Year Ender 2021: How a year of COVID-19 impacted India

2021 tested the resilience of India's healthcare infrastructure, which revealed some glaring gaps in its delivery system. The second wave of the COVID-19 pandemic from April-June 2021 showed the country's limited preparedness-- contrastingly, six months later, India vaccinated 60 per cent of its adult population with both doses. 

The country recorded the world's highest single-day total on April 28, 2021. The World Health Organization recommended countries who were registering lower positivity test rates below 5 per cent for at least two weeks before considering easing restrictions. At that time, India registered a 20 per cent positivity rate.

Hospitalisations

In April-May 2021, India witnessed an unprecedented number of hospitalisations, when the share of severe cases increased significantly as compared to mid-August 2020 when the pandemic was at its nascent stage. The second wave was far more fatal than the first wave. 

With 8.5 hospital beds per 10,000 population and eight physicians per 10,000, the country's healthcare sector was caught unprepared. Loss of lives was 40 per cent higher in 2021, with those below 45 years worst hit, according to a study conducted by MAX Healthcare. 

In the 45–59-year age group, mortality rose from 5 per cent in 2020 to 7.6 per cent in 2021. In the 60-74 year and above 75-year age groups, the increase was from 12 per cent to 13.8 per cent, and from 18.9 per cent to 26.9 per cent, respectively.

Experts attributed increased mortality in the second wave to the delay in finding hospital beds.

Oxygen support

As COVID-19 cases increased, Indian hospitals were gasping because of a shortage of oxygen supply and medicines. In April 2021, India had the highest demand for oxygen out of all other low, lower-middle and upper-middle-income countries.

The intensity of the crisis was such that healthcare facilities that usually consumed about 15 per cent of the oxygen supply in India used 90 per cent of the country's oxygen supply. About 7,500 metric tonnes daily was being diverted for medical use as demand grew between 6 per cent-8 per cent each day.

Vaccine milestone

By December 10, 2021, nearly 38 per cent of the total population was fully inoculated, and 60 per cent had received at least one dose of the vaccine. 

On November 3, the central government announced the Har Ghar Dastak programme to vaccinate those who were yet to take the first dose and those due for the second dose by vaccinating them at their homes.  

India has administered more than 139.70 crore of COVID-19 vaccines doses (Dec 24). Despite India's breakthrough, vaccine inequities remain in districts within the same state. 

There are geographical, and gender imbalances in India's COVID-19 vaccination programme. There are 13 states below the average countrywide numbers of full vaccinated, while 12 states lag in giving at least one dose to their total population. Bihar, Chhattisgarh, Jharkhand, Manipur, Meghalaya, Nagaland, Maharashtra, Punjab, Tamil Nadu and Uttar Pradesh have to catch up with average countrywide vaccination.

COVID-19 spread deep into rural India in the second wave. The urban-rural gap in vaccination coverage has persisted in larger states like West Bengal, Haryana, Uttarakhand, Telangana, Punjab and Jharkhand.

Fiscal pressure

Further, India's learning from COVID-19 focused on strengthening the inadequately resourced health system. The Fifteenth Finance Commission accorded special attention to health infrastructure and workforce.

India's most socioeconomically backward states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh) spent as much as 30 per cent of their health budgets to procure COVID-19 vaccines for their populations, an IndiaSpend analysis found.

States were challenged as they reported a revenue deficit in their revised budget estimates for 2020-21 and faced falling revenues and increasing expenditure due to the COVID-19 pandemic, according to the PRS Legislative Research study.

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