Posted by: John Elliott | April 28, 2021

India’s health system implodes under the strain of Covid

Surge forecast to peak in May and continue till June or July

Finance minister’s husband attacks government performance

India is facing the prospect of the crippling Covid-19 pandemic surge increasing with massive numbers of cases and mounting deaths till it peaks in mid-May, and then continues till June and July. The official number of new cases has been rising at more than 300,000 a day for the past seven days – over 2m a week – though the real total is far higher. 

This is an unimaginable catastrophe as families cope with the tragedies of the virus, the desperate lack of medical advice, shortages of hospital beds and equipment, and the ill health that can follow, and the deaths. 

April 22, India record international total of over 300,000 cases – source John Hopkins University

Scenes that have been viewed around the world on television tell of the extreme panic and desperation as families trudge from the over-loaded crowded chaos of one hospital to another, seeking medical help, oxygen cylinders and other facilities, and then mourn as their relatives pass away, sometimes lying in cars, ambulances and hospital corridors.

The peak could be reached by “possibly mid-May” with new cases going up to 500,000 or more a day, NITI Aayog, a government policy commission, told a review meeting held last week by Modi with chief ministers of states. After that, the wave would “take time to subside — be ready till June/July”. 

In the context of India’s 1.3bn population, the figures are proportionately lower than other parts of the world, though they are far higher than elsewhere in South Asia. India’s total deaths figure of nearly 200,000 is only the fourth largest in the world and the total of 14.5m recovered is by far the largest – though none of these figures are reliable.

Such comparisons become irrelevant when set against the misery and social upheaval that is being caused by the implosion of the country’s ill-prepared health service. How much damage that will do to India’s stability remains to be seen.

Usually, India rides out such crises. The Modi government has escaped much blame for the economically devastating demonetisation of 2016, and last year’s flight of millions of migrant workers when the country was locked down in March.

Narendra Modi address large crowd in Kolkata March 7 2021 – @NarendrModi

“The prime minister’s popularity, political capital and communication skills seem to indemnify him from the impact of the ineptitude, incompetence and heartlessness of this government,” Parakala Prabhakar, the economist​ husband of finance minister Nirmala Sitharaman, said in his weekly YouTube broadcast on April 21. 

Prabhakar has voiced criticisms in the past, but not to the extent of this carefully aimed attack. “The government and the ruling party are adept at outrage management,” he said. “They understood that the initial sharp yelp after the pain will quickly be followed by the country becoming numb to suffering”. Popularity and political capital however had “a habit of running out without giving notice”

Modi will now try to ease himself away being blamed. He has said the surge is like being “hit by a storm”, comparing what has happened to a natural event beyond the control of governments or anyone else, like the floods and earthquakes that people in countries such as India regard as part of their lives. 

India has far more cases than the rest of South Asia – source John Hopkins University

He presumably hopes his followers will pick up that theme and say to each other, “Modi says it is like a storm, so it will pass, no?”

This is not the India that Modi set out to build when he became prime minister. Nor could he have ever envisaged that he would have to ask other countries’ prime ministers and presidents, as he has done in he past week, for the oxygen, vaccines and other equipment that his government, and state governments, have failed to provide. Relief is being flown in by at least 15 countries including the US ($100m supplies), the UK and Australia, though the impact may be slow and uncertain. 

The shortages are undoubtedly being exacerbated by panic buying (and a black market) of items such as oxygen cylinders and the Remdesivir drug, and that is the result of fear and uncertainty caused by a lack of adequate medical advice and hospital facilities.

As Prabhakar indicates, Modi should surely take the lead in shouldering the blame for what has happened. Constitutionally, health is the responsibility of the states, not the central government, but Modi’s government has been in charge of vaccines (which it has just devolved to the states) and it is a prime minister’s duty to lead and set an example, which he failed to do till last week.

Other countries’ prime ministers have made many mistakes in the past year since the pandemic began. Few however have Modi’s iconic leadership stature, which gives him increased responsibility to lead the country’s people competently.

Modi and his government have focussed on politics and election campaigns with large mass and unprotected rallies, while millions of pilgrims have attended the Hindu religion’s vast Kumbh Mela that is now being wound down, having seen more than 10m worshippers since January.

The crowds seemed to believe they were safe till some of their leaders caught the pandemic and over 1,700 people tested positive between April 10 and 14. Compulsory PCR tests are being ordered for pilgrims returning to cities like Delhi, but that will be almost impossible to administer effectively.

“Kumbh is at the bank of the River Ganga. Maa Ganga’s blessings are there in the flow. So, there should be no corona,” declared Tirath Singh Rawahe, the chief minister of Uttarakhand where the current Maha Kumbh Mela takes place in Haridwar every 12 years.

