India has been struggling to control a devastating second coronavirus wave. But government action against COVID-19 is not uniform, with some states and cities getting a better grip over the health crisis than others.
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India's second coronavirus wave has claimed the lives of thousands of people daily since the beginning of May, with over 75,000 COVID-19-related deaths recorded so far this month, according to Health Ministry data.
On Wednesday, authorities recorded 4,529 fatalities due to the illness, its highest single-day death toll.
The surge in cases has overwhelmed the nation's poorly funded and dilapidated public health infrastructure, with many states suffering from acute shortages of medical oxygen, essential drugs, beds, health workers and vaccines, among other vital supplies.
The spread of the virus has become rampant in rural areas where cases can go unreported due to a lack of testing.
COVID: An unfolding health crisis in rural India
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'Mumbai model' lauded for containing COVID-19
Nevertheless, some states and cities have managed the health emergency better than others.
The nation's financial capital Mumbai, in western Maharashtra state, has come a long way from being the epicenter of the virus outbreak in the region to a city with a successful containment model.
Coronavirus cases in the city started to peak in February this year. On April 4, Mumbai counted its highest single-day surge of 11,206 fresh cases.
But in recent days, the metropolis — with a population of over 12 million — has been recording a decline in infections, with 1,425 new cases recorded on Wednesday.
In addition to controlling the virus spread, the city administration has been hailed for making sure that there are enough hospital beds, essential drugs and oxygen supplies, among others, to cope with the demand.
"We are on auto-pilot now and prepared for any contingency. There is not a single case where someone who needed an oxygen-equipped bed didn't get one," Iqbal Singh Chahal, the commissioner of the city's municipal corporation, told DW.
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As India records high daily death tolls, the second wave of the coronavirus has shown no sign of slowing down. However, for many, life goes on amid the sea of tragedy.
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Social distancing, a farce?
People — many without masks — shop at a vegetable market in Mumbai. India has been struggling to contain a massive coronavirus outbreak, with nearly 24 million infections recorded to date. The country has logged around 260,000 deaths linked to the virus. According to medical experts, these numbers are vastly underreported.
Image: Niharika Kulkarni/REUTERS
Shortage of essential supplies
A young man unloads empty oxygen cylinders for refilling in Srinagar, Kashmir. India's health infrastructure has been under severe stress in recent days, with several states reeling under the shortage of medical oxygen, essential drugs, beds, health workers and vaccines, among other vital supplies.
Image: Dar Yasin/AP/picture alliance
Crematoriums overrun by bodies
Volunteers at a nonprofit organization carry bags full of unclaimed ashes belonging to COVID-19 victims at a crematorium in New Delhi. As the intense second coronavirus wave grips India, apocalyptic scenes of mass cremations have emerged, as queues of bodies wait outside overwhelmed crematoriums.
Image: Adnan Abidi/REUTERS
Disregarding scientific evidence
A man bathes in cow milk to remove cow dung from his body during "cow dung therapy" at a cow shelter on the outskirts of the city of Ahmedabad. Participants believe cow excrement boosts their bodies' ability to defend against the virus. The Indian government has faced heightened criticism for ignoring scientific evidence and warnings about variants.
Image: Amit Dave/REUTERS
Concern over new variants
A worker carries bricks on her head in Jaipur, Rajasthan. The World Health Organization (WHO) has classified the B.1.617 coronavirus variant — first detected in India last October — as a "variant of concern." Epidemiologists note that this variant may be more resistant to vaccines.
Image: Vishal Bhatnagar/NurPhoto/picture alliance
No nationwide lockdown
Policemen check the credentials of delivery personnel from India's leading food delivery service, Zomato, in the southern city of Kochi. While Prime Minister Narendra Modi's government has refused to announce a nationwide lockdown over economic concerns, several states have imposed strict restrictions and nighttime curfews to curb spread of the virus.
Image: R S Iyer/AP/picture alliance
Scramble to reach home
A woman arrives at a bus stand in Jaipur to leave for her hometown, after authorities in the western state of Rajasthan announced a lockdown. Many people have left bigger cities for their towns and villages in order to avoid a repeat of the massive migrant crisis that accompanied India's first coronavirus lockdown last year.
Image: Vishal Bhatnagar/NurPhoto/picture alliance
Living with the virus?
A young man is seen carrying cans of beer as liquor shops in several districts of Uttar Pradesh are reopened. The northern state, led by Modi ally Yogi Adityanath, has registered one of the largest outbreaks in the country. In recent days, several bodies have washed up on the shores of the river Ganges, which runs through the state. Many believe that they belong to victims of the virus.
Image: Pradeep Gaur/SOPA/Zuma/picture alliance
Politics amid pandemic
Catholic nuns wear protective face masks as they wait to cast their votes outside a polling station in Kolkata. The government has been under fire for holding regional elections and massive rallies during a time when the country was descending into chaos over the new surge. Since the onset of the pandemic, West Bengal state has recorded more than 1.05 million infections so far.
Image: Rupak De Chowdhuri/REUTERS
A long road ahead
A man dressed as a clown sprays disinfectant outside a house in Mumbai. He told Reuters that he wears other different costumes aside from dressing up as a clown to raise awareness and spread information about the coronavirus. Many in India fear that the second wave is far from stemmed and if the virus spreads unabated, mass grief and mourning may soon be replaced by apathy.
