MUMBAI — India on Wednesday recorded its biggest jump in COVID-19 deaths so far this year, as authorities in worst-hit Mumbai commandeered private hospitals and nursing homes amid an unprecedented wave of coronavirus infections.
Wednesday's death toll from the coronavirus was 354 — the highest since mid-December. India's confirmed caseload has more than quintupled from some 9,000 cases in late January to 53,000 today. The increase follows a marked decline in cases from their peak in September 2020 that scientists are still trying to understand.
The commercial capital Mumbai, hard-hit in the virus' first wave last spring, has once again emerged as South Asia's epicenter. It's now seeing its highest caseload since the pandemic began. The surrounding state of Maharashtra is reporting about 10 times more cases than any other Indian state.
Scientists are scrambling to figure out which parts of the population are now most affected. "Are these people who were not infected before? Or are these cases of reinfection?" asks Dr. Gagandeep Kang, a virologist at the Christian Medical College in Vellore, India.
Last summer, a survey of serologic tests in Mumbai found that 57% of the city's slum-dwellers had antibodies suggesting prior exposure to the coronavirus. But in wealthier areas, the percentage of people with antibodies was much lower. So Kang and other medical experts believe this wave may be among people who weren't infected the first time around.
"People who were previously able to isolate themselves and stay away from getting infected are now out and about and more likely to be infected," Kang explains.
She says private hospitals, which cater to affluent Indians, appear to be more strained this time around than public ones. The opposite was true during India's first wave last spring.
Kang believes a combination of factors is likely fueling new cases.
"Protection from a first infection is time-limited, and now we've reached a state where previously infected people cannot ward off infection anymore," she says.
Another possibility is infection by the virus' new variants.
Last week, India's health ministry said it had identified several coronavirus variants in the country, including one it called a "double mutant" because it has two mutations. But the ministry said it was too early to tell whether that variant was to blame for the latest spike in infections.
Infections are also surging in neighboring Pakistan, following a similar previous pattern of decline. On Tuesday, the country confirmed its highest single-day toll of the year, with 100 new deaths.
Prime Minister Imran Khan tested positive on March 20, and President Arif Alvi announced Monday that he had, too. Lagging in vaccine supplies, Pakistan said this week that it would import raw materials from China's CanSino Biologics, to assemble an additional 3 million vaccine doses.
In a circular published Monday, Mumbai put all hospitals and nursing homes under temporary government control. It ordered them to discharge asymptomatic patients who don't have comorbidities, and instructed private hospitals to reserve all intensive care units for COVID-19 patients.
India is the world's biggest vaccine producer, and it's trying to ramp up inoculations quickly. On Thursday, it plans to open eligibility to anyone 45 or older. India has administered about 63 million vaccinations so far. But with a population of nearly 1.4 billion, only a tiny fraction of people have gained protection.
"While our absolute vaccination numbers are high, for our population, if you look at the percentage, it's very, very low," says Dr. Vineeta Bal, an immunologist at the Indian Institute of Science Education and Research. "Is the virus going to win, or is vaccination going to protect us? This race is really against time."
NPR producer Sushmita Pathak contributed reporting from Mumbai.