The scenes broadcasted across news channels around the world were grim. Firewood became a treasured resource as it was desperately sought out for performing last rites. Rain washed away bodies buried under riverbeds. Hospitals turned away patients due to a lack of medical supplies and beds.

When the second wave of the COVID-19 pandemic hit India this spring with the full force of the delta variant, it flung a myriad of problems out into the open as the country’s healthcare infrastructure crumbled and burning pyres made headlines. At its peak, India reported over 400,000 cases in one day, shattering global records.

Meanwhile, the U.S. had begun lifting restrictions and opening up, even as chaos brewed in India. When thousands from all across Wisconsin gathered at Mifflin Street April 25 — unmasked, drinking, defying public health orders and smashing cars — almost three thousand people in India died from COVID-19 the same day.

Though the crisis in the world’s largest democracy seemed far away for many University of Wisconsin students wrapping up their spring semester, a number of international and Indian-American students were sounding the alarm and desperately trying to turn eyes toward the horrifying events unfolding in India.

Now, as the U.S. begins its own intensifying battle against the delta variant, the realities faced by UW students, faculty and citizens of India serve as a cautionary tale for Americans about the months ahead.

On the ground at UW and overseas

In a heritage town lined with limestone palatial houses at the heart of the Sivagangai district in Tamil Nadu, India, several government health officers are at the forefront of monitoring and controlling the spread of COVID-19. Dr. M. Karthikeyan is one of them.

Karthikeyan said Indian citizens followed social distancing and masking guidelines seriously during the first wave. But when the second wave hit, people gathered despite restrictions. The delta variant, which originated in India, resulted in an enormous case spike.

Throughout the country, the response to the crisis has varied state to state. For instance, the Tamil Nadu state government was quick to organize healthcare supplies, Karthikeyan said. But even for the prepared states, the second wave was quick, unexpected and relentless.

“The [Tamil Nadu] government immediately responded and established oxygen beds in no time, but the short gap in organizing beds and oxygen support was an issue,” Karthikeyan said.

Karthikeyan’s parents and sister are doctors, and he grew up wanting to become one. While it is a moment of pride for him to work to minimize the COVID-19 pandemic’s damage, he said it was difficult to face the psychological brunt of experiencing trauma every day.

“There is a huge psychological impact on all doctors, nurses, healthcare workers,” Karthikeyan said. “‘What if I get infected? What if I fall prey to this disease?’ These thoughts haunt us everyday.”

Infectious disease epidemiologist Ajay Sethi has been at the forefront of providing science communication to the public as UW’s resident COVID-19 expert.

Sethi called the second wave of the COVID-19 pandemic in India a “tragedy” and said the statistics were likely grossly underrepresenting the crisis due to low testing for confirming cases.

“It’s a true crisis — a humanitarian crisis even — perhaps not surprising because relaxation of vigilance towards this virus really in any country results in the situation we see in India,” Sethi said.

The situation in India is not singular in its sudden severity. Several countries across the world have faced crisis situations that forced their healthcare systems to the verge of collapse as deaths due to COVID-19 surged to dire levels. The delta variant has drive more countries to the brink recently. The variant currently makes up over 80% of new cases in the U.S.

In the beginning of the pandemic, Sethi said Italy and New York City were hotspots where the crisis felt insurmountable, but both places made progress and overcame the initial surge. India was still in that crisis situation as the second wave hit, he explained.

A year ago, highly dense countries like India and China were seen as having the greatest risk for a surge in COVID-19 infections, Sethi said. While higher population density puts people at a greater risk for transmitting viruses through air, even rural areas have experienced COVID-19 transmission because gathering is key in transmitting infections.

“New York City was able to overcome its surge with large numbers of people never infected with COVID simply because you can maintain social distance, even in the greatest, most dense areas on this planet,” Sethi said. “It’s just a matter of taking those precautions.”

India went through a national lockdown in March 2020 — and it worked, Sethi said. Still, like in most countries, the virus did not go away and the delta variant emerged to complicate damage control.

Inside the second wave

In addition to lack of social distancing and quarantining, a number of factors contributed to the impact of the second wave of COVID-19 in India. A man who lives in Uttar Pradesh, the most populated state in India, spoke to The Badger Herald on the condition of anonymity due to fear of persecution by his state government. He will be referred to as Himanshu.

Himanshu said the situation in India was so “grim” that people with severe cases of COVID-19 were not getting hospital beds, markets had a medicine shortage and the central government was not making COVID-19 data accessible to allow the public to judge the gravity of the situation.

Moreover, the caste system — a form of social class hierarchy determined by birth — continued to impact the lives of marginalized communities in India. Himanshu said the Indian government has showed little interest in tackling COVID-19 disparities that plague those at the bottom of the caste ladder such as the Dalits and Adivasis.

