April 24, 2021 | EMH2
Burial of a COVID-19 Victim in India
The Counterterrorism Group (CTG) is issuing a FLASH ALERT for hospitals, citizens, and the Government of India as unprecedented infection and death rates are rapidly accelerating the collapse of health systems. India is experiencing the world’s most severe wave of COVID-19 with sustained reports of over 300,000 new cases every 24 hours over the past week. This surge is causing mass overcrowding of the Sir Ganga Ram Hospital in New Delhi. With the hospital operating at maximum bed capacity and facing oxygen shortages, patients are being turned away, causing a lack of access to life-saving medications and equipment. Amongst the daily reported fatalities from COVID-19, 25 people have passed away due to oxygen tank shortages in the last 24 hours. While India’s health system was expected to collapse at some point in 2021, this resurgence has forced the Indian Government to declare the collapse of New Delhi's health services earlier than predicted. They now face increased pressures to put actionable measures in place sooner than anticipated to reduce more deaths. The current CTG Threat Matrix indicates the likelihood of further deaths from infections and complications due to supply shortages is HIGH as the Emergency Management, Health, and Hazards (EMH2) team has predicted it will take at least a week for response measures to take effect, with secondary negative impacts to medical treatment lasting over the coming months.
CTG is on HIGH alert and cautions that the ongoing situation must be monitored closely to assess the impact this surge will have on India and internationally. Some countries have already instituted travel bans to and from India, and surrounding areas such as Pakistan, in an attempt to prevent the further spread of the virus. With less than 10% of the population having received the COVID-19 vaccine, India is facing increased pressure to continue vaccine rollout in a desperate attempt to protect individuals from the virus. To slow the inevitable collapse of the health system, India has appealed to the international community for assistance through the provision of supplies such as oxygen, beds, and antiviral drugs.
As the second-highest populated country in the world, India has 1.366 billion citizens, with 21.75 million residing in New Delhi. Mass overcrowding and limited access to water and healthcare in some regions make India a prime location for rapid disease spread. Although declining case numbers at the end of 2020 led many to believe that India was effectively combating the COVID-19 pandemic, this past week’s extreme surge in new cases has caused an unprecedented number of fatalities. As the death toll passes 190,000 since the beginning of the pandemic, it is evident that prevention measures such as social distancing and self-isolation are difficult amidst overcrowding. Restrictions had been relaxed after the decline in cases; the Government of India has admitted that the illusion of the pandemic end caused them to let their guard down. Additionally, despite high numbers of infections throughout 2020, there were still millions who were vulnerable to the virus due to the large population, the prevalence of other infectious illnesses, and poor living conditions. The development and spread of the “double mutant” variant in March, also known as B.1.617, or the “Indian variant” likely played a large role in the recent resurgence. This is now the most prominent variant in India, and preliminary research suggests that it is the most contagious variant, although not necessarily the deadliest. Poor living conditions, underlying health issues, and ineffective prevention measures make individuals more susceptible to disease and create opportunities prime for the virus to transmit. India is also seeing increased cases of the Brazilian (P.1) and UK (B.1.1.7) variants. The P.1 variant is known for its high rates of reinfection, whereas the B.1.1.7 variant is known for its high transmissibility and ability to cause severe disease, requiring hospital admission, and further medical aid. The triple threat of deadly variants, overcrowding, and pandemic fatigue make it likely that infections will continue to rise, leading to more hospitalizations. Without medical treatment, more fatalities will likely occur in the coming weeks.
Vaccine rollout throughout India has been slow. About 17 million, 0.01% of the population, have been fully vaccinated, with 109 million people have received their first vaccine. Increasing cases before the current acute surge resulted in manufacturing delays, restricting access to the vaccine. India has been a large contributor to the United Nations (UN) COVID-19 Vaccines Global Access (COVAX) distribution campaign. However, their donations of AstraZeneca vaccines were delayed in March 2021 due to increasing demands for in-country vaccines. Additionally, the production of the Covovax vaccine, which was expected to roll out in early 2021, will be delayed until September 2021, further demonstrating stresses on resources that have impacted the COVID-19 response. These setbacks have caused many to miss their second dose of the vaccine, which is supposed to be administered 12 weeks after the first inoculation. The effectiveness of one jab ranges depending on age and country, however, it is less effective at preventing individuals from contracting, spreading, and becoming severely ill from COVID-19. Disorganization in vaccine management and at vaccine clinics has caused inaccessibility, and the healthcare system is calling for alternative administrative measures to be implemented to ensure people are receiving both doses to increase their resistance to the virus. With hospitals at maximum capacity, the healthcare system is quickly being ravaged, making it difficult to divert already scarce resources to vaccine rollouts.
Sir Ganga Ram Hospital
Sir Ganga Ram Hospital in Delhi is a multi-specialty private hospital with 675 beds. Since the beginning of the pandemic, many patients have received treatment at this hospital. This wave has not only taken up all of the hospital beds but has left no room in the emergency room due to the surges in cases. Healthcare workers are trying to discharge people as soon as they can to free up a bed. The rush to replace could mean hygiene methods are skipped, or not cleaned as rigorously as required, which could add to the spread of the virus. This could also mean that individuals are sent home sooner than would otherwise be ideal under better circumstances. As the hospital is having to turn people away, queues are forming outside of the hospital, creating large crowds that are obstructing ambulance routes. With routes blocked, ambulances are trying to help those outside by offering medical services where possible. Additionally, the hospital call lines are all blocked up from people trying to ring for medical advice, making it likely that more people will attempt to visit the hospital to speak with someone. This will create larger pressures on the hospital.
