• Rapidly-spreading variants are fueling India’s dramatic surge in coronavirus cases, experts said.
  • Hospitals are running low on oxygen and bodies are piling up at crematoriums.
  • It’s a reminder not to scale back on testing or social distancing before vaccinations are over.
  • See more stories on Insider’s business page.

Just two months ago, India’s coronavirus outbreak seemed to have turned the corner. Cases had plummeted to their lowest point since the beginning of the pandemic and vaccines were starting to be rolled out across the country.

But Bramer Mukherjee, an epidemiology professor at the University of Michigan, wasn’t convinced the progress would last. By mid-February, she spotted an uptick in cases amid an increase in weddings, family gatherings, festivals, and sporting events.

She called up her 81-year-old father and 79-year-other mother, who live in Calcutta, to see if they were getting vaccinated soon.

“They said, ‘There’s no virus right now. There is no rush,'” Mukherjee told Insider. “I think this actually tells you what happened: that in the valley of the virus, that was the right time for India to accelerate vaccination, but that did not happen.”

Now India is the epicenter of the pandemic: Average daily cases there have risen more than 20-fold in the last two months. On Friday, India reported nearly 333,000 coronavirus infections — the world’s highest single-day increase in cases since the pandemic started. Deaths, too, have risen more than 17-fold in the last two months. Local media outlets are now reporting long lines at hospitals, ventilator and oxygen shortages, and bodies piling up at crematoriums. 

Public-health experts said there’s one major culprit for why the outbreak spiraled out of control so quickly: rapidly-spreading variants. One variant in particular, B.1.617, has a troubling “double mutation” that may help it evade protection from vaccines or natural infection. Scientists say the variant also shows early hallmarks of being more transmissible than the original strain.

But India’s latest surge wouldn’t have been quite so bad, experts added, if the country hadn’t loosened social distancing restrictions or been slow to distribute vaccines to the public. 

“Unfortunately the narrative that played out about how well India did caused a false sense of security,” Krutika Kuppalli, an assistant professor at the Medical University of South Carolina, told Insider. “I always felt and believed that India would become the epicenter of this pandemic.”

Mukherjee said India’s “premature celebration of victory” should serve as a warning to other countries who are seeing cases decline.

“The double mutant is now in California, it is in the UK, and similar variants are going to circulate all over the world,” she said. “It’s really a global problem.”

India’s ‘double mutant’ variant knows no borders

Scientists from the Indian state of Maharashtra first identified the B.1.617 strain in March. At the time, they said the variant was linked to between 15% and 20% of cases there. By April, the variant had come to represent more than half of India’s new coronavirus cases, according to data from GISAID, a global database that collects coronavirus genomes.

“This new variant seems more infectious, seems to grab younger people, and seems to have really driven the numbers up,” Prabhat Jha, an epidemiologist at the University of Toronto, told Insider.

But other coronavirus strains could also be fueling the virus’ spread.

Scientists recently identified a variant with three mutations, B.1.618, in West Bengal. And a variant in Bangalore, B.1.36, carries a mutation that has been associated with coronavirus reinfections. 

Experts said India would benefit from regional lockdowns in areas where variants are spreading widely — but ultimately, the virus doesn’t respect borders.

“If India doesn’t get their pandemic under control, it affects the entire world,” Kuppalli said. “We can put all the travel restrictions we want, but that’s not going to prevent these mutations from getting to other places.”

Social gatherings gave variants more opportunities to spread

Variants had plenty of opportunities to spread as more Indians mingled this spring.

Earlier this month, at least 50 million Hindus crowded along the Ganga river for a religious festival that has now been linked to at least 2,000 coronavirus cases. Indian Prime Minister Narendra Modi has also held large election rallies — including one in March that attracted 800,000 people.

On top of that, experts said, many Indians felt it was no longer vital to continue social distancing or wearing masks. A January survey found that 56% out 28,000 people sampled in Delhi tested positive for coronavirus antibodies — leading many locals to believe that large cities had already reached herd immunity, Mukherjee said.

“Many people were thinking by December, January, ‘Oh, we’ve got this under control,'” Jha said. “That turned out to be just hubris and I, among others, had warned that it could really bite back.”

Even countries like the US, UK, and Israel — which have vaccinated between 40% and 65% of their populations — need to be mindful that the virus hasn’t disappeared, experts said.

“The real lesson here is: respect the virus, respect science,” Jha said. “There’s no other way out.”

‘You can’t vaccinate your way out of a surge’

India has immunized less than 8% of its population since its national vaccine program started three months ago. That isn’t particularly surprising, given the country’s size.

“The challenges there of vaccinating a billion people are just extraordinary,” Jha said.  

But India’s vaccine rollout also suffered from a lack of urgency, experts said: Some residents didn’t feel the need to get vaccinated right away. Others remained skeptical of the shots.

India approved its own vaccine, Covaxin, before human trials were finished. Its makers, Bharat Biotech and the Indian Council of Medical Research, have said the shot is at least 78% effective against mild to severe COVID-19, according to the latest trial results. But Jha there’s still some uncertainty about how well the vaccine is working among the population.

“We know that a similarly-designed Chinese vaccine is underperforming in Latin America, and there might well be the same phenomenon occurring in India,” he said. Scientists still don’t know how well coronavirus vaccines work against new variants, either.

Once cases began to rise, Kuppalli added, healthcare workers had to shift their focus away from administering vaccinates to preventing as many deaths as possible. By then, it was too late for vaccines to prevent another outbreak.

“Vaccines are great, and we need to be rolling them out and ramping them up, but you can’t vaccinate your way out of a surge,” Kuppalli said.

India could have used the winter to bolster its healthcare system

Experts said the situation on the ground in India is likely more harrowing than any reports so far.

Widespread testing shortages mean the nation can’t quantify the scale of its outbreak — and locals report that official tallies don’t reflect the number of bodies arriving at crematoriums. India’s healthcare providers also lack the resources, including beds and medications, to treat patients.

“If you under-report and suppress data and number of deaths, then you cannot really estimate how many people are going to show up at the hospital the next day,” Mukherjee said. “And that really harms your ability to provide oxygen and to provide healthcare resources to people.”

Experts said doctors in India are often inclined — whether from lack of training or sheer desperation — to administer medications that don’t work against the virus, like ivermectin, a prescription used to treat parasitic infections.

“I’ve heard stories of people getting three, four, five, six meds prescribed to them, medications that have not been shown to be effective at all,” Kuppalli said. “I think people are just grasping for straws and that just adds to the chaos and the anxiety.” 

There’s also a financial incentive to offer drugs to patients at their dying hour, experts added.

“When you have a scenario like this, you’ll get really desperate people,” Jha said. “And then you also have very unsavory private providers that’ll take advantage of that and offer all sorts of treatment, whether they work or not.”

Kuppalli said the antiviral drug remdesivir — which showed early promise as a COVID-19 treatment but appears less effective in recent studies — is now in high demand.

“There’s a huge black market for remdesivir and I’m worried that might happen for vaccines now as well,” she said.

It didn’t have to be this bad, experts said: Had India used its brief respite over the winter to ramp up testing, genomic surveillance, and the supply of critical medications, the nation would have been better prepared to handle this latest surge.

“The treacherous thing about this virus is that you cannot wait to see its action,” Mukherjee said. “You have to really track its silent footsteps.”

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