India Covid-19 Crisis Deepened by Missteps and Complacency

NEW DELHI — 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 strains, 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.

But 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, 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.

The roots of India’s crisis lie in the previous one. The coronavirus hit the country hard, and India long held the second-largest number of infections after the United States. (It is now behind the United States and Brazil.) The economic blowback of the resulting lockdown was devastating.

But the numbers at the time actually understated the first wave, scientists now say, and deaths in India never matched levels of the United States or Britain. Leaders began acting as if the problem had been solved.

But improvements in testing capacity have led to more accurate counts this time. The virus likely raced through some populations like the urban poor, infecting between 300 and 500 million people, Dr. Laxminarayan estimates. While they may have won a level of immunity, that led to a lull until the virus hit others.

“The sad thing is that in a country like India, you can have 400 million infections, but that means 900 million people are not yet infected,” Dr. Laxminarayan said.

The mortality data was also misleading. Official figures show about 167,000 deaths, or 0.04 per 100,000 people, an astonishingly low rate compared with other countries. But about two-thirds of the population here is younger than 35. Among people between 45 and 75, fatality rates could be on par with or worse than Italy, Brazil, and the United States, Dr. Laxminarayan said.

India’s vaccine preparedness was also worse than it seemed. For months, the Serum Institute of India, one of the world’s largest vaccine makers, boasted of a major stockpile of the Oxford-AstraZeneca vaccine, which makes up the bulk of the country’s drive. The government even launched a “vaccine diplomacy” campaign that sent doses to other countries.

But the initial rollout within India was slowed by complacency and plagued with public skepticism, including questions about the Oxford-AstraZeneca vaccine and lack of disclosure about an Indian-developed dose. Now the vaccination program is not matching the spread. The Serum Institute has said that practically all of its daily production of about two million doses will over the next two months go to the government, delaying commitments to other countries.

Several Indian states now worry that their vaccine stocks will run out. Mumbai, India’s largest city, had shut more than half of its vaccination centers, local media reported on Friday. The central government’s health minister lashed out at the states, reassuring that there would be no shortage and that more supplies were in the pipeline.

Still, many people shed masks and resumed normal life.

In Pune, one of the worst-afflicted places in the hard-hit state of Maharashtra, relaxed attitudes and an overwhelming proportion of largely asymptomatic cases worsened the spread, said Sudhir Mehta, the response coordinator there. The district of about 10 million people reported more than 12,000 new cases on Friday, while the cumulative death toll has crossed 10,000. In a letter to the central government, Mr. Mehta described transmission as so rampant that contact tracing was almost impossible.

“There are so many mild cases where people even don’t realize that they have Covid,” Mr. Mehta said in an interview. (The positivity rate for tests in Maharashtra over the past week was one quarter, compared with a roughly 8 percent national average.)

Some of the relaxed attitude comes from the top. India’s senior leaders, who have taken vaccines publicly to support the inoculation effort, have been urging people to take precautions even as they hit the campaign trail for state elections. Prime Minister Modi has addressed more than 20 rallies, each with thousands of often-unmasked people.

On Wednesday, Delhi officials said that even a solo car driver would be punished for not wearing a mask properly. The same day, Amit Shah, the country’s de facto No. 2 leader, drove through a campaign crowd in the state of West Bengal, waving without a mask and throwing rose petals.

The government also gave the go ahead for a long Hindu religious festival called Kumbh Mela, which runs through the end of April. Between one million to five million people attend the festival each day in the city of Haridwar, on the banks of the river Ganges in the state of Uttarakhand.

Tirath Singh Rawat, the state’s chief minister, said no one would face restrictions as “the faith in God will overcome the fear of Covid-19.” Days later, Mr. Rawat tested positive for Covid.

The positivity rate of random tests is rising at the festival, and more than 300 participants have tested positive, said Dr. Arjun Singh Senger, a health officer at the festival.

The sheer speed of new infections has surprised health officials, who wonder whether variants might be a factor. Answering that question will be difficult. India has put only about 1 percent of its cases through genome sequencing tests, according to Dr. Reddy, of the Public Health Foundation of India, but researchers require a minimum of 5 percent to determine what is circulating.

So far, the government has found variants from the U.K. and South Africa as well as a local mutation. Limited information suggests that more infectious variants are circulating in India, as well, Dr. Reddy said.

Even if the variants have not yet been a major part of the new wave of infections, they have cast a shadow over India’s crucial vaccination drive. The AstraZeneca vaccine has been rejected by South Africa as ineffective against that variant.

“This time, the speed is much faster than the last time,” said Dr. Vinod K. Paul, the head of India’s Covid response task force. “The next four weeks are very, very crucial for us.”