New cases of COVID-19 are declining in India but the health system is failing and daily deaths continue rising, writes MedicalBrief. There have been horror stories of bodies in streets and rivers while hospitals overflow, as cases topped 25 million this week. Only one in 10 of India’s 1.4 billion people have received a vaccine dose and illicit markets for drugs and treatment supplies have emerged as people try desperately to fend for themselves.
According to CNN, India reported 4,529 new COVID related fatalities on Wednesday morning, 19 May 2021 – the highest daily death toll the country has seen since the start of the pandemic. This brought total COVID deaths to 283,248. “India has reported more than 3,000 new COVID deaths every day since 28 April,” said CNN.
The Economist calculates actual deaths from COVID to be much higher – as many as one million according to a model it has constructed based on excess deaths.
“Our model suggests the country is seeing between 6,000 and 31,000 excess deaths a day, well in excess of official figures around the 4,000 mark. This fits with independent epidemiological estimates of between 8,000 and 32,000 a day.”
Now India’s second wave, along with a possibly more contagious variant first identified there, appears to be spreading across the region.
Better news, published on Monday in the Indian Express, was the announcement by Indian company Bharat Biotech that its COVID-19 vaccine Covaxin has been found to be effective against coronavirus strains found in India and the United Kingdom.
Citing a study published in peer-reviewed medical journal Clinical Infectious Diseases, the Hyderabad-based vaccine major noted that vaccination with Covaxin produced neutralising titres against all key emerging variants tested, including B.1.617 and B.1.1.7, first identified in India and the UK respectively.
COVID-19 cases are stabilising in some states, rising in others
At the weekend, India reported its smallest daily increase in coronavirus infections in nearly three weeks and federal health officials said cases and fatalities were rapidly stabilising, wrote Swati Bhat and Manas Mishra for Reuters.
The overall rate of positive cases per tests dipped to 19.8% from 21.9% a week before, federal health officials said. Last week the country added about 1.7 million new cases and more than 20,000 deaths in a pandemic that has overwhelmed hospitals and medical staff.
Randeep Guleria, director of AIIMS Hospital in Delhi, warned that secondary infections like mucormycosis or ‘black fungus’ were adding to India's mortality rate with states having reported more than 500 cases recently in COVID-19 patients with diabetes.
Prime Minister Narendra Modi told officials to focus on distributing resources including oxygen supplies in hard-hit rural areas, according to a government statement, Reuters reported. He also called for more testing in India's vast countryside, which is witnessing a rapid spread of the virus.
The World Health Organization said India was a huge concern. WHO head Tedros Adhanom Ghebreyesus tweeted that 4,000 WHO-supported oxygen concentrators arrived in Delhi last Saturday and were being rushed to states to support the COVID-19 response.
Reuters reported that police were patrolling the banks of the Ganges in India's most populous state of Uttar Pradesh – home to 240 million people – to stop dumping of corpses in the river, a government official said.
Every now and then, 10 to 20 bodies were being recovered from the river, said Navneet Sehgal, a spokesman for the state. “We have put a police force on the river and have also sent communications to local authorities that this practice be stopped.”
Some riverside villages did not cremate their dead in line with Hindu tradition during certain periods of religious significance, he told Reuters.
Cases have fallen steadily in some states hit by an initial surge in infections, such as the richest state of Maharashtra and the capital New Delhi, after they imposed strict lockdowns. Delhi has extended its lockdown to 24 May. But some states – such as West Bengal and Karnataka – reported recent rises, implying that a fall in overall cases is still some time away.
A desperate India falls prey to COVID scammers
As India’s health care system fails, clandestine markets have emerged for drugs, oxygen, hospital beds and funeral services, wrote Hari Kumar and Jeffrey Gettleman for The New York Times on 16 May.
Within the world’s worst coronavirus outbreak, few treasures are more coveted than an empty oxygen canister. India’s hospitals desperately need the metal cylinders to store and transport the lifesaving gas as patients across the country gasp for breath.
So a local charity reacted with outrage when one supplier more than doubled the price, to nearly $200 each. The charity called the police, who discovered what could be one of the most brazen, dangerous scams in a country awash with coronavirus-related fraud and black-market profiteering.
The police say the supplier had been repainting fire extinguishers and selling them as oxygen canisters. The consequences could be deadly: the less-sturdy fire extinguishers might explode if filled with high-pressure oxygen.
The coronavirus has devastated India’s medical system and undermined confidence in the ability of Modi’s government to treat its people and quell the disease. Hospitals are full. Drugs, vaccines, oxygen and other supplies are running out.
Pandemic profiteers are filling the gap. Medicine, oxygen and other supplies are brokered online or in hushed phone calls. In many cases, the sellers prey on the desperation and grief of families, according to The New York Times.
Sometimes the goods are fraudulent, and some are potentially harmful. Last week, police in the state of Uttar Pradesh accused one group of stealing used funeral shrouds from bodies and selling them as new. The day before, officers in the same state discovered more than 100 vials of fake remdesivir, an antiviral drug that many doctors are prescribing to treat COVID.
Over the past month, New Delhi police have arrested more than 210 people on allegations of cheating, hoarding, criminal conspiracy or fraud in connection with COVID-related scams. Similarly, the police in Uttar Pradesh have arrested 160 people.
“I have seen all kinds of predators and all forms of depravity,” said Vikram Singh, a former police chief in Uttar Pradesh, “but this level of predation and depravity I have not seen in the 36 years of my career or in my life.”
The scams and profiteering represent the flip side of the huge online help system that has emerged to fill the void left by the government. Do-gooders across the country have swooped in to connect those in need with lifesaving resources.
