May 10, 2021
Former President George W. Bush and Indian Prime Minister Narendra Modi don’t have much in common… but they do share this…
On May 1, 2003, with the backdrop of a banner reading “Mission Accomplished,” Bush infamously announced the end of U.S. combat operations in Iraq – after just five weeks and 138 dead American soldiers.
On January 28, 2021, Modi told the World Economic Forum that India had “solved [its] problems [with] the pandemic.” He pulled a rhetorical muscle patting himself on the back for saving “humanity from a big disaster by containing the coronavirus effectively.”
What Bush and Modi share is an intimate experience with that bastard, karma – taunting the fates, and paying for it.
Declaring Victory – Prematurely
When the last U.S. soldiers left Iraq in December 2011 – at which point the mission was over, though not remotely accomplished – nearly 4,500 soldiers had been killed (in addition to tens of thousands of Iraqis). The conflict cost the U.S. upwards of $800 billion. And the number of weapons of mass destruction discovered, the ostensible reason for the conflict? Zero.
And just three months after Modi’s smug self-congratulation, India donned the thorned crown as the new global COVID-19 epicenter. Each day this week, another 400,000 people were reported ill with COVID-19. The descriptions of the scale of disease death are breathtakingly tragic, as reported in Foreign Policy last week…
The country’s health care system is on the precipice of total collapse… patients are suffocating to death, relatives are scrambling for beds, the most advanced hospitals have been reduced to begging the government for emergency supplies of oxygen, and crematoriums–blazing nonstop–have run out of room and wood… Some have buried their dead in their gardens. Others have cremated them on makeshift pyres erected on pavements.
A few days ago, I checked in with my friend Rahul, who heads up a publishing company in Mumbai (which people of a certain age still think of as Bombay). He told me, “It’s shocking how many people I know who are unwell, or who have passed away.”
There’s not much traffic on the streets now, Rahul said – though more than the first lockdown. Some air conditioning maintenance guys (essential workers in Mumbai’s stifling heat, with highs in the low 90s) visited earlier in the day. But otherwise, Rahul and his family aren’t going anywhere.
India’s Early Success
Early on in the coronavirus pandemic, Modi imposed what Bloomberg then called “the world’s toughest stay-at-home restrictions,” giving the country’s 1.4 billion people less than four hours’ warning before locking down the entire country. Unemployment spiked to 27% as upwards of 120 million people lost their jobs (by comparison, the size of the entire U.S. workforce is 160 million).
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At the time, it looked like using a sledgehammer to kill a gnat. India’s daily coronavirus caseload was still denominated in the hundreds. But there was good reason to be concerned, as India is custom-made for the spread of germs (in March I wrote that it was “the one country I don’t want to visit right now“).
One reason for that is there are just so many people in India. The world’s second-most-populous country, India has more than four times the number of inhabitants of the United States – crammed into just an area the size of the four largest American states (i.e., Alaska, Texas, California, and Montana).
And in much of India, it feels like there are people everywhere all the time, whatever time of day – selling things, going somewhere, playing a game of pickup cricket, making tea, or just milling about. Think of the crowds when you’re leaving a concert or a baseball game… that’s what a regular day, at any snippet in time, is like in much of India.
Social distancing is difficult in any city – after all, the point of an urban center is high population density. But in India, the notion of personal space is as foreign as a bird with fins. If you can turn around without bumping into someone, you’re probably not in India.
Lockdown restrictions were slowly lifted in the spring. It was too early from an epidemiological perspective but essential for a population where the average person earns $6 per day (and if you don’t work, you don’t eat). And sure enough – you’ve seen this movie before – the number of cases surged, resulting in a second (first?) wave in September.
In response, India followed the garbled script of much of the rest of the world. It selectively reimposed lockdowns, fudged trying to control the outbreak, and new infections peaked at around 100,000 new cases per day.
And for a time, it looked like India had beaten COVID-19… When I spoke with Rahul in November, he told me that things were well on their way back to normal. Though most offices were still closed and people were working remotely, the market near where he lives was packed with people shopping for Diwali, a major Hindu holiday.
