This week, India surpassed 210,000 Covid-19 deaths amid a catastrophic second wave of the virus. Hospitals are overflowing, crematoriums are overwhelmed and oxygen and medicines are in short supply. People are turning to the black market to secure treatment for their loved ones.

On Thursday, the country of nearly 1.4 billion reported the world’s highest number of new cases and deaths in a single day, with 386,452 more recorded, taking the total number of infections to over 18 million. 

There were a further 386,452 new cases reported on Friday – the biggest one-day increase on record for any country.  There were another 3,500 deaths nationwide and nearly 400 in Delhi alone. 

The true number of cases and deaths is thought to be far higher, as many are struggling to access testing (or are avoiding it), and rural…, and rural deaths and infections often go unregistered.

The World Health Organization (WHO) this week blamed India’s deadly second wave on a “perfect storm” of mass gatherings, low vaccination rates and more contagious variants of the virus.

Early research and accounts from frontline doctors suggest the B1617 variant with two mutations, which is driving the current crisis (and has been detected in the UK), is similarly transmissible at the UK variant. Research has yet to conclude if it’s more deadly than the original virus.

“The situation is beyond crisis point,” said Dr Zarir Udwadia, who works in two of Mumbai’s biggest private hospitals, on the BBC Radio 4’s Today programme on Tuesday. “This virus has a country of 1.4 billion firmly in a stranglehold and it’s really exposed our threadbare healthcare system and our failure of leadership.”

Dr Udwadia said he’s seeing “ward after ward full of patients struggling to breathe,” and that more younger patients are afflicted this time compared to the first wave of the virus. Just this week he watched a 35-year-old husband and wife who had been on ventilators die from the disease.

The pace of India’s vaccine rollout is also slow – less than 10% of the country has received an initial vaccine so far (by contrast, the UK government claims all adults will have been offered a first dose by the end of July).

Since January, India had been an important worldwide exporter of the Oxford-AstraZeneca vaccine, but a “temporary” halt on all exports was imposed in late March due to rising domestic demand. Among those receiving vaccine doses from India were the UK, Brazil and 74 other countries.

“In an act of largesse we’ve been donating vaccines to our neighbours without doing the maths – this country needs 2 billion doses at the very least,” Dr Zarir Udwadia said. “There was initial vaccine hesitancy [and] vaccine scepticism, like there is in many parts of Europe, but now there is vaccine desperation.”

In response to the crisis, the UK has sent help in the form of ventilators and oxygen concentrator devices, while the US is lifting a ban on sending raw materials abroad to enable India to make more of the AstraZeneca vaccine. However, the international aid effort amounts to “a drop in the ocean” that will “have a limited impact,” according to Dr Udwadia. 

When the world’s first Covid-19 cases were discovered, there was concern about how countries like India – with a vast population and poor healthcare system – would cope. But after a strict lockdown imposed by Prime Minister Narendra Modi at just four hours’ notice in March 2020, many claimed the human cost of the lockdown was more severe than the virus itself.

By November, rates were relatively low and a narrative of “Indian exceptionalism” emerged. People started asking if Indians were more immune to Covid-19, leading many to begin taking fewer precautions against the virus. Mask wearing slipped and vaccine take-up stalled because people didn’t see the need.

In March this year, India’s health minister Harsh Vardhan claimed the country had defeated the virus and praised Prime Minister Modi’s leadership. Meanwhile, others criticised Modi’s decision to allow rallies, sports events and religious festivals to go ahead in mid-March, during which thousands of mostly unmasked people attended with little social distancing.

Within a month, the second wave became too serious to ignore – oxygen began to run out and localised lockdowns in cities like Delhi were imposed. Prime Minister Modi has ruled out another nationwide lockdown, yet the public health emergency appears to be worsening by the day.

Many high profile commentators and doctors place the blame squarely on government complacency and bad leadership. This week, Indian author Arundhati Roy deemed the Indian government’s response to the crisis an “outright crime against humanity.”

“The system hasn’t collapsed. The government has failed,” she wrote on Wednesday. “Perhaps ‘failed’ is an inaccurate word, because what we are witnessing is not criminal negligence, but an outright crime against humanity.”

Dr Udwadia blamed government complacency and “years of disinvestment” in healthcare. “We’re in the mess we are right now because of complacency from the government. We let down our collective guard and we were urged to by our leaders.”

Instead of telling the public to be vigilant and take Covid seriously, the government declared victory against the virus when the country seemed to be conquering the first wave, Dr Udwadia added.

“We patted ourselves on the back telling ourselves we were vaccine producers for the world and the government lapped up this hype… They didn’t ramp up production and were lulled by complacency. In the early stages, January and February, when the rollout started, there were no takers,” Dr Udwadia explained.

He said even doctors were wondering why they needed vaccines given that the virus seemed to be over. “Now there’s a desperate clamour for vaccines.”

Images: Raj K Raj/Hindustan Times via Getty Images

This story was update on 1 May 2021.