India’s crushing COVID caseload the result of a ‘perfect storm’ of factors, experts say

Last March, when COVID-19 arrived in India, the country of 1.4 billion people quickly went into lockdown for two months, keeping infection rates under tight control. There was a spike in September but then the numbers came back down.

By February, cases were at an all-time low, and the country began relaxing, thinking it had overcome the virus, said Dr. Amita Gupta, an infectious disease specialist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

People started attending cricket games, religious festivals and weddings. “There was essentially a lot of relaxation of rules,” she said.

Now, the country’s caseload is growing exponentially and its health care system, particularly in smaller cities, is completely overwhelmed.

“It’s almost like India hit a perfect storm,” said S.V. Subramanian, a professor of population health and geography at the Harvard T.H. Chan School of Public Health.

India is so large that different factors may have played a role in different areas, and cities seem to be suffering more at the moment than rural areas, he said. But the combination has led to catastrophe.

“Hospitals full and having no beds – they are absolutely facing that. They’re in a war mentality,” Gupta said, with train cars and hotels being converted into COVID hospitals.

India’s Prime Minister has pleaded for help and other nations, including the United States, have responded.

Family members of a person who died due to COVID-19 light the funeral pyre at a crematorium in Jammu, India, Monday, April 26, 2021.

Shipments of oxygen tanks and devices for making oxygen should be on their way to India within the next week, White House officials said Tuesday. Medications like remdesivir that help COVID-19 patients recover faster will be sent soon, too.

“We are sending immediately a whole series of help that (India) needs,” President Joe Biden said Tuesday.

The administration also has promised to send supplies for Indian vaccine production and 60 million doses of vaccine made by AstraZeneca, which the U.S. government pre-purchased last year but doesn’t need to vaccinate Americans.

Only 10 million of those doses have been made so far, and are currently awaiting review by the Food and Drug Administration to ensure their safety before being shipped; the remaining doses will be sent over the next few months as they are manufactured, Andy Slavitt, a senior adviser to the president’s coronavirus response team, said in a Tuesday news conference.

Gupta and several other infectious disease experts said this week that a combination of political, biological, behavioral and meteorological factors led to the current disaster.

Parts of India, including Delhi, the nation’s capital with nearly 19 million residents, have lower humidity this time of year. The virus is known to spread better when the air is dry, likely contributing to the enormous outbreak there, said Dr. Ashish Jha, dean of the Brown University School of Public Health in Providence, Rhode Island.

Holiday crowds also helped spread the virus. Authorities postponed the annual pilgrimage of Kumbh Mela by a month until mid-February, but more than 700,000 already had arrived on the banks of the Ganges River by mid-January, and millions more were expected through the end of this month.

“It’s a huge gathering and it’s a very efficient way of spreading the virus to a large group of people,” Jha said. “And then those people dispersed all across India and spread the virus all over the country.”

Relatives and municipal workers in protective suit bury the body of a person who died due to COVID-19 in Gauhati, India, Sunday, April 25, 2021.

Prime Minister Narendra Modi didn’t want to jeopardize his popularity by banning the gathering, said Chunhuei Chi, professor of international health at Oregon State University and director of its Center for Global Health. “Even before the celebration cases were already rising, but since the holiday, cases have been rising exponentially,” he said.

India also tried to ban criticism of government policies in social media, he said.

Then there are the variants. The B1.1.7 variant first seen in the U.K. is far more contagious than the original strain of the virus and may be helping to infect more people, Jha said.

Lack of surveillance has been a problem in India, he said, making it impossible to understand which variants are there and how far they’ve spread.

While more surveillance would have been helpful in understanding the outbreak, that alone would not have prevented the current tsunami of cases, said Jha. There was enough data without genetic surveillance by early to mid-March to indicate the situation in India was getting worse.

“There was plenty of information for action and that didn’t happen, so I don’t know to what extent adding genomic surveillance data … would have moved the policy,” he said.

In February, there were about 350,000 COVID cases in India and 2,670 deaths. So far this month, there have been more than 3 million cases, a nine-fold increase, and 17,000 deaths, according to data Subramanian tracks at Harvard.

Models suggest India’s caseload will not peak until mid-May, and it could be even longer if Indians fail totake measures now to reduce infections, Gupta said.

Roughly 10% of Indians have been vaccinated so far, she said, with large-scale production and distribution underway in a country well versed in running mass vaccination campaigns. On May 1, every adult will be eligible for a vaccine, she said.

But even at the current delivery rate of about 2 million shots a day, the population is so large it will take time to vaccinate enough people to help infection rates fall.

A woman is pictured receiving the AstraZeneca COVID-19 vaccine at an apartment building in Bengaluru, India.

Some communities have instituted curfews and others are considering movement restrictions. No one is expecting a national lockdown, but “in states that are facing unbelievable numbers, numbers you could not even imagine would occur, there has to be more thought to the lockdowns,” Gupta said.

In the meantime, she said, more testing is needed, along with spaces for sick people to isolate from healthy family members and additional high-quality masks. Many people don’t bother with masks, and even those who do often wear ones made of thin cloth that are not tight-fitting and are “not really an optimal barrier,” she said.

Gupta called on Americans, particularly those of Indian heritage, to help by supporting charities and lobbying governments to provide more assistance.

Even though she’s in Baltimore, far from the tragedies unfolding in India, Gupta said she and many others are directly touched by them. “This effects the whole world,” she said. “This is not just some faraway place.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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