COVID-19 pandemic in India
The COVID-19 pandemic in India is a part of the COVID-19 pandemic. COVID-19 is caused by SARS-CoV-2. As of, according to Indian government figures, India has the second-highest number of confirmed cases in the world with reported cases of COVID-19 infection and the third-highest number of COVID-19 deaths at deaths. In October 2021, the World Health Organization estimated 4.7 million excess deaths, both directly and indirectly related to COVID-19 to have taken place in India.
The first cases of COVID-19 in India were reported on 30 January 2020 in three towns of Kerala, among three Indian medical students who had returned from Wuhan, the epicenter of the pandemic. Lockdowns were announced in Kerala on 23 March, and in the rest of the country on 25 March. Infection rates started to drop in September. Daily cases peaked mid-September with over 90,000 cases reported per-day, dropping to below 15,000 in January 2021. A second wave beginning in March 2021 was much more devastating than the first, with shortages of vaccines, hospital beds, oxygen cylinders and other medical supplies in parts of the country. By late April, India led the world in new and active cases. On 30 April 2021, it became the first country to report over 400,000 new cases in a 24-hour period. Experts stated that the virus may reach an endemic stage in India rather than completely disappear; in late August 2021, Soumya Swaminathan said India may be in some stage of endemicity where the country learns to live with the virus.
India began its vaccination programme on 16 January 2021 with AstraZeneca vaccine and the indigenous Covaxin. Later, Sputnik V and the Moderna vaccine was approved for emergency use too. On 30 January 2022, India announced that it administered about 1.7 billion doses of vaccines and more than 720 million people were fully vaccinated.
Timeline
2020
On 12 January 2020, the WHO confirmed that a novel coronavirus was the cause of a respiratory illness in a cluster of people in Wuhan, Hubei, China, which was reported to the WHO on 31 December 2019.On 30 January 2020, India reported its first case of COVID-19 in Thrissur, Kerala, which rose to three cases by 3 February 2020; all were students returning from Wuhan. Apart from these, no significant rise in transmissions was observed in February. On 4 March 22 new cases were reported, including 14 infected members of an Italian tourist group. Transmissions increased over the month after several people with travel history to affected countries, and their contacts, tested positive. On 12 March, a 76-year-old man, with a travel history to Saudi Arabia, became the first COVID-19 fatality of India.
A Sikh preacher, who had a travel history to Italy and Germany, turned into a superspreader by attending a Sikh festival in Anandpur Sahib during 10–12 March. Over 40,000 people in 20 villages in Punjab were quarantined on 27 March to contain the spread. On 31 March, a Tablighi Jamaat religious congregation event in Delhi, which had taken place earlier in March, emerged as a COVID-19 hotspot. On 2 May, around 4,000 stranded pilgrims returned from Hazur Sahib in Nanded, Maharashtra to Punjab. Many of them tested positive, including 27 bus drivers and conductors who had been part of the transport arrangement.
In July 2020, it was estimated based on antibody tests that at least 57% of the inhabitants of Mumbai's slums may have been infected with COVID-19 at some point.
A government panel on COVID-19 stated in October 2020 that the pandemic had peaked in India, and could come under control by February 2021. This prediction was based on a mathematical simulation referred to as the "Indian Supermodel", assuming that India reaches herd immunity. That month, a new SARS-CoV-2 variant, Lineage B.1.617, was detected in the country.
2021: Second wave
India began its vaccination programme on 16 January 2021. On 19 January 2021, nearly a year after the first reported case in the country, Lakshadweep became the last region of India to report its first case. By February 2021, daily cases had fallen to 9,000 per-day. However, by early-April 2021, a major second wave of infections took hold in the country with destructive consequences; on 9 April, India surpassed 1 million active cases, and by 12 April, India overtook Brazil as having the second-most COVID-19 cases worldwide. By late April, India passed 2.5 million active cases and was reporting an average of 300,000 new cases and 2,000 deaths per-day. Some analysts feared this was an undercount. On 30 April, India reported over 400,000 new cases and over 3,500 deaths in one day.Multiple factors have been proposed to have potentially contributed to the, including highly-infectious variants of concern such as Lineage B.1.617, a lack of preparations as temporary hospitals were often dismantled after cases started to decline, and new facilities were not built, and health and safety precautions being poorly-implemented or enforced during weddings, festivals, sporting events, state and local elections in which politicians and activists have held in several states, and in public places. An economic slowdown put pressure on the government to lift restrictions, and there had been a feeling of exceptionalism based on the hope that India's young population and childhood immunisation scheme would blunt the impact of the virus. Models may have underestimated projected cases and deaths due to the under-reporting of cases in the country.