But the ad hoc system has limits. Vital supplies like oxygen are still stuck in bottlenecks, and people keep dying after hospitals run out. Vaccine and pharmaceutical makers can’t keep up. Politicians in some places are threatening people who publicly plead for supplies, The New York Times continues.
That empowers the black market, with its exorbitant prices and dicey goods. Many people feel they have no choice. Other examples include selling access to beds, a brisk market for contraband plasma, and a number of scams involving remdesivir and fake drugs.
Why India’s second COVID-19 surge is much worse than its first
The Wall Street Journal used six charts show how a hasty reopening, new variants and a struggling vaccine rollout allowed the coronavirus to stage a comeback.
Now in the middle of a devastating COVID-19 surge, the current situation is a far cry from just five months ago, when the country had seemingly tamed a first surge of the pandemic, writes Josh Ulick in the story published on 15 May.
What’s different this time around?
One factor, explains the newspaper, is a false sense of security. India’s first surge peaked in September, when newly reported cases were approaching 100,000 a day. By the start of this year, that number had dropped by 80%. Meanwhile, the other hard-hit countries – US and Brazil – were facing rapidly rising caseloads.
With the outbreak ebbing this winter, Indians eased up on mask-wearing and social distancing. Life was returning to normal, with visits to malls, movies and restaurants approaching pre-pandemic levels. Political rallies and religious festivals, where masses of people crowded together, potentially served as “super-spreader” events.
A second factor has been the rise of the variants. Just as India was opening up, new coronavirus variants were gaining hold in the population. These include the one first detected in the U.K., as well as B.1.617, which was first identified in the state of Maharashtra and has since gone on to become the dominant variant on the subcontinent.
Last week WHO said B.1.617 may spread more easily than earlier versions of the virus and classified it as a global “variant of concern”, along with the ones first detected in the UK, Brazil and South Africa.
Despite occupying a different branch of the coronavirus family tree, B.1.617 has developed several of the mutations found in these other variants, as well as related mutations affecting the same stretches of genetic code.
Third has been the slow pace of vaccinations. Swelling infections have given new urgency to India’s efforts to vaccinate its massive population. The country has grappled with logistics challenges and raw-material shortages that have hampered its inoculation campaign, writes The Wall Street Journal.
Last month, it suspended vaccine exports to give priority to domestic needs. The country has fully inoculated less than 3% of its 1.4 billion people. This is the lowest rate among the 10 countries with the most Covid-19 cases.
How India's vaccine drive went horribly wrong
Narendra Modi's federal government opened up COVID vaccinations for some 960 million eligible Indians without having anything close to the required supply – more than 1.8 billion doses – wrote Nikhil Inamdar and Aparna Alluri for BBC News last Friday.
A cocktail of blunders – poor planning, piecemeal procuring and unregulated pricing – by Modi's government has turned India's vaccine drive into a deeply unfair competition, public health experts told the BBC.
How did the world's largest vaccine manufacturer, often dubbed the ‘pharmacy of the world’ for generic drugs, end up with so few vaccines for itself?
"India waited till January to place orders for its vaccines when it could have pre-ordered them much earlier. And it procured such paltry amounts," says Achal Prabhala, a co-ordinator with AccessIBSA, which campaigns for access to medicines in India, Brazil and South Africa.
Between January and May 2021, India bought roughly 350 million doses of the two approved vaccines – the Oxford-AstraZeneca jab, manufactured as Covishield by the Serum Institute of India (SII), and Covaxin by Indian firmBharat Biotech.
At $2 per dose, they were among the cheapest in the world, but not nearly enough to inoculate even 20% of the country's population.
Declaring that India had defeated COVID, Modi even took to "vaccine diplomacy", exporting more jabs than were administered in India by March.
India also waited until 20 April – well into the second wave – to extend a $610m financing line to SII and Bharat Biotech to boost production.
Another failure, according to Malini Aisola, co-convener of the All India Drug Action Network, was the decision not to enlist the vast swathe of India's manufacturing capabilities – biologics factories, for instance, that could have been repurposed into vaccine production lines.
Four firms have only recently been given rights to make Covaxin, which is partially publicly-funded. BBC News continues:
As the sole buyer initially, the federal government could have held far greater leverage over pricing, Aisola says. "Centralised bulk procurement would have allowed the price to come down from $2. Instead it has gone up," she adds. This is because since 1 May, it has been up to individual states and private hospitals to broker their own deals with manufacturers.
States have to pay double – $4 – the federal government's rate for a dose of Covishield and four times as much for Covaxin – $8. This was after the two companies lowered prices for states as a "philanthropic gesture". States are also competing for scarce stocks alongside private hospitals, which can pass on the costs to customers.
The result: a veritable free market for vaccines that have been developed and manufactured with both public and private funding. At private hospitals, a single dose can now cost up to 1,500 rupees ($20).
Several states have now announced plans to import other vaccines from Pfizer, Moderna and Johnson & Johnson. But no manufacturer is able to guarantee supply in the next few months since richer countries have pre-ordered stocks.
Some have accused SII and Bharat Biotech of "profiteering" during a pandemic, especially after receiving public funding. But others say they took substantial risks and that the fault lies with the government. India is the only country where the federal government is not the sole buyer, and one of the few where vaccinations are not free.
The Economist story – Modelling COVID-19’s death toll (Restricted access)
New York Times story – A desperate India falls prey to COVID scammers (Limited access)
BBC News – How India's vaccine drive went horribly wrong (Open access)
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