India: the deadliest wave

India has been hit by a second wave of Covid-19, which appears to be more lethal than when it peaked in last September.

A report by medical journal Lancet indicated that India may witness 1,750 deaths daily rising to approximately 2,320 in the first week of June.

And so far, it is looking much more ominous.

As of Thursday, more than 300,000 cases in the last 24 hours have been recorded, while deaths also jumped by a record 2,104 fatalities.

In the worst affected Maharashtra, with the third highest population among 28 Indian states, the depth of the crisis can be witnessed over social media with desperate calls for beds in hospitals, oxygen and ventilators.

“I am really lucky,” said Amitabha Banerjee, an executive with a private insurance company.

A resident of Mira-Bhayandar, adjacent to Mumbai, Mr Banerjee’s mother was detected with coronavirus and he first tried to get her admitted in a private facility. He failed and admitted her in one of top of line hospitals of India, INHS Asvini, run by the navy.

“Even then I was surprised. It is possibly one of the best hospitals in the country and by early April it was overflowing. INHS Asvini had a severe shortage of beds which they managed to arrange by the time my mother was released in two weeks. But the shortage of personnel was evident,” said Banerjee.

“If this is what it was in early April in the top hospital, I am scared to think of the situation now.”

But the hospital staff saw it coming, says Dilnaz Boga, a journalist.

About two weeks back, when she made rounds of mostly private hospitals – owing to illness of family members – she noticed how the facilities were ramped up.

“Beds were getting added and the nurses told me that the number of cases had risen and it was not in the media but hospitals could see it coming,” she said. Now, she had to wait for three days to arrange for tests in the private clinics.

A viral video shows one of Mumbai’s top Lilavati hospitals busy setting up the makeshift beds in its sprawling lobby outside the elevator, while reports – which reads like nightmares on print – are appearing from various states.

At least five bodies are being cremated in one pyre – following Hindu rituals to dispose of their dead – in Gujarat, while crematorium in Uttar Pradesh augmented the pyre platforms to negotiate the rush to cremate.

From a week’s moving average of little over 93,000 cases in the middle of last September, the active cases in India has jumped to 205,000 last week after hitting a low of about 11,000 in mid-February, indicated Johns Hopkins University.

India has added the highest ever 121,576 cases on Sunday rallying only behind the United States with over 32 million cases. Maharashtra alone accounts for 38 percent of the total active caseload in the country.

Meanwhile a bitter war of words broke out between Maharashtra government led by regional party Shiv Sena and centrally governing Bharatiya Janata Party (BJP). Shiv Sena has accused the central government of ‘limiting’ oxygen and Rendesivir supply. The allegation is denied by BJP.

The good part

Compared to last September, when the case fatality rate (CFR) was 1.7 percent, “strikingly low” compared to world average, on Saturday, it was 1.2 percent, reported Indian media.

But it may not remain so, warned Dr Sanjay Nagral, a Mumbai based surgeon who publishes Indian Journal of Medical Ethics, a peer reviewed journal.

Dr Nagral said, two weeks back the number of cases in Mumbai was between 10 and 20, while it is between 50 to 60 now.

“The number of cases is certainly larger than last time (2020) but mortality is low. Usually deaths follow the cases and perhaps it is little early to predict if it would remain low. By end of April or May we will have a clearer mortality rate and a better idea to predict,” he said.

He is worried about the prevalence among younger people, even children.

“I am not sure if it is more worrying but there is definitely a big question mark. We have seen elderly need isolation. Now, if young people need isolation the job would be doubly difficult, given the capacity of facilities,” he said.

Realising the depth of the calamity the municipal corporation of greater Mumbai is setting up what it describes as ‘jumbo centres.’

In addition to six existing jumbo centres for Covid patients, four more will be ready by “mid-may to early June”, a senior official of the corporation Sanjeev Jaiswal told the journalists. Each new centre will have 300 to 2000 beds and 200 intensive care units.

The functional jumbos are not bad, certified Swapna Katalkar (whose name has been changed), a 40-year-old NGO worker.  

A resident of Chunabhatti slum, Ms Katalkar said she is “happy” with the government’s Covid centre at Powai, where her husband, a security guard, was admitted on April 11.

“The food is good, so are the rooms. He sent a video,” she said. Ms Katalkar is rather worried about her husband’s pay cut.

“If he cannot go to work for 15 days (the quarantine period), then he would get half of his salary of Rs 13000 ($180),” she explained.

Dilnaz Boga feels the pandemic is “about saving livelihood and survival.”

The livelihood issue

As per the 2011 census, India has 450 million internal migrant workers, or 37 percent of the country's population. Mumbai being business nucleus attracts migrant workers from poorer parts of east, north and central India.

“Half of Mumbai’s 20 million people are casual workers with no guarantee of jobs or income,” said Bilal Khan, an activist with a housing right movement for the slum workers, Ghar Bachao, Ghar Banao (save home, make home).

The disjointed pockets of slum colonies houses hundreds of thousands of migrant workers who are not paid half government specified daily wage, said Mr Khan.

Interestingly, it is not the slums, with a deep congestion of dwellers, but the high rises which are reporting cases.

“When I go out for morning walks, I notice scores of upper or middle class high rises with boards indicating presence of Covid patients,” said Amitabha Banerjee. Dr Nagral confirmed that the cases from slums are low.

“The pressure on public hospitals is less than private ones but again it could be early days. Possibly after a month we would be able to assess if there is a drop in cases in slums and why it is so,” Dr Nagral said.

Md Umar Sheikh, 55, who had a tiny sling bag manufacturing unit in Mankhurd-Mandala area, provided the answer.  

“The workers fear loss of jobs if they test positive and never get themselves tested,” said Sheikh, who too has shut his unit.

The Maharashtra government has announced a 15 day lockdown on April 15, shutting most of activities. It has hit the casual migrant workers who earn about $5 a day.

“A lockdown call is the easiest way to suppress the crisis,” said Sheikh.

Akhilesh Rao, another activist of housing rights campaign, shut down his car rental service after last years’ lockdown failing to pay bank loans. This year he loaned again to start a garments manufacturing unit but shut that too.

“I have asked the boys to leave as I cannot pay them anymore,” he said.

“Everyone is finished. The construction workers used to stand in particular points in the city to get hired and now they cannot assemble. They want to go back home in other states but cannot as they do not have enough money to buy tickets,” said Mr Rao.

The government is ready to help ‘registered’ workers and Mr Khan claims that “over 90 percent of the casual workers” are not registered.

“They do not have a salary, they do not have enough for two square meals a day with children and burdened with loans which they availed to survive during last year’s lockdown,” said Khan.

He thinks in the prevailing situation it is not possible for the workers to disclose their sickness voluntarily and lose the thin potential to get work after a fortnight.

“Those who cannot afford food cannot go for treatment, as they will starve in any case, now or later,” said Mr Khan. The government, he says, continues to justify lockdowns by citing Europe’s policy to shut cities.

“But Europe also has social security for workers,” said Khan.

The situation is more or less the same across India and successive lockdowns may have placed India on a powder cake.

The public health officials accede that India’s Covid combat response was about controlling public behaviour, instead of sprucing up the health system.

“The entire onus shifted on the people and we have to pay a price for this,” an official said on condition of anonymity.

Meanwhile, nearly 13 million doses of vaccines are administered in India which is “very encouraging”, the official said.