s Human Development Report, India has just five beds for every 10,000 people, ranking an appallingly low 155 out of 167 countries in the index.

“No state and no part of the county should be complacent. Trends show that the virus is still very active and can penetrate our defences,” V.K.Paul, a senior government official, said yesterday. The situation was “going from bad to worse”. Echoing a message heard in many countries over the past few months, he added, “When we think we have controlled it, it strikes back”.

This is a major blow for a country whose total caseload exceeds 12m, a massive figure that needs however to be seen in the context of India’s total population of over 1.3bn. 

The government announced on March 29 that it has detected 795 positive cases of the UK, South African and Brazilian variants, half of them in the past fortnight. Together with the surge, this has dashed hopes, which developed at the turn of the year, that India was gradually achieving herd immunity. That would involve sufficient people being infected, and having antibodies, to reduce the chances of the virus spreading rapidly again. 

At a time when new cases were declining, the optimism was based on insufficient understanding about the length of protection that antibodies would provide, especially with the arrival of the fresh mutants.

As optimism grew at the beginning of the year, precautions were abandoned with reduced wearing of masks, increased travelling, and a gradual opening up of the economy.

Illustrating the problem, the surge in Gujarat was partly attributed to an India-England test match and a T-20 match early in March at the world’s largest newly-inaugurated stadium in Motera, Ahmedabad. The stadium was named after Narendra Modi, India’s prime minister, who attended the match. (see FT front page below).

The crowd at the England-India test match in the newly named Narendra Modi stadium – AP photo/Aijaz Rahi, Indian Express

“India is not an easy place to maintain precautions”, says Kiran Mazumdar-Shaw, founder and chief executive of Biocon, one of India’s largest biotech companies. “It’s just not possible to do social distancing. Also people have been getting very mild symptoms so felt there was less worry about“.

The situation is especially poignant, reflecting the country’s complexities and contradictions. Brilliant brains developing and applying technology have led to it playing a leading role on vaccines. A Pune-based company, Serum Institute of India (SII), which is the world’s largest producer, has been turning out the internationally problem-prone Astra-Zeneca version. It is also starting trials of Novavax. Another company, Bharat Biotech, has successfully developed Covaxin with two Indian government institutes.

Two-thirds of the vast population are however too poor and preoccupied with the basic necessities of life to focus on receiving a vaccination or taking other precautions. Rural India has not been hit as badly as might have been expected, partly because villages are less crowded and many people work outdoors.

The better off, living in urban areas, are too busy with their lives and there is an habitual lack of community concern, plus widespread distrust of the vaccinations. Randeep Guleria, head of AIIMS, a large government-run hospital in Delhi, said in a recent Print.in on-line interview that only 60% of his staff had been willing to be vaccinated. 

Masks are rarely seen in rural areas and their usage is patchy in towns and cities, apart from some up-market locations, or where they are compulsory such as on air flights and where police are actively monitoring urban traffic. While 90% of people are aware of their importance, only 44% actually wear them according to a health ministry survey, though that seems a surprisingly high percentage.

It was different a year ago when the pandemic began. Modi created a crisis across India when he ordered a national lockdown on March 24 at a few hours notice. Tens of millions of migrant workers immediately started fleeing home from major cities. 

In rural areas like deepest Madhya Pradesh, where I have spent several weeks this year, the poor immediately protected their home areas. “Local people, especially the tribals, did not comprehend the threat of Covid, but they still took some action to protect themselves and their families,” I was told. Villagers stood guard on river bridges blocking people from crossing so that whole areas remained secure. Some of the travelling workers were quarantined in schools and other public buildings.

A year later, it is not likely that the same fear and response will be repeated. The mood has changed and the fear seems to have evaporated, though it remains to be seen whether it revives as the seriousness of the current surge becomes clear. 

There is a debate nationally, and in individual states, about whether to have fresh lockdowns of whole conurbations, or to avoid them, given the economic disruption and hardship that was caused last year. Average household incomes fell by 9.2% last March and 27.9% in April. Employment this February was 7m less than last year.

The FT front page Feb 25, 2021

The alternative could involve smaller local containment zones that are already operating, plus increased social distancing and mask-using, more testing and tracing, and more vaccinations. The health ministry has asked 47 districts across the country to increase RT-PCR testing so that fresh cases can be identified and tracked faster.

Meanwhile the government is increasing the focus on vaccinations and is being criticised internationally for restricting exports – so far over 60m vaccines have been sent abroad. Those exports are now being curbed at the request of the government so that they can be used for a fresh drive in the country.

Initially the government targeted health care and other vulnerable workers, but has now moved on to older people aged over 60 and those over 45 with other illnesses. That will be extended to everyone over 45 on April 1, covering 25% of the population. So far some 50m people have been vaccinated, most with just one dose.

Mazumdar-Shaw says the focus should quickly move on to the young. Many of them live in extended families with older relatives, who may not be fully protected from mutated infections by their first jab. “We need a two-pronged attack targeting these younger people and also stepping up testing in areas like Maharashtra and Punjab where there are fresh surges,” she told me.

“India needs to manage its pandemic with large scale vaccinations so it is right to stop exports for a few months till we get production levels up. Our vaccine production is just about adequate to support our current vaccination rate of 2.5m per day. Production is expected to double by end of May, so exports should only resume post May”.

It is ironic that India is now being criticised for curbing exports because it was not rated as a supplier last year when Astra-Zeneca emerged as the world’s first major producer (along with Pfizer whose product is not being used in India because it requires deep-freezing facilities).

International agencies such as the World Heath Organisation’s COVAX, which aims to ensure that world-wide vaccine supplies are evenly spread, rapidly found that production in Europe, the UK and the US was inadequate for global needs. It turned to the Serum Institute, which had taken a commercial risk and started producing Astra-Zeneca’s vaccine for the Indian market at the beginning of the year.

It is now planned that the entire April production of 60m doses will be supplied to the government as a temporary move until the supply situation improves with a boost to production.

So far, India has only vaccinated about 4% of its vast population. It seems unlikely that it will ever cover everyone. But while the programme progresses, it is human behaviour on distancing and masks that can contribute most, along with prompt government action containing the worst-hit areas.


Responses

  1. Watching on TV the enthralling Ahmedabad Test and T20 matches between India and England in the crowd- filled Modi Stadium, it can not be a surprise to anyone that the aftermath would be the rapid spread of the contagion within Gujarat. I guess the rise of the virus across Maharashtra and other States is also because of the close proximity of large volumes of people at sporting and other events. This means, sadly I presume, that the forthcoming IPL matches will have to be staged once again in empty stadia. A necessary pity.


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