India’s health care system close to collapse

India’s health care system and other essential services are close to collapse as a second coronavirus wave that started in mid-March tears through the country with devastating speed.

On Wednesday, the country saw its highest daily rise in infections and deaths since the start of the pandemic — 295,041 new Covid-19 cases and 2,023 fatalities — as hospitals turn away patients and beg for more oxygen, while desperate families plead for beds and medicines on social media.

“The volume is humongous,” said Jalil Parkar, a senior pulmonary consultant at the Lilavati Hospital in Mumbai, which has had to convert its lobby into an additional Covid ward. “It’s just like a tsunami.”

Prime Minister Narendra Modi addressed the nation on Tuesday, acknowledging the country’s “very big battle” against Covid-19. He however appealed to states to “use a lockdown as their last option,” even as the capital New Delhi entered its first full day of a week-long lockdown, Jessie Yung and Vedika Sud report.

On Monday, Delhi Chief Minister Arvind Kejriwal warned that failing to halt movement in the city could lead to “tragedy.” When India went into lockdown last March, the mass exodus of migrant workers from the cities became one of the most enduring images of the country’s battle against the virus — and is believed to have helped to spread Covid-19 nationwide.

This month, thousands of people have been seen heading to railway stations and bus stops in cities such as Mumbai and Delhi, yet the central government has maintained that no reverse migration is taking place.

The second wave, which has surpassed the first, was a situation created by complacency, say experts, pointing to the government relaxing measures, and a false sense of security from the public. Weeks before cases began climbing again, the federal health minister declared that India was “in the endgame” of the pandemic.

Despite warnings of Covid risks, sports matches resumed, elaborate weddings were held and movie cinemas reopened. This month, one of the biggest pilgrimages on Earth, the Hindu festival the Kumbh Mela, went ahead.

Modi, who has a significant Hindu base, refrained from commenting on the Kumbh Mela and its Covid risks for weeks. He finally appealed to pilgrims to avoid congregating in Haridwar earlier this week. But for some, Modi’s message rang hollow, as he continued to hold massive political rallies ahead of parliamentary and local council elections in four states and one union territory.

YOU ASKED. WE ANSWERED.

Q. What should we do differently now that the B.1.1.7 variant has become dominant in the United States?

A: The B.1.1.7 variant, which was first identified in the United Kingdom, is more transmissible than previous strains, which means we must be extra cautious, says CNN Medical Analyst Dr. Leana Wen. This includes:

• Being even more on guard than before. “For example, if you are going to eat outdoors at a restaurant, check to make sure that they are abiding by CDC guidelines and there is at least 6 feet of distancing between tables. Those not yet fully vaccinated should wait until they are vaccinated before dining in close proximity with someone else at their table,” she said.  
• Wear a mask in public, practice physical distancing, and avoid indoor gatherings with people not in your household. 
• “It’s even more critical than ever to be vaccinated as soon as it’s your turn,” Wen added. 

Send your questions here. Are you a health care worker fighting Covid-19? Message us on WhatsApp about the challenges you’re facing: +1 347-322-0415.

WHAT’S IMPORTANT TODAY

EU regulator says benefits outweigh risks in Johnson & Johnson vaccine, after finding possible link to blood clots. 

The European Medicines Agency (EMA) said Tuesday it had found a possible link between the Johnson & Johnson Covid-19 vaccine and rare blood clots, but stressed the overall benefits outweigh the risks. For use in the European Union, the agency said the vaccine must include a warning about “unusual blood clots with low blood platelets.”

The underlying mechanism that may be involved in the blood clots linked to the Johnson & Johnson vaccine in the US and AstraZeneca’s vaccine in Europe is extremely rare and appears to involve a little-understood immune response.  

Experts say taking the vaccines far outweighs the risks. Blood clots in general are relatively common — affecting 900,000 Americans a year, according to the Centers for Disease Control and Prevention (CDC). And being infected with coronavirus greatly raises this risk.

Covid-19 cases keep going up in the US despite vaccinations. Here’s why. 

Covid-19 vaccinations in the United States are continuing at an impressive pace, and now all Americans aged 16 and up can get a shot. But health officials warn that the country remains in a “complicated stage” of the pandemic. 

In the past seven days, the US reported an average of more than 67,100 new Covid-19 infections daily, according to Johns Hopkins University data. That’s slightly below the previous week’s figure, but it’s still 25% above what it was nearly a month ago.

There are several reasons for this rise, say experts, namely dangerous coronavirus variants — such as the more contagious B.1.1.7 strain that has helped fuel another surge in Michigan. Pandemic fatigue and more Americans moving around are also not helping.

China’s vaccine nationalism softens as country signals it may approve foreign-made shots

As much as China may want to promote its domestically produced Covid-19 vaccines, it also has to face reality.

Beijing issued a policy last month making it easier for foreigners to apply for a visa to China if they had received a Chinese vaccine. Experts warn it sets a dangerous precedent that could leave the world separated into vaccine silos.

There’s also a practical problem: it is impossible to get a Chinese vaccine in many countries, including the US, because they have not been approved for use by regulators, Nectar Gan and James Griffiths report.

ON OUR RADAR

• Mexican President Andrés Manuel López Obrador got his first AstraZeneca shot on a livestream yesterday, as he urged the country to trust vaccines.
• Economic recovery from the Covid-19 crisis is unsustainable, says the International Energy Agency, as it estimates that carbon emissions from energy use are on track to spike by 1.5 billion tons in 2021.
• A national nightly curfew in the Netherlands, designed to reduce social contact, will end on April 28, Prime Minister Mark Rutte announced. The curfew has been in place since January 23 and runs from 10 p.m. to 4:30 a.m.
• As US health officials race to get more Covid-19 shots into arms to control the virus, experts warn the country will run into another challenge in the next few weeks: vaccine supply will likely outstrip demand.
• Russia’s President Vladimir Putin urged all citizens to get vaccinated against Covid-19, in his annual address to the nation on Wednesday. “It is the only way to stop the deadly pandemic,” Putin said.

TODAY’S PODCAST

“About 30-40% of the people with long Covid report improvement in their symptoms after vaccines, so that gives us some hope in trying to understand what we can do to help them, but also what is potentially causing the disease,” — Akiko Iwasaki, immunologist at Yale University.

In today’s episode, CNN’s Chief Medical Correspondent Dr. Sanjay Gupta talks with Iwasaki about treating Covid long-haulers and what we can do to help women and minorities succeed after an incredibly difficult year. Listen now.