Despite a strong response at the outset of the pandemic, as of Sept 22, India has the world’s fastest growing outbreak of COVID-19 in absolute numbers according to WHO, reporting more than 5·6 million infections. Restrictions began to be lifted in June, and this relaxation has continued in the face of a continuing dramatic increase in case numbers nationally. Beneath these alarming national figures, the pattern of spread in India is nuanced and complex, with marked differences between states, and between rural and urban areas. For example, cities like Kolkata and rural areas in the north of India were relatively spared the outbreak initially, whereas Delhi, with strong international connections, was at the forefront of the first wave. Even so, India is clearly facing a dangerous period.The country has responded well in many regards, especially for such a large and diverse nation. India instigated a national lockdown in March, which was praised by WHO. During the lockdown period, tertiary care provision was increased, including access to specialist equipment such as ventilators. Testing numbers also increased quickly, with India being among the first to roll out innovations like pooled testing. India has also been at the forefront of efforts to develop and manufacture a vaccine, both through domestic vaccine candidates and manufacturers such as the Serum Institute of India preparing production capacity for internationally developed vaccine candidates.
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