According to Himanshu, religious gatherings and election rallies greatly contributed to skyrocketing cases. In April, the Indian government went forward with organizing the Kumbh Mela, a religious festival held every 12 years in India, which attracted millions of devotees on the banks of the River Ganga and quickly became a COVID-19 super-spreader event.

Additionally, packed legislative, parliamentary and local body election rallies with little to no social distancing measures added to the growing pile of infections.

The entire second wave cannot be attributed to election rallies and the Kumbh Mela, Karthikeyan said. For instance, the state of Maharashtra, located in the western and central peninsular region of the country, had the highest number of cases during the peak of COVID-19 back in April even though the state did not host rallies. 

For Vairakumar Kannuchamy, who lives in Chennai located in Eastern India, COVID-19 hit home when he was infected by customers while working at Indian Overseas Bank. He passed it to his wife as well as his mother, who is 59 and has underlying heart conditions.

When Kannuchamy’s mother started showing symptoms and her oxygen level dropped critically, he spent hours in the dark of the night, going from one hospital to another in search of medical help. It wasn’t until the next morning at 11 a.m. — after going to five different hospitals and standing in endless queues — he was able to get his mother a hospital bed.

“It was a little scary because we didn’t know whether we [would] come back or not,” Kannuchamy said.

Kannuchamy’s situation was not unique.

Easwari Engineering College Professor Muthukumar Senthivadivel contracted the virus while teaching in Ramapuram, Chennai, and was forced to be isolated from family and friends. Faced with long queues outside testing centers, he was unable to get tested. As his symptoms worsened, Senthivadivel was fitted with an in-home oxygen mask, yet his oxygen levels continued to drop. He was later rushed to the hospital where he remained for 10 days.

“It was a terrible experience,” Senthivadivel said. “I was scared because I never expected that COVID [would] take me to that level.”

Not wanting to make his wife, Suseela, worry, Senthivadivel said he kept his experience to himself. While he was still at home and isolating, she would watch over him throughout the night and pray.

No visitors were allowed in hospitals. Suseela and Senthivadivel were able to keep in contact through video conferencing while he was in the hospital, but some family members never got the chance to see their loved ones for one last time.

“I didn’t put the TV on because there is [always] so many deaths — there is a shortage of ambulances and oxygen,” Suseela said. “On the way, so many people are dying. Really, I was shocked to hear the news, so I didn’t listen to the news.”

Streets outside of several hospitals were lined by people, desperately hoping to get a hospital bed, Himanshu said. Many died in ambulances, awaiting treatment.

Four members of Kannuchamy’s family died from COVID-19 — his father-in-law, his aunt’s son and both of his father’s brothers. Kannuchamy and his family did not get the opportunity to pay their respects for the family members they lost. Corpses were taken straight from the hospital to the graveyard.

Most of Kannuchamy’s family that passed away lived in villages where healthcare resources, such as oxygen tanks and oximeters, were not available. Many people in those villages are ignorant about the coronavirus. For them, they think it is just a fever and within days without the proper treatment, they pass away without ever knowing they had COVID-19 to begin with, Kannuchamy said.

Tale of two cultures

For many Indian-American UW students straddling two cultures, living in the U.S. amid the COVID-19 crisis in India was like living a double life. On one hand, at the peak of the second wave, social media feeds were full of calls for help and mutual aid.

Simultaneously, cities in the U.S. began opening up, states struck down mask mandates and the CDC imposed a travel ban to India.

“I think about how helpless some people feel that they can’t just go to India and get the medications for their grandparents or they can’t get their grandparents to a hospital or get them oxygen, or just very basic necessities that we could find here in the U.S.,” said UW senior Simran Sandhu.

Sandhu, who is a Punjabi Sikh and was born and raised in Madison, took the fight for awareness to campus.

Sandhu first started advocating for human rights in India after the farmer’s protests that gained international recognition — her grandparents are farmers and her mother moved to the U.S. in the ‘90s. Sandhu played an active role in bringing the protests to light on the UW campus as a member of the Sikh Student Association, which paved the way for her advocacy work and awareness initiatives about the COVID-19 crisis in India.

Along with fellow UW senior Milan Stolpman and other UW students, Sandhu launched a COVID-19 India Awareness Initiative on social media for spreading awareness about the devastating impact of the COVID-19 pandemic in India and resources on how to help. According to Stolpman, COVID-19 coverage at UW centered on vaccinations in the U.S. and a return to normal.

“It really is neglecting right now the extremity and the severity of the crisis that’s happening in India and how it’s worse than it was at any point [in] the US,” Stolpman said. “Because of that lack of activism, or frankly just plain awareness about the COVID crisis right now in India, [was] why I wanted to help out with this COVID awareness initiative related to India.”

For Stolpman and several of his Indian-American friends, he said there was a feeling of powerlessness that comes with not being able to help out their families who are struggling thousands of miles away.

