One of my new year’s resolutions for 2021 was to write a bit more. I had originally envisioned writing about reflections from the pandemic, resuming family travel, learnings coming out of an unusual year….favorite pandemic streaming shows. But all of those topics got pushed to the side in the last two weeks given the recent events in India. For those who haven’t kept up, India is undergoing a second wave of Covid-19 infections that has completely overwhelmed the country’s health infrastructure. The stories and images are heartbreaking to say the least. This will undoubtedly be the single largest humanitarian crisis in India since the Partition of India in 1947. I’ve tried to reconcile how exactly this all happened so unexpectedly. I’ve also dug in to try and see what the greatest needs are and how I individually (and all of us collectively) can have the most short and long term impact on helping alleviate the crisis at hand. Finally, I think we must remember that even if the Covid-19 crisis is quelled over the next few months there are longer term issues around a potential economic crisis and mental health epidemic that must be addressed before they end up exacerbating an already debilitating crisis.
“”India is the cradle of the human race, the birthplace of human speech, the mother of history, the grandmother of legend, and the great grand mother of tradition. Our most valuable and most artistic materials in the history of man are treasured up in India only!” — Mark Twain
My parents emigrated from India to the US (by way of Canada) in the 1970’s. We grew up truly a bi-cultural household absorbing the incredible traditions and holidays of American life (Christmas, July 4th, Thanksgiving…….National Ice Cream Day) while also maintaining many of the cultural traditions of India (Diwali/Deepavali, Ganesh Chaturthi, Holi). I also had the fortune of going to India every 12–18 months from the time I was born and even starting my career working in India after graduating from UC Berkeley (more on that in a later post). It’s hard to really describe India for those who haven’t visited. The great writer Arundhoti Roy once described India by saying “India lives in several centuries at once.”. You see in the villages the throwback to agrarian roots and lifestyles that have been slower to evolve than the typical post industrial society. In the cities you see the effects of digitization and urbanization combined with ever evolving movement between social classes. And in the towns you see a hybrid of both — a desire to create upward trajectories for those seeking greater opportunity while not losing out on the things that make India so profoundly unique. I had the blessing of being able to experience all of these through the many trips I took that ranged from spending time in the largest Indian cities (Mumbai, New Delhi, Bengaluru) to the smallest villages in Odisha (where my parents hail from). The most salient memory that has lasted throughout the decades is one of community. There is a deep ethos around collective responsibility. Indians know that politics are to be followed and debated but beyond this mutuality is to be expected from those around you. The concept of neighbors is quite different — doors are left open, food/drinks are exchanged daily and there’s no real barriers constructed. Which is why this is such a difficult time for the 1.4 billion people that live in India (and hundreds of millions of Indians around the world). The idea of a quarantine is so…….un Indian. It’s not a surprise that the largest social networks (Facebook, Twitter, Snap, etc.) have some of their highest usage in India. It’s an extremely social culture with a desire to consume plenty of media (in any and every form) both in analog and digital formfactors. Even though my parents left India 40+ years ago and I was born here (as a proud American), not a day goes by without both being appreciative of the greatness of the US while also remembering the cultural heritage that’s a core part of our identity.
How did we get here?
In January, Prime Minister Modi gave a 14 minute speech virtually at the World Economic Forum (link: https://www.youtube.com/watch?v=z1h3M4zQXPY). 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 causes 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.
What happens now?
The situation in India is both dire and consequential to the global fight against the pandemic. The biggest challenge in India is an already small and impacted health infrastructure crumbling under duress. The biggest shortages fall under Oxygen, Vaccines, Tests, Hospital Beds, Masks and Doctors:
- Oxygen — India has the lowest number of hospital beds per capita of any developed country. When the pandemic started, India had only ~63,000 beds with oxygen attached. In the last year, they’ve added close to 100K more beds with Oxygen. You can do the math. 400,000 reported infections per day in a country with less than 200,000 total beds with oxygen attached. There is an absolute crisis around Oxygen availability. The crisis exists in two different arenas. The first is oxygen availability. There’s an immediate need to get oxygen both into India from other countries and from areas with lower case counts to those with higher numbers. The second is oxygen distribution. This is a massive supply chain and logistics issue. Transporting oxygen requires specialized containers that can keep oxygen cryogenically liquid so that it’s usable for patients in hospitals and homes. These containers are not readily available and will be needed to save those lives most in danger.
- Hospitals — There’s a big shortage of hospital capacity that is eerily reminiscent of Spring 2020 in the US. Sick patients are travelling hospital to hospital gasping for air while they hope to find a bed that they can use. Relatives are braving this health Armageddon just to try and get their loved ones a fighting chance to survive. Both the government and the private sector have jumped forward to add hospital bed capacity but more is needed quickly.
- Masks — A shortage of masks exists for the infected population, their caretakers and doctors. Beyond supply, Compliance around mask wearing is essential given only 2 percent of the population is vaccinated to date. Law enforcement can’t be expected to enforce this — many officers are working under dangerous conditions to maintain law and order and even doing things like lighting funeral pyres for the recently deceased. This has to become culturally normative across India until herd immunity is across the line.