Due to high demand, the vaccination programme began to be hit with supply issues; exports of the Oxford–AstraZeneca vaccine were suspended to meet domestic demand, there have been shortages of the raw materials required to manufacture vaccines domestically, while hesitancy and a lack of knowledge among poorer, rural communities has also impacted the programme.
The second wave placed a major strain on the healthcare system, including a shortage of liquid medical oxygen due to ignored warnings which began in the first wave itself, logistic issues, and a lack of cryogenic tankers. On 23 April, Modi met via video conference with liquid oxygen suppliers including Reliance, SAIL, JSW, Tata Steel, JSPL, AMNS, LINDE, INOX Air Products and Air Water Jamshedpur, where he acknowledged the need to "provide solutions in a very short time", and acknowledged efforts such as increases in production, and the use of rail, and air transport to deliver oxygen supplies. A large number of new oxygen plants were announced; the installation burden being shared by the center, coordination with foreign countries with regard to oxygen plants received in the form of aid, and DRDO. A number of countries sent emergency aid to India in the form of oxygen supplies, medicines, raw material for vaccines and ventilators. This reflected a policy shift in India, as comparable aid offers had been rejected during the past sixteen years.
The number of new cases had begun to steadily drop by late-May; on 25 May, the country reported 195,994 new cases—its lowest daily increase since 13 April. However, the mortality rate has remained high; by 24 May, India recorded over 300,000 deaths attributed to COVID-19. Around 100,000 deaths had occurred in the last 26 days, and 50,000 in the last 12. In May 2021, WHO declared that two variants first found in India will be referred to as 'Delta' and 'Kappa'. The state of Karnataka announced a COVID-19 memorial later that spring, to honour healthcare professionals who had succumbed to the virus.
On 25 August 2021, Soumya Swaminathan said that India "may be entering some kind of stage of endemicity where there is low level transmission or moderate level transmission going on" but nothing as severe as before, in other words India is learning to live with the virus.
India announced a mandatory 10-day quarantine on travellers arriving from United Kingdom irrespective of their vaccination status starting 4 October 2021 after United Kingdom also put the same restrictions on travellers from India by not recognizing India's vaccine certificate. On 8 October the United Kingdom opened up the restrictions on travelers from 47 countries and locations including India.
2022
By March, India had just 22,487 cases across the country. With 58.8% population fully vaccinated and 70% having received at least one dose opening up post-pandemic has been steady. Buoyed by the success of its vaccination program among senior citizens, adults, and adolescents, the vaccination program is now inoculating children in the 12-15 age group. Further, the central government has urged state governments to end all COVID curbs except masks and social distancing. International flights were resumed on 27 March after a gap of two years.2023
On 22 March 2023, Prime Minister Modi held a high-level meeting to discuss the nation's preparedness for a new wave of infections, potentially driven by the newly detected SARS-CoV-2 strain, XBB.1.16. Active cases had reached a 5-month high as of 23 March and came amid an ongoing H3N2 influenza outbreak, prompting officials to determine the readiness of the healthcare system and its logistical needs. In response to the rising number of cases, some hospitals reopened Covid wards that had previously been shuttered following a yearlong lull in infections.In August, a new subvariant of Omicron, named Eris was detected in the state of Maharashtra with cases increasing in a few cities.
While in December, the JN.1 variant, believed to be a descendant of Omicron subvariant known as BA.2.86 or Pirola, arrived in the southern state Kerala with an RT-PCR-positive sample from Karakulam in Thiruvananthapuram district.
Response
Health care and testing
The Union Health Ministry's war room and policy making team in New Delhi decide how coronavirus should be tackled in the country, and consists of the ministry's Emergency Medical Response Unit, the Central Surveillance Unit (IDSP), the National Centre for Disease Control and experts from three government hospitals among others. In March 2020, India's strategy was focused on cluster-containment, similar to how India contained previous epidemics, as well as "breaking the chain of transmission". 52 labs were named capable of virus testing by 13 March.On 14 March 2020, scientists at the National Institute of Virology isolated a strain of the novel coronavirus. India was the fifth country to successfully obtain a pure sample of the virus; isolation of the virus would help towards expediting the development of drugs, vaccines and rapid diagnostic kits in the country. NIV shared two SARS-CoV-2 genome sequences with GISAID. In May, the NIV introduced another test kit for rapid testing.