Modi welcomed crowds at political rallies instead of restricting them till last week. Campaigning in West Bengal on April 17, the day a record-breaking 234,000 new Covid cases were registered along with 1,341 deaths, Modi said that he had “never seen such huge crowds” at a rally, but he did not call for social distancing or masks. 

Patients wait in a Delhi hospital – Danish Siddiqui Reuters/NYT

Politicians from other parties did the same in the Bengal and four other state assembly election campaigns that are drawing to a close this week. (The count will take place next Sunday May 3, but it is unlikely that Modi’s BJP will suffer much from the pandemic because voting in all the states apart from West Bengal ended on April 6 before the full scale of the emergency had emerged).

There was no attempt by national and state governments to curb the assembly of massive crowds, and virtually no precautions at events such as an England test and other cricket matches in Gujarat in early March, when Modi was preoccupied with having the world’s largest stadium re-named after himself in front of massed spectators.

There is now a glimmer of possibly good news as the number of new cases appeared to have plateaued in Maharashtra, which includes India’s commercial capital of Mumbai and accounted for 60% of India’s total cases in March. Elsewhere, curfews and other restrictions are being turned into lockdowns across the country in small containment zones, cities and states.

The official daily all-India figures – record figures of 362,770 new cases on April 27 with 3,286 deaths – understate the total. State governments and hospitals obscure figures and there are inevitable administrative failings as well as a tendency for families not to report illness and death.

“From all the modelling we’ve done, we believe the true number of deaths is two to five times what is being reported,” Professor Bhramar Mukherjee, an epidemiologist at the University of Michigan, has said.

Mumbai vaccination centre April 20, 2021.
 Indranil Mukherjee/AFP via Getty Images

A Financial Times analysis earlier this month, based mostly on local news reports of cremations in seven districts across Gujarat, Uttar Pradesh, Madhya Pradesh and Bihar, showed that, while at least 1,833 people had died of Covid, only 228 were officially reported. In the Jamnagar district of Gujarat, 100 people died but only one death was reported.  

Mukherjee told The that infections would peak in mid-May when India could see 800,000 to one million new cases daily. In terms of deaths, the peak would be two weeks later at the end of May with an expected 4,500 daily deaths.

This means that India is facing two and maybe three months of the pandemic surging across the country faster than medical facilities and vaccines can cope.  “No state has adequate infrastructure to deal with the surge in cases. (The) number of deaths may increase due to lack of treatment facilities,” NITI-Aayog said in its presentation. 

The problems began at the beginning of the year when, after several months of a declining rate of new cases, India thought it was escaping the second surge that hit Europe and the US. This led to complacency and a growing disregard for safety precautions such as mask wearing and social distancing. 

“India is bending the COVID infection curve: since mid-September, barring localised surges, infections are slanting fashion to support investment and consumption demand”, a bullish article in the Reserve Bank of India’s Bulletin declared just before Christmas, noting “the absence of the dreaded second wave”. 

In January, Modi told the World Economic Forum, “In a country which is home to 18% of the world population, that country has saved humanity from a big disaster by containing corona effectively.”

No attempt was made during the winter to build up buffer stocks of vaccines and other medicines and equipment.

Harsh Vardhan declaring the “endgame”, India Today March 7 2021

In February, just as the numbers were beginning to rise again, many states started dismantling Covid facilities, believing they would no longer be needed, and 60m Covid vaccines were sent abroad to help other countries. That meant the states were far from ready for the surge, and there was a national shortage vaccines.

We are in the endgame of the pandemic,” health minister Harsh Vardhan declared on March 7, ignoring an already obvious surge. “Unlike most other countries, we have a steady supply of Covid-19 vaccines”.

Taken together, these developments underline four trends:

– an over-riding relentless desire for political power, especially in Modi’s BJP, that diverts political leaders and government from their primary jobs – in recent weeks and months, tackling the pandemic;

weak state and national government administration and a lack of focussed political leadership, and a widespread failure to maintain continuity of standards of performance;

– a lack of respect for legal or social rules and norms, and the absence of a sense of community, leading to disdain for pandemic precautions such as distancing and mask wearing;

– deep religious beliefs that led to millions of people attending the mega festival despite Covid, with political leaders as well as gurus saying that worshipping in the sacred River Ganges would negate pandemic risks.

As an FT editorial remarked on April 26, “In the global struggle against the virus, the chain of humanity is only as strong as its weakest link.”


  1. […] is what happened with Covid because India’s governance and systems failed to provide what the country needed. The health service failed to work across vast swathes of the country and […]

  2. Dear John well done. Hope someone listens. How many people would they silence?

  3. One of the better pieces I have read on India’s second wave of Covid-19. Good analysis, structure and well-written. Congratulations !

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