- Vaccines — Vaccine availability is a complicated issue in India. India is one of the largest producer/exporters of vaccines for the last decade that are used across the world. The Serum Institute of India (SII) is considered one the premier vaccine producers in the world. Both the SII and Bharat Biotech (a two decade old vaccine producer out of India) received approval to produce vaccines for use within India. Interestingly, neither produced the mRNA equivalents of what Pfizer and Moderna produced in the US. Over 60 million doses of the vaccine were exported to over 80 countries across the world. What’s worrisome is production capacity is now halted and diverted to help manage the crisis in India and away from other developing countries. This will cause delays in vaccine availability in South America, Africa and European countries. The global vaccine marketplace is a great example of supply/demand imbalance. I sit in California with numerous hospitals, pharmacies and universities begging for people to show up to take the vaccine. Meanwhile, friends in India are desperately trying to find the vaccine but can’t. While the government has announced availability for any Indian resident over 18, the supply has not kept up. The Biden administration was late to the party but announced this past week that they will send unused supplies of the 60 million AstraZeneca vaccines stockpiled to India for immediate use. How much of the 60M will be sent to India is still TBD and how quickly it can be utilized is essential to saving lives. The hope is the world’s excess supply can be sent to fulfill the massively needed demand in India.
- Doctors — There is a massive shortage of doctors to help care for those in greatest need. The frontline workers had already been paralyzed with long hours, dire conditions and genuine fear for the safety of their own lives along with their families. One area that doctors around the world may help with is volunteering to help answer basic questions for patients and their families. Mobile penetration is huge in india and lightweight telemedicine may actually make a material difference.
What can we do?
It’s clear everyone wants to help but a real question exists as to how best to do so. There are three primary areas individuals can make a difference: donating to select nonprofits, raising awareness around the issue and checking in on their South Asian friends
- Giving to Nonprofits — There are many amazing nonprofits that have jumped to help solve this the Covid-19 issue. It’s worth noting that the nonprofit sector does have participants that have religious or political affiliations that may not be optimal for those giving from outside of India. It’s super important to take the time to do a bit of homework on specific nonprofits prior to making a donation. There are two specific nonprofits I plan to both contribute and help grow awareness around:
- US Strategic India Partnership Forum (https://usispf.org/): The US Strategic India Partnership Forum focuses on engagement around policy and trade between the US and India public and private sectors. They’ve done incredible work on the ground and have heeded the need of the moment by focusing on Oxygen distribution (by securing Oxygen concentrators), home medical kits (for those who can’t make it to a hospital) and other medical supplies. The group has created a 501c3 nonprofit called the US India Friendship Alliance that will work closely with the Government of India, the Indian Red Cross and US Industry partners. They have made a goal to secure 100,000 oxygen containers and have already secured 35,000 containers due to the generosity of donors like Deloitte and individuals like USISPF Chairman John Chambers. Here’s a tweet showing the first shipment of containers arriving in New Delhi earlier this week: https://twitter.com/USISPForum/status/1388162958363185154. If you are interested in supporting the US India Friendship Alliance institutionally or individually, please contact Gaurav Verma at [email protected], visit the website for frequent updates and follow @usispforum on Twitter.
- American India Foundation (https://aif.org/) — The American India Foundation was started nearly 20 years ago in the aftermath of another crisis, the Bhuj earthquake in the state of Gujurat that killed nearly 20,000 people and injured another 167,000. Former President Clinton partnered up with leading Indian Americans to start a dedicated foundation oriented around investing in education, livelihood and healthcare. I had the privilege of seeing this group get started and helping catalyze their first volunteer chapter in the SF Bay Area back in 2003. That experience helped foster my interest in the development sector within India. AIF is focused on the health infrastructure issues and plans to add 2000 portable hospitals across India in the coming months. This gives an additional 2.5 million people access to healthcare. AIF is partnering with both the Government of India (through the office of the Principal Scientific Advisor) and Mastercard on this initiative. If you’re interested in contributing, please visit http://aif.org.
Some additional nonprofits that I strongly urge engaging with include:
- Give India — A great nonprofit aggregating and curating a variety of nonprofits focused on food, oxygen, supplies, etc. Special thanks to Vinod Khosla for highlighting their amazing work
- Oxygen for India — Focused on sourcing oxygen for those in need
- ACT India— A group of entrepreneurs, investors and executives within the Indian startup ecosystem came together to help with Covid-19 relief. They are sourcing oxygen concentrators for those most at risk within the startup ecosystem and in partnership with the government of India.
A great initiative has been taken by Sonal Chokshi to capture and curate key organizations and resources in the fight against Covid-19 in India in this Google doc: https://docs.google.com/document/d/1_Pzyx8oc6rNd0gE0XE_cEHwzBpE-04VYT7NC2xuo0aE/edit?usp=sharing. Please take a look as its got many useful articles and is updated frequently.