Initial testing
Initially, the labs tested samples only from those with a travel history to 12 countries designated as high-risk, or those who had come in contact with anyone testing positive for the coronavirus, or showing symptoms as per the government guidelines. On 20 March 2020, the government decided to also include all pneumonia cases, regardless of travel or contact history. On 9 April, ICMR further revised the testing strategy and allowed testing of the people showing symptoms for a week in the hotspot areas of the country, regardless of travel history or local contact to a patient. While the health ministry claimed enough tests were being performed, experts disagreed, saying that community transmission may go undetected.Expansion of tests
On 17 March 2020, the health ministry decided to allow accredited private pathology labs to test for COVID-19. A person could get a COVID-19 test at a private lab after a qualified physician in a government facility recommended it. Experts said this increased testing may ultimately result in a correction of the current under-counting and an increase in confirmed cases.111 additional labs for testing became functional on 21 March. On 24 March, Mylab Discovery Solutions became the first Indian company to have received regulatory validation for its RT-PCR tests. In April, Institute of Genomics and Integrative Biology, Delhi had developed a low cost paper-strip test that could detect COVID-19 within an hour. Each test would cost. On 13 April, ICMR advised pool testing in low infection areas to increase the capacity of the testing and save resources. In this process maximum five samples are tested at once and samples are tested individually only if a pool tests positive. Faulty test kits from China were subsequently returned and future orders cancelled.
By 9 July 2020, 1132 testing labs were functional. Following testing shortages, non-accredited private laboratories applying for accreditation were also given permission to test for coronavirus. In September 2020, India had attained the highest number of daily tests in the world. By 5 May 2021, 2506 testing labs were functional and the total daily national testing capacity reached 1,500,000 tests.
Testing community transmission
Testing for community transmission began on 15 March 2020. 65 government laboratories started testing random samples of people who exhibit flu-like symptoms and samples from patients without any travel history or contact with infected persons. As of 18 March, no evidence of community transmission was found after results of 500 random samples tested negative. Between 15 February and 2 April, 5,911 SARI patients were tested throughout the country of which, 104 tested positive in 20 states and union territories. About 40% of the identified patients did not have a travel history or any history of contact with a positive patient. The ICMR advised to prioritise containment in the 36 districts of 15 states which had reported positive cases among SARI patients.In April 2020 WHO placed India in the community transmission stage however in June moved India to clusters of cases. In October 2020, the health minister admitted to community transmission limited to some states and districts. Until May 2021, India insisted that clusters of cases remained, and there was no nationwide community transmission.
Research and treatment
On 23 March, the National Task Force for COVID-19 constituted by the ICMR recommended the use of hydroxychloroquine for the treatment of high-risk cases. In the same month, the Indian Institute of Chemical Technology, the Council of Scientific and Industrial Research and Cipla launched a joint venture to develop anti-COVID-19 drugs. In April, funds for a number of preventive agents were released to initiate research. The Centre for Cellular and Molecular Biology started working on genome sequencing of COVID-19 in early 2020.India was estimated to have approximately 40,000 ventilators in March 2020, of which 8,432 were with the public sector. The government aimed to double the capacity of ventilators by June 2020, with the assistance from Indian PSUs, firms and startups, including Bharat Electronics, DRDO and ISRO. This led to the creation of some of the world's smallest and cheapest ventilators. Production lines were repurposed to manufacture general Personal protective equipment, full body suits and ventilators; India was producing around 200,000 PPE kits and 250,000 N95 masks per day in May 2020, compared to virtually zero shortly before.
Several states were allowed by ICMR and Drugs Controller General of India to start clinical trials of convalescent plasma therapy and plasma exchange therapy. Initial optimism around plasma therapy, resulted in ICMR stating that there is no robust evidence to support convalescent plasma therapy as a routine therapy, describing it is as an emerging and experimental therapy. Convalescent plasma therapy was dropped form the COVID-19 treatment protocol by ICMR in mid May 2021.
In June 2020, India approved the repurposing of generic versions of the antiviral medication favipiravir for the treatment of mild-to-moderate COVID-19 symptoms by Glenmark, Cipla and the Indian Institute of Chemical Technology and Lupin Limited. In July 2020, the Indian firm Biocon received emergency authorisation for the use of the repurposed drug Itolizumab in treatments for chronic plaque psoriasis, one of the symptoms of the disease.
