India's devastating new COVID wave

Coronavirus is spreading rapidly in India, with new cases smashing records daily and overwhelming hospitals. What's fueling the surge, and should the rest of the world be worried?

How bad is India's new crisis?

India on April 23 reported more than 332,000 infections over the previous 24 hours, the most ever confirmed by any country in one day. The day before, the country confirmed more than 310,000 new cases, breaking the previous single-day high of 300,669 set in the United States on Jan. 8, at the peak of America's deadly winter surge. This wave hit fast. India was averaging about 11,000 new cases and losing fewer than 100 lives per day to the virus in February. In contrast, India is now averaging roughly 2,000 coronavirus deaths per day, although fatalities probably have been undercounted due to a lack of testing on those dying outside hospitals. Deaths trail infections, so the country is bracing for a rising toll.

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How is the health-care system holding up?

The surge is putting a massive burden on the country's hospitals, which are overwhelmed with patients suffering shortness of breath. Hospitals are running dangerously low on beds and supplemental oxygen many patients with severe COVID-19 need. Normally, India's hospitals and clinics use about 15 percent of the liquid oxygen the country produces, with the rest going to industrial use. Now that figure has surged to nearly 90 percent, according to Rajesh Bhushan, a senior health official. There's a rising sense of desperation as the health-care system shows signs of breaking down: Hospitals have posted on social media that they have just a few hours of oxygen left, warning hundreds could die if they run out. "Without oxygen," said lawmaker Saurabh Bharadwaj from his hospital bed in Delhi, "people are going to die like flies."

How did this wave get so out of control?

India's first wave of infections, which peaked in mid-September of last year, should have served as a practice run "to be prepared for the second wave" that was likely to come, said public health expert Anant Bhan. But critics say the country's leaders let their guard down. The government relaxed restrictions and failed to prepare for a resurgence, or even warn the public that precautions were still crucial. "We really didn't prepare in the time we got," virologist Shahid Jameel told The Times of India. "As a result, the health-care system is severely short-staffed right now, the infrastructure is crumbling." Critics say Prime Minister Narendra Modi's Hindu nationalist government made matters worse by permitting superspreader events, including a massive Hindu festival that drew millions. The second wave also has been fueled by 771 new strains, including highly infectious ones first detected in the United Kingdom, South Africa, and Brazil. Another, B.1.617, was first discovered in India, and authorities believe it spreads more rapidly than earlier strains. It appears more resistant to vaccines, too.

What is India's government doing to address the crisis?

To confront the potentially deadly oxygen shortage, Modi's government has started an "oxygen express" train, sending tankers filled with liquid oxygen to places with urgent demand. The Indian Air Force is airlifting more from military bases. Earlier this month, Indian health authorities fast-tracked approval of vaccines already cleared for emergency use in the U.S., U.K., Japan, and the European Union. The government also approved a $610 million grant to help the Serum Institute of India, which makes a COVID-19 vaccine, boost production. Meanwhile, Modi has all but ruled out imposing another national lockdown like the one in 2020. That shutdown prompted an exodus of low-income migrant workers to rural areas that disrupted the economy and caused hundreds of people to die on sweltering, clogged highways, and Modi said states should take such drastic measures only as a last resort.

Can India get help from abroad?

It is pleading for it. Due to recent U.S. and European limits on crucial COVID-19 vaccine production materials, India's biotech firms can't produce enough vaccine to meet international orders or India's own needs: So far, only about 130 million vaccine doses have been administered in India, a country with a population of nearly 1.4 billion. Serum, which needs sterile materials imported from the U.S., is asking President Biden to lift the U.S. export ban on raw materials so it can ramp up production, but so far its pleas have gone unanswered. When asked about the export ban, State Department spokesman Ned Price said, "the United States first and foremost is engaged in an ambitious and effective and, so far, successful effort to vaccinate the American people."

Should other countries be alarmed?

They already are. British Prime Minister Boris Johnson and Japanese Prime Minister Yoshihide Suga canceled trips to India, and the U.K. put India on its travel-ban list. Their counterpart in Australia, Scott Morrison, said his country would cut flights from India by 30 percent, adding that Australians could only go to India in "very urgent circumstances." The new B.1.617 variant found in India is of particular concern because it has several mutations that experts worry could lead to reinfections. "It is something to watch very closely, and something that will not be limited to India," Dr. Kavita Patel, a non-resident fellow at the Brookings Institution, told CNBC. "It is something we will likely see around the world, as we have with other variants."