By Relying On Unsustainable Measures, We Ignored Both History And Reality In The World’s Most Vulnerable Nation
In June, 1918, in a crowded apartment block in the port city of Mumbai, India – then called Bombay – a crackling chorus of coughs echoed through the halls and streets. Several young people had fallen ill with a fever, chills and uncontrollable coughs, and that number seemed to double, triple and quadruple in the coming days. Within weeks, the malady spread across the city like a raging fire, the Indian people like thick trees and timber of a parched forest. By the end of the summer, the entire country, then the most populated territory in the sprawling British Empire, seemed to succumb to the viral conflagration.
India, the second most populated country on Earth and home to some of the most densely-populated places on Earth, was the part of the world hardest hit by the 1918 Spanish Flu Pandemic. It is unknown just how many people died, as many who were taken by the flu were rushed away to the funeral pyres before they could be counted. Estimates put the death toll at anywhere from 12 to 15 million people; five percent of the population of India at the time, and a quarter of all fatalities worldwide from that pandemic.
The pandemic’s effect on India is often forgotten about, overshadowed by its terrible toll in Europe – especially in Spain which gave the illness its name – and the United States, but the Subcontinent suffered far worse than anywhere else. For weeks bodies piled in the streets and clogged the Ganges River; British occupiers put entire cities on lockdown, leaving Indians to die in their homes as the flu ravaged apartment block after apartment block. A young Mahatma Gandhi fell ill from the flu, and the feelings of abandonment and ill-treatment by the British helped spur the uprising that led to India’s independence a generation later.
Knowing that India, which to this day suffered regular epidemics of diseases practically nonexistent in the Western World, was hardest hit by the 1918 pandemic, the historical plague that has inspired much of our reaction to COVID-19, the questions we must ask ourselves is; why and how? Why did we not see a massive outbreak of a severely contagious novel virus as a catastrophe-in-waiting for India and take the past year in which India had been spared to prepare accordingly? How did we let this happen? Italy, England, America, even Brazil might have taken us all by surprise, but India was always vulnerable to disease.
The answer, I believe, comes from the moralization of COVID-19 mitigation measures this past year. At the start of the pandemic, India enacted a strict lockdown, which was credited with preventing a massive epidemic there. After the lockdown lifted, India had a smaller epidemic late summer into mid-autumn last year, but one that was managed, unlike the massive spikes that brought hospitals to near collapse in Italy, Spain, UK, United States, France, Mexico and Brazil. The reason India was spared up until now isn’t quite clear, but many experts appeared to give credit to the Indian people themselves. As recently as February, experts like Yaneer Bar-Yam, a longtime studier of pandemics and an advocate for #ZeroCOVID, which aims to get global consensus on restrictions and policies he argues would eradicate SARS-COVID 2, praised India for its pandemic response. Bar-Yam credited the nation with utilizing “impressive community case finding, contact tracing, isolation, quarantine, communications, massive health and volunteer effort, lockdown, support” among other ideas, to reduce the country’s caseload to then only 10,000 a day. Six weeks after he made that post, India was seeing nearly 20 times as many cases a day and the chart of the daily case growth was almost a vertical line. in February, Bar-Yam praised Indian Prime Minister Narendra Modi, who politically is aligned with COVID failbros President Jair Bolsonaro of Brazil, British Prime Minister Boris Johnson and former President Donald Trump of the United States, for his leadership. Now, just two months later, Modi is seen with the same level of disdain by experts around the world as Bolsonaro, Johnson and Trump were when their countries were being strangled by the virus.
So what happened? Well experts like Bar-Yam suggest India had succeeded due to adherence to mitigation measures, but then stopped. For a year, the Indian people wore masks, social distanced and observed recommended practices that experts refer to as “smart,” “common sense” and “tried and true.”
In the first days and weeks of the Indian outbreak, videos of big outdoor religious gatherings popped up on social media, and those were immediately blamed for the outbreak. The Indian people, they said, gave up on mitigation measures with the blessing of Modi, who allowed the religious gatherings to go on.
But to place the blame entirely on that, you have to accept a few things that go against some parts of the narrative we’ve gotten from experts.
First, you have to believe the Indian people were not engaging in crowded public gatherings for the past 15 months, which is untrue. Since India’s lockdown lifted last June, there have been several examples of huge public gatherings in the country, some of which were blamed for India’s late 2020 spike in cases, even as those gatherings were illegal.
