Via The New Yorker, another excellent report by Dhruv Khullar: Inside India’s COVID-19 Surge. Excerpt:
The tale of the Indian pandemic is both mysterious and familiar. For much of the past year, the world’s largest democracy—with a population of some 1.4 billion living on a landmass a third the size of the U.S.—escaped the worst.
Researchers have advanced all sorts of theories to explain this outcome. They point out that India is a young country, with a median age of twenty-eight; that it instituted an early and strict lockdown; that it has undercounted cases and deaths; and that Indians may have had some level of preëxisting immunity to the novel coronavirus, owing to exposure to similar viruses in the past. Studies have indicated, perplexingly, that more than half of the residents in some dense urban centers had previously been infected, even though their hospitals hadn't filled up.
None of these explanations have been fully proved, and, separately or in combination, they may not account for why India was spared last year. That debate will likely continue for a long time to come.
The reasons for the country’s current surge, on the other hand, appear straightforward. Since the New Year, there’s been a substantial relaxing of public-health precautions. Mask-wearing declined; sporting events, political rallies, and religious festivals brought large numbers of people close together. Lacking a sense of urgency, the country’s vaccination campaign proceeded slowly: India is the world’s leading manufacturer of vaccines for a wide range of diseases, but has fully immunized roughly two per cent of its population against covid-19.
Many assume that the rise of more contagious variants is accelerating the damage. Almost certainly, B.1.1.7—originally identified in the U.K. and now dominant in many countries, including the U.S.—is contributing to India’s viral spread. But a new variant, known as B.1.617, has also captured headlines and the attention of scientists and the general public. The predominant form of the variant, misleadingly referred to as the “double-mutant”—it has at least thirteen mutations—was first detected in December. B.1.617 has several mutations on its spike protein, including E484Q and L452R, which seem to increase the virus’s ability to bind to and enter human cells, and which may improve its capacity for evading the immune system. Some scientists have hypothesized that another mutation, P681R, could improve the variant’s ability to infect cells.
Still, the role played by B.1.617 in India’s crisis is uncertain. India has sequenced only about one per cent of positive coronavirus tests, rendering claims about the relative contribution of variants hard to disentangle from other factors, such as a rise in unrestricted gatherings in a densely populated country with limited health-system capacity. In any case, Covaxin—India’s domestically developed covid-19 vaccine—appears to work against both B.1.1.7 and B.1.617. Arora told me that, although several fully vaccinated clinicians at his hospital have recently contracted the virus, none went on to develop severe disease—exactly the kind of protection the vaccines are designed to deliver.
Last week, the Biden Administration announced that the U.S. would send a hundred-million-dollar aid package to India, including testing kits, ventilators, oxygen cylinders, and P.P.E. The U.S. has also removed restrictions on exporting raw materials for vaccines so that India can increase its production. Last weekend, syringes, oxygen generators, and ventilators poured in from across Europe, and a hundred and fifty thousand doses of Sputnik V, Russia’s vaccine, landed in Hyderabad. The Indian diaspora has committed tens of millions of dollars in aid.
Whether these interventions will be enough remains to be seen. In a country as large, diverse, and bureaucratically complex as India, the logistical challenges of converting aid into impact cannot be overestimated. Meanwhile, the Indian experience holds a deeper lesson for the world—especially for wealthy countries that have hoarded vaccines and supplies. The constellation of forces that led to India’s crisis—pandemic fatigue, the premature relaxation of precautions, more transmissible variants, limited vaccine supplies, weak health-care infrastructure—is not unique; it’s the default in most of the world. Absent a paradigm shift in our approach, there’s no reason to believe that what’s happening in India today won’t happen somewhere else tomorrow.
