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Why is India having a covid-19 surge?

BMJ 2021; 373 doi: (Published 30 April 2021) Cite this as: BMJ 2021;373:n1124
  1. Kamala Thiagarajan
  1. Tamil Nadu, India

India’s infections set new pandemic records in April, with more than 300 000 positive tests each day for a week. Kamala Thiagarajan looks at the many unanswered questions

On 26 April India saw the highest daily tally of new SARS-CoV-2 infections ever recorded in the world, 360 960, taking its pandemic total to 16 million cases, second only to the US, and more than 200 000 deaths.

The devastating second wave comes a year after the country imposed one of the most rigid lockdown restrictions in the world—and just three months since its health ministry declared that infections and mortality were at an all time low.1

What is causing India’s second wave, and why is it so much worse than the first?

After the first wave people dropped their guard, said Chandrakant Lahariya, an epidemiologist who helped write India’s national covid vaccine policy. “In some of the most badly hit states, like Delhi and Maharashtra, community transmission was so rampant that there have been several localised waves,” he said. Media reports have blamed lax social distancing and mask wearing, alongside mass political rallies for recent elections and religious events such as the Kumbh Mela, in which hundreds of thousands of Hindus gather at the Ganges river.

“The government was easing restrictions by what seemed to be the end of the first wave,” said V Raman Kutty, an epidemiologist and honorary chairman of the non-profit organisation Health Action by People in Thrissur, Kerala. “Malls and theatres opened; there were sporting events, elections, and religious events. Politicians even made the unsupported claim that India had beaten the pandemic.”

A report published in the International Journal of Infectious Diseases in December 2020 concluded that the transmission rate fell significantly during the first lockdown but warned that lockdown was only a temporary measure to quell outbreaks.2 The authors recommended ramping up testing and self-isolation to prevent secondary infections, …

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