India's COVID tsunami is the worst in the world. Why that should concern Americans.

In America, it’s easy to believe — and likely correct, given the country’s rapid pace of vaccination and high level of prior infection — that the worst of the COVID-19 pandemic is over.

But in India right now, every day is worse than the last.

“In the last 24 hours alone, [India has] had 300,000 cases, and that’s most certainly an undercount,” said Dr. Kavita Patel, a Yahoo News medical contributor. “In some parts of India, like Mumbai and New Delhi, as high as 1 in 3 or 1 in 4 people are testing positive, [and that’s] actually, again, an underestimate. As a result, India’s hospitals are completely full. There is now rationing of everything, including doctors, nurses, oxygen, beds, supplies.”

More than one year into the pandemic, the deepening disparities between two of the world’s largest countries should remind optimistic Americans that the light at the end of their own tunnel remains a long way off for most of the planet’s population — and that it’s probably time for the U.S. to start thinking about how it can help end the pandemic elsewhere too.

A woman is consoled after her husband died due to the coronavirus disease (COVID-19) outside a mortuary of a COVID-19 hospital in Ahmedabad, India, April 20, 2021. (Amit Dave/Reuters)
A woman in Ahmedabad, India, is consoled Tuesday after her husband died from COVID-19. (Amit Dave/Reuters)

At its peak this winter, the U.S. was recording an average of 260,000 new COVID-19 cases each day. Yet after skyrocketing 122 percent over the last 14 days, India’s daily case counts have already crossed that threshold twice this week. The curve is so steep, it’s almost vertical.

If the virus continues to spread at the same clip, according to Bhramar Mukherjee, a biostatistician at the University of Michigan, India could be averaging half a million new daily cases within the next month — a figure that no other country has ever come close to. Deaths are likely to follow: Over the past two weeks alone, they have soared 128 percent.

At this point, India accounts for about 1 in every 3 new cases globally. Its rate of spread is the fastest in the world. And the tsunami shows no sign of subsiding anytime soon.

But the bigger problem is that these terrible numbers tell only part of the story. For one thing, India is currently testing at a much lower rate (about 1 test per 1,000 residents per day) than the recent high-water marks in Western countries such as the U.S. (5.5), France (8) or the U.K. (21). Meanwhile, in Delhi, one of India’s hardest-hit areas, test positivity reached 30 percent this week, prompting a six-day lockdown. The combination of inadequate testing and high positivity suggests that hundreds of thousands of infections are going undetected each day.

A health worker takes a nasal swab sample of a Kashmiri girl to test for COVID-19 in Srinagar, Indian-controlled Kashmir on April 21, 2021. (Dar Yasin/AP)
A health worker tests a girl for COVID-19 in Srinagar, Indian-controlled Kashmir, on Wednesday. (Dar Yasin/AP)

Many — perhaps most — COVID-19 deaths are being missed as well. India is currently averaging more than 1,100 daily deaths, the second-highest level in the world after Brazil. But as Ramanan Laxminarayan, an economist and epidemiologist who is the founder and director of the Center for Disease Dynamics, Economics & Policy, explained in a recent interview with the New Yorker, “We don’t know the cause of death for four out of five people in normal times” in India because “only one in five deaths is medically recorded” — and “that has continued during COVID.”

At the same time, Laxminarayan continued, “the levels of testing are so low that the people who didn’t get tested and then died of a stroke or a heart attack that was likely COVID-related would not be reported as a COVID death.”

The undercount, in other words, is probably huge.

Reports from the frontlines of India’s spiraling surge support this theory. According to a Reuters investigation published Monday, “Several major [Indian] cities are reporting far larger numbers of cremations and burials under coronavirus protocols than official COVID-19 death tolls, according to crematorium and cemetery workers, media and a review of government data.”

Relatives wearing personal protective equipment (PPE) attend the funeral of a man, who died from the coronavirus disease (COVID-19), at a crematorium in New Delhi, India April 21, 2021. (Adnan Abidi/Reuters)
Relatives wearing personal protective equipment at the funeral of a man who died from COVID-19, at a New Delhi crematorium on Wednesday. (Adnan Abidi/Reuters)

In Surat, for instance, Reuters reported that over the last week, two facilities have cremated more than 100 bodies a day under COVID protocols — far in excess of the city’s official daily COVID death toll of around 25. At one of them, gas and firewood furnaces have been running so long without a break that “metal parts have begun to melt.”

