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Friday, January 28, 2022

The biggest COVID-19 crisis now facing the United States is the one that is happening in India

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On Tuesday, India reported over 360,000 new cases of COVID-19. That’s a new record for any day in any nation. It was just last week that India first surged past the worst days of the United States’ big fall wave, but now even those numbers are starting to recede into the “not so bad” territory. Worse still, it’s painfully obvious that the numbers coming from India, in terms of both cases and deaths, are massively undercounting what’s really happening. At every stage—testing, hospitalization, and handling deaths—the system is simply overrun. 

As The Washington Post reported on Tuesday, patients in India are now on their own. Families are conducting a mad search for a hospital bed in a system that’s overwhelmed on every level, and where effective communication has been crushed under the burden of simple need. That means ferrying sick relatives from one location to the next, seeking assistance that doesn’t exist. Or desperately trying to find oxygen. It means watching people who could easily survive COVID-19 if they could get basic treatment die in their homes. Then it means hauling them to parks or parking lots to be burned in mass cremations that are burning 24/7.

It’s leading to genuine horrors like this one reported in The Daily Beast

The sons of a mother in her fifties who died of COVID-19 while trying to find a hospital bed were forced to wedge her between them and drive her miles to be cremated, according to media accounts in India.

And it’s also full of stories like this one from ABP News

Mumbai resident, Shahnawaz Sheikh, is known as Oxygen Man for all the right reasons. Shahnawaz provides oxygen cylinders to the needy in Mumbai. Shahnawaz started the campaign last year when he lost his sister to deadly Coronavirus disease. Sheikh sends a cylinder as soon as he receives a call from a COVID patient or a family.

President Joe Biden has announced support for India and spoken directly with Prime Minister Narendra Modi. The U.S. has already begun shipping equipment needed for ventilators and oxygen production, and as The Hindu reports, India expects to soon receive the bulk of the 60 million doses of AstraZeneca vaccine that are already in U.S. stockpiles.

Following issues in their phase 3 trial (and concerns about blood clots similar to those that temporarily sidelined Johnson & Johnson’s vaccine), AstraZeneca never applied to the FDA for an emergency use authorization for their vaccine. That means that the doses the U.S. has on hand, which were purchased as part of Operation Warp Speed, are simply sitting idle. With a more than adequate supple of Pfizer, Moderna, and J&J vaccines coming into the United States, there is no better use of the AstraZeneca reserve than to send it somewhere it’s needed immediately.

But getting enough people vaccinated to slow India’s surge of new cases will be a challenge. As of Monday, less than 9% of the adult population had received a single shot and less than 2% were fully vaccinated. Despite starting out with a large stock of vaccine, the rollout of vaccination in India has hit all kinds of organizational and logistical snags. It also hasn’t helped that until the last few weeks, vaccine hesitancy in India has been very high, egged on by media that has focused heavily on claims that vaccines can cause everything up to and including death. But as the massive spike in cases has come on, attitudes have reversed. Now Indians are showing up at vaccine clinics and finding no jabs available as the supply, like everything else, has been overrun.

Every person on Earth has value. India is not the only nation in need, and getting vaccine to every nation where it’s not currently available has vital importance. But taking steps to slow what’s happening in India is vitally important to the world.

  • The world’s largest democracy is no more safe from disruption than any other. The balance of power in India, and the level of authoritarian control ceded to the ruling party is … historically complicated. But democracies under stress can easily turn toward less democratic solutions. In an extraordinary crisis, it’s all too easy to surrender power and drop safeguards—and sometimes it’s impossible to get them back.
  • India is a major source of pharmaceuticals that are used around the world, including in the United States. That not only includes manufacture of COVID-19 vaccine, but vaccines and treatments for many other ailments. In fact, India has been labeled “The Pharmacy of the World.” A breakdown of this industry could spread death and disability around the world faster than coronavirus.
  • India is a nuclear power that shares borders with two other, often antagonistic, nuclear powers. A destabilized India may look to its neighbors like an opportunity. Or a destabilized and fearful India may suspect its neighbors of those thoughts. In any case, India and Pakistan exist in a state of perpetual agitation and have conducted four large-scale wars since 1970. This is a really bad time for anyone to be getting bright ideas about Kashmir, or about just where that border with China should be drawn.
  • India is a very large country, the second most populous on Earth. Until this recent outbreak, only about 1% of the nation had tested positive for COVID-19. That’s not only a vast playing field on which the virus can run wild, its one that provides all the bodies needed for the production of new variants. In fact, the surge of cases in India is directly related to the rise of the B.1.617 variant that was first identified there and the B.1.1.7 variant first identified in the U.K. Every human case of COVID-19 is another trillion opportunities for SARS-CoV-2 to kick off some new mutation that’s more contagious, more deadly, more evasive of vaccines, or any combination of the above. India is giving the virus a lot more chances to get around the world’s defenses.
  • India is 8% of the total global economy. That may not seem enormous, but it is certainly enough that a major downturn in India will ripple through the world economy. And India is a particularly dominant player in parts of the IT world, with many U.S. companies dependent on India for both personnel and services. If India sneezes, a whole lot of American companies will catch a cold. That’s part of why a lot of tech executives are joining with Indian American leaders to organize assistance. 

Every case of COVID-19 is a concern. Every death is a tragedy. Addressing vaccine shortages in Bolivia or the Philippines is also critical. But right now, India is accounting for 43% of all the cases on the planet—and it’s clear that number is vastly underestimating the truth in a nation that is simply running out of tests. India is a health, economic, humanitarian, and national security crisis all in one.

When healthcare resources are overrun, the fatality rate of COVID-19 rises from the 1-2% that is seen with adequate treatment to the 15-20% rate of those needing hospitalization. India is a nation of nearly 1.4 billion people. Barely 10% of them have any protection from this disease. I’ve made a lot of charts and tables showing potential outcomes over the course of the pandemic, but I’m not making a chart of that. Let’s just do what we can to help.


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