How did we get here?

In January, Prime Minister Modi gave a 14 minute speech virtually at the World Economic Forum:

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In this speech, the Prime Minister noted that India had beaten the doubters and controlled Covid-19 more effectively than other countries. At that point of time, the peak number of infections (throughout 2020) in the first wave across the country was sub 100,000 per day. Two days ago, that number crossed 400,000. It’s also pretty clear that the recorded number of infections is widely underreported due to inadequate testing infrastructure and the real number is likely 5–10x the reported number. Which means there may be 4M Covid-19 infections per day across the country.

I’ve racked my brain to understand how this could be possible given the speech was only 3 months ago. We don’t know for certain just quite yet how this could be happening but a few key reasons are most likely behind the surge:

New Strains

There are two new strains that have simultaneously hit India — the B 1617 strain and the B 117 strain. The B 1617 strain has been found across Northern India (Delhi, Uttar Pradesh, Rajasthan) and the B 117 strain has been found in Western India (Mumbai, Gujurat). These strains are both more contagious/viral and likely more severe than the GH strain that hit North America last March. It’s hard to compare apples to apples the morbidity rate versus the US given both testing and fatalities attributed to Covid are massively underreported. But there’s a clear sense that this new “double mutant” variant is a more dangerous strain than the original strain in March 2020.

Large Gatherings

The low case count led to a loosening on restrictions in early 2021 across India. It’s worth remembering that India has 1.4 billion people across 3M square kilometers. By contrast the US has around 350M people across 10M square kilometers. 4x the population, 1/3 the land…not a great combo for fighting the spread of an ultra contagious virus.

There are a few key events that in particular may have caused the rapid surge:

Weddings — If you’ve ever been to an Indian wedding you can attest to both the size and duration being a few multiples larger than a typical American wedding. Even though there were guidelines and stated restrictions, reports emerged of lots of weddings taking place without masks or distancing. Changing dates of weddings is considered both a logistical nightmare and “inauspicious” so many powered through even though it was inadvisable to do so.

Religious Festivals — One of India’s largest religious festivals, the Kumbh Mela, took place between late January and late April. It’s estimated that close to 10 million people attended this event over the course of 3 months. The festival itself takes place on the banks of the Ganges river (the largest river in India) in India’s most populous state, Uttar Pradesh.

Elections — 5 of the 36 states (which includes Union Territories) in India had elections between late March and late April. Large election rallies were held across massive stadiums within those states. It’s worth noting — India’s 2019 general election (the closest equivalent to the US Presidential election) had close to 600M people vote of the 900M eligible voters. It was the largest turnout of any election in any country ever in the history of the world. By contrast, the 2020 US Presidential election had 160M people vote of the 240M eligible voters. Both countries saw the largest % turnout ever in history (ironically both around 2/3 of the registered voter count) but India’s voting populace was larger by close to 4x the US amount.

Cricket — For those who aren’t aware, Cricket is basically the NFL, NBA and MLB combined into one mega popular sport across India. Cricket matches are massively popular and stadiums were filled with spectators with only partial compliance on mask wearing (and certainly not enough social distancing)

Ask any Indian about their topics of interest and it’s likely weddings, politics, religion and cricket will be a part of the conversation. Unfortunately all 4 likely inadvertently led to a massive unexpected surge that led India to where it is today.

New Strains

Large Gatherings

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