Image: Francis Mascarenhas/REUTERS
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Chahal said Mumbai had adopted a decentralized approach to managing the health crisis, setting up command posts in each of the city's 24 wards, equipped with ambulances, doctors, telephone operators and basic health infrastructure.
The city administration has also focused on effective management of medical oxygen, ensuring that there are enough supplies of this critical resource to treat severe COVID-19 patients.
India's Supreme Court has also praised Mumbai's handling of the crisis and urged other states, including the capital New Delhi, to emulate the model to fight the pandemic.
"I have an outstanding team. We have not let our guard down and will overcome hurdles, including getting people vaccinated," added Chahal.
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Southern states doing relatively well
The southern state of Kerala has also managed to keep the active caseload curve flat and mortality low since the start of the pandemic.
The state has so far recorded more than 2.2 million infections and over 6,600 deaths, resulting in a case fatality rate of about 0.32%, which is India's lowest.
Leading from the front was K. K. Shailaja, who served as the state's health minister for the past five years, until May 2021.
"We did everything scientifically possible to contain the spread, delay peaking and use that time to augment infrastructure," Shailaja told DW. "At the peak of the COVID-19 pandemic in the state, just 50% of the ICU beds were occupied and occupancy of ventilators was below 40%," she added.
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India has added hundreds of thousands of cases in recent days, and the total death toll has surpassed 220,000. Cities are running out of space to bury or cremate the dead.
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COVID sufferers seek medical support at temples
An elderly woman suffering from breathing difficulties due to COVID-19 waits to receive free supplemental oxygen outside a Sikh temple on the outskirts of Delhi in Ghaziabad. Many who are struggling for breath due to COVID-19 have flocked to the temple, hoping to secure some of its limited oxygen supplies.
Image: ADNAN ABIDI/REUTERS
COVID patients turn to informal health services
Hospitals in Delhi and across the country are turning away patients after running out of medical oxygen and beds. Many have put out urgent notices saying they can't cope with the rush of patients. The Sikh temple in Ghaziabad has come to resemble the emergency ward of a hospital. People all across Delhi are seeking and creating makeshift health care spaces.
Image: ADNAN ABIDI/REUTERS
Doctors treating patients wherever possible
A health care worker tests blood oxygen levels of a COVID patient inside an ambulance in the eastern city of Kolkata. With people being forced to wait many hours to receive treatment, doctors have been treating people in cars and taxis parked in front of hospitals.
A couple wait inside a rickshaw until they can enter a COVID-19 hospital for treatment in the western city of Ahmedabad. Social media and local news footage have captured desperate relatives begging for oxygen outside hospitals or weeping in the street for loved ones who have died waiting for treatment.
Image: Amit Dave/REUTERS
India in mourning
A young boy at a crematorium mourns the loss of his father, who died from COVID-19. In the last month alone, daily COVID cases in India have increased eight times over — and deaths, 10 times. Health experts have said the actual death toll is probably far higher than the official numbers.
Image: Adnan Abidi/REUTERS
India's younger population also hit
This 35-year-old woman is suffering from breathing difficulties due to COVID-19. Like many others, she is waiting in front of a hospital to receive oxygen support. Scientists are concerned that a more infectious "double mutation" of the virus is spreading in India.
Image: ADNAN ABIDI/REUTERS
Second COVID wave 'supremely contagious'
The family of a COVID victim mourn together outside a mortuary of a hospital in New Delhi. Delhi Chief Minister Arvind Kejriwal said India's current infection wave is "particularly dangerous" and that people were falling sick more severely and for longer.
"It is supremely contagious, and those who are contracting it are not able to recover as swiftly."
The unfolding crisis is most noticeable in India's overwhelmed graveyards and crematoriums. Burial grounds in the capital New Delhi are running out of space. In other cities, glowing funeral pyres light up the night sky. "The virus is swallowing our city's people like a monster,'' said Mamtesh Sharma, an official at Bhadbhada Vishram Ghat crematorium in the central city of Bhopal.
Image: Adnan Abidi/REUTERS
Vaccine drive falling behind
India's vaccination program is lagging, with only 10% of the country's population having received one dose, and 1.5% having received both doses. Indians aged 18 and older are now eligible for a vaccine. The United States has said it would send raw materials for vaccine production to help strengthen India's capacity to manufacture more AstraZeneca vaccine.
Image: Francis Mascarenhas/REUTERS
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Early identification of susceptible patients and triggers for monitoring a deterioration in admitted patients has helped keep the situation under control, say observers.
In addition, evidence-based health management and effective nursing care for the prevention of secondary infections has been crucial to keeping the number of fatalities low.
Experts say that the southern states of Karnataka and Andhra Pradesh have also been doing relatively well, by incorporating expert-led technical advice into their policies.
Government decision-making in those states is being driven by the input given by epidemiology committees.
"The Andhra committee monitors matters on the ground closely. It looks to see where testing is weak, the quality of testing and delays, the hospital and ICU occupancies," Gautam Menon, public health expert and a professor of physics and biology at Ashoka University in Sonipat, told DW.
Public health spending very low
Since the onset of the pandemic, many states have put in place measures to strengthen their health care infrastructure.
Still, the Indian government's spending on public health care continues to be abysmally low at a meager 1.3% of GDP, below that of some countries in South Asia like Sri Lanka and Bhutan.
The huge shock delivered by the pandemic could now serve as a wake-up call for authorities to overhaul and modernize the nation's ill-equipped health system.