On 23 April 2021, Cadila Healthcare received an emergency authorisation to repurpose Peginterferon alfa-2b, a medication used to treat hepatitis C, as a treatment for moderate COVID-19 in adults. On 8 May 2021, DCGI gave permission for emergency use of the drug 2-Deoxy-D-glucose developed by DRDO in collaboration with Dr. Reddy's Laboratories as an adjunct or alternative therapy for treating moderate to severe cases of COVID-19.
By April 2021, the latest treatment guidelines mirrored those of the WHO and the United States with the important exception that, in India, mildly ill patients were allowed to be given Hydroxychloroquine or Ivermectin. This potential off-label prescription seems to have taken off in some parts of India: Kavery Nambisan, an Indian surgeon, said that a doctor in Kandivali, Mumbai, has treated thousands of patients with ivermectin. In January 2023, hydroxychloroquine and ivermectin were not recommended anymore at all in the national clinical guidance for management of adult covid-19 patients.
Vaccine development and production
The Indian government infused into the Department of Biotechnology in November 2020 to aid the development of a COVID vaccine. The 2021 budget of India also allocated for vaccine procurement.In January 2021, the DCGI initially approved the Oxford–AstraZeneca vaccine, manufactured by the Serum Institute of India under the trade name "Covishield", and BBV152, a vaccine developed by Bharat Biotech in association with the Indian Council of Medical Research and National Institute of Virology.
The approval of Covaxin was met with some concern, as the vaccine had not then completed phase 3 trials. Due to this status, those receiving Covaxin were required to sign a consent form, while some states chose to relegate Covaxin to a "buffer stock" and primarily distribute the Oxford–AstraZeneca vaccine. Following the conclusion of its trial, the DCGI issued a standard emergency-use authorisation to Covaxin in March 2021. The slogan '
In April 2021, the DCGI approved the Russian Sputnik V vaccine, which was trialled in India by Dr. Reddy's Laboratories. The initial shipment of 150 million Sputnik V doses arrived on 1 May, and began to be administered on 14 May. Domestic manufacturing of Sputnik V is expected to begin by August 2021, with doses imported from Russia being used in the meantime.
In May 2021, the DCGI approved phase 2 and 3 trials of Covaxin among children 2–18.
In late-June 2021, after the DCGI removed a requirement that all COVID-19 vaccines must be trialed locally before approval, the DCGI approved the Moderna vaccine for emergency use.
Vaccination policy and distribution
Administratively, India began preparing to vaccinate its population in April 2020 with the setting up a Vaccine Task Force. Following this the National Expert Group on Vaccine Administration for COVID-19 was formed, and in October 2020 states were asked to set up state level mechanisms for the COVID-19 vaccine programme, and prepare cold chains points. A communication strategy for the vaccination programme was also revealed by the health ministry in January 2021, targeting issues such as vaccine eagerness and hesitancy.India started out with a vaccination policy targeting 300 million people based on occupation and age group, to be completed a time period of six months, by August 2021.Phase 1 started on 16 January 2021 and targeted 10 million health workers first followed by 20 million frontline workers. Phase 1 was to be completed by 31 March. On 3 April, registrations for this group was closed. 67% of health, frontline workers received at least one dose; taking into account registered health and frontline workers, the number of fully vaccinated is 47%.Phase 2 began on 1 March 2021 to cover 45+ year old's with co-morbidities and 60+ year old's. On 1 April, vaccinations were opened for everyone above 45 years. Shortages in vaccine supplies were evident in March.
On 19 March 2021, in the Lok Sabha, the health minister of India stated that "It is not necessary, scientifically, to give each and every person in the country the vaccine. Not each and every person in the world will be vaccinated. The prioritisation process is a dynamic process..."Phase 3 of the vaccination campaign was opened up to include all eligible adults from 1 May 2021 following a surge in cases in April, a second wave. This expansion resulted in immediate, increased and prolonged vaccine shortages.
Changes in procurement policies, the liberalised vaccination policy, and differential pricing further complicated the situation. Children in India experienced coverage and greater delays in immunization during this time. Global vaccine obligations of India were also severely affected including those with south-Asian neighbours, and 190 countries associated with COVAX.
