A surge of coronavirus cases in small towns, more rural and poorer parts of India has led to the country overtaking Brazil to have world’s second-highest number of infections after the US.
The densely populated country of 1.4bn is adding roughly 90,000 new cases every day as it eases out of one of the world’s most draconian lockdowns in an attempt to revive its battered economy.
In poorer regions such as Bihar, fragile health infrastructure is ill-prepared to cope with the onslaught.
“The ICU is always full,” Dr Prabhat Kumar Singh, director of the All India Institute of Medical Sciences in Bihar’s state capital Patna, told the Financial Times. “Our biggest challenge is expanding our critical care capacity.”
More than 71,700 Indians are known to have died from coronavirus, including former president Pranab Mukherjee, who passed away last week.
India’s new daily cases have exceeded those in the US and Brazil since mid-August, as the government has pushed to increase testing to its current levels of about 1m a day. Last week, India accounted for roughly 30 per cent of all new cases in the world.
The surging caseload comes as prime minister Narendra Modi’s government eases the restrictions that led to a 24 per cent year-on-year contraction in India’s GDP during the April to June quarter.
The administration had imposed a strict lockdown in late March, abruptly ordering all economic activities — and all public transport — to a halt when India only had about 550 confirmed cases.
Though New Delhi had hoped the measures would allow it to contain the pathogen, it proved a massive shock to India’s army of vulnerable workers in the informal sector, triggering a mass exodus of urban labourers back to the countryside.
As migrants made their ways home — often after weeks or months trapped in cities struggling for food — many were likely to be carrying the virus with them.
“When migrant workers returned, there was a surge of infections,” says Dr Kumar Gaurav, of Bhagalpur’s Jawaharlal Nehru Medical College hospital. “The infection just kept spreading.”
Today, authorities are encouraging widespread reopening, permitting operations of everything from bars to metro systems, in a bid to breathe life into a battered economy, and to help fill empty public coffers.
“Economic activities are restarting out of sheer necessity,” says virologist Jacob John, a former professor at Christian Medical College, Vellore. “It has nothing to do with an assessment of the epidemic. The priority has shifted from people’s health to the economy of the country.”
Yet public health experts gripe that many Indians do not fully understand the risks of the virus, or how to protect themselves with correct mask wearing, because of insufficient communication from the government. Delhi has been reluctant to publicly acknowledge the pervasiveness of the disease.
Though many Indians do carry masks in public places to avoid trouble with police, most are as likely to have the masks dangling around their chin as to have it covering their mouths and noses.
“There is a total lack of awareness and social distancing rules are not followed,” says Dr Gaurav.
Numerous senior leaders in Mr Modi’s ruling Bharatiya Janata Party — including a clutch of cabinet ministers and state chief ministers — are among those who have been infected.
Mr Modi’s government emphasises that India’s case fatality rate has so far been lower than those of more advanced, wealthier countries, at about 2 per cent.
In part, this may be a result of India’s younger population, while the stringent early lockdown may have protected those most vulnerable. Mr John says the pathogen may also be losing its virulence as the pandemic goes on.
Sero-prevalence studies — which test for antibodies indicating past infections — conducted in several urban hotspots such as Delhi, Mumbai and Pune have also indicated that the virus may have been more widespread than realised.
But experts note that the case fatality rate is a lagging indicator because many patients die only after protracted battles with the virus. They say India will still be tested in the months ahead as the number of active cases rise.
This is likely to put fresh strain on the health system, which has suffered from decades of chronic under-investment
“Our health services are overstretched even in normal times because we have not made health services our priority,” says Dr Singh of AIIMS Patna. “If we don’t increase our health spending, we will be discussing the same thing for another 25 years . . . The pandemic has exposed our limitation.”