Science reports:

One morning in mid-May, Nasim Qureshi suddenly developed a fever, cough, and shortness of breath. Qureshi, a member of Mumbai, India’s street vendor union, rushed to a small private hospital, where doctors gave him a check up but refused to admit him. Later the same day, he was turned away from two more hospitals before he finally found a bed at a municipal hospital. By then, his breathing trouble had worsened—and the hospital only had a few ventilators.

By the time one was made available, his friends say, Qureshi had died.

Stories like Qureshi’s have been unfolding across Mumbai, a city of more than 12 million that has been the epicenter of India’s COVID-19 epidemic, with 33,000 of the country’s 150,000 confirmed cases. A shortage of hospital beds and poor coordination has overwhelmed public hospitals and left authorities scrambling to ramp up capacity. Media have reported grim stories about people dying before they even got their test results, patients lying next to dead bodies, and kidney patients failing to get life-saving dialysis.

Similarly dramatic scenes could soon play out in other parts of India. So far, the country’s COVID-19 cases have been concentrated in a few states and cities. But last week, the government began to lift travel restrictions imposed on 25 March as part of the world’s largest pandemic lockdown, affecting all 1.2 billion Indian citizens. Millions of jobless migrant workers are now making their way back from cities to rural hometowns. Domestic flights also resumed on Monday. The lockdown has slowed the spread of the coronavirus, but not by nearly enough, experts say, with cases still doubling every 14 days. The lifting of restrictions promises a new surge, because many of those now fleeing Mumbai and New Delhi may be infected.

“The country has been in different stages of outbreak,” says Giridhar Babu, an epidemiologist with the Public Health Foundation of India. “But the state dynamics may now change.”

In late March, when India had only 600 confirmed cases, all transportation in the country was stopped within 4 hours after the lockdown was announced; few migrant workers were able to go home. But keeping them trapped for almost 2 months has made the situation worse by exposing many of them to the virus that causes COVID-19, says Vikram Patel of the Harvard T.H. Chan School of Public Health. “You deny the right of people to move when the cases are few, and you allow them to do so when the epidemic is rising,” Patel says. “I cannot imagine a more insane policy.” [Continue reading…]