By 22 October 2021, India delivered 1 Billion doses for COVID-19 out of which, 700 million were single doses and 300 million were double doses.
According to a 2022 modelling study published in The Lancet Infectious Diseases journal, over 4.2 million lives were saved in India in 2021 due to vaccination against COVID-19.
Immediate relief
Welfare
On 19 March 2020, Kerala announced a stimulus package of to help the state overcome both the COVID-19 epidemic and economic hardship caused by it. On 21 March, Uttar Pradesh announced to all daily wage labourers. On 22 March, Punjab announced to all registered construction workers. A number of states and union territories went on to announce free and increased rations for ration card holders. Karnataka announced relief for unorganised sectors including flower growers, washer-men and women, barbers, construction workers, auto and cab drivers, MSMEs, and weavers. The Delhi government announced that if a doctor, nurse or hygiene worker dies during treatment, their family will be provided. The Union government also announced the distribution of rations.Economic relief and stimulus package
A food security scheme, part of wider economic relief package of, was announced by the center on 26 March 2020. This also included direct cash transfer, primarily for migrant labourers and daily wage labourers; and free gas cylinders for three months. This was followed by RBI cutting repo rates, injecting liquidity and permitting banks to provide a moratorium on all loans for three months. Payment of taxes was relaxed and states were provided with short term credit via increased ways and means advances limits. Pending wages of daily wage labourers under Mgnrega scheme were released. On 12 May the Prime Minister announced an economic package of ; this included previous government actions, including the RBI announcements and the Finance Ministers announcement on 26 March. On 12 October and 12 November, the government announced two more economic stimulus packages, bringing the total economic stimulus to. was sanctioned for the health sectors response to COVID-19.On 12 June 2021, Finance Minister Nirmala Sitharaman announced to reduce the GST tax rates on the equipments, medicines, masks, sanitizers etc. which are being using for the treatment of COVID-19.
Lockdowns
First wave: Nation-wide
The Epidemic Diseases Act, 1897 and Disaster Management Act, 2005 was invoked in mid-March 2020. All commercial domestic and international flights were suspended in March. A number of cities and states announced that they would restrict public gatherings, dine-in restaurants, or order the closure of various non-essential businesses through 31 March to . On 19 March 2020, Prime Minister Modi asked all Indians to observe a 14-hour Janata curfew on 22 March, and to thank essential workers by clapping or ringing bells at 5 p.m. outside their homes. The curfew was used to evaluate the feasibility of a national lockdown.On 24 March, with 519 confirmed cases and 9 deaths in the country, the Prime Minister announced that India would be placed under a "total lockdown" for at least three weeks. All non-critical businesses and services were ordered closed except for hospitals, grocery stores, and pharmacies, and there was a "total ban" on leaving the home for non-essential purposes. All public transport was suspended.
On 16 April, districts were divided into zones using a colour-coded tier system based on incidence rates, classified as a "Red", "Orange", or "Green" zone. All of India's major cities fell into Red zones. Beginning 20 April, agricultural businesses and stores selling farming supplies were allowed to resume operation, as well as public works programmes, cargo transport, and banks and government centres distributing benefits. Phase 3 and 4 of the lockdown extended until 31 May, with incremental relaxations and changes. The country began a phased lifting of restrictions on 8 June. This phased lifting of restrictions continued in a series of "unlocks" which extended into November 2020.
The government was criticised for not using the lockdown to prepare the health system for when the lockdown would be lifted.