Many South Asian immigrants, children of immigrants and international students struggle with thriver’s guilt as their homelands are devastated by one crisis after another.

“It’s almost like we’re sitting here on the other side of the ocean, on the other side of the world, and we’re not able to help out after hearing about family members struggling over there,” Stolpman said. “It isn’t a monolithic experience, but due to the severity of COVID in the country, if you have family in India then they’re likely in a similar position right now where they’re on lockdown and scared for their health.”

Vying for more vaccinations

While hospital beds and oxygen were in a severe shortage through the second wave, the vaccine situation proved not to be much better.

A lot of hesitancy was present among the population initially regarding vaccines, Karthikeyan said. Rumors spread by social media made people question the safety and efficacy of vaccines, especially in rural parts of India.

Former government official Senthivadivel Muthuramalingam said politicians were scaring the people into not getting the vaccine and using the people to do politics. Some people started to think vaccines were causing death.

Additionally, after the first wave subsided, people began to feel COVID-19 was no longer a pressing issue and thought getting the vaccine was not a necessary measure, Karthikeyan said. Initially, though there was a large supply of vaccines available, many doses ended up being wasted because there was not enough people to take them. 

When the devastating second wave caught up, people became increasingly interested in receiving the vaccine as they realized it was a good way to combat the spread of the infection. The demand drastically increased but the supply at this point could not keep up, Karthikeyan said.

“There would only be 350 vaccines available in a day, but there would be 2,000 people waiting in line for the vaccine,” Muthuramalingam said.

Additionally Muthuramalingam explained how the allocation of vaccines was not enough. For example, in the Sivagangai district, initially only 10,000 vaccines were sent. Within the district, only 500 vaccines were allocated to the city of Karaikudi even though the population was 125,000 people, Muthuramalingam said.

Though India was one of the first countries to start producing vaccines in house, they began exporting them to other countries. Even when the crisis hit close to home, they were under pressure to continue exporting them instead of keeping them for their people, Muthuramalingam said.

Covishield and Covaxin, the two main vaccine manufacturers in India, are producing at maximum capacity and distributing the vaccines all across the country as fast as possible, Karthikeyan said.

While the Indian government was open to buying vaccines, the vaccines were simply not available. On the production side, the companies were manufacturing at the maximum pace of production which was simply not enough to satisfy the demand which was present.

“In India, there isn’t a way to plan and execute a process immediately whether it be a disease or any other issue,” Muthuramalingam said. “There are still places in India where there is no bus transportation or electricity. We cannot make sure all the resources reach even these people.”

“In other countries, laws are more stringent and the population is smaller, but here, because of the large population, a process cannot be executed easily. Sometimes it can take 10 to 12 years to execute something.”

India has vaccinated a large number of people compared to other countries in terms of sheer numbers. As of Aug. 1, 104 million people have been fully vaccinated. But, in terms of proportion of residents, only 7.6% of the population has been vaccinated.

Paying it forward

Though the second wave and continuing struggles of the pandemic devastated the Indian people, the power of community and social media lended a hand from all over the world to help the nation combat the relentless virus.

Himanshu said a number of social media initiatives amplifying aid and resources were started by Indian university students and activists, like the one Sandhu and Stopleman started. Other initiatives included helping people call hospitals to check ICU availability, verifying tips and leads on oxygen cylinders and compiling information on regularly updated databases.

“The government has set up a central helpline, and people have been relentlessly calling those helplines without a response,” Himanshu said. “A lot of good Samaritans on Instagram and Twitter have stepped in to play their part with the dwindling infrastructure of the medical system.”

Sethi said the health care system needs assistance with simply being able to provide people with oxygen so they can have a fighting chance to live — likely one of the first priorities for people who are ill. Vaccination is a key tool to prevent the spread of the virus, Sethi said.

As people continue to be vaccinated, the question still remains whether India is producing enough for everybody. With India’s population, around 285 million doses per month will be needed over the next five months to vaccinate all remaining adults by the end of 2021. But by government estimates, India’s current monthly production capacity could be only around 120 to 130 million doses.

Experts claim a third wave of infections in India is inevitable. As of Aug. 4, India has reported over 31.8 million cases and deaths of over 426,000 people.

For people who want to help, there are several fundraisers to donate to and provide aid to struggling families and patients in India, including one for COVID-19 relief in Karaikudi, India started in Brookfield, Wisconsin.

Even with help online and overseas, Karthikeyan said ending the pandemic in India and across the world remains an uphill battle — one that can only be won if all nations and people do their part. 

“We are well-equipped compared to previous pandemics, but people tend to travel much more than they used to a hundred years ago, and unfortunately the vehicle of transmission is humans themselves, from person-to-person,” he said. “If people could be more cooperative, more supportive in guarding themselves by taking vaccines and wearing a mask, this disease can be stopped.”