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CWA # 461, 25 April 2021

India and COVID-19
Deadly second wave spirals into a humanitarian disaster

  Lokendra Sharma

Only a month earlier, even as many countries around the world were grappling with mutant strains and surge in cases, India was returning to normalcy and celebrated an 'undeclared victory'. How did it then reach from there to a collapsing healthcare system? 

The nearly vertical infection curve, collapsing healthcare system, people dying due to shortages of beds and oxygen, and round-the-clock functioning crematoriums highlight the failure of the State to learn from the experiences of the first wave. India's worst humanitarian disasters in decades, this unpreparedness has cost it very dear.  

When India reported over 3.14 lakh COVID-19 infections on 22 April, it crossed a grim milestone - the highest daily infection recorded anywhere in the world. On 23 April, even this milestone was surpassed as the country reported over 3.22 lakh infections and 2,247 deaths, taking the total cases to 1,62,57,337 cases and deaths to 1,86,919.   

Only a month earlier, even as many countries around the world were grappling with mutant strains and surge in cases, India was returning to normalcy and celebrated an 'undeclared victory'. How did it then reach from there to a collapsing healthcare system? 

The collapsing healthcare system
The healthcare system has collapsed in major Indian cities, including Delhi, Mumbai, Lucknow, Ahmedabad and Bengaluru. With demand for beds, oxygen and drugs surpassing the supply by a large measure, India has witnessed, over the last two weeks, people dying in search of beds and oxygen, long lines outside hospitals, and round-the-clock working crematoriums. The situation is so grim that even the healthcare workers themselves cannot get beds in their own or other hospitals. Multiple reports highlight that many deaths are not being recorded across the country; this means that the official death figure could be a gross understatement of the humanitarian disaster unfolding currently. 

Even those who got admitted into hospitals have not been fortunate;  patients have died due to shortages of oxygen in hospitals. On 23 April, New Delhi's premier Sir Ganga Ram Hospital said that 25 patients had died due to a shortage of oxygen. Another 20 patients died at Delhi's Jaipur Golden Hospital due to oxygen shortage. In Madhya Pradesh's Jabalpur city, five patients died due to an oxygen shortage.  

Misplaced priorities of the political class
That a disaster is imminent was becoming clearer in late March and early April. Meanwhile, political leaders, cutting across Indian geography and party lines, were either busy holding political rallies or organizing religious congregations. PM Modi, Home Minister Amit Shah, Congress leader Rahul Gandhi and West Bengal Chief Minister Mamata Banerjee among others, held massive rallies in the poll-bound states, even as the cases were spiralling. Political leaders themselves did not observe the safety protocols, and some even downplayed the pandemic. 

While there might be no data to back the claim that elections in four states (West Bengal, Kerala, Assam, Tamil Nadu) and one Union Territory (Puducherry) led to rise in cases (which might be on account of low testing, suppression of data), that question is not relevant. What is relevant is that these elections diverted the entire administrative machinery of central and State governments towards organizing the elections. 

The above has diverted the attention of PM Modi. His recent meeting held on 23 April with chief ministers of 11 high burden states came too late. Chief ministers flagged various issues, including that of oxygen supply and vaccine pricing/availability. He asked states to ensure uninterrupted movement of medical oxygen. He also assured that the Railways and the Indian Air Force had been pressed into service. In a separate meeting with industrialists, he called on them to ramp up the manufacture of medical oxygen. On the same day, the central government also announced free 5 kg of food grains to the 80 crore beneficiaries under the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) for May and June, expected to cost INR 26,000 crores. Earlier, on 21 April, the government also extended the INR 50 lakh insurance scheme for healthcare workers for another year.  

Other pillars of democracy
While political leaders and the administrative machinery led by them performed poorly, other pillars of Indian democracy — the Supreme Court (SC), Election Commission of India (ECI) and the mainstream TV media industry — have also contributed to the crisis. 

The SC took a very delayed cognizance of the healthcare crisis on 22 April, only after various High Courts passed very critical orders and observations. On 23 April, unfortunately, despite the urgency of the oxygen crisis, the SC adjourned the matter to 27 April. In comparison, the various High Courts, including that of Delhi, have acted more responsibly. 

Even though the Election Commission of India (ECI) announced the election schedule in the poll-bound states before the crisis began, it did little to rein in political parties or various leaders once the crisis unfolded; these political actors continued to defy all safety guidelines. While the ECI has finally banned roadshows and vehicle rallies during the election campaign in West Bengal, it has allowed public meetings with up to 500 people. The ECI has been so toothless in West Bengal in enforcing guidelines that the Calcutta High Court recently warned that it would step in if the poll body failed to act. 

The mainstream media also failed to highlight people's sufferings and failed to hold the central and State governments accountable. Rather than flagging the unpreparedness of the healthcare system or giving early warning based on ground reports, most TV channels gave excessive coverage to the elections. And rather than holding the government accountable, they questioned the motives and intentions of the opposition parties. It is only when the magnitude of the crisis has assumed extreme proportions that they have changed their focus. 

False sense of security
The above is not just a result of state failure; it is also a failure of Indian people, especially those at the urban metropoles with privileged access to information and resources. 
After a trend of declining cases for four months (November 2020 - February 2021), people assumed that the pandemic had waned away. With this false sense of security, they observed safety protocols like distancing and masking more in violation and less in adherence. A narrative about the innate immunity of Indian people also surfaced and was readily bought by people; this happened even when epidemiologists have been continuously warning out about the imminent second wave. Whether this warning got transmitted to the masses is a separate question in itself. 

To conclude, the ongoing second wave has exposed the administrative inefficiency of the governments in both states and at centre and also highlighted the inadequacies of healthcare infrastructure to cope with any major crisis. Despite the experience of the first wave, and despite more than a year to build healthcare capacity, India did little on this front. The central government also did not spend enough resources and attention on studying the mutant strains, despite knowing the havoc they have wrecked in the UK and Brazil. These factors clubbed with the misplaced priorities of political leaders only made the humanitarian disaster inevitable. 

That some states are even disrupting the movement of oxygen tankers and that it requires the PM to ask states to ensure free movement highlights not just the desperation of states to secure oxygen, but also the strains in cooperative federalism in this moment of crisis when it is most needed. 

The only positive story so far, notwithstanding the delayed approval of the Sputnik V vaccine, is India's vaccination programme. According to the Health Ministry, India became the fastest nation to administer 13 crore doses in 95 days. Rolling out vaccines for all aged above 18 is a welcome development. 

This commentary is an expanded version of a brief story on the same issue published as a part of The World This Week alert.   


About the author
Lokendra Sharma is a PhD scholar in the School of Conflict and Security Studies, National Institute of Advanced Studies (NIAS), Bengaluru. He is currently researching in the field of Technology and International Relations. He also follows India's domestic political developments. 

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