The international community comes to the rescue of India 0:30
(CNN) -
In February, it appeared that India had gotten Covid-19 under control, with daily cases falling almost 90% from the peak of the first wave last year.
Now, the country is experiencing the worst outbreak in the world.
Daily cases have increased continuously for the past 10 days;
on Monday, India reported 352,991 new cases, breaking another record for the highest number in a single day worldwide.
On the ground, these numbers translate into a heartbreaking tragedy.
The photos show grieving families dressed in full protective suits during mass cremations, performing the last rites surrounded by dozens of other burning funeral pyres.
Hospitals have run out of basic medical supplies and many patients die due to oxygen shortages.
Family members drive from clinic to clinic, desperately searching open intensive care unit (ICU) beds for their loved ones.
The government struggles to respond to the crisis, while countries around the world offer help.
But for now, the outbreak shows no signs of abating, and experts warn it could get worse.
"I'm afraid this is not the peak," Dr. Giridhara R. Babu of the Public Health Foundation of India said Monday.
"The kind of data we see, (we are) at least two to three weeks away from the peak."
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Others say India may be approaching the peak now, earlier than Babu's estimate, but with so many sick people and so few supplies available, the country will see many more deaths before the second wave subsides.
Here's what you need to know about the crisis in India.
How did it get so bad?
Record rise in covid-19 depletes oxygen in India 3:46
The cases began to rise in early March, but accelerated rapidly: the number of daily cases at the end of the month had risen six times more than at the beginning of the month.
That exponential increase has only continued with greater speed and severity.
The second wave hit much harder because people weren't prepared, experts say.
The first wave peaked in September and daily cases declined steadily in the following months;
the apparent recovery seemed so successful that the country's health minister declared in early March that they were "in the final stage" of the pandemic.
And the country's vaccination campaign, one of the largest and most ambitious in the world, was launched in January.
Residents relaxed safe covid practices, such as social distancing, and authorities were more flexible in enforcing them.
Although some states remained cautious and prepared for a second wave, none of that was enough, and no one foresaw the massive wave to come.
"Nobody saw the magnitude of the surge," said K. VijayRaghavan, chief scientific adviser to the Indian government.
“As the previous wave descended, we all had the feeling that this was something that had been substantially addressed.
We saw signs of an upcoming wave, but the scale and intensity of the wave were unclear. '
The crisis was aggravated by the slow response of the central government.
Although some state ministers and local authorities began to take action since February, there appears to be a leadership vacuum within the central government, and Prime Minister Narendra Modi remained largely silent on the situation until recent weeks.
Modi finally broke his silence last week, acknowledging the urgency of the situation in a speech to the nation, and launched a series of emergency measures to ease the burden on states and hospitals.
But by then, some critics say, the damage was done.
As India breaks another covid-19 world record and hospitals run out of oxygen, there are countries promising assistance and aid
Where is it happening?
A man performs the last rites of a relative who died of COVID-19, while other funeral pyres are seen burning during a mass cremation in New Delhi, India, on April 24.
New Delhi, the capital, has been hit hard by the second wave.
The Delhi Union Territory, where New Delhi is located, was placed under lockdown on April 19.
Since then, the shutdown has been extended until May 3.
Delhi hospitals report fatal oxygen shortage.
On April 23, 20 critically ill patients died at the Jaipur Golden Hospital in Delhi after their oxygen supply was delayed seven hours, according to the hospital's medical director.
"Everything we had was exhausted," said Dr. DK Baluja.
'The oxygen was not delivered on time.
It was supposed to arrive at 5pm, but it arrived around midnight.
People who were critically ill needed oxygen.
The western state of Maharashtra has also been hit hard, with a number of restrictions in place.
Public gatherings have been limited to four people, and public transportation in districts and within cities has been limited to essential services and "unavoidable events" such as funerals.
The entire state is enforcing weekend closings through the end of the month.
Several other states that also report the highest number of active cases include Kerala, Uttar Pradesh, Karnataka, Rajasthan, and Chhattisgarh.
Who is affected?
The message of hope they send to India from Dubai 0:52
Although current covid patients span almost all age groups, this second wave appears to be infecting young people more than before, experts say.
"The virus and its second wave are affecting the very young, and even children, in a way that it had not done in its first wave," said New Delhi-based author and journalist Barkha Dutt.
"We have met 18-day-old babies who are fighting for their lives in ICUs."
Part of this may have to do with India being a young country, said Dr. Lancelot Pinto, a consultant pulmonologist at PD Hinduja Hospital in Mumbai.
The average age of the population is 27, which means that when there is a virus that affects the whole country at such a high rate, "there are likely to be many young people who come to the hospital."
There is a possibility that the greater number of younger patients during this second wave could be related to the virus itself, or its variants, but there is simply not enough information or data yet to point to a specific cause.
However, the highest mortality is still seen among patients aged 70 and over, said Babu of the Public Health Foundation of India, "which means that we must protect the elderly by providing critical care."
What about covid-19 variants?
Covid-19: new variant with two mutations in India 1:03
There is a correlation between the current rise and the rise in the "Indian variant," according to the country's leading epidemiology experts.
“In Maharashtra we saw a rise (the variant first identified in India), we saw an outbreak.
We are seeing it rise in Delhi, we are seeing an outbreak, ”Anurag Agrawal, director of the Institute for Genomics and Integral Biology, said in a webinar on Friday.
