When the coronavirus first hit India last year, the country imposed one of the toughest national lockdowns in the world. The warning was clear: rapid spread to a population of 1.3 billion would be devastating.
While damaging and ultimately faulty, locking and other efforts seemed to work. Infections fell and deaths remained low. Civil servants and the public have let their guard down. Experts have unsuccessfully warned that the government’s messy approach will lead to a crisis when a new wave emerges.
Now the crisis is here.
India reported a daily record of 145,384 new infections on Saturday as Covid-19 went out of control. Deaths, although still relatively low, are on the increase. Vaccinations, a gigantic task in such a great nation, are dangerously overdue. Hospital beds are running out.
Parts of the country are tightening lockdowns. Scientists are rushing to track new versions, including the more dangerous variants found in Britain and South Africa, which could speed up the spread. But authorities said tracing contacts in some places was simply impossible.
The government’s complacency and missteps have helped make India, apparently successful, one of the worst-affected countries in the world, experts say. And epidemiologists warn that the continued failure in India would have global implications.
Indian politicians, still gripped by the pain of the latest nationwide lockdown, have mostly avoided major restrictions and even returned to holding large election rallies, sending mixed messages to the public. The deployment of vaccines in India has been late and strewn with pitfalls, despite the country’s status as a major pharmaceutical manufacturer.
The large number of infections during the first wave led some to believe that the worst was over. India’s young population, less susceptible to symptoms and death, has created misconceptions about how another outbreak could be damaging.
What India needs now, epidemiologists and experts say, is concerted and consistent leadership to contain infections and buy time to make vaccinations more widely available and faster.
“Public behavior and administrative behavior are important,” said Dr K. Srinath Reddy, President of the Public Health Foundation of India. “If we do something for six or four weeks, then declare victory and open the door wide open again, then we’re in trouble.”
India in distress will slow down the global effort. The government has limited vaccine exports to the country’s own needs. If inoculations do not accelerate, India would need more than two years to inoculate 70% of its population, said Dr Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, headquartered in Washington and New Delhi.
“India’s size is going to dominate the global numbers – the world’s performance on Covid will depend a lot on India’s performance on Covid,” said Dr Laxminarayan. “If it’s not over in India, it’s not really over in the world.”
Prime Minister Narendra Modi on Thursday played down the possibility of another nationwide lockdown, pushing instead for “micro-containment zones.” He said India could contain a second wave with “testing, monitoring, treatment and appropriate behavior for Covid”.
Mr Modi officials blamed the mismanagement of state governments and the public’s failure to adhere to security measures such as masks and social distancing for the new wave.
New research has identified unusual antibodies that appear to have caused, in rare cases, serious and sometimes fatal blood clots in people who have received the Covid vaccine made by AstraZeneca.
The exact reason why the rare reactions to the vaccine have occurred remains a mystery.
Scientific teams from Germany and Norway found that people who developed clots after vaccination had produced antibodies that activated their platelets, a blood component involved in clotting. The new reports add many details to what researchers have already said publicly about the blood disease.
Younger people seem more susceptible than older ones, but researchers say no pre-existing health issues are known to predispose people to this rare reaction. This is worrying, they say, because there is no way to know if a person is at high risk.
Reports of clots have already led a number of countries to limit AstraZeneca vaccine to the elderly, or to stop using it altogether. These cases have been a major blow to global efforts to end the pandemic, as the AstraZeneca vaccine – easy to store and relatively inexpensive – has been a mainstay of immunization programs in more than 100 countries.
The European Medicines Agency, the regulator of the European Union, has repeatedly stressed that the bleeding disorder is rare and that the benefits of the vaccine far outweigh its risks. But when a side effect has the potential to be devastating or fatal – like blood clots in the brain from this vaccine – some regulators and segments of the public find the risk unacceptable, even if extremely rare.
As of Sunday, European regulators had received reports of 222 cases of a rare blood clotting problem in Britain and the 30 countries of the European Economic Area (the European Union plus Iceland, Norway and Liechtenstein). They said about 34 million people had received the AstraZeneca vaccine in those countries and that bleeding problems were occurring at a rate of about one in 100,000 recipients.
She broke into the hospital morgue and the bodies were everywhere, more than a dozen of them in black bags on stretchers. She walked straight to the autopsy room, begging the guard in the black jacket: “May I speak to the doctor who opened my father?”
Olga Kagarlitskaya’s father had been hospitalized weeks earlier in a coronavirus ward. Now he was gone, cause of death: “viral pneumonia, unspecified”. Ms. Kagarlitskaya, recording the scene on her smartphone, wanted to know the truth. But the guard, his hands in his pockets, sent her back.
There were thousands of similar cases across Russia last year, according to the government’s own statistics. At least 300,000 more people died in the coronavirus pandemic last year than was reported in Russia’s most cited official statistics.
Not all of these deaths were necessarily caused by the virus. But they deny President Vladimir V. Putin’s claim that the country has handled the virus better than most. In fact, according to a New York Times analysis of mortality data, deaths in Russia last year were 28% higher than normal – a larger increase in mortality than in the United States and most countries in Europe.
“People did not know the objective situation,” Ms. Kagarlitskaya said. “And if you don’t know the objective situation, you are not afraid.”
For much of the past year, Russia has appeared more focused on public relations and the economics of the pandemic than on tackling the virus itself. After a severe two-month lockdown last spring, the government largely lifted restrictions last summer, a boon to public opinion and the economy, even as the disease spread faster.