Did India not prepare for the COVID-19 crisis?
Data and numbers do not support this biased view.
by Anil Sangwan
5 May 2021
There has been intense concern expressed across the world about the sharp increase in COVID-19 cases in India. There should be. India is the pharmacy of the world and produces sixty percent of global vaccines. Before the present crisis erupted, India was supplying vaccines to several other countries. In fact, many poor countries were dependent on India providing the required vaccines and medicines for riding over their COVID-19 outbreaks.
The western media has been critical of the situation in India, using insensitive and often crass images of crowded crematoriums to make their point that the Indian systems somehow failed to cope with the crisis and that the COVID management in India was not adequate.
The people of India are in pain- suffering a plight that they did not create. There is no doubt that the situation is grim and that the world must do everything in its power to help the government and people of India in this hour of their need.
But has the Indian system really failed? Or would this have been the state of any system had it been subjected to the same shock?
The numbers coming out of India would be alarming to most Canadians. Our entire population is 39 million- but for India is just the combined population of the cities of Mumbai and Delhi! India has 1.3 billion people. That number changes the dynamics of most things in India and magnifies its issues.
Despite the recent surge, the overall infection rates in India are still among the lowest in the world. The death rates due to COVID-19 are also among the lowest. For instance, the USA has 1,762 Covid-19 deaths per million population, France has 1,573, the United Kingdom has 1,869, Italy has 1,974, Spain has 1,659, Germany has 979, the Netherlands has 993, and Canada has 630 deaths per million population. The same number for India is 140.
In early March 2021, the per-day COVID-19 infections had fallen to less than 10,000. Most Indians thought, and rightly so, that the worst was behind them. The preceding year had been hard, and it was time to revive their businesses and argument their livelihood.
By mid-April of 2021, India was reporting over 300,000 cases a day. Any country facing such an alarming surge in infections would invariably have its medical infrastructure strained. We have seen how the health system in New York, which had 1000 more per capita investment in health than India did before the pandemic, collapsed when met with a surge in infections. The same had happened in London and Milan.
India's Principal Scientist recently informed that no predictive model had envisioned the numbers being seen in India, adding that several factors are likely to be at play — public behavior, increased susceptibility of the population, and new variants of the virus. The greater-than-expected vulnerability may reflect the heterogeneity in the exposure to the virus during the first wave. Certain sections of the population were more exposed than others during the first wave, but in the second wave, newer sections were exposed. Or, the greater susceptibility could also be linked to the emergence of new variants.
In dealing with the response, the Indian government has rallied all stakeholders, including the industry, scientists, healthcare fraternity, medical students, and civil society.
Starting with a single National Institute of Virology in Pune handholding 75 government labs in March 2020, India now has 1,231 government and 1,227 private labs testing for the virus. India is now conducting more than 2 million tests daily.
In one year, the production capacity for PPE kits has gone up 46 times, and that of N95 masks has gone up 43 times. There was no shortage of these crucial supplies. Despite starting with a small base, India is now the second-largest global producer of PPE kits in this period.
In March 2020, before the pandemic hit, India had 9000 ICU beds. Today the country has 1.5 million isolation beds and more than 80 thousand ICU beds to manage Covid-19 patients. This is an increase of 10 times. In addition, the Indian Railways had added more than 40000 emergency COVID-19 beds by converting railway coaches. Government hospitals in India had about 17 thousand ventilators before the pandemic. Since then, almost 35 thousand new ventilators have been allocated and delivered based on the states' demand. One can imagine the magnitude of this second wave that even a 10 times increased capacity fell short of the demand.
Like Canada, India is a federal country with responsibilities shared between the central and the provincial governments. Like in Canada, health is an area of responsibility of the states. In August 2020, the Central government had released $ 200 million to states to fight Covid-19. The beneficiary states included Kerala, Himachal Pradesh, Punjab, Assam, Andhra Pradesh, Uttarakhand, and West Bengal. As an immediate measure to help the states, the central government hiked Remdesivir injections to states by almost 1.2 million doses.
On March 26, 2020, the central government allocated $ 22 billion as an immediate relief package. Later, on May 15, 2020, Prime Minister Modi announced an additional COVID relief package of $ 260 billion. In November 2020, the central government announced an additional $ 400 billion comprehensive stimulus package to help the country recover from the pandemic. These grants and allocations go towards benefits like free food to 800 million poor, assured work benefits to 50 million families, support to 86.9 million farmers, grant payments to 200 million women beneficiaries and 30 million senior citizens, free cooking gas to 83 million families, pandemic related pension benefits, an extension of insurance cover to healthcare workers and for research activities related to COVID-19 vaccine development.
