When the coronavirus first struck India last year, the country enforced one of the world’s strictest national lockdowns. The warning was clear: A fast spread in a population of 1.3 billion would be devastating.
Though damaging and ultimately flawed, the lockdown and other efforts appeared to work. Infections dropped and deaths remained low. Officials and the public dropped their guard. Experts warned fruitlessly that the government’s haphazard approach would bring a crisis when a new wave appeared.
Now the crisis is here.
India on Saturday reported a daily record of 145,384 new infections as Covid-19 raced out of control. Deaths, while still relatively low, are rising. Vaccinations, a mammoth task in such a large nation, are dangerously behind schedule. Hospital beds are running short.
Parts of the country are reinforcing lockdowns. Scientists are rushing to track new versions, including the more hazardous variants found in Britain and South Africa, that may be hastening the spread. But the authorities have declared contact tracing in some places to be simply impossible.
Complacency and government missteps have helped turned India from a seeming success story into one of the world’s worst-hit places, experts say. And epidemiologists warn that continuing failure in India would have global implications.
Politicians in India, still stinging from the pain of the last national lockdown, have mostly avoided major restrictions and have even returned to holding big election rallies, sending mixed messages to the public. India’s vaccine rollout was late and riddled with setbacks, despite the country’s status as a major pharmaceutical manufacturer.
The sheer number of infections during the first wave led some to believe the worst was over. India’s youthful population, less susceptible to symptoms and death, created misperceptions about how damaging another outbreak could be.
What India needs now, epidemiologists and experts say, is concerted and consistent leadership to contain infections and buy time to make vaccinations more widely available and faster.
“Public behavior and administrative behavior matters,” said Dr. K. Srinath Reddy, the chairman of Public Health Foundation of India. “If we do something for six weeks, or four weeks, and then declare victory and again open the door wide open, then we are in trouble.”
A stricken India will set back the global effort. The government has restricted vaccine exports to the country’s own needs. If inoculations don’t quicken, India would need more than two years to inoculate 70 percent of its population, said Dr. Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics and Policy, with headquarters in Washington and New Delhi.
“India’s size is going to dominate the global numbers — how the world performs on Covid is going to be very dependent on how India performs on Covid,” Dr. Laxminarayan said. “If it is not over in India, it is not really over in the world.”
Prime Minister Narendra Modi on Thursday played down the possibility of another countrywide lockdown, instead pushing for “micro containment zones.” He said India could contain a second wave with “test, track, treat, and Covid-appropriate behavior.”
Mr. Modi’s officials have blamed mismanagement by state governments, and the population’s flouting of safety measures such as masks and social distancing, for the new wave.
New research has identified unusual antibodies that appear to have caused, in rare cases, serious and sometimes fatal blood clots in people who received the Covid vaccine made by AstraZeneca.
Exactly why the rare reactions to the vaccine occurred is still a mystery.
Scientific teams from Germany and Norway found that people who developed the clots after vaccination had produced antibodies that activated their platelets, a blood component involved in clotting. The new reports add extensive details to what the researchers have already stated publicly about the blood disorder.
Younger people appear more susceptible than older ones, but researchers say no pre-existing health conditions are known to predispose people to the rare reaction. That is worrisome, they say, because there is no way to tell if an individual is at high risk.
Reports of the clots have already led a number of countries to limit AstraZeneca’s vaccine to older people, or to stop using it entirely. These cases have dealt a crushing blow to global efforts to halt the pandemic, because the AstraZeneca shot — easy to store and relatively cheap — has been a mainstay of vaccination programs in more than 100 countries.
The European Medicines Agency, the regulator for the European Union, has emphasized repeatedly that the clotting disorder is rare, and that the vaccine’s benefits far outweigh its risks. But when a side effect has the potential to be devastating or fatal — like the blood clots in the brain linked to this vaccine — some regulators and segments of the public are finding that the risk is unacceptable, even if it is extremely rare.
As of Sunday, European regulators had received reports of 222 cases of the rare blood-clotting problem in Britain and the 30-nation European Economic Area (the European Union plus Iceland, Norway and Liechtenstein). They said that about 34 million people had received the AstraZeneca vaccine in those countries, and that the clotting problems were appearing at a rate of about one in 100,000 recipients.
WHAT WE LEARNED
A highly infectious and more lethal variant first identified in Britain is now the most common source of new infections in the United States, the director of the Centers for Disease Control and Prevention announced this week.
That variant, B.1.1.7, has been found to be most prevalent in Michigan, Florida, Colorado, California, Minnesota and Massachusetts, according to the C.D.C. Until recently, the variant’s rise was somewhat camouflaged by the drastic drop in reported cases over all, lulling Americans into a false sense of security and leading to a relaxing of restrictions that researchers have warned was premature.