2. Raising Awareness — It’s important to make everyone aware of the severity of the issue at hand. A friend of mine asked how this most affects the US. There are innumerable ways that this will trickle down to the US but here are a few of the key areas:
- New Viral Strains — There are a number of cases now in the US of the double mutant strain. These are folks who likely visited India and returned to the US either pre or post vaccination. The looming question is how well do the mRNA vaccines protect against these new strains. Early studies and assertions from immunologists suggest they should be effective in preventing serious hospitalizations or death, but the reality is we won’t know until there’s additional data from the mRNA vaccine manufacturers and the CDC (which could take months). It’s important to not get carried away with the isolated incidents that will likely start getting lots of engagement on social media and local news.
- Business Continuity — There are going to be significant business continuity issues related to companies that do business with India and have employees located in India. Accenture has 200,000 employees in India and an executive recently noted several have passed away already. There will be significant impacts to the world economy broadly and the US economy specifically with this unforeseen second surge which will undoubtedly affect earnings and the market over the next few quarters. Please ask your employers if they are thinking of offering help in India and offer your time and money to enable saving the critical lives at stake.
3. Checking In — The events in India not only directly affect those resident in the region but also the hundreds of millions of Indians across the diaspora. Mental health is still an underdeveloped field and there are significant cultural stigmas around therapy which hinder having open conversations. It’s incredibly important to try and reach out to your South Asian friends and colleagues to see if they’re doing okay. Many don’t want to express their stress or grief (especially in professional settings) but they need to know it’s okay to feel anxious and have a safe space to talk if it’s helpful. I’ve talked to many friends and family members over the past week and so many have noted that they’ve not shared widely their own fears related to family members living in India. Many have lost loved ones already and didn’t get to say goodbye. The impact of Covid-19 will be felt across all ages for years to come and the small acts of empathy and kindness truly go a long way in the healing process. May marks Mental Health Awareness month and I encourage all to both take time for self care and provide support for others.
We won’t be seeing a rapid decline in cases anytime soon. There’s likely to be a 60–90 day emergency around the second surge followed by an economic crisis and lastly a mental health epidemic. Sitting in the US, there are a few learnings we can apply from our own experience around what’s likely to take place in India:
- Rich/Poor Gap: The pandemic has most acutely affected the less fortunate in our society. Black and Brown communities have seen massive disruption, the poor have lost their livelihoods and savings and children on the bottom of the economic spectrum have regressed in terms of education. India will likely see the same phenomenon in slightly different ways. The news now is noteworthy given it’s hit the most affluent cities (Mumbai, Delhi, Bengaluru) and affected all social classes. It’s likely though that the virus will ramp in smaller towns and villages where people have less access to social media and news coverage is sparse. 70% of India’s population lives in villages and just above or below the poverty line. They have even less access to healthcare and may be abandoned as the world sees less of them on Twitter, Facebook, BBC, CNN and other major networks. It’s important to continue giving to those NGOs focused on helping them rehabilitate post pandemic.
- Job Creation: The Indian economy will take a major beating between multiple lockdowns and the various surges that have upended life. The long term solution is to foster an economic boom fueled by entrepreneurship and innovation. India’s economy still has elements of the socialist heritage (even Bharat Biotech is partially owned by the Indian government with IP assigned to the public sector) and there needs to be sustained economic growth to prevent massive unemployment. 50% of the country is below 25 years old and nearly 2/3 is in the working age group (15–59). S&P just cut it’s credit rating for India and FDI is likely to ebb as a result. A vibrant startup ecosystem has been fostered in the last few years and without investment into seed and venture rounds, many founders will go back to safer albeit slower growth companies. Companies should continue to hire talent and invest in the incredible labor pool within India. And investors should look to fund venture and growth opportunities — if you take a longer term view there’s no doubt that India will be among the most important economies in the next 30–50 years.
- Discrimination: We have seen both massive social unrest and progress with the Black Lives Matter (BLM) and Asian American Pacific Islander (AAPI) movements over the last year. If we aren’t mindful, hate crimes against South Asians could rapidly increase. The rhetoric used by politicians and the media around the “China virus” directly led to hate crimes and racism within the AAPI community. Similarly, if politicians choose to blame the “India virus” for more precautions, we could see more hate crimes against South Asians. Local and national community leaders must advocate for solidarity not division. South Asians saw the ugly side of this during 9/11 when innocent Sikhs were targeted and killed during the backlash to the terrorist attacks in New York and Washington DC. I’m hopeful that this won’t happen but also know from experience that we are always only a stone’s throw (or tweet) away from unrest.
On a personal note, I’ve now had several friends and family members get Covid-19 and a number of extended family members pass away in the last two weeks. Some had received the first dose of the AstraZeneca vaccine. Others weren’t able to get oxygen or hospital beds in time. As the situation unfolds, remember that we’re all connected in ways that we can’t even comprehend. The US and India are the last two large scale democracies in the world and need each other more than ever. Let’s pray for the victims in India, do our part to help those most in need, and hope that better days are ahead. And let’s try to be proactive instead of reactive given this is unfortunately just the beginning of what’s likely to be a long road to recovery for India and South Asians across the globe.
This article was first published on Medium.com