The world’s fastest pace of spreading infections and the highest daily increase in coronavirus cases are pushing India further into a deepening and deadly health care crisis. India is massive — it’s the world’s second-most populous country with nearly 1.4 billion people — and its size presents extraordinary challenges to fighting COVID-19. Some 2.7 million vaccine doses are given daily, but that’s still less than 10% of its people who’ve gotten their first shot. Overall, India has confirmed 15.9 million cases of infection, the second highest after the United States, and 184,657 deaths. The latest surge has driven India’s fragile health systems to the breaking point: Understaffed hospitals are overflowing with patients. Medical oxygen is in short supply. Intensive care units are full. Nearly all ventilators are in use, and the dead are piling up at crematoriums and graveyards. HOW DID WE GET HERE? Authorities were lulled into believing the worst was behind them when cases started to recede in September. Cases dipped for 30 consecutive weeks before starting to rise in mid-February, and experts say the country failed to seize the opportunity to augment healthcare infrastructure and aggressively vaccinate. “We were so close to success,” said Bhramar Mukherjee, a biostatistician at the University of Michigan who has been tracking India’s pandemic. Despite warnings and advice that precautions were needed, authorities were unprepared for the magnitude of the surge, said K Srinath Reddy, president of the Public Health Foundation of India. Critics have pointed to the government deciding to not pause Hindu religious festivals or elections, and experts say that these may have exacerbated the surge. “Authorities across India, without exception, put public health priorities on the back burner,” Reddy said. Consequently, India’s 7-day rolling average of confirmed daily new cases has risen over the past two weeks from 6.75 new cases per 100,000 people on April 6 to 18.04 new cases per 100,000 people on April 20, possibly driven by new variants of the virus, including one that was first detected in India, experts say. India’s top health official Rajesh Bhushan would not speculate Wednesday why authorities could have been better prepared, saying: “Today is not the time to go into why did we miss, or did we miss, did we prepare?” WHY IS INDIA’S HEALTH SYSTEM COLLAPSING? India only spends a fraction of its gross domestic product on its health system, lower than most major economies. As the virus took hold last year, India imposed a harsh, nationwide lockdown for months to prevent hospitals from being overwhelmed. This brought terrible hardship to millions, but also bought time to implement measures to plug critical gaps, like hiring additional health care workers on short-term contracts, establishing field hospitals and installing hospital beds in banquet halls. But authorities didn’t take a long-term view of the pandemic, said Dr. Vineeta Bal, who studies immune systems at the Indian Institute of Science Education and Research in Pune city. Suggestions for permanent improvements like adding capacity to existing hospitals or hiring more epidemiologists to help track the virus were widely ignored, she said. Now authorities are scrambling to resuscitate many emergency measures that had been ended once the numbers fell. A year ago, India was able to avoid the shortages of medical oxygen that plagued Latin America and Africa after it converted industrial oxygen […]

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