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Dr. Jalal Baig With Covid variant raging, U.S. puts restrictions on travel from India. How this happened.

Prime Minister Narendra Modi’s hubris, lax restrictions, the new variant and a misguided vaccine policy have plunged India into crisis. The world could be next.
Image: Indian Covid-19 Death Toll Continues To Mount
Men wearing protective equipment perform the last rites for a deceased relative in a granite quarry repurposed to cremate the dead on Friday in Bengaluru, India. Abhishek Chinnappa / Getty Images

India’s second Covid-19 wave has left much of the populace literally gasping for air. More daily infections — almost 390,000 — are now being logged there than in any other country since the start of the pandemic. Yet the true numbers likely dwarf these official figures as many cases and deaths are going uncounted. The spike led the U.S. to announce it would restrict travel from India starting on Tuesday.

The Indian double mutant is shrouded in mystery. And though it’s premature to say anything with certitude about B1617, the devastation on offer in India’s second wave is a troubling sign.

To handle the overwhelming number of cases, makeshift funeral pyres are being built in parking lots as crematories are overflowing with bodies. Hospitals have been overrun by infections, with sick patients being turned away and lifesaving medicines and oxygen supplies woefully low. As journalist Rana Ayyub wrote in Time, “If the apocalypse had an image, it would be the hospitals of India.”

This horror show is a stunning development for a country that registered less than 10,000 cases in mid-February and declared victory against the contagion. But the combination of Prime Minister Narendra Modi’s hubris, lax restrictions, the emergence of an insidious new variant and a misguided vaccine policy of national self-reliance have conspired to plunge India into its current Covid abyss.

Though the culpability of Modi’s Hindu nationalist regime in this public health carnage must be recognized, the greater concern still is how India’s galactic infection burden may further the spread and development of vaccine-resistant Covid-19 variants inside the country and out.

A jarring example of how quickly foreign variants can become domestic problems is on offer right now in the form of B.1.1.7., a coronavirus strain that arose in the U.K. and has become dominant in the U.S. just months since it was first identified. Even in India, B.1.1.7. has caused an uptick in cases, most notably in the state of Punjab.

As the world starts to answer India’s distress call and begins to help its suffering masses breathe again via shipments of medical supplies and vaccines, this situation is a reminder of how our collective fates are bound to one another. An uncontrolled Covid-19 wave anywhere is a threat to human life everywhere. Though the U.K. variant is currently ascendant in the U.S., from initial impressions, the Indian strain — B.1.6.1.7. — may be more problematic for an American population that remains suboptimally vaccinated.

While other known variants carry one mutation in the all-important spike protein that enables SARS-CoV-2, the virus that causes Covid-19, to infect unsuspecting cells, the Indian variant carries two of these. Multiple mutations such as these threaten to create a virus that is not only more contagious and potentially deadlier, but one that can also evade a vaccinated body’s immune system. While existing vaccines promise efficacy against better studied variants, such as those from the U.K. and South Africa, the Indian double mutant is shrouded in mystery. And though it’s premature to say anything with certitude about B.1.6.1.7., the devastation on offer in India’s second wave is a troubling sign.

While a second Covid wave was long overdue in India, the current scale was never envisaged. Cases had been dropping since last September, and the country had several inherent advantages that seemed like it could curb any coming viral onslaught: youthful demographics, natural immunity from prior exposure to other coronavirus strains and high prevalence of Covid-19 antibodies— suggesting past infection — in the population.

The government pounced on these trends and declared an early victory. India’s health minister, Harsh Vardhan, stated that the country was “in the endgame” of the pandemic on March 7. In February, Modi’s Bharatiya Janata Party (BJP) hailed its premier “for introducing India to the world as a proud and victorious nation in the fight against Covid.”

As the government eased restrictions in the wake of these bold declarations, superspreader events like weddings, religious gatherings and election rallies soon followed. In March, cricket matches were played in front of packed, maskless stadiums in the city of Raipur. On April 17, Modi was “elated” by the turnout at one of many campaign rallies that were being held in the critical state of West Bengal. And recently, BJP leaders encouraged millions of Hindu pilgrims to flout Covid-19 protocols for God and congregate at a monthlong religious festival.

At the same time, India’s vaccine supply has fallen far short of demand. Despite anointing itself the “pharmacy of the world” for its prodigious vaccine production, only 1.9 percent of the nation’s citizens are fully inoculated, in part due to Modi’s initial desire to export vaccines as part of a diplomacy effort to “save humanity with two ‘Made in India’ coronavirus vaccines.” The country’s national pride in its two domestically manufactured vaccines (Covishield and Covaxin) also contributed to it spurning foreign vaccines early on. These shortages have been compounded by the United States’ export ban on vaccine supplies.

All of this is superimposed on a first wave that saw the Indian government scapegoat Muslims for Covid-19 outbreaks and unilaterally institute a snap “lockdown and scatter” policy that left tens of millions of migrants jobless while shuttling coronavirus to all parts of India. Now the Indian government has been accused of censoring social media criticism of its Covid-19 policies.

“It’s part of the authoritarian playbook. It’s another egregious instance of the BJP regime systematically showing callousness and hubris,” Prerna Singh, a professor at Brown University, told me. “The key thing will be for this present crisis to be recognized as not just a natural disaster but also for the political culpability of the regime.”

The uncontrolled virus transmission that has resulted from these manifold failures has created the potential for India to serve as a variant factory. As the virus hurries to replicate its genome, it can make “mistakes” that produce a more virulent and potent form of the virus. The more unvaccinated bodies it can replicate in, the greater the potential for these errant mutations to occur. In India’s large, dense and vulnerable population, the virus has been able to infect the cells of millions.

Though scientists are still working to understand the full implications of this Indian variant’s mutations, anecdotal evidence from doctors on the ground suggests something more pernicious than the first wave: Reinfections are being seen in people who had Covid-19; younger adults and children are getting seriously ill; and entire families are being infected.

The uncontrolled virus transmission that has resulted from these manifold failures has created the potential for India to serve as a variant factory.

“The risk that you will have with these large outbreaks in big regions with dense populations and strong virus transmission is that you will allow the virus to develop into strains that are completely vaccine-resistant,” Zulfiqar Bhutta, the founding director of the Institute for Global Health & Development at Aga Khan University in Pakistan, told me. “If you have to start from scratch with a new vaccine, can you imagine what a logistics nightmare that is?”

In a globalized world, the consequences of India’s unchecked infections won’t stop at the country’s borders. Already, the shockwaves are being felt in more than 20 other countries.

While Donald Trump’s pandemic failures toppled his presidency, Modi will not face the electorate again until 2024 — though the sheer scale of India’s suffering coupled with international accountability may not insulate him. And whatever Modi’s political fate, his missteps have already helped unleash a variant whose consequences may well be felt globally.