After a year-long global travel ban, safety debates, and strict lockdowns, I finally got the opportunity to visit my family in Delhi, India during late March this year. COVID cases in India had maintained a steady decline since November 2020, with an average of 10,000 cases/day reported country wide. Vaccination rollouts had successfully commenced in major cities for frontline workers and the elderly population aged sixty years and above. COVID-appropriate behavior like avoiding mass gatherings, social distancing, and wearing face masks had become the new normal. Being the 2nd most populated country in the world, since the onset of the pandemic in March 2020, epidemiologists had warned India to be analogous to a fire-pit, where if lit uncontrolled, COVID cases would spread like a wildfire. However, almost everyone in the country was complacent that India had successfully fought and controlled the spread of COVID-19.
Two weeks into my vacation, India was gripped by a devastating second wave of coronavirus that crippled the entire nation. On April 7th, India recorded a daily average of 100,000 new cases, and these numbers soared higher during the weeks to follow. The positivity rate in the capital, New Delhi, rose to 36% and statewide lockdowns were imposed. The steep increase in cases by the highly transmissible ‘Delta’ variant overwhelmed one of the best healthcare systems on the continent. There was an increasing shortage of healthcare equipment like ICU beds, oxygen cylinders, drugs, and injections. Even basic amenities like oximeters and thermometers were becoming harder to find.
On the ground, these numbers translated to devastating stories of individuals gasping for breath. The high transmissibility of this variant meant that if one person in the family was positive, the entire family would soon contract the virus, including children and young adults. The symptoms reported were more severe than those reported earlier in the pandemic, ranging from previously reported loss of smell and taste, dry cough and cold to debilitating body aches, weakness and fatigue, high fever, headache, loss of appetite, severe abdominal pain, and diarrhea. In the second week of the infection increasing numbers of people reported sudden drop in their blood oxygen levels, severe chest pain, and inability to breathe. These symptoms often lead to blood clots and heart attacks, and required immediate hospitalization. A majority of people who lost their lives belonged to the unvaccinated demographic ranging between forty-five to fifty-five years of age, orphaning many young adults in their twenties.
An over-burdened healthcare system resulted in shortage of trained staff and resources to handle the increasing load of RT-PCR testing. People were requested to stay at home upon onset of mild symptoms in an effort to save hospital beds for others in severe conditions. As a result, with no specific antivirals known, people were encouraged to do a course of strong antibiotics like azithromycin, multivitamins including Vitamin C and Vitamin E, zinc tablets, anti-diarrheals, and antipyretics with the onset of mild symptoms. News channels soared with stories of oxygen shortage even in well-established private hospitals, continuous debates between central and state governments playing the ‘blame games’ for the abysmal condition of the country, and overburdened crematoriums. Personally, I can never forget attending a funeral for a distant family friend virtually, the constant state of fear for the safety of my family and friends, mental exhaustion and disarray. For the first time since the start of the pandemic in March 2020, it truly felt like the inevitable end of the world, an apocalypse in totality!
It was heart wrenching to see social media abuzz with pleas for hospital beds, anti-viral Remdesivir injections, and oxygen cylinders. Volunteers groups composed of college students, retired government and military officials, religious groups, social workers, doctors from other countries, and people from all walks of life came together and worked day-and-night to report the availability of healthcare resources, manage contact tracing, provide emotional and psychological aid, or just help elderly and un-abled with groceries and transportation. Gurudwaras (holy place of worship for Sikhs) organized drives to feed the homeless and daily wage workers, healthy families cooked food to deliver to the families infected, both known and unknown. There were reports of doctors and nurses converting their homes into makeshift hospitals to admit patients due to the growing shortage of hospital beds, auto-rickshaw drivers transporting patients for free, and volunteers helping to cremate bodies of people who had died and didn’t have anyone to take care of the final rites. It was deeply inspiring to see a diverse nation like India, united in their sorrows, fighting the horrors of the pandemic together.
More than 400,000 lives have been lost within India since the start of the pandemic. Questions have been raised on the credibility of the state and central governments in power, political blunders like allowing super-spreader religious and political mass gatherings, government’s strategies to combat the situation, and most importantly the delay in vaccinating middle-aged and younger demographic of the country. While the steep rise in the number of positive cases was met with an equally steep decline in the positivity rate of infection, the second wave of the pandemic is far from being over. Availability of vaccines from multiple vendors, standardization of vaccine prices by the central government, and an increase in vaccination drive in both urban and rural India remain critical for the overcoming of the pandemic.
The resurgence of the devastating second wave of COVID-19 in India at the same time when COVID-19 restrictions were being relaxed in the other parts of the world, highlights the striking gap in equitable access to vaccines between developed and developing nations. Factors such as over-purchase of vaccines by rich nations to vaccinate their entire population several times over, lack of transparency in quoting global vaccine prices, stringent policies around intellectual property rights and technology transfer, and lack of adequate healthcare infrastructure are some of the major causes for this inequity. The second wave of the COVID-19 pandemic in India dealt a serious blow to The Serum Institute of India (SII), the largest vaccine producer of the world, and one of the major suppliers for vaccines under COVAX (global initiative to ensure rapid and equitable access to COVID-19 vaccines for all countries, regardless of income level). As a result, only 41 million doses of the initially planned 200 million doses have been rolled out by SII amongst more than 100 countries around the world, further exacerbating the problem. The delay in vaccinating developing countries severely threatens the social and economic recovery in developed nations by leaving large reservoirs of coronavirus circulating, providing grounds for the virus to mutate and transmit to developed countries. There have not been graver times than this to remember that we all see the same sunset. Let’s be united under humankind and adopt joint collaborative efforts to ensure equitable vaccine access throughout different parts of the world, thus pushing the pandemic to its end.
References
https://www.bbc.com/news/56987209
https://www.cnn.com/2021/06/04/opinions/india-covid-second-wave-reporter-intl-hnk/index.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106236/
https://www.bbc.com/news/world-asia-india-57225922
https://www.worldometers.info/coronavirus/country/india/
13.https://www.reuters.com/world/india/indias-30093-new-covid-19-cases-are-lowest-daily-figure-4-mths-2021-07-20/
https://www.wsj.com/articles/covax-covid-19-vaccine-11613577473?mod=article_inline
https://apnews.com/article/poorer-countries-coronavirus-vaccine-0980fa905b6e1ce2f14a149cd2c438cd
https://www.kff.org/policy-watch/global-covid-19-vaccine-access-snapshot-of-inequality/
https://www.who.int/news/item/03-12-2020-global-access-to-covid-19-vaccines-estimated-to-generate-economic-benefits-of-at-least-153-billion-in-2020-21
https://www.brookings.edu/blog/up-front/2021/02/11/rich-countries-have-a-moral-obligation-to-help-poor-countries-get-vaccines-but-catastrophic-scenarios-are-overrated/
https://www.un.org/press/en/2021/ecosoc7039.doc.htm