In Lucknow, data from the largest COVID-only crematorium shows that the number of bodies that arrived on six different days in April was twice as high as the official number of deaths recorded across the entire city. Elsewhere, India Today reported that two Bhopal facilities alone cremated 187 bodies on days when the city’s official death toll stood at five, and in Ahmedabad last week, 63 bodies left a single COVID-only hospital for cremation on a day when the entire city recorded just 20 coronavirus deaths.

Hospitals, likewise, are on the brink of collapse. “There are two patients per bed in the big hospitals in New Delhi, and that’s if you can get into the hospital in the first place. There are literally lines of ambulances that are fifty or a hundred long,” Laxminarayan said. The result is a vicious cycle: the more patients have to compete for limited beds, oxygen and medicine, the more care suffers — and the more people die who could have been saved.

Ambulances carrying COVID-19 patients queue up waiting for their turn to be attended at a dedicated COVID-19 government hospital in Ahmedabad, India on April 17, 2021. (Ajit Solanki/AP)
Ambulances carrying COVID patients at a dedicated COVID-19 government hospital in Ahmedabad, India, last week. (Ajit Solanki/AP)

“The huge pressure on hospitals and the health system right now will mean that a good number who would have recovered had they been able to access hospital services may die,” Gautam Menon, a professor at Ashoka University, told Reuters.

The point is not just that the situation is bad in India, and likely to deteriorate even further. The point is that India is not all that unique. Like many poorer countries across the developing world, it seemed to dodge a bullet during earlier stages of the pandemic, leaving most of its population untouched — and lacking any immunity.

Like many of those same countries, India was lulled into a false sense of security after a seemingly successful lockdown and a recent ebb in infections; less than two months ago, the country’s health minister announced that it had entered “the endgame” of the pandemic, and mass gatherings — cricket matches, large weddings, election rallies — promptly resumed. And as in nearly all other developing countries, barely anyone in India — just 8 percent of its vast population — has received at least one vaccine dose.

Sadhus, or Hindu holy men take a dip in the Ganges river during Shahi Snan at
Hindu holy men, not following COVID-19 precautions, in the Ganges River earlier this month in a ritual called Shahi Snan, or royal bath. (Danish Siddiqui/Reuters)

To put that in perspective, 40 percent of Americans, 50 percent of Britons and 60 percent of Israelis have received at least one vaccine dose.

Yet globally, the U.S., the U.K. and Israel are outliers. So far, just 33 countries have administered one vaccine dose to at least 20 percent of their residents. The other 160 or so haven’t — and more than 100 of them are lagging even further behind than India.

Epidemiologists tend to tell Americans they should care about these inequities because they pose a direct risk to America’s progress against the pandemic in the form of variants, or mutant versions of the virus that can potentially dodge immunity, evade vaccines and/or transmit more efficiently from person to person. Why? Because dangerous variants are most likely to evolve in places where spread is high and lots of people are sick for long periods of time.

And it’s true, for what it’s worth, that India is now battling a concerning variant of its own. Called B.1.617, it is a “double mutant,” with a pair of protein-spike changes that may increase its transmissibility and help it partly resist immunity. Scientists are still trying to figure out what role, if any, B.1.617 is playing in India’s surge. To be safe, the U.K. on Monday banned travel from India, and Prime Minister Boris Johnson canceled his own trip there.

The bottom line, however, is that India — with its relative lack of prior immunity, its slow rate of vaccination, its mass gatherings and its close quarters — was vulnerable to a massive COVID-19 surge even without a new variant making matters worse. And so are most other countries around the world.

A notice about the shortage of coronavirus disease (COVID-19) vaccine supplies is seen at a vaccination centre, in Mumbai, India, April 8, 2021. (Francis Mascarenhas/Reuters)
A notice about a COVID-19 vaccine shortage in Mumbai on April 8. (Francis Mascarenhas/Reuters)

By the same token, a country like the U.S. — home to just 4.3 percent of the world’s population but a full 23.9 percent of its vaccinations — is increasingly invulnerable. Even the risk of variants is likely overhyped in America: The existing vaccines still protect against them, and extra-effective booster shots are already in development.

So as U.S. supply starts to exceed demand — and as even the nation with the world’s largest vaccine maker struggles to vaccinate its own people — the question then becomes: What is America, with a population of 328 million, ultimately going to do with the rest of the 1.2 billion vaccine doses it has already secured?

“Now that we have experienced our own supply and it is sufficient for our entire population, [the United States] should shift gears to thinking about allocating any excess vaccines, as well as our own domestic manufacturing ability, to help other countries,” said Patel.

“That is something that we’re going to have to contend with as we are getting closer and closer to our own herd immunity … but other countries are significantly behind.”


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