Bodies dumped in rivers or burned in car parks, queues for crematoriums, and people frantically searching for oxygen bottles while sick relatives lay outside hospitals – India has been haunted by such images as the second wave of coronavirus sweeps across the nation.
India set successive world records for new cases in a day, passing 400,000 on 1 May after surging upwards in March. By mid-May, India had reported nearly 25m cases, averaging about 4,000 deaths a day and more than 266,000 in all. The World Health Organization (WHO) reported that India accounted for 50% of cases and 30% of deaths globally.
And yet even these gargantuan figures are likely to be a vast underestimate, with Indian authorities suspected of covering up the true figures as many people die untested and unrecorded at home. The Observer found that while the official toll in Muzaffarnagar, Uttar Pradesh, was just 10 Covid deaths over four days in late April, the city’s main crematorium had received 25 bodies in one day and was cremating corpses on open ground or sending them elsewhere. ‘We haven’t had any less than 12 bodies a day – 90% of them corona deaths,’ he said. Furthermore, no tests were carried out on some days and many deaths were not recorded as due to Covid but from other complications. Ashish Jha, dean of Brown University’s school of public health, said daily deaths were six times higher than the official figure – ‘at least 25,000 and maybe more’.
B.1.617, a more contagious ‘double-mutation’ variant of Covid-19 that emerged in India, has fuelled the ferocious resurgence. Many factors, however, are purely manmade. Not least is the complacency that settled over India after the first wave subsided. Udaya Regmi, of the International Federation of Red Cross and Red Crescent Societies, said: ‘People slowly stopped keeping up basic critical life-saving measures, like wearing a mask.’ However, they took their lead from the government. The WHO coyly blamed ‘several religious and political mass gathering events which increased social mixing; and under use of and reduced adherence to public health and social measures’. But the Indian Medical Association (IMA) was explicit, telling the Chandigarh Tribune that the prime minister, Narendra Modi, was a ‘super spreader’ by encouraging huge political rallies for the ruling Bharatiya Janata Party (BJP) ahead of four state elections. At one campaign event, the habitually unmasked Modi boasted that he had ‘never before seen such huge crowds in a rally’. Local elections also spread the virus: about 2,000 civil servants, including 700 teachers, probably died of Covid-19 after being deployed for polls in Uttar Pradesh, said unions, which tried to postpone the election, the Wall Street Journal reported.
The IMA also criticised Modi for allowing the Kumbh Mela, a vast Hindu festival that drew 50 million people in one day in 2019. While Modi has never denied the science of Covid, unlike Brazil’s Jair Bolsonaro and Donald Trump in the US, he ‘did allow government officials to peddle pseudoscience on the side’, according to Milan Vaishnav, at Washington’s Carnegie Endowment for International Peace. The IMA had to warn devout Hindus not to smear themselves in cow dung and urine. ‘There is no concrete scientific evidence that cow dung or urine work to boost immunity against Covid-19 – it is based entirely on belief,’ said JA Jayalal, IMA president. ‘There are also health risks involved in smearing or consuming these products.’
Other causes include the slow rollout of vaccines. Though India is the world’s largest producer, only 26 million people in a population of 1.4 billion are fully vaccinated. The dire shortage of medical oxygen and Covid drugs, such as remdesivir, was also a critical factor, spurring desperate searches by relatives and fuelling a black market. Some just stole oxygen from hospitals.
Crucially, there seems to be an inescapable correlation between a country’s leadership and rates of Covid-19. ‘It becomes painfully clear,’ Yascha Mounk wrote, ‘that those countries that are ruled by populists have paid an especially heavy toll in economic damage, caseload and mortality.’ Nearly half of all cases – 73,196,493 out of 162,623,572 at the time of writing – have been in the US, India and Brazil. Gideon Lasco, an anthropologist at the University of the Philippines, calls the catastrophic approach of Modi, Bolsonaro and Trump ‘medical populism’ – leaders oversimplifying the pandemic, asserting unscientific beliefs and dismissing intergovernmental solutions.
Deutsche Welle noted how Modi and Bolsonaro both led ‘far-right nationalist governments gnawing at democratic institutions with the help of religious zealots’ in countries where most people live in poverty. Unlike Bolsonaro, Modi did impose a strict nationwide lockdown but, the German broadcaster said, the low infection rate after the lockdown was lifted ‘emboldened Modi to sit back when the number of cases started rising again’. In early March, Harsh Vardhan, health minister, declared India was in the pandemic’s ’endgame’. ‘Authoritarians believe what they want to,’ Prof Nikita Sud, at Oxford University, told the Christian Science Monitor. They can also use whatever methods they want to, such as extending government powers through the colonial-era Epidemic Diseases Act, which allows any measures deemed necessary to prevent infections (with anyone contravening them facing six months’ imprisonment), and the Disaster Management Act (which prescribes a one-year sentence for spreading ‘fake news’).
Modi’s government has also turned to censorship to manage the crisis, ordering social media sites such as Twitter, Facebook and Instagram to take down posts critical of government failures to secure medical supplies, oxygen and hospital beds. ‘The government’s first instinct is to control information,’ media commentator Pamela Philipose told DW. ‘Pandemics lead to misinformation, but a blunt censorship tool such as wide-ranging takedowns is most unhelpful as it suppresses important information.’ Earlier in the pandemic, the government charged journalists under the Disaster Management Act for reporting on official corruption and doctors facing food shortages. ‘Earlier, what we witnessed was shoot the messenger. Now, the government is shooting the platform too,’ said Sevanti Ninan, a media critic.
A report on the pandemic, commissioned by the WHO, concluded it was ‘a preventable disaster’. The Independent Panel for Pandemic Preparedness and Response, co-chaired by New Zealand’s former prime minister Helen Clark and Liberia’s former president Ellen Johnson Sirleaf, said the ‘initial outbreak became a pandemic as a result of gaps and failings at every critical juncture’, finding among other things that warnings about zoonotic diseases were not acted on, that some countries responded too slowly and had poor leadership, and that the pandemic widened inequalities. India was exemplary in areas, such as its regulator expediting clinical testing and approval; its use of regional languages for announcements on mobile phones; and how it went from zero to 100 manufacturers of protective equipment in a few months.
But the panel also found that fewer than half of India’s health facilities had reliable oxygen supplies; most people could not work from home but received no financial support allowing them to isolate; and that stringent lockdowns disproportionately affected India’s migrant workers (who numbered at least 41 million in 2001). India has one of the world’s worst-funded state healthcare systems, receiving barely 1% of GDP (compared with 2.15% for defence) and not even one doctor for every 1,000 people (fewer in rural areas and poorer states). One of the report’s conclusions seems particularly apposite for India: ‘If national governments had better social protection systems already in place, they would have been more resilient, and people would have suffered less, and if there were fewer people in precarious or informal employment, there would have been fewer people exposed to risk.’