"These are very important epidemiological correlations."
"It is also important to note that these variants have become very widespread," said VijayRaghavan.
"They constitute, according to some estimates, about 60% in one state, Maharashtra."
The proportion of variant cases could be similar in Delhi, as well as other regions in the coming weeks, he added.
Scientists are still studying the Indian variant and sequencing the genome to determine what effect, if any, the mutation has.
But some experts caution that the new variants pose a clear, observable risk even before formal data has been collected.
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Congested areas in the worst-hit cities that saw antibody levels of nearly 50% during the first wave now still report positivity rates of more than 25%, Babu said.
"Clearly, it means that any protection against the old variant is not really useful because the newer variant spreads faster."
What is happening with vaccines against covid-19?
India: covid-19 crisis affects vaccine production 1:33
India is administering two vaccines domestically: the Oxford / AstraZeneca vaccine, known as Covishield in India, and its own Covaxin, jointly developed by Bharat Biotech and the Indian Council for Medical Research (ICMR), run by the government. In mid-April, India also approved Russia's Sputnik V vaccine.
The country began its vaccination program in January for health workers and priority groups - and celebrated its 100th day on April 25 - with the goal of fully inoculating 300 million people by August.
But the program got off to a slow start, facing logistical problems as well as vacillation about the vaccine among the population, especially towards Covaxin, which was approved for emergency use before the efficacy data from its third-party trial was released. phase.
As of April 25, India had administered 140.9 million doses of COVID-19 vaccines, according to the Health Ministry.
Despite administering the largest number of coronavirus vaccines in the world after the United States and China, India ranks lower than many countries in per capita vaccination, according to CNN data.
In early April, the central government said it would speed up emergency approvals for vaccines already approved by the World Health Organization or authorities in the United States, Europe, Britain and Japan.
Businesses have yet to apply for approval in India, but will be exempt from having to run local security tests, streamlining the process.
Starting May 1, all residents over the age of 18 will be eligible for vaccination.
Private vaccination providers will also be able to sell and administer vaccines.
But state ministers have criticized the new measures, noting that there are simply not enough vaccines even if more people become eligible.
The West Bengal Prime Minister called the decision "hollow, without substance and a regrettable demonstration of evasion of responsibility by the central government in a time of crisis", adding that it could lead to "unscrupulous mechanisms" regarding the pricing in the market.
Covid-19 crisis in India could delay delivery of vaccines from the Covax program
What is the government doing in the face of the crisis?
The central government took action in late April when the scope of the crisis became clear.
On April 20, in his address to the nation, Modi said the government was working to deliver 100,000 new oxygen cylinders to states and was suspending all industrial use of oxygen to free up the supply for medical use.
Work is underway to increase the number of hospital beds and build dedicated covid hospitals in some cities, he said.
In his speech, Modi urged states to avoid imposing lockdowns if possible, calling such measures the "last option."
India's health minister said on April 24 that the central government had provided Delhi with more oxygen "than they had asked for" and urged people not to seek hospitalizations "with the slightest bit of panic;
this is not necessary".
The next day, Modi expanded on ongoing efforts, saying his administration would establish 551 oxygen generating plants "in each district to ensure adequate oxygen availability."
The government is now exploring how to use the railroads and the Air Force more effectively to get oxygen tanker trucks to local centers as soon as possible.
How has the world responded to the covid-19 crisis in India?
The US and Mexico show solidarity with India over covid-19 1:08
Countries around the world have stepped up to offer critical help.
The Biden administration and the US Department of Defense will deploy supplies and support to India, including the shipment of ventilators, personal protective equipment, rapid diagnostic test kits and therapies, according to the White House and senior officials.
"The United States is also looking for options to provide oxygen generation and related supplies on an urgent basis," according to a reading of a call between the two countries' national security advisers.
The US has a temporary ban on exporting critical raw materials for vaccine production, but the White House announced that it would partially lift it by identifying "the specific raw material urgently required for Indian manufacture of Covishield vaccine that will be immediately available for India. '
On Monday, the White House said it could share with other countries up to 60 million doses of the AstraZeneca vaccine - which the United States has currently stockpiled - in the coming months, assuming the US Food and Drug Administration. (FDA) issues an emergency use authorization for that vaccine.
However, a senior Biden administration official said Modi did not make a specific request for vaccines when he spoke to President Biden on Monday, and it is unclear whether the unused AstraZeneca doses will be shipped to India.
Multiple world leaders have pressured Biden to share the doses while other countries have struggled to increase vaccines.
The UK will also send 600 medical equipment to India, including oxygen concentrators and ventilators, the government announced on Sunday.
The aid follows a direct request from Modi to the UK.
India is also importing 23 mobile oxygen generating plants and containers from Germany, which will be airlifted and arrive in India in a week.
The supplies will be sent to military hospitals treating COVID-19 patients, the Indian Defense Ministry said on Friday.
Neighboring Pakistan, which has a long and hostile history with India, announced that it would provide "relief support", including ventilators, personal protective equipment and other medical assistance.
"I want to express our solidarity with the people of India as they fight a dangerous wave of covid-19," Pakistani Prime Minister Imran Khan said in a statement on Saturday.
"Our prayers for a speedy recovery go out to all those suffering from the pandemic," Khan said.
"We must fight together against this global challenge facing humanity."
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