How coronavirus eventually gripped India - and why it took so long

As Covid-19 spread through Europe in February and March, India braced for a similar wave of infections.

Worried politicians placed the billion-strong population under a strict lockdown and sent healthcare workers out into villages to look for coronavirus symptoms - yet at first, medics found little to report.

“South Asia’s relatively low case numbers are a bit of a puzzle, especially given high population density and poor health care systems across the region”, Foreign Policy reported in April.

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Now, however, India’s coronavirus count is “rising at an alarming rate”, says the BBC.

The authorities today reported 23,000 new cases, pushing India ahead of Russia to become the country with the third-highest number of confirmed infections, behind only the US and Brazil. According to latest figures, India has recorded a total of more than 700,000 cases and nearly 20,000 Covid-related deaths.

What’s happening?

Infection rates across India have been climbing as a strict lockdown in place since late March is gradually lifted, with most activities now allowed “after the economy nose-dived during the shutdown”, The Guardian reports.

Even though masks remain compulsory and commuter trains are suspended, many Indians are complacent about Covid-19, says Jayaprakash Muliyil, an epidemiologist at the Christian Medical College in Vellore, Tamil Nadu.

“The general population’s anxiety about the disease is low,” he told the journal Nature.

A sharp increase in Covid-related fatalities may soon change that. Indian officials “recorded 421 new deaths from the virus” on Sunday, “taking the toll to over 2,300 in the five days of this month alone”, The Times of India reports.

And the official numbers almost certainly don’t tell the whole story.

A nationwide testing programme found that 0.73% of the population had Covid-19 antibodies in their blood by early June. That would imply that ten million Indians had already “contracted the deadly contagion”, The Hindustan Times reports.

The official death toll, too, is likely to be well below the true figure. “At least half of all deaths will happen in rural villages - around 66% of our population,” says diseases expert Muliyil. “And there are no real mechanisms to ascertain causes of deaths in these villages.”

Why did coronavirus seem to spread slowly at first?

At least part of the explanation probably lies in the size of India’s population and the relatively small proportion of the country’s people who had been tested. By the end of April, India had conducted 830,201 tests, or 614 for every million people - among the lowest testing rates in the world.

Other potential explanations have also been advanced. “After coronavirus entered India, speculations were rife that it won’t be able to survive the scorching heat or humid weather conditions,” says India.com. Even a “unique Indian genome” was credited with protecting the country - but those theories have now “fallen flat”, adds the news site.

While scientists do believe that the coronavirus spreads less rapidly in hot weather, high temperatures alone do not offer complete protection.

Some researchers also believe that the BCG vaccine, widely used in India to prevent tuberculosis, may offer some protection against Covid-19 - but only to the extent of slowing, rather than stopping, its spread.

What next?

Epidemiologists now expect the outbreak to accelerate, especially in India’s crowded cities.

The Guardian reports that “state government officials fear Delhi, home to 25 million people, could record more than half-a-million cases by the end of the month”, with disastrous consequences for public health.

In Delhi and Mumbai, hospitals are already “struggling to accommodate critically ill patients”, says Nature.

Some restrictions are likely to be reimposed and others that would have been lifted will be retained. “The Taj Mahal, which was scheduled to reopen on Monday, will remain closed,” reports Al Jazeera.

But a repeat of the India-wide shutdown is unlikely.

“The lockdown all over the country was not the right response,” Muliyil told Nature. “It brought misery to untold numbers of people and destroyed lives. And we haven’t been able to repair its consequences for society.”