What does a health care catastrophe in a country of almost 1.4bn people sound like? Ambulance sirens wail night and day, phones beep relentlessly with messages of new Covid-positive diagnoses, desperate pleas for help, brief announcements of lives lost. Newscasters on most mainstream channels report on the numbingly grim scenes, but with little analysis and no demands for accountability. This, of course, is the soundtrack for anyone lucky enough to be cloistered at home merely fearing the worst. Others who have to travel to work, or seek medical treatment, will have heard and seen far worse.
India is in the grip of a public health calamity, reporting almost 350,000 coronavirus cases on 25th April, the highest number recorded in one day in any country since the pandemic began. Hospitals have been pushed beyond all capacity; people are dying laid on stretchers in car parks or in stationary ambulances; metal equipment in crematoriums has melted from the sheer number of bodies. Some of India’s finest hospitals have begun announcing on Twitter how long they have before their oxygen supply runs out: two hours, one hour, 30 minutes.
How did we get here? After one of the strictest and most sudden lockdowns in the world last March, precipitating an enormous crisis for migrant workers within India, when restrictions were eventually lifted Covid numbers surged in July and August. Cases and deaths began to decline in September, creating the breathing space to take stock, conduct scientific evaluations and assess health care capacity, if those responsible had been willing to do so. That month India’s health minister, Harsh Vardhan, stated that the government was “well prepared to deal with any kind of contingency that may arise.” The following month his ministry released a protocol which included herbal treatments and yoga to prevent Covid and to treat mild symptoms, prompting stern questions from the Indian Medical Association.
In January, Narendra Modi made an exultant address to the World Economic Forum in Davos on India’s “success and potential” in the face of coronavirus. Three weeks later the governing BJP’s National Executive passed a resolution stating that “India not only defeated Covid under the able, sensible, committed and visionary leadership of Prime Minister Modi, but also infused in all its citizens the confidence to build an Atmanirbhar Bharat (self-reliant India).” An assessment of the situation driven by triumphant exceptionalism and dangerous politicking led many in the country to genuinely believe that India had beaten Covid. Public behaviour started to revert to its pre-pandemic ease, often led by affluent Indians who resumed their circuits of parties, weddings and holidays. In February, case numbers began to rise.
The list of continuing failures and abdications of responsibility speak for themselves. Genome sequencing, which could have provided vital information about the trajectory of the virus and new variants, was gravely neglected. The $1.3bn PM-Cares fund, which was set up days after the first national lockdown, remains a shadowy project, its precise purpose and expenditures protected from all scrutiny. The government was aware of the dangers of a Covid-related oxygen shortage as far back as April 2020; yet it took the Modi government almost eight months to invite bids for new oxygen generation plants. Only a fifth of the planned number have been installed, not all of them operational. India’s national scientific taskforce on Covid did not even meet in February and March this year, even though signs of an impending, serious second wave were evident in mid-February. Instead, election rallies were planned in five states and the Kumbh Mela, a huge Hindu religious gathering scheduled for next year, was brought forward and over a million people each day congregated in Haridwar. The central government has declined to treat vaccines as an essential public good to be provided for free: in the future, their cost will have to be borne by individual states or citizens themselves. Meanwhile, official data-fudging, state propaganda and censorship continue apace.
While there has been a country-wide collapse of the health care system, how individual Indians have fared has depended on where they live. Kerala, while ill-prepared for this second wave, has one of the more successful vaccination programmes in the country, and from mid-April imposed lockdown restrictions in hundreds of mini-containment zones, ramped up testing and now has a triage system involving primary health centres, ward health groups, medical colleges and empanelled private hospitals. In Uttar Pradesh, on the other hand, the state government mandated that patients seeking hospital treatment for Covid would need a letter from the Chief Medical Officer, a bureaucratic demand that would be difficult to comply with at the best of times, let alone during an uncontrollable pandemic. Local reporters have called it a failure of the system.
As with any catastrophe, the best and worst of human nature have been on display. People have formed groups on social media to share information on the availability of oxygen, hospital beds, ventilators and essential drugs. Food delivery services have sprung up in people’s kitchens, sending out food free or at minimal cost to homes where almost every person has been laid low by the virus. Volunteers have organised outreach programmes to call vulnerable and isolated women to offer help and support, including single mothers, elderly women and sex workers. In Mumbai, Rozy Saldanha, a housebound woman with a chronic kidney complaint, was celebrated in the local press after donating her spare oxygen cylinder to a Covid patient and selling some jewellery to donate eight more. Health care and sanitation workers, as well as journalists deeply committed to seeking the truth, have had to push themselves to the limit while facing the greatest risks.
As for the worst aspects, ruthless black markets have sprung up, with the antiviral drug Remdesivir and oxygen cylinders being sold to panic-stricken family members for at least ten times their normal price. Meanwhile, as cases soared in mid-April, an unmasked Modi boasted at an election rally in West Bengal that there were people as far as the eye could see. And when Sitaram Yechury, the general secretary of one of India’s main communist parties, announced on Twitter that he had lost his son to Covid, the vice-president of the BJP in Bihar tweeted that “the Chinese supporter’s son” had died from “Chinese corona.” He later deleted the tweet but we all saw it—just as he had intended.
There is an overwhelming sense of desperation, fear and anger as deaths continue to mount. We have little idea of what is happening in those remote parts of the country that are beyond the orbit of social media and the mainstream press. Almost a sixth of the world’s population is steeled, utterly helpless, for what the next hour or day could bring. The graveyards are full. The funeral pyres burn long into the night, queues of more bodies snaking into the distance. The noise continues: the sirens, the beeps. And taken with the silences, they make up the sound of an entire citizenry abandoned at their greatest hour of need by those who hold highest office, entrusted to serve and protect them.