India, the world’s second-most populous country, is facing a deadly surge of the coronavirus, threatening the nation’s fragile healthcare system. As cases and hospitalizations soar, a photo of two men wearing oxygen masks lying side-by-side in the same hospital bed is going viral online after Reuters first reported the news. A surge of patients recently flooded Lok Nayak Jai Prakash Narayan Hospital (LNJP), one of the country’s largest COVID-19 facilities, in New Delhi, leaving staff overwhelmed.
It’s a nightmare no one should ever have to confront.
The Mysterious Case of India
Experts say the country is facing the second-worst outbreak in the world since the pandemic began. It recently became the country with the world’s second highest number of confirmed COVID-19 cases, just behind the U.S. However, it didn’t start out looking so grim.
India had largely avoided the worst of the pandemic last spring when western nations were experiencing some of the worst outbreaks on record.
When cases started to rise last fall, the country imposed some of the harshest lockdowns in the world, but it took several weeks for the number of cases to decline. Those restrictions were lifted at the beginning of this year.
Now, the country is facing its worst outbreak on record. Earlier this year, the country was reporting around 100,000 new cases a day. That number crossed 200,000 last Thursday.
Two to a Bed
The same night the country started reporting more than 200,000 cases a day, streams of ambulances converged on LNJP, one of the country’s only facilities with over 1,500-beds. Others arrived via bus and three-wheeled auto rickshaws. Patients ranged from the elderly to a newborn baby. The influx quickly overwhelmed staff, forcing them to assign two patients to the same bed.
Suresh Kumar, the hospital’s director, told Reuters, “We are definitely over-burdened. We are already working at full capacity.”
The facility expanded its COVID-19 ward from just 54 beds to over 300, but it’s already running out space. “Today, we have 158 admissions in Lok Nayak alone,” Kumar added. Almost all were severe cases.
He mentions the crowds of relatives gathering in the hot sun waiting for the bodies of their loved ones to be released from the mortuary. Several gas furnaces melted after running nonstop.
Kumar credits the spike to a new variant first detected in the U.K. known as B.1.1.7., which is currently causing around 40% of all cases in Asia. He says the variant spreads more easily and is harder to detect. Now that the strict lockdowns have been lifted, people haven’t been following basic safety guidelines, such as wearing a mask and practicing social distancing.
“People are not following the COVID guidelines. They are just careless,” he added.
“While new variants are surfacing in India, a decline in COVID-appropriate behavior such as wearing masks and social distancing is adding to their faster spread,” says Randeep Guleria, director of the All India Institute of Medical Sciences in New Delhi.
A Shocking Rise in Cases
With a population of over 1.3 billion in India, some experts believe the latest testing figures may not tell the whole story.
“From what has been reported, I think India definitely has the most infections in the world,” says Ramanan Laxminarayan, director of the Washington, D.C.-based Center for Disease Dynamics, Economics and Policy.
“For every 30 infections, you’re pretty much only picking up one as a case,” Laxminarayan adds. Even though the country’s testing capacity has increased, he believes the virus is running rampant. “I would still apply the 30-fold undercount even now,” he says.
If Laxminarayan is right, India’s true case number would stand at around 400 million infections, compared to 14 million being reported. “400 million infections in a country the size of India still means that a billion people are not infected. So, there’s still plenty of room for infection, even with a lot of people [already] being infected,” Laxminarayan says.
The rapid increase in cases has made it difficult to get patients into the hospital.
Prashant Mehra told reporters that he paid a broker for preferential treatment to get his elderly father into a local hospital. The hospital didn’t respond to requests for comments.
“He died after six or seven hours,” Mehra said. “We already asked for our money back.”
Indian officials are also crediting the surge to a double mutation known as “B.1.617”. While little is known about the new variant, Shaheed Jameel, a virologist at Ashoka University in Sonipat, says this “double mutant” accounts for 15-20% of samples from Maharashtra, the country’s worst-hit state.
“The two mutations are likely to improve the virus’s binding capacity to the receptors and evade antibodies,” he says.
Over 111 million Indians have been vaccinated against COVID-19, but Jameel would like to see more post-vaccination surveillance to see if vaccinated people are still getting infected. India is manufacturing and distributing the Oxford-AstraZeneca vaccine using the name Covishield at the Serum Institute of India, as well as the vaccine known as Covaxin, but more research is needed to see if it’s effective.