Second, you have to believe that the Indian people made extremely liberal use of face masks in indoor settings, and then suddenly stopped in late March. It doesn’t make sense if you think masking in India just slowly faded away: No. For this to make sense, you have to accept everyone stopped wearing masks almost at the same time, otherwise the virus would be spreading more slowly, or the outbreak would have started much earlier.
Basically, you have to believe those public health measures kept a bad COVID outbreak, in a country where social distancing is almost impossible, at bay for as long as it has; and you have to believe that the Indian people, en masse, all 1.8 billion of them, suddenly gave up sometime in late March. This seems almost comically unlikely, and that it is the current narrative just tells you how ridiculous COVID moralism has become. The pandemic lives and dies based on masking and distancing, and a population’s virtuous adherence to those protocols and the government’s mandates of said protocols. People, like lemmings, stop following rules the moment a government lifts them. When people are good, there is no COVID, but when they are bad, well, you get America, Europe, Brazil and India.
Finally, you have to accept that even if you get COVID under some level of control through restrictions, you’d have to keep them place indefinitely until COVID is eradicated from the world, or you risk another wave, and you have to accept that this is entirely possible in a world of 7 billion people. Bar-Yam specifically blamed the “relaxing of restrictions” for India’s wave just this week. You don’t need to be a public health expert to know indefinite restrictions are not realistic, and eradication globally would take years, if even possible at all. COVID fatigue is real, in every part of the world, and it is not some moral failing caused by weakness, but a reality of human behavior.
The truth is probably far more nuanced, but it is not entirely understood yet. Certainly more contagious variants are likely to blame. The B 117 variant first identified in the UK which caused a massive winter wave in Europe and later in North America exploded in India in April, as did a new variant first identified in the continent which has similar mutations to B 117, possibly making it more contagious as well. The level of contagiousness probably swamped whatever reasonable measures Indians were taken to keep themselves safe, making them no longer viable.
The truth of how India fell to COVID may never be truly understood, which is why we will likely let an easy answer shoulder the blame: Indians got tired and lazy, and stopped doing what I’ve termed “all the things” – my shorthand for the list of non-pharmaceutical interventions employed first as an emergency stopgap to prevent hospital collapse, and later as the standard COVID-fighting toolbox.
What should we have done? We should have surged healthcare resources to the country and had them on standby for when an outbreak inevitably happened. The situation in India is such that exponential growth was likely to happen quicker than anywhere else (and indeed that’s what we saw in late April). We should have acknowledged two things. One, that NPIs failed all over the world when in place for long periods of time, and they will in India; and two, that once an outbreak starts, it would be impossible to stop it quickly. We should have been prepared to surge medical help to the country in the form of field hospitals, oxygen supplies and other needs. This especially should have been done as cases in the west started plummeting in March, and from countries like the United States and UK, which have successful vaccination campaigns that provided a backstop against any new rise in cases; and China and Australia, which has managed successful border quarantines to prevent domestic outbreaks.
We should have also surged production of vaccines to ship and distribute in the Subcontinent. India, being among the most vulnerable nations, should have been among the first to see mass vaccinations. Moderna has waived its patents to allow production of its vaccines elsewhere, and the Biden Administration has sent vaccine supplies to India so they can begin producing vaccines, and is sending millions of AstraZeneca vaccines that had been bought in case the other vaccines didn’t work out. Since the FDA hasn’t approved that vaccine and we have enough of the others, the administration is sending those to the rest of the world, mostly to India. But this should have been done earlier. Going forward, mass vaccinations need to be part of an outbreak response.
None of that was done, however, and instead we wrote off India as a success story too soon. Rather than recognize the unique vulnerability the country has to a contagious virus and more contagious variants, experts, desperate to sell the narrative that masking and distancing are the pandemic panacea, ignored the risks. Now, India will have to bear the brunt of what is likely to be the worst, but hopefully the last, major national outbreak of this pandemic.
My hope is that we learn something in the postmortem to this. It was a mistake to rely solely on human behavior to control the pandemic. Experts were never sure NPIs would work, and even where they did work, they weren’t sustainable anywhere. Even countries like Thailand and Cambodia, which escaped earlier COVID waves, another consequence of good behavior, experts say, are now being rocked by COVID. We should have predicted NPIs would eventually fail, as they had across the world in the past year in Europe, South Korea and Canada, and that would leave India uniquely vulnerable to a dire epidemic.