The variant is about 60 percent more contagious and 67 percent more deadly than the original form of the virus, according to the most recent estimates. Infected people seem to carry more of the B.1.1.7 virus and for longer, said Katrina Lythgoe, an evolutionary biologist at the University of Oxford.
At the moment, most Covid-19 vaccines appear to be effective against the variants. But public health officials are deeply worried that future iterations of the virus may be more resistant, requiring Americans to line up for regular rounds of booster shots or even for new vaccines.
“We don’t have evolution on our side,” said Devi Sridhar, a professor of public health at the University of Edinburgh in Scotland. “This pathogen seems to always be changing in a way that makes it harder for us to suppress.”
Health officials see an urgent need to expand vaccinations, which reduce transmission and therefore the virus’s opportunities to mutate. The United States is administering an average of about three million doses a day, up from roughly two million a month ago.
President Biden said on Tuesday that he was moving up the deadline to April 19 for states to make all adults eligible for a vaccine. Puerto Rico and Washington, D.C. said this week that residents 16 or older would become eligible for vaccinations on Monday, meaning all 50 states, the capital and the largest U.S. territory have now said they would beat or meet Mr. Biden’s call to accelerate their eligibility timelines.
Here’s what else we learned this week:
On Tuesday, the American Federation of Teachers, the second-largest U.S. teachers’ union, released a survey reporting that over 80 percent of association members had been vaccinated or had made a vaccine appointment. About 85 percent of members said their school was “operating on at least a part-time basis,” according to the survey.
As the United States struggles to emerge from the worst public health crisis in a century, the arrival of digital vaccine verification apps — a modern version of the World Health Organization’s “yellow card” that provides international proof of yellow fever vaccination — has generated intense debate over whether proof of vaccination can be required at all.
In Mississippi on Thursday, there were more than 73,000 vaccine appointments available as the state struggles to find enough people to inoculate. Though access remains a problem in rural Mississippi, experts say that the state — one of the first to open eligibility to all adults three weeks ago — may be a harbinger of what much of the United States will confront in the coming weeks, as increasing supplies enable most Americans who want the vaccine to easily make appointments.
She burst into the hospital morgue and the bodies were everywhere, more than a dozen of them in black bags on stretchers. She headed straight for the autopsy room, pleading with the guard in a black jacket: “Can I speak to the doctor who opened up my father?”
Olga Kagarlitskaya’s father had been hospitalized weeks earlier in a coronavirus ward. Now he was gone, cause of death: “viral pneumonia, unspecified.” Ms. Kagarlitskaya, recording the scene on her smartphone, wanted to know the truth. But the guard, hands in pockets, sent her away.
There were thousands of similar cases across Russia last year, the government’s own statistics show. At least 300,000 more people died last year during the coronavirus pandemic than were reported in Russia’s most widely cited official statistics.
Not all those deaths were necessarily caused by the virus. But they belie President Vladimir V. Putin’s contention that the country has managed the virus better than most. In reality, a New York Times analysis of mortality data shows, deaths in Russia last year were 28 percent higher than normal — an increase in mortality greater than in the U.S. and most countries in Europe.
“People didn’t know the objective situation,” Ms. Kagarlitskaya said. “And if you don’t know the objective situation, you are not afraid.”
For much of the last year, Russia has appeared more focused on the public-relations and economic aspects of the pandemic than on fighting the virus itself. After a harsh, two-month lockdown last spring, the government largely lifted restrictions last summer, a boon for public opinion and the economy, even as the disease spread more rapidly.
Outbreaks are ripping through workplaces, restaurants, churches and family weddings. Hospitals are overwhelmed with patients. Officials are reporting more than 7,000 new infections each day, a sevenfold increase from late February. And Michigan is home to nine of the 10 metro areas with the country’s highest recent case rates.
During previous surges in Michigan, a resolute Gov. Gretchen Whitmer shut down businesses and schools as she saw fit — over the din of both praise and protests. But this time, Ms. Whitmer has stopped far short of the sweeping shutdowns that made her a lightning rod.
“Policy change alone won’t change the tide,” Ms. Whitmer said on Friday, as she asked — but did not order — that the public take a two-week break from indoor dining, in-person high school and youth sports. “We need everyone to step up and to take personal responsibility here.”
It is a rare moment in the pandemic: a high-profile Democratic governor bucking the pleas of doctors and epidemiologists in her state and instead asking for voluntary actions from the public to control the virus’s spread. Restaurants and bars remain open at a reduced capacity, Detroit Tigers fans are back at the stadium and most schools have welcomed students into the classroom.
Ms. Whitmer’s new position reflects the shifting politics of the pandemic, shaped more by growing public impatience with restrictions and the hope offered by vaccines than by any reassessment among public health authorities of how best to contain the virus.