Amidst the overcrowded wards, Sir Ganga Ram Hospital is also experiencing oxygen shortages. There is a limited number of bed areas where oxygen canisters can be accessed and these are being filled quickly. The hospital staff in New Dehli are appealing to people who are on oxygen to bring their own if they need medical care, or for donations of spare canisters to try and source more supplies. The Indian Government is working to transport oxygen canisters from other parts of India via trains and airplanes, along with appeals to source further supplies internationally. It is unlikely that enough oxygen will be available to deal with the demand, even with deliveries. This will cause more people to die because they cannot access life-saving medication and equipment. It is also likely that additional illnesses will remain untreated which could lead to weakened immunities and make people more susceptible to being hospitalized for COVID-19. This repetitive circle could see the hospital being continuously overwhelmed as long as this surge lasts.
The EMH2 Team assesses that COVID-19 cases are highly likely to continue increasing until further preventative measures are revised and implemented, including faster vaccination rollouts and increased health guidelines. Even with support from England and the United States, a quick solution is unlikely. The collapse of the health system in New Delhi is likely to further slow down vaccination campaigns, leading to higher cases, and more people attempting to seek medical assistance. The oxygen shortages are also likely to continue given the excessive demand, intensifying the need to implement other virus preventative measures alongside medical intervention.
With this repetitive cycle, the EMH2 Team recommends immediate action by the Government of India to combat transmission of COVID-19 and deal with medical demand. As demonstrated in other countries, field hospitals would likely deal with the overspill of patients, and enable more people to receive medical care. We also recommend that humanitarian aid organizations deploy and appeal for healthcare workers to staff the temporary hospitals. It is likely that implementing a nationwide lockdown, with immediate effect and considering closing non-essential businesses will help curb transmission while also strictly limiting public transportation such as trains and busses. In addition to a travel ban within India, other countries should consider restricting travel to and from India to prevent the further spread of “Variants of Concern.” Mandatory two-week quarantine protocols need to be implemented for necessary commerce coming in and out of India. Other nations must respond to India’s appeal for supplies such as oxygen, beds, and antiviral drugs. Increased availability of these scarce supplies is very likely to help improve patient treatment, which will allow infected individuals to recover more quickly and free up space in overcrowded hospitals. The United States has just pledged to immediately send vaccination resources to India to assist with the surge and help curb cases. Other countries in the international community must follow suit to prevent the triple threat of variants from further spreading outside of India’s borders.
Our analysis indicates that there is a HIGH PROBABILITY that India will continue to experience record highs in daily infections and deaths over the coming weeks as the health system continues to collapse. Without access to medical assistance, other viruses and diseases will likely go untreated, leading to multiple epidemics at one time without remedial provisions.
The Counterterrorism Group (CTG) is a unit of the global risk consulting and security firm Paladin 7. CTG proactively searches for and analyzes the threat of terrorism that comes from International Terrorist Organizations, Domestic Terrorist Organizations, and Individuals determined to inflict terror upon societies, organizations, and individuals. Our international and national security professionals set up protective measures to detect, deter, and prevent, discourage, and dissuade any terrorist organization or individual from attacking organizations and individuals. We work to protect our clients from any terrorist threat or attack. We also work proactively with the proper authorities to find those in terrorist organizations and individuals who will cause harm and assist in bringing them to justice and mitigating the threat long-term.
 “PTI30-04-2020_000280B” by Ninian Reid, licensed under Creative Commons
 Hospitals overrun as India’s COVID-19 infections top global record for second day, Reuters, April 2021, https://www.reuters.com/world/india/fire-covid-19-hospital-kills-12-india-struggles-with-huge-second-wave-2021-04-23/
 Why are COVID cases surging in India?, April 2021, DW, April 2021, https://www.dw.com/en/why-are-covid-cases-surging-in-india/a-57300436
 Interior Health has 160 confirmed cases of COVID-19 variants, Kamloops This Week (KTW), April 2021, https://www.kamloopsthisweek.com/news/interior-health-has-160-confirmed-cases-of-covid-19-variants-1.24307593
 Covid-19 vaccination: How is India's inoculation drive going, BBC, April 2021, https://www.bbc.co.uk/news/world-asia-india-56345591
 Top Indian vaccine maker’s production capacity is reportedly ‘stressed’ as Covid-19 cases rise, CNBC, April 2021, https://www.cnbc.com/2021/04/08/india-covid-19-cases-rise-vaccination-accelerates.html
 Serum Institute to delay launch of Novavax vaccine in India, Pharmaceutical Technology, March 2021, https://www.pharmaceutical-technology.com/news/serum-institute-novavax-vaccine/
 Explained: What happens if you miss second dose of COVID-19 vaccine, The News Minute, April 2021, https://www.thenewsminute.com/article/explained-what-happens-if-you-miss-second-dose-covid-19-vaccine-147763
 Sir Ganga Ram Hospital (India), Wikipedia, April 2021, https://en.wikipedia.org/wiki/Sir_Ganga_Ram_Hospital_(India)
 India Covid crisis: Hospitals buckle under record surge, BBC, April 2021, https://www.bbc.co.uk/news/world-asia-56858403
 U.S. to give India raw materials for vaccines, medical supplies to help fight Covid surge, CNBC, April 2021,https://www.cnbc.com/2021/04/25/us-to-give-india-raw-materials-for-vaccines-medical-supplies-to-fight-covid.html