India’s initial COVID-19 surge was a gradual process. Unlike many countries, India weathered the storm and officially remained free of the disease for a long period of time, before a gradual and sustained increase in cases saw it rise to one of the most highly affected. The spike that has occurred over the last few days has, however, been far more rapid.
India, thought at the beginning of the COVID-19 pandemic to be one of the most at-risk countries — a conjecture derived from India’s abundance of endemic infectious diseases — proved to be remarkably resilient given its border with China. This was not to last though, as cases began to slowly rise across 2020.
Unlike many countries that witnessed a sudden surge followed by either a plateau or an equally sudden decline, India’s increase occurred over a period of months. Cases began to notably increase in April 2020. This initial wave would not reach its peak until mid-September, at which point India was thought to be likely to dethrone the US as the worst affected country by case count.
The gradual rise seemed contrary to a number of events and factors that were postulated at the time to cause sudden surges in COVID-19 cases. At the start of the year, there was the initial evacuation of Indian citizens from China following the first announcements of a disease outbreak. Fears existed that the return of citizens at a time when testing was minimal could lead to individuals spreading the virus to India.
Upon the arrival of COVID-19 into India, and with the sudden imposition of lockdown measures the vast numbers of day labourers and migrant workers in India’s cities were left suddenly without work — often without food and shelter. As Health Issues India noted during mid-June
“Outbreaks of COVID-19 in rural India have been reported for some time. Reports at the beginning of June indicated a surge in COVID-19 cases in rural communities, precipitated by the influx of approximately forty million migrant workers into their native villages following a mass exodus from the cities.”
With this mass exodus from cities that had already reported positive cases of COVID-19 it was expected that crowds of individuals numbering often in the thousands would hasten the spread of the disease to India’s rural areas. Footage of the crowds revealed that physical distancing was not taking place and few were wearing any kind of protective face coverings. It was, therefore, an ideal breeding ground for the spread of the virus.
While the exodus did not result in a recorded surge, it is likely to have been a major contributing factor to the continuing spread of the disease that led to the mid-September peak. It may, however, be the case that in rural locations the lower volume of testing taking place may have allowed for surges to have taken place without being recorded.
Currently, following an elongated period of declining COVID-19 cases, and the plateau at a low point, cases are again beginning to rise. Concerningly, the increase in cases is far more rapid compared to the initial wave.
A total of 46,951 cases were reported on Sunday according to data from the Union ministry of health and family welfare. The rise in cases can be attributed to a small number of areas, indicating concentrated outbreaks with high case numbers. Six states contributed 84.49 percent of the current outbreak cases. These states are Maharashtra, Punjab, Kerala, Karnataka, Gujarat and Madhya Pradesh.
Maharashtra bears the brunt of the increase, with 30,535 cases in just the one state alone. Maharashtra’s current caseload alone is higher than India’s reported total since December, highlighting the pace of increase of just this single outbreak within one state.
The city of Mumbai has announced mandatory COVID-19 testing in all crowded public places as a measure to combat the sudden rise in cases. The rapid tests will be mandatory in crowded places such as shopping centres and train stations from March 22nd, city officials said. Refusing a test will “amount to an offence” according to reports.
Vaccination against the disease is the only bulwark against a resurgence. India has ramped up vaccine rollout, however, given its population exceeds a billion individuals, progress in comparison to population size is slow. With roughly thirty million doses administered so far, India is facing a gargantuan task. It may be years before the population is immunised to the point that COVID-19 is no longer a threat, in the meantime, it is looking ever more likely that India faces a second wave in the coming weeks.