In its 2021 budget of the central government had increased transfer to states by 10% and allocations for food subsidy by 49% over 2019-20 allocations. The allocated budget was increased by 137% for healthcare, from $13 billion to $31 billion. The budget had also made provisions for the launch of a new scheme to develop the capacity of health systems, strengthen national institutions, and create institutions to detect and cure new and emerging diseases.
The surge in cases led to a massive increase in demand for oxygen. No one had predicted this sharp increase. India has been an oxygen surplus country for many years. The medical use of the capacity was less than 10% of installed capacity. By the middle of April 2021, this demand increased by 50% of the capacity. In addition, the oxygen production facilities in India were mainly in the eastern parts of the country, while the sudden increase in demand came from the North and the West. These factors made it virtually impossible to meet the peak demand.
The Indian government reacted fast in diverting almost all of the country's installed capacity for medical purposes as was practically possible. This order was passed on April 7 at the first sign of a jump in oxygen consumption. More than 1200 pressure swing absorption technology-based oxygen plants sanctioned under PM CARES Fund are being installed. Many of them will be commissioned by May end. Several of these were allocated to the states a few months ago, but very few states actually acted on the building of these plants. The central government has also sanctioned 100,000 Portable Oxygen Concentrators for states with high case burden.
India also increased the domestic oxygen production, and the private sector jumped in to supply oxygen. For example, Reliance, a petrochemical company, ramped up output from near-zero to 1,000 tonnes per day and now produces over 11 percent of India's total medical-grade liquid oxygen (LMO) production in just one month. The production of LMO has increased from 5700 MT/day in August 2020 to over 9000 MT/day now. To address the shortage of oxygen tankers in the country, India has promptly imported 20 cryogenic tankers of 10 MT and 20 MT capacity and allocated them to states.
India began its COVID-19 vaccination drive on January 16, 2021. The phased program aimed to vaccinate 30 million health care workers first. The second phase benefited those above 60 years of age and ones above 45 years with co-morbidities. From April 1, the vaccines were available to all above 45 years. The vaccination program has been opened up to all above 18 from May 1 while ramping up vaccine production facilities. So far, India has administered around 160 million doses of the domestically manufactured COVAXIN and Covishield vaccines, and on average, 3 million people are being vaccinated every day. Compare this to Canada's own vaccination drive, where we are struggling to vaccinate 39 million people. India's vaccine figure exceeds the total vaccines administered in EU countries combined, making India the third-largest globally after China and the US. The government of India has so far provided more than 163 million vaccine doses to states. The states have now been authorized to procure vaccines directly, and more vaccines, including the Russian Sputnik, have been approved for use in India, increasing vaccine availability.
Before the current crisis, India had supplied 66 million doses of vaccines to 95 countries under their Vaccine Maitri program, which has built considerable goodwill for India, as witnessed from the worldwide offers of support today in the time of our need. India had even provided Canada with vaccines when we faced a severe crunch following restrictions imposed by the United States.
India used its accumulated diplomatic goodwill to quickly secure essential supplies from its partners across the world. Medical devices and medicines have been flown in from the US, the UK, France, Germany, and Russia. Over 30 countries have sent thousands of tonnes of material to support India's efforts in dealing with the pandemic.
Canada has been slow in offering its modest help. Prime Minister Trudeau announced support of $ 10 million to the Canadian Red Cross towards supporting its sister organization, the Indian Red Cross. On 5 May, the Canadian government announced that it was flying in 25,000 vials of the antiviral remdesivir (brand name Veklury) and up to 350 ventilators from its National Emergency Strategic Stockpile to help respond to the critical situation across India.
The Indo-Canadian people in Canada are rightly concerned about the situation in India. They have demanded that the government of Canada do more to support the COVID efforts in India, and several Indo-Canadain organizations are working to collect aid and raise funds for sending equipment and funds to charities in India.
The situation in India remains concerning for now. However, the latest data indicates that the number of cases being reported daily is stabilizing, and in the worst-hit areas, the healthcare system is bouncing back. Mumbai, for example, reported no scarcity of oxygen or ICU beds on 4 May.
The people of India are resilient, and the systems, despite the enormous strain put on them, have performed remarkably. It is just a matter of time before India comes through this crisis and resumes its normal position of helping heal the world once again.
Anil Sangwan is a medical professional based in Toronto.