Second wave: State-wise and localized
Cities in Maharashtra such as Amravati and Nagpur started imposing curfew restrictions and lockdown measures in late February and early to mid-March 2021. On 4 April, Maharashtra imposed a weekend lockdown and night curfew among other restrictions. By early to mid-May, 35 of 36 of India's states and union territories had some form of state-wide and localised restriction. The second wave of the pandemic in India has seen no nationwide lockdown. Phased unlocking was announced starting June in Delhi, Tamil Nadu, Maharashtra, Uttar Pradesh and a number of other states.Administration, committees and task forces
India's covid response is being guided by a number of committees, empowered groups, advisory groups and task forces. Some of these were formed before the pandemic such as the National Technical Advisory Group on Immunisation, "India's apex advisory body on immunization", and the Integrated Disease Surveillance Programme under the National Centre for Disease Control. IDSP was brought in as early as 17 January 2020. Some of these were constituted following the onset of the pandemic such as the ICMR COVID-19 Task Force. The National Expert Group on Vaccine Administration for COVID-19, formed in August 2020 would guide the national vaccine delivery strategy. In October 2020, NEGVAC advice resulted in the formation of a three-tier state level mechanism for the implementation of the vaccine strategy. The overall response has been led by the Prime Minister and his office; at least 67 review meetings have been held by it between January 2020 and May 2021.Pseudoscience practices
Despite no scientific evidence behind the use of animal products to boost immunity against COVID-19, some individuals sought out traditional or religiously inspired methods. One such method involved scrubbing oneself in cow dung and urine, followed by rinsing off in cow milk or buttermilk on a weekly basis at cow shelters. Other methods involved consumption of cow dung and urine. Proponents of these pseudoscience preventative methods also occasionally consumed cow urine to boost immunity against SARS-CoV-2, and some Indian healthcare professionals likewise participated in these rituals. Cow dung and urine were promoted as effective treatment for COVID-19 by many religious leaders, medical professionals, other key opinion leaders, and government officials.Military
The Indian military has supported the Indian government's response during the pandemic. During the second wave, some of the steps taken by the Indian military to help the fight against the pandemic includes setting up of COVID facilities, setting up of oxygen PSA plants, providing domestic and international air and water transport assistance, providing medical assistance to civilians, providing nursing assistance and truck drivers, providing support to centre and states as requested, roping in retired military medics, providing manpower with specialised skills, and roping in the National Cadet Corps. The three armed forces were functioning under Operation CO-JEET. Operation Samudra Setu 1 which was officially conducted between 5 May 2020 and 8 July 2020 and focused on repatriation; and Samudra Setu 2 in 2021 focused on oxygen related transport.Private sector
In March–April 2020, several companies and organisations donated masks and other pandemic related supplies. Several large business groups contributed to the PM CARES Fund. Leading Indian corporates have come forward to provide support to hospitals across the country. This includes procuring, setting up and maintaining cryogenic tanks, medical equipment and ventilators. Business leaders in India have also set up COVID-19 facilities. The chief executive officers of 40 US companies set up a global task force to collaborate on procuring equipment to support India. Ola is providing doorstep delivery of medical oxygen.International
International support
The Indian government provided around 65.5 million doses of covid vaccines to 95 countries between 20 January 2021 and late March 2021. 10.5 million doses were gifted while the remaining were commercial and COVAX obligations.International support has been provided to India since the beginning of the pandemic in 2020. In late April 2021, international relief being transported to India increased. European countries such as France, Ireland, Belgium, Romania, Luxembourg, Portugal and Sweden sent pandemic related aid such as oxygen concentrators, ventilators and medicines. France and Germany also sent oxygen plants; Germany also sent 12 army paramedics to operate the plants. Oxygen related equipment was shipped from Bahrain, Thailand, Singapore, Saudi Arabia and the United Kingdom. Russia, United States of America and UNICEF sent various relief material including oxygen producing units. In April 2021 Taiwan sent 150 oxygen machines to India. The oxygen machines had been purchased by the Taiwanese government and modified for India's electrical voltage. Other countries to have provided support include Bhutan, Bangladesh, Kuwait, Kenya, Turkiye, Switzerland, Poland, Netherlands and Israel. On 5 May 2021, Indian External Affairs Minister said that "What you describe as aid, we call friendship" in response to foreign support during the pandemic. On 16 April, China sent 650,000 testing kits to India, but their use was discontinued in view of a very low accuracy.
There were international concerns related to how the support being sent to India is being used. By 5 May India had received items in aid. Support between 27 April and 14 May included "10,796 oxygen concentrators, 12,269 oxygen cylinders; 19 oxygen generation plants; 6,497 ventilators, more than 4.2 lakh Remdesivir vials". The government released the institutions and the states to which the support had been sent.
