As the sun sets in Mumbai, police orders residents to vacate public spaces and return home. The inhabitants of India’s second most populous city, however, resist curfew, seen as the prelude to a second lockdown, despite the alarming rise in infections.
Just this Wednesday (7), the country registered 126,789 new cases of coronavirus – only the United States already had a greater number of contaminated in one day, 300,295, on January 2 -, which led the Indian authorities to impose confinements again and curfews in various states.
Public health experts say the increase in cases was caused, at least in part, by a lack of compliance with the rules of social isolation. “Poor adherence to the protocol and correct behavior is the biggest reason for the increase in Covid infections. People thought the pandemic was behind them and are not following the guidelines, ”says Shashank Joshi, a doctor and member of the health crisis-fighting task force in the state of Maharashtra, where Mumbai is located.
India’s financial capital, the city has almost 19 million inhabitants, and the idea of a second lockdown scares the population – many residents lost their jobs and saw their businesses close in the first wave of the coronavirus.
Junaid Wani, 39, remembers well the night of March 23, 2020, when the Mumbai authorities told him to end a ceremony he had organized. He runs an event promotion company that works primarily for Bollywood, the Indian film industry, and for international cricket matches – one of the country’s most popular sports.
The company held at least 300 events a year, he says, but due to the lockdown against Covid, Wani says he has now only been able to promote ten events, and without an audience. “The poor will have nothing to eat, and we do not know how long this confinement will last,” he says. Frightened by the increasing number of cases, Wani left Mumbai, responsible for more than half of the new coronavirus infections in the country, to live with his parents in Kashmir, where new infections are relatively rare – the moving average of cases in the past seven days in the region is 552, far below the 51,469 in Maharashtra.
With the growth of the second wave of Covid-19 in the country, hospitals are running out of space in ICUs. Data from the program to combat Covid in Mumbai show that 78% of hospital beds in the city are occupied, in a context of high cases and deaths. Videos on social media show factory workers in India being treated in zinc shacks due to a lack of hospital beds.
Lawyer Arjun Shinde, from Maharashtra, spent a whole day wandering in hospitals looking for beds for his family members, but found no vacancies. “Everywhere I went, there were already lines of people waiting for vacancies. There are no beds or oxygen available. Covid patients stand outside the hospitals, in a 40ºC heat, waiting for a vacancy, “he says.” Doctors and hospital staff are in a panic. The government has completely failed to respond to the crisis. ”
In the face of the growing crisis, volunteers help patients and their families to look for places in hospitals.
“Covid’s second wave has unleashed a crisis in the healthcare system,” says Sandhya Fernandes, whose SOS Saviors organization helps to search for vacancies in Mumbai medical centers. “Is it over there [a segunda onda] it is much worse than the first, and the seriousness of the situation is being minimized. Hospitals in Mumbai are distributing bed tickets to patients with Covid. I know of patients who had to wait two days to receive oxygen and ended up dying. ”
Fernandes says that stocks of important medicines are running out and that private hospitals are charging up to US $ 3,000 (R $ 16.8 thousand) for a bed. According to a survey carried out by the Center for Disease Dynamics, Economics and Policy and Princeton University, in April 2020, there are 95 thousand ICU beds and 1.9 million hospital beds in public and private centers for the Indian population, of 1.36 billion people, which equates to 1.46 beds for every thousand inhabitants. The World Health Organization (WHO) defines the need for a minimum of three beds per thousand inhabitants.
“Better public-private partnerships are needed to ensure medical care for patients with Covid and other problems at affordable costs,” says Jyoti Joshi, director for South Asia at the Center for Disease Dynamics, Economics and Policy.
Maharashtra Health Minister Rajesh Tope said the government is working to increase the number of vacancies available in the main regions of the state. With its health system overburdened, India has seen a sharp rise in deaths from Covid, which rose from 97 on March 7 to 685 on Wednesday, a month later, according to data from Johns Hopkins University.
While the country’s hospitals are overwhelmed by Covid’s second wave, doctors and local government officials are calling on Prime Minister Narendra Modi to extend vaccination to younger people and impose “a continuous lockdown for a limited period”.
The Indian Medical Association (IMA) advocated in a letter to Modi that the vaccination strategy be improved immediately. “Our vaccination rate is very low,” says Jayesh Lele, secretary general at IMA. “With the increase in Covid cases, we need to vaccinate all adults over the age of 18.”
At the moment, the country only allows vaccination of frontline workers, health professionals and people over 45 years of age. The immunization rate in the country is 6.7 doses per 100 people, a rate lower than in Brazil (12/100). So far, 5.8% of the population has received a dose of the immunizer, according to data compiled by the New York Times, and only 0.8% is fully vaccinated.
The Indian Ministry of Health excluded the possibility of vaccination being extended to the younger population. Secretary of the portfolio, Rajesh Bhushan said that, in view of the limited supply of immunizers, the program was designed to protect the most vulnerable sectors of the population. “The main objective is to reduce deaths and protect the health system involved in fighting the pandemic.”
Bhushan says the next four weeks will be critical, as the cases appear to be spreading faster than the last time. A total of 90.2 million doses have been applied in India so far, including 3.12 million on Wednesday, according to Our World in Data. The total number of Covid cases reached 12.92 million, and the death toll reached 166,862.
Tope, the minister of health in Maharashtra, said that vaccine doses are starting to run out at several immunization centers in the state and that people are being sent home due to scarcity. Vaccination would be suspended in several districts starting this Thursday (8).
To raise monthly vaccine production to over 100 million doses by the end of May, the Serum Institute, the world’s largest vaccine manufacturer, asked the government for help of US $ 402.97 million (R $ 2.3 billion) to increase the production capacity of the AstraZeneca / Oxfrod vaccine.
Giridhar Babu, of the Public Health Foundation of India, said that the virus variants are more contagious than before, although there is no evidence in terms of genomic sequencing. “There is also the possibility that the immunity of those who have already had the disease will decrease after the first infection. Although the proportion of reinfected people is lower, there is evidence that the antibodies weaken, especially if the first infection was asymptomatic. ”