Five points about the second wave

What do we know about India’s devastating second wave, and can we assign responsibility for it? In the chaos of a pandemic, these may not be easy questions to answer. But there is no reason to suppose that they will be necessarily easier to answer once this particular wave recedes. Given India’s paucity of data and the tendency to allow media- and state-set narratives to condense into unquestionable truth, it is important to make a start at analysis while we are still enduring it.
 
Here are three points on the current state of the second wave:
 
First, we have to recognise that India is a large country, and that this wave will hit different parts of it at different times. It is clear that, for various reasons, urban Maharashtra was the first to be hit by it and may be the first to emerge. The chances are that this is because of the rapid spread of the Nagpur variant, B.1617, which limited data suggests dominates cases in Mumbai and the south. In Delhi, the UK variant or B.117 is probably still dominant, and it is also circulating in Bengaluru — which is only now approaching its peak, and where the cases per head seem to be even worse than in Mumbai or Delhi this time around. A quick policy lesson from this is that the systems being put into place to get oxygen, for example, to the worst-hit areas today must be flexible enough to shift swiftly in response to demand. Next month oxygen trains may need to run to the south-eastern coast or Assam, not to the north.

 

Second, it seems almost certain that the pandemic has finally penetrated to the great black hole for media coverage that is the peri-urban hinterland of the Gangetic plain. Excellent ground reporting from reporters such as Jyoti Yadav at The Print, Arunabh Saikia at Scroll, Yogita Limaye at the BBC, and a few others suggests that in large parts of Uttar Pradesh and Bihar a grossly inadequate health care system has clearly been overwhelmed. Several reports say, in fact, that in some parts of the rural north, the symptoms of Covid-19 are being thought of as just another fever, with few precautions taken. This is a failure of communication on a grand scale, given the pandemic has been with us for over a year. It needs to be remedied within days.

 
Third, in metropolitan India the data surrounding the pandemic is only useful as a gauge to whether hospitals are currently overwhelmed — and outside the metros, not even that. The Financial Times estimated that deaths in some urban centres are 10 times the official statistics; The Washington Post, 20 times. It’s best to try and avoid sweeping statements that use any data such as total cases, deaths per million, and so on, given these limitations. (This is true in particular for cross-sectional data. Time series data might still be helpful, as long as we try and control for the effect of differential testing over time.) A flexible and responsive government would seek to use other forms of data — anything from social media posts to random rapid cluster testing — to identify the worst-hit areas.

 
And here are two points about responsibility:
 
First, this wave was entirely predictable. We know this because it was, in fact, predicted. Multiple experts predicted it: Reuters reported that the government’s own expert group tracking variants did so. The economist Shamika Ravi pointed out in February that we were in the initial stages of exponential growth in cases, and in early March said that the second wave was upon us. Tabassum Barnagarwala wrote in The Indian Express about a seven-fold rise in cases in interior Maharashtra in February, and shortly thereafter Soutik Biswas of the BBC reported on the surge driven by a new variant. And as early as mid-December, the mathematician Murad Banaji warned against interpreting serosurveys and other data to imply that India would escape a second wave. There is no excuse for the irresponsible levels of openness seen from December 2020 to March 2021.

 
Second, the Union and state governments share responsibility. The Union has completely abdicated its duties. In an act of hypocrisy and cowardice, it simultaneously defends the last stringent national lockdown and also claims that a national lockdown today — in the face of a far worse situation — is impossible. It would be honest if they claimed that they thought the costs of the last national lockdown, whether human, economic, or political, were so high that it is worth losing hundreds of thousands of Indian lives to avoid another national lockdown. State governments, meanwhile, have shown a very variable performance. Maharashtra, dealing with the initial effects of the second wave, seemed to have been able to manage better than most. Delhi had no governance whatsoever, and might as well just dissolve its state government and its municipal corporations and be ruled by RWAs, since post Sheila Dikshit it is some sort of anarchic-collective anyway. And Uttar Pradesh may be the worst performer in India, since it has actively stifled not just accurate data but used the official lathi against hospitals and patients asking for oxygen. There is more than enough blame to go around, and let us not hesitate to share it out.