Response shortages and criticism
The role of the National Centre for Disease Control during the COVID-19 pandemic has been questioned including the subdued sharing of data collected by the IDSP. Disease surveillance in India through IDSP faces perpetual shortage of funds and manpower resulting in a weak nationwide data collection system. The IDSP does not track deaths taking place outside hospitals, or deaths due to COVID-19 of those not tested, one of the many reasons under-counting is built into the system. The lack of epidemiologists in senior decision-making positions of COVID-19 related committees has been evident, including the absence of state-level epidemiologists in a number of states. In April 2020, the health ministry asked states to go on a hiring spree and fill vacancies for epidemiologists. Indian Council of Medical Research has been criticised for did not updating the "treatment protocol for COVID-19" between July 2020 and April 2021. The "National Task Force for COVID-19" did not meet during February and March despite members claiming it was obvious a second wave was in the making. A number of warnings pertaining to a surge in cases in March, shortages in life-saving equipment and a second wave were downsized and went unheeded. A number of problems were found with the forecasting and modelling by the National COVID-19 Supermodel Committee by independent commentators. In early May 2021, the committee said that they had not been able to predict the second wave accurately. A lot of problems with India's failing response to the second wave was the general and long term issues of the public health system in India.Evacuations by India related to the COVID-19 pandemic
Throughout the COVID-19 pandemic, the central and state governments of India coordinated numerous international and domestic evacuations.Background
COVID-19 pandemic
SARS-CoV-2 was first identified in the city of Wuhan, Hubei, China in mid-December 2019, when a group of people developed a pneumonia without clear causes, and existing treatments were found to be ineffective. SARS-CoV-2 has similar characteristics to severe acute respiratory syndrome and Middle East respiratory syndrome, with the resulting disease being named COVID-19. Within a number of weeks, several thousand people in Hubei's provincial capital of Wuhan were infected, and the Chinese central government imposed strict containment measures, including a lockdown of Hubei itself.As the virus spread worldwide, more countries also instilled their own lockdowns and put travel restrictions into place. In response, many nations evacuated their citizens as well as other nationals to transport them home. India was no exception: to control the COVID-19 pandemic in the country, all visas were suspended from 13 March and international flights were suspended nine days later from 22 March. India had started a national lockdown on 25 March, which restricted the movement of people in the country.
Migration
The Indian diaspora is the largest in the world, with the UN estimating their size at 17.5 million in 2019. The Ministry of External Affairs has higher figures, with the number of Non-resident Indians or NRIs alone being over 13 million. In addition, India also has a substantial population of internal migrant workers, with Reuters estimating that there are 100 million such workers.Previous evacuations
India has conducted several large-scale evacuations in modern times, particularly in the Middle East where there is a high concentration of Indians and several conflicts in recent history. The 1990 airlift of Indians from Kuwait has been recognized as the world's largest civilian airlift, with over 110,000 people evacuated. Domestically, Operation Rahat, which the Indian Air Force claimed was the biggest civilian helicopter evacuation ever, airlifted over 19,600 people from Uttarakhand and Himachal Pradesh during the 2013 North India floods.International
January–April 2020
After the lockdown in Hubei, the government owned flag carrier Air India flew to Wuhan to evacuate Indian citizens, particularly students, stranded there. As cases spiked in Italy and Iran, the latter country of which some pilgrims had been stuck in, efforts were shifted to evacuate Indians from Milan and Iranian cities. These flights were free for passengers.| Departure date | Evacuees | Nationalities | Departure airport | Arrival airport | Notes | |||||||||||||||||
| 1 February 2020 | 324 |  May 2020–present: Vande Bharat MissionThe Indian government initiated a massive evacuation program called "Vande Bharat Mission" on 7 May 2020. This involved flights via Air India and its low-cost arm Air India Express. In the first three phases of the mission, the government did not allow private airlines to participate, though they have been allowed to participate in the fourth phase onwards. The government continues to set the fare, determine the routes and decide the number of flights.Over 67,000 evacuation requests were registered by MEA by 8 May; twenty days later, the number of registrations had increased to over 300,000. It was initially predicted that the total number of civilians evacuated could surpass the Kuwait airlift, with estimates ranging from 192,000 to 250,000. On 6 August, the MEA declared that almost 950,000 Indians were repatriated. As well as evacuating Indian nationals back to the country, certain flights will also evacuate anyone who wants to leave, provided they are a national, permanent resident, or have a visa valid for at least one year. Unlike previous evacuations, passengers have to pay for their journey, with fares ranging from for the Gulf states to for the United States. Phase IPhase one, which was conducted from 7–17 May, mostly targeted areas with high concentrations of Indians. It was predicted that this phase would feature a total of 64 flights, half of which were for the Gulf states, as well as two naval ships for Indians in the Maldives under the label "Samudra Setu". The MEA gave a higher number of 84 flights, which may have been due to counting domestic connections on the same plane as a separate flight. As of 15 May, All India Radio reported that 56 flights had been conducted.
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