In India’s Crisis, the Virus Rages Amid Vaccine Shortages
It was supposed to be a day when India made a bold step forward in its fight against Covid-19, when everyone 18 and older in its vast population became eligible to be inoculated. Instead, several states reported that vaccine shortages had forced them to delay expanding access, and the country’s latest report of cases remained higher than any other has ever reached.
As families of the sick fill social media with pleas for oxygen and cremation grounds burn thousands of bodies daily, India has gone from declaring victory over Covid to suffering its gravest emergency in decades.
India has pushed the world record for daily new cases higher and higher, reporting 401,993 new cases and then 392,488 over the weekend. It is averaging over 3,000 Covid deaths each day, with more than 200,000 dead in total. And evidence suggests the official numbers vastly understate the toll.
Less than 2 percent of India’s 940 million adults have been fully vaccinated, according to data compiled from government sources by the Our World in Data project at the University of Oxford. Officials in Delhi, the capital, and big states like West Bengal and Karnataka have announced that the planned expansion of vaccine eligibility to everyone 18 and older is on hold because of shortages.
“As soon as vaccines arrive, we will let you know, then you can come for shots,” said Delhi’s chief minister, Arvind Kejriwal, the BBC reported. “We appeal to you not to crowd vaccine centers in the next few days.”
As long as vaccines are in short supply and the virus is running rampant, experts warn that dangerous variants will evolve, spread and possibly evade vaccines. That could eventually pose a threat even for countries like the United States, where 40 percent of the population is fully vaccinated. Michael Diamond, a viral immunologist at Washington University in St. Louis, said that the only way to break the cycle is to ensure countries like India get enough vaccines.
“In order to stop this pandemic, we have to vaccinate the whole world,” Dr. Diamond said. “There will be new waves of infection over and over again unless we vaccinate at a global scale.”
India has a homegrown variant called B.1.617, which some in the news media and medical industry have concluded is responsible for the ferocious second wave.
Researchers outside of India, however, say the limited data so far suggests that a better-known variant may be more to blame: the highly contagious B.1.1.7 variant that was first found in Britain and is now the most common source of new infection in the United States. All of the major vaccines in use have been shown to be effective against B.1.1.7.
Dr. Anthony Fauci, President Biden’s Covid adviser and the top U.S. infectious disease expert, said in an interview with The Indian Express that to get a clearer picture, genetic materials could be sent from India to Britain and the United States to be sequenced, though U.S. efforts only recently ramped up.
Dr. Fauci also said India should consider another lockdown, a politically charged subject in a country that shut down early in the pandemic, some say prematurely. In recent weeks, a Hindu festival with millions of worshipers was allowed to take place and Prime Minister Narendra Modi appeared maskless at campaign rallies with thousands of supporters who also weren’t wearing masks.
“No one likes to lock down the country,” Dr. Fauci said.
“But if you do it just for a few weeks,” he added, “you could have a significant impact on the dynamics of the outbreak.”
Dr. Manisha Jadhav, the chief medical officer at the Group of Tuberculosis Hospitals in Mumbai, died on April 19 in a hospital in that city. She was 51. The cause was complications of Covid-19, her husband said.
Her job involved managing the hospital’s staff and handling its operations. When the pandemic hit Mumbai in March 2020, she quickly organized personal protective equipment for the hospital’s workers amid a severe shortage, ensured that they had food and made travel arrangements for the staff when public transport was suspended during the lockdown.
She was one of 13 doctors honored for their efforts by the governor of Maharashtra State in December.
“Doctors are like soldiers,” she would say. “They can’t be unavailable.”
Manisha Ramugade was born in Mumbai on May 11, 1969, to Ram and Ratan Ramugade. Her father was a postal worker, her mother a homemaker. She was the youngest of four siblings.
“As a kid, she would tell us that she wanted to become a doctor, and joke about giving injections,” her sister Sunita said.
Along with her husband and her sister Sunita, Dr. Jadhav is survived by her son, Darshan, a medical student in Ukraine, and another sister, Anita. Her brother, Ravi, died last year.
— Jyoti Shelar
In recent months, the chief executive of Serum Institute of India, the world’s largest vaccine manufacturer, has come under increasingly intense pressure as both pro-government voices and leaders of the state governments headed by opposition politicians criticized him.
Some accused him for delays in supplying vaccines; some called him a “profiteer” for not offering Covid-19 vaccines to state governments at cost. There were calls for his company to be nationalized.
In an interview with The Times of London published on Saturday, the executive, Adar Poonawalla, described menacing calls from some of the most powerful men in India, creating an environment so ugly that he anticipated being out of the country for an extended period while he made plans to start producing vaccines elsewhere.
“‘Threats’ is an understatement,” Mr. Poonawalla said. “The level of expectation and aggression is really unprecedented.”
The interview reported that he had flown into London to join his wife and children hours before Britain barred travelers from India on April 23.
“I’m staying here an extended time, because I don’t want to go back to that situation,” he added. “Everything falls on my shoulders, but I can’t do it alone.”
The interview set off a storm on social media, with some interpreting his interest in manufacturing outside India as a threat to move his business and others seeing him as having been driven out of the country by the viciousness of his critics.
Within hours, Mr. Poonawalla wrote on Twitter that he would be returning to India “in a few days.”
Had an excellent meeting with all our partners & stakeholders in the U.K. Meanwhile, pleased to state that COVISHIELD’s production is in full swing in Pune. I look forward to reviewing operations upon my return in a few days.
The New York Times was unable to reach Mr. Poonawalla directly on Saturday, and a request for comment from his company was not immediately returned.
