In a televised address to the nation on April 25, Prime Minister Narendra Modi termed the gigantic second wave of the coronavirus in India as a "toofan." Five days later, in his monthly radio broadcast "Mann ki Baat," he said the second wave has "shaken" the country. Modi was stating the obvious. It was just four months ago that his government had declared that the first wave of the virus had been controlled. Time is of little relevance for a deadly and dicey virus which keeps mutating every now and then.
It is indeed a national health emergency for India now. India added over three lakh fresh Covid cases everyday between April 24-29 with each day setting a new world record of fresh infections and death count. The number of active Covid cases went past the three million mark for the first time, the second highest after 6.8 million active cases in the US. What has remained unchanged from the first wave is that Maharashtra, Delhi and Kerala are in the front in the second wave too. Some states which had gone by largely unscathed in the first wave are among the 12 high-burden states in the second—Uttar Pradesh, Madhya Pradesh, Tamil Nadu, Karnataka, Kerala, Rajasthan and Gujarat. Kerala, a tiny state once touted as a model of fighting the pandemic, is today in a pitiable situation, staring at the prospect of re-imposition of lockdown. In 24 hours between April 28-29, Kerala reported 38,607 fresh infections, an extremely worrying sign for a small state where the cumulative death count stands at 5,259. Kerala did manage to contain the situation till October last year before Onam, the state's biggest religious festival, saw people there throwing Covid protocols to the wind. The state has never recovered from that. Added to it was the extensive electioneering for Kerala assembly elections in April this year.
What has changed from the first wave is that the pandemic was at that time confined to Indian cities. But in the second wave, as Modi said, it has spread to Tier 2 and 3 cities. Such is the unprecedented severity of the latest round of infections. As if this is not enough, mathematical projection of the progress of the virus in the country paints a more terrible picture—that India may log four to five lakh cases daily by first week of May.
What triggered such a mammoth second wave that threatens to bring India's public health system to its knees? Where did India go wrong? Did India show foresight and prepare enough for the second wave. Did Indian scientists in the government alert about the coming catastrophe to be triggered by changing mutants of the virus which are much more deadly and faster-spreading? Did none in the federal and the state government see the second wave coming when it began raising its head in the middle of February and became more pronounced in the middle of March? Has the Indian government faltered with its vaccine policy which saw the country exporting million doses of Covishield and Covaxin in the belief that no one is safe until everyone is safe? From chest-thumping of India being the "pharmacy of the world" supplying 66 million doses of vaccines to 80 countries, India is now struggling to meets its domestic needs following a substantial expansion of the ambit of the vaccination campaign. There is apprehension that the huge surge in cases in the second wave could slow down vaccination by discouraging people from going to hospitals to get the jabs.
Agreeing that even the best of public health infrastructure in the world has been mauled by Covid due to the unpredictability of the virus, there are reasons to veer round to the inescapable conclusion that India failed to foresee the second coming of the pandemic in such a ferocious manner and push forward with efforts to further tone up the health infrastructure. At the same time, one may not entirely disagree with what K Vijayaraghavan, Principal Scientific Adviser to the Indian government, told The Indian Express: "there were major efforts by central and state governments in ramping up the hospital and health infrastructure during the first wave… But as that wave declined, so perhaps did the sense of urgency to get this completed." At the same time, one may not entirely disagree with Vijayaraghavan's remark that in one year, "it would not have been possible to upgrade the (health) infrastructure to a level adequate enough to meet the unprecedented requirements of the second wave."
India, federal and state governments included, could have prepared better for the second wave especially by ensuring adequate and timely delivery of oxygen which turned out to be so critical an element in treating the much higher number of serious patients. Official statistics show that in the second wave, 54.5 percent cases needed oxygen during treatment, marking a 13.4 percent increase from the previous wave which had peaked in September-November period.
The second wave has caught India on the wrong foot and off guard and laid bare the huge gaps in its public health system which has remained neglected over decades. Hospitals in major cities like Delhi, Mumbai, Bengaluru, Jalandhar and Indore sending repeated SOS for oxygen supply replenishment in the face of hugely rising patients in the second wave. Some leading private hospitals in Delhi even knocked the doors of the High Court to get oxygen on urgent basis when in normal course they should have coordinated with the federal or the state government. The strictures from the High Courts of Calcutta, Bombay, Allahabad, Gujarat and Delhi left both the federal and state governments red faced about the shortcomings in public health system.
Under the Indian constitution, health is an issue that comes under the jurisdiction of state governments. Indian government has a Health Ministry and so do states. It's not the Centres job to create beds in hospitals, set up new hospitals, store medicines, buy ambulances and oxygen. The Centre can only facilitate procurement of all this. But in an extraordinary crisis like the second wave, such technicalities matter little. What is called for is both the federal and state governments joining hands to fight the pandemic instead of pointing fingers at each other for acute shortage of hospital beds and oxygen and paucity of vaccines which has slowed down the vaccination process at a time when it should have gathered much greater momentum.
What made the second wave stand out and more devastating is a blend of a high number of asymptomatic people with Covid and more virulent variants of the virus. It is officially estimated that nearly 90 percent of India's population is asymptomatic and is the biggest carrier and spreader of the disease. The UK strain, which has shown a 50 percent faster transmission rate, was noticed among a substantial section of the people in Delhi and Punjab, another worst-hit state, in genome sequencing. In Maharashtra, nearly 60 percent of swab samples tested found the presence of the Indian variant of SARS Cov-2 known as B.1617.
India slid into complacency after the first wave was brought under control. An example of this is, as per a report in The Indian Express on April 20, the Indian-origin double mutant strain of the coronavirus, B.1167 that many experts say could be behind the rapid spread of the second wave was first detected on October 5 last year through genome sequencing of a virus sample. However, "the genome sequencing exercise slowed down between November and January due to lack of funds, absence of clear directives, and, possibly, also disinterest because of the steadily falling Covid curve." A question on this went unanswered by Health Ministry officials who maintained this was not the time to revisit the past.
Compounding the woes was the long queues for Covid tests and long delay in getting test reports leading many asymptomatic people to move around freely and spreading the infection. Also, marking and monitoring of containment zones in high caseload areas in major cities has been sloth in the second wave.
As late as April 20, Indian Health Minister Harsh Vardhan pointed to the detailed measures taken to scale up the health infrastructure to fight the virus. "In the shortest possible time, we ramped up testing from one lab to 2,467 labs today with a capacity of more than 15 lakh tests per day, set up hospital infrastructure including Covid care Centres, Covid hospitals with oxygen beds and ventilator bed. More than 12,000 quarantine centres were established. We also overcame the need for PPE kits and N95 masks. This helped to tide over the pandemic last year." It is one thing to talk about achievements after one wave and then get buffeted by a much stronger second which threw up totally different needs on multiple logistical fronts including medical oxygen and hospital beds.
What is more disconcerting is that the second wave has also had the effect of further hardening political divides and mutual recrimination in the Indian society. If the opposition has been toxic while pointing out where the Modi government went wrong, the ruling party too reacted harshly to former PM Manmohan Singh's suggestions to improve India's vaccine and oxygen policies.
How does India go about tackling the second wave? The Indian government has been galvanised into action ramping up domestic production of oxygen and diverting the same from industrial use and liberalising import of oxygen generators and foreign-made vaccines.
This is a moment of reckoning for the Indian political classes which must put mud-slinging and recriminations on the backburner. It is easy to be wiser by hindsight but it should not be difficult to have foresight. What is of utmost importance is that all put their heads together to tackle the crisis at hand.
Pallab Bhattacharya is a special correspondent of The Daily Star. He writes from New Delhi, India.