Some people thought that the early severe lockdown, combined with the resilience of India’s relatively young population, contributed to the overall lower impact of COVID-19. Or else, maybe India had achieved herd immunity.
Karma, Meet the Prime Minister
And then Modi declared victory – if karma is a fly, hubris is honey – and India opened back up in earnest this year.
The prime minister headlined massive political rallies – for example, on April 17 in West Bengal, where he told supporters, “I have never seen such a huge crowd before!” He continued, “Wherever I can see, I can only see people. I can see nothing else.” This was just a month after tens of thousands of cricket fans cheered on the local team at his namesake stadium in the state of Gujarat.
Also in April, around 6 million Hindu pilgrims convened at the Ganges River at the holy city of Haridwar, as part of the festival of Kumbh Mela. It’s held every 12 years but was brought forward a year this time because Hindu priests had said 2021 was an auspicious year for it. (And as the Washington Postexplained, “The Kumbh has a long and well-documented history with disease outbreaks, which occurred in 1783, 1895 and 1906” – for centuries, it’s been a superspreader event of cholera, plague, and other easily transmittable diseases.)
In mid-March at Goa, a popular vacation spot in western India, hotel rooms were sold out, even at premium pricing. “There wasn’t even any place to sit at the breakfast buffet,” Rahul told me. And virtually no one was wearing a mask.
Are the Numbers Real?
By the end of March, daily new cases were approaching September highs. The government tried to pretend that it wasn’t happening. But with the latest surge in cases, India just this week broached the 20 million mark – for the moment, still shy of the world’s No. 1, the U.S., at 33 million recorded cases.
If you can ignore the human tragedy of it all, and if you believe the numbers – more on that in a minute – India’s situation actually doesn’t look so bad, adjusted for population. In terms of cases per million people, India – with a population of 1.4 billion – has an infection rate that’s just 15% of the U.S.’s level so far. Total deaths per million people in India is running at just one-tenth the rate of that of the U.S.
And India’s current daily infection rate of 400,000 people would be equivalent – adjusted for population – to 94,000 new infections a day in the U.S. The worst day for new infections in the U.S. was far worse, at just over 300,000, in early January.
But no one believes the official figures. “Suspicions abound that the grisly official toll is itself a massive underestimate,” the Economist warned, and suggests the actual caseload “could be anything from ten to 30 times higher.” That would make what’s happening in India – in relative terms, as well as absolute (adjusted for population) terms – a whole lot worse than the U.S.
It would be one thing if India’s health care infrastructure was up for the fight… But it’s not. The country has just half a hospital bed per 1,000 inhabitants, which is a way to measure the availability of health care. That’s by far the lowest of any country in the Organization for Economic Cooperation and Development (“OECD”), an economic club of 36 countries. It’s half of the second-least-prepared country, Indonesia. (By comparison, the U.S. has 2.8 hospital beds per 1,000 people. Japan has the most, with 13.1 beds.)
Similarly, India has 0.8 doctors per 1,000 people. Within the OECD, Turkey has the second-fewest doctors, with more than double the figure in India. In the U.S., there are 2.6 doctors, while world leader Austria has just over 5 MDs per 1,000 people.
Unfortunately, India didn’t prepare when it had time. Nikkei Asia Review cautioned back in June that the first lockdown had “failed in its basic objective of boosting capacity in an overstretched health system.”
India is in a terrible place just now. COVID-19 has wreaked havoc throughout the world. But it’s on a double dose of steroids in India due to the sheer enormity of its population.
Most immediately, “It is evident that India needs a new, centrally coordinated lockdown now,” Abhijit Banerjee and Esther Duflo, winners of the Nobel prize in economics for their work on global poverty, recommended in the New York Times a few days ago.
In the meantime, India is vaccinating people as fast as it can. This week, around 2 million people per day got a shot. But that’s around half of the rate a month ago because the country doesn’t have enough vaccines (as of the end of February, the government – confident that it had the coronavirus beat – had ordered only 21 million doses).