India, the world’s leading producer of vaccines, is struggling to vaccinate itself out of a crisis as a voracious second wave leaves a tableau of death and despair. When cases were relatively low, the country exported more than 60 million shots. On Saturday, India expanded vaccination eligibility to all people over age 18, but many states said that they would not be able to meet the demand because of a shortage of doses.
Less than 2 percent of India’s 940 million adults have been fully vaccinated, according to data compiled from government sources by the Our World in Data project at the University of Oxford. Several states have reported vaccine shortages, enough to derail plans in some to expand access to everyone 18 and over on Saturday.
All that has made Mr. Poonawalla, a 40-year-old billionaire, a focus for public anger.
Dr. Angelique Ramirez, the chief medical officer of the main health care system in Fairbanks, Alaska, started the monthly coronavirus briefing in April by saying that she thought March’s meeting would be the last. But amid a new surge of cases in the state, one of the country’s worst surges, Dr. Ramirez was blunt about her past assessment.
“I was wrong,” she said.
With nearly 100,000 people, the Fairbanks metropolitan area is Alaska’s second largest and the largest in the state’s vast interior. According to a New York Times database, the number of new coronavirus cases in the borough of which Fairbanks is the seat,North Star, has risen by 253 percent over the past two weeks. The positivity rate has doubled since March, to about 10 percent from 5 percent, and hospitalizations at Fairbanks Memorial Hospital, the area’s only hospital, have hit a record number.
“This place is on fire with Covid,” Dr. Barb Creighton, an internist at Fairbanks Memorial Hospital, said at the meeting.
Experts are unsure what is driving the surge, though a low vaccination rate certainly plays a role. Thirty-six percent of Alaskans are fully vaccinated, and in some boroughs that number is over 50 percent, but in the Fairbanks area just 29 percent of the population has been fully vaccinated.
“There is no big outbreak or two big outbreaks that are really driving this,” said Dr. Joe McLaughlin, the state epidemiologist for Alaska. “We have cases and clusters being associated with a wide range of different settings.”
With two-thirds of the older population in Fairbanks having received at least one dose of a vaccine, those who have recently been hospitalized in Fairbanks are younger than the Covid patients during the winter, when there was a peak in case numbers. Dr. Creighton said people who were hospitalized in April tended to be in their 40s and 50s and were unvaccinated because they were waiting to see what side effects might come from receiving a Covid-19 vaccine.
“We are seeing them stay longer because they are not dying,” Dr. Creighton said. “We are giving them noninvasive ventilation and they are staying for two, three weeks and turning around, which I’ve never been more proud of.”
But while those older patients during the winter peak were largely grateful to be receiving care, those hospitalized now feel differently.
“Some of these folks are folks that are anti-vaxxers, anti-maskers, and they don’t believe they have Covid or are sick because of it, and our staff is getting pretty angry folks,” Shelley Ebenal, the chief executive of the health care system, Foundation Health Partners, said, imploring the system’s trustees to share their appreciation of the hospital staff with them.
She sounded a dire warning: “We are not out of Covid, and our staff in particular is not out of Covid. Our morale is really low.”
Oregon is reporting about 816 new cases a day, a roughly 31 percent increase from two weeks ago, according to a New York Times database. Hospitalizations have also risen by about 42 percent in the same period. Deaths from the virus, which tend to lag behind cases for several weeks, remain relatively low.
“Here is the reality Oregon is facing right now: cases are widespread, driven by new, more contagious variants,” the state’s governor, Kate Brown, said at a news conference on Friday. “Oregon leads the nation for our rate of increase in cases over the last two weeks.”
A total of 15 counties, including some in the Portland metro area, moved back into the fourth and most extreme level of restrictions on Friday, after meeting the state’s threshold. In these counties, indoor dining is now prohibited and businesses such as gyms and movie theaters must significantly reduce their capacity.
The new limits are likely to prompt a political backlash. Some states that have seen recent surges, like in Michigan where cases have leveled off but total numbers still remain high, have chosen not to tighten restrictions again and instead have asked residents to take greater precautions in an effort to halt the spread of the virus.
Ms. Brown said she was optimistic that the state would be able to get ahead of the variants over the next two to three weeks, estimating that Oregon could lift statewide restrictions and return to some degree of normalcy by the end of June.
The governor urged Oregonians to get vaccinated, calling it the key to fully reopening the state’s economy.
Public health experts have suggested a combination of factors could be driving the surge, including more contagious variants, increased travel during spring break and the loosening of state guidelines before vaccination rates had sufficiently risen. As of Saturday, nearly 30 percent of the state’s population was fully vaccinated and 44 percent had received at least one dose, according to a New York Times vaccine tracker.
“We didn’t get down far enough,” Ken Stedman, a biology professor at Portland State University, told local news outlet KATU, referring to case numbers, “and now we seem to be going back up again.”
Across the United States, parents and graduates will confront commencements in May that are as atypical, modified and sometimes contentious as the past school year has been.
Each institution is making its own decision, and the result is an uneven landscape.
Harvard University announced that its seniors would graduate virtually and that their diplomas would be mailed to them. Just two miles away, Boston University will be hosting an in-person graduation.
With millions vaccinated, experts say that an increasing number of campuses are choosing to do in-person events. Campuses that are sticking to virtual-only ceremonies have become outliers, sometimes breeding frustration — and creativity.
When the University of Tampa decided to hold a virtual ceremony, Allison Clark, a senior, and two classmates started a GoFundMe drive and raised enough money to rent out a convention center for a do-it-yourself graduation.
“To be with my classmates, to walk across the stage, to receive the diploma that we all worked so hard for, it means absolutely everything,” she said.