Doctor explains why the 2nd wave of COVID-19 is devastating India

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People in India are "desperately" trying to get hospital care as the country faces another day of record-breaking COVID-19 cases, says Dr. Srinath Reddy.

There have been more than 330,000 new cases in the last 24 hours, India's health ministry said Friday. That's the highest daily infection rate of any country in the world. The death toll on Friday was more than 2,200, which is also a new high for the country.

The Indian government wasn't expecting the second wave to get this bad, let alone take place. In March, Health Minister Harsh Vardhan said the country was "in the endgame" of the pandemic.

Reddy is the president of the Public Health Foundation of India. As It Happens guest host Nil Köksal spoke with him about the renewed COVID surge. Here is part of their conversation.

Dr. Reddy, what is it like for COVID patients in India's hospitals right now?

It's varying from state to state. The southern states are doing quite well.... They've always had stronger health systems, much better organized. 

But the states in northern India, particularly Delhi and the surrounding region, Uttar Pradesh, for example, they're all having a terrible time.

If we were to walk into one, what would we see?

In many of these places, there is a great rush for beds, which are not available in the hospital. Even getting a hospital admission is becoming extremely difficult. And unfortunately, this has been compounded by a shortage of oxygen ... and that's created a crisis. 

There are emergency measures being taken to ensure that oxygen from other states reaches Delhi. The government of India has even ordered 23 oxygen generation plants to be airlifted from Germany for the armed forces hospitals ... [which are now] also opening up for non-military personnel for treatment. 

One member of parliament tweeted out a plea for more oxygen tanks. [He said,] "These people will die just like fish die in the absence of water." How is it that hospitals don't have enough oxygen tanks?

They never expected so many patients to be requiring oxygen. 

And the supplies from the other states, which would have been generating oxygen ... [and then] transporting [it] to other states, they started retaining, thinking that they are coming under pressure themselves. 

But now the central government has stepped in invoking the Disaster Management Act. They said that all interstate transport will be unhindered and protected.

How did India get to this point?

There was a sense of false comfort.

From September and onwards, the cases on a daily case count basis, the daily deaths, as well as the test positivity rates, all started declining. And by January, they had reached a very low point, each one of them. 

The feeling came not only that the first wave had ended, but the pandemic had completely passed India for the second wave. There were all kinds of estimates made that herd immunity had arrived and India would not actually see the pandemic again ... and that led the public to feel that they could go about the full flow of normal life. 

Even the public administration and the political leaders felt that India could actually return to accelerating its economic growth, which had suffered during the pandemic and was a bit slow before that as well. 

So [we had] the complete abandonment of caution and [allowed] superspreader events, large gatherings, to take place whether for political or for religious reasons.

And [then came] the emergence of three variants in different parts of the country, one from Britain ... B117, affecting Punjab, Delhi and the surrounding states. The double-mutant coming up in Maharashtra. And now a triple-mutant coming up in West Bengal.

What about all the vaccines India has been producing? Why aren't those helping?

The essential workers were first vaccinated ... then people above 60, people above 45 with health conditions, [and] then all people above 45. 

All this was sequenced, thinking that there was no rush in order to protect everybody at once because it was thought that we are not going to have a second wave again.

And that's why India started exporting to 80 countries and it felt that it could easily manage with the production of vaccines that were already receiving regulatory approval in India. 

With the surge that has happened, now there is a sense of urgency that we need to vaccinate in a hurry. 

Therefore, firstly, exports are being stopped. We are beginning to import some of the vaccines which have been approved by foreign regulators while stepping up the domestic production of those vaccines ... plus other ones also being now produced in India under licence.

But one more factor is that, unfortunately, this scale-up is also dependent upon the availability of some small ancillaries and some reagents which are usually sourced from the United States. The invocation of the Defence Production Act by the Trump administration, and now carried on by the Biden administration in order to protect the resources for the United States itself, whether it's vaccines or personal protection equipment or testing kits, means that some of these relatively minor but essential ancillary reagents, bags and single-use tubing are not reaching India. 

Therefore, [while] our vaccine capacity for manufacture [is gearing] up substantially, it will be critically dependent upon the resumption of these ingredients coming into India.

At last count, India has close to 16 million confirmed infections. What is the way forward for India here?

It is a very grim situation. But obviously the solutions are very clear.

Everybody has to wear a mask when moving out of the house.

It is also important that the administration, everywhere in India, ensures that superspreader events with large gatherings do not take place.

Third, we must try and provide home care in an efficient manner because 80 per cent of the people do not need hospitalization. And now there is a rush to hospitals because nobody is sure what will happen to them if they stay back home…. The right kind of primary care support can actually reduce the pressure on hospitals.

And finally, we need to speed up vaccination efforts. 

If we do all of these things properly, then we'll be able to tide over. Though we have actually landed ourselves in a crisis through our complacence.

Written by Mehek Mazhar. Interview produced by Niza Lyapa Nondo. Q&A edited for length and clarity.