And just months ago, India was a proud exporter of COVID-19 vaccines… Now, it’s a desperate importer. A bit less than 10% of the population has received at least one dose – compared to 25% in the European Union and 45% in the U.S.
But the good thing is that – once it has vaccines – India can get people vaccinated, even in the country’s far-flung rural areas. Connecting the countryside to the rest of the country is something that India does relatively well. My friend Rahul points to the efficiency of India’s elections, which are the world’s largest (with 900 million eligible voters) and are entirely electronic. That means that elections run smoothly even in the most remote areas of the country – boding well for getting doses into arms throughout India. “This is something we in India are really good at,” he says.
The U.S. promised to send 20 million doses to India. That’s something – but only enough to inoculate 1.4% of the Indian population, with only one jab each. Helpfully, a few days ago, the U.S. finally announced it was in favor of waiving intellectual property protections that cover coronavirus vaccines. That would allow other companies to make, for example, Pfizer vaccines.
But it’s only a first step, and a lot of hurdles remain – like angry pharmaceutical companies putting people over profit in what’s an exceptional situation, the World Trade Organization organizing itself to discuss the issue, and – in time – the transfer of technical details to allow for the production of vaccines by other companies.
Yet Indians who are dying outside of hospitals, begging for oxygen, don’t have time. Rahul – and the rest of India – is anxious.
The Big Questions
India has long aspired to vie to be the Pepsi to China’s Coke… that is, to compete for the throne of the world’s most dynamic developing economy. India lost that battle a while ago, and China’s economy is now around four times larger than India’s – over the past 30 years, China’s economy has grown 50% faster than India’s.
But now, India’s status as even the Dr. Pepper of the emerging world is under question, as the Nikkei Asia Review wrote last week…
Modi’s spectacular failure to manage the crisis raises important questions about India’s future role in the world. Far from being a reliable partner, and a possible counterweight to a rising China, India has shown that it is barely even able to look after itself.
And given what’s happening in India, it’s natural to turn to another poor part of the world with lousy health care, where people live in very close proximity to each other: Africa, which has been the COVID-19 dog that hasn’t barked. Even worse, India was to be a major source of vaccines for much of Africa – but now, India is keeping everything it produces for itself.
Fears are running high that Africa might be next, as the Financial Times explained last week… “The crisis in India… has provided proof… of what could happen in Africa if vaccination campaigns are not rapidly accelerated and the virus is allowed to spread and mutate,” it warned.
But the U.S. Is Fine… Right?
For most people in the U.S., where the war against COVID-19 seems to be in its final stages, it’s easy to turn away from soul-wrenching images of what’s going on in India. Now in America, daily new cases are down 80% from all-time highs in January. More than 140 million Americans have received at least one dose of a vaccine, which are as easy to get as a pack of gum from your local drugstore – only cheaper.
That spoilsport Anthony Fauci of the National Institute of Allergy and Infectious Disease recently warned Americans – perhaps channeling the inverse of George W. Bush of 2003 – that it would “not be prudent at all to declare victory prematurely.” But few people are listening: Even your local Olive Garden boasts a 45-minute wait to get a table – on a Tuesday night.
But what’s happening in India presents a very real danger for Americans and everyone else. The more people who are infected around the world, the more virus variants will evolve… and the greater the chances that a biologically updated version that can penetrate the defenses offered by current vaccines will emerge.
A variant reflects a genetic change, or mutation, that makes the virus different from the original sequence. Already, a range of variants – from South Africa, the U.K., India, and elsewhere –have been found to be more easily transmissible and may also evade some of the immunity offered by vaccines. And they spread fast: The U.K. coronavirus variant is the dominant strain in the U.S. now.
These kinds of changes happen to all viruses (you get a new flu shot every year because each season brings with it new versions of the flu virus). But the danger with COVID-19 – with a mortality rate as much as 10 times higher or more, depending on circumstances, than the flu – is that the effectiveness of vaccines may diminish dramatically. The scope for an altogether different version of the coronavirus to emerge increases, the more time and opportunity it has to mutate in countries like India.
And then, it’s a question of time before those variants cross a few borders… and karma comes back on those countries running a victory lap.
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