Illustration by Molly Oleson

By now you’ve seen the photos of funeral pyres in India, lined up like headstones in Arlington or tents in a safe-sleeping facility. Then add fire and smoke and human misery: These are apocalyptic images befitting what feels like an apocalyptic time. 

For the Indian diaspora, these are not mere images: Here in the Bay Area, Ruchika Kumar has written so many condolence messages that she’s been forced to resort to cutting-and-pasting. 

“It makes me feel so bad when I do it, but I can’t keep up,” says the New Delhi native. “There are so many coming through my What’sApp. I am swapping out names.” 

Kumar, like too many local Indian Americans, is living what feels like a dual life. By day she’s an attorney at Genentech. But by night — and, truth be told, by day too — she’s besieged by a constant stream of messages announcing the deaths of friends or family or ominous symptoms or desperate pleas for oxygen or medicine. In San Francisco, things are improving; we’re arguing about honey bears and you can now walk into a bar, order a drink, and proceed to argue about honey bears. 

In India, civilization is failing, and black-market transactions are filling the void. Kumar’s sister has come down with Covid-19, and her elderly mother now has Covid-like symptoms. 

For the Indian diaspora, these are soul-trying times. Doctors are taking their work home with them in the worst possible way; UCSF infectious disease and HIV specialist Dr. Monica Gandhi says that friends — and even acquaintances — in India are sending her their lab reports. 

Some Indian tech workers, she says, are being provided oxygen by their global employers — in their work cubicles. 

To call the situation in India a humanitarian crisis feels a bit like calling the Grand Canyon a hole. The official tally is creeping toward 400,000 Covid diagnoses per day, and more than 3,000 deaths — but San Francisco doctors tell me that the actual numbers could be 10 times higher. Or perhaps even 30 times higher. 

And it will get worse before it gets better.

“Those of us who know India, this is exactly where we feared we would find ourselves,” says Dr. Sriram Shamasunder, a UCSF associate professor and the co-founder of Health Equity Action Leadership (HEAL), which is active in nine countries, including the Navajo Nation.

“A grotesque number of people are dying.” 

At the onset of the pandemic, Shamasunder spent five weeks in the Southwest working with the Navajos. The conditions among American Indians mirror those facing millions of East Indians: a lack of running water, large numbers of multi-generational people living tightly in small homes, an inability to work from the home or shelter in place (to an extent, you could make similar comparisons to the Mission District, or many crowded urban areas where people simply can’t take off work and wait at home — though the conditions here are not nearly on the same level).

A year ago, the situation among the Navajo was dire. Now, Shamasunder points out, the Navajo Nation is donating protective equipment to India.  

How did things get so bad? Dr. Vivek Jain is the director of the infectious disease clinic at San Francisco General Hospital; he’s helped to mold the hospital’s Covid response, and has been directly involved in the clinical care for many of the city’s sickest patients.  

Whether it’s in the Mission or Mumbai, Jain points to “five or six major variables” that are common across all nations and all societies. These include:

How much virus is circulating? How transmissible is the virus? What level of vaccination has been achieved? How much movement is happening in society? How much masking and distancing is occurring? And, of course, “a complicated mathematical interplay between all of these variables.” 

“Those of us who know India, this is exactly where we feared we would find ourselves.”

Dr. Sriram Shamasunder

In India, this equation has gone sideways and is getting worse. And, in India specifically, the nation’s leadership declared victory over Covid and did not spend the last year ramping up hospital capacity or amassing oxygen reserves. Millions of religious pilgrims traveled throughout the nation and disseminated the disease, and India’s Trump-like Prime Minister, Narendra Modi, has held large, mask-free rallies. 

Modi is pushing forward with multi-billion dollar plans to renovate parliamentary buildings and erect a new residence for the prime minister, despite the nation being an open-air crematorium. Social media critics of India’s government have been silenced or booted off platforms — with those platforms’ consent. Dire problems, unsurprisingly, have not been so quickly alleviated. 

The lockdowns Modi’s government ordered last year, meanwhile, were draconian and extreme — and offered no accommodations or financial subsistence for the nation’s poorest, who could not reasonably shelter in place. 

“In normal times, India has 400 million people, on a day-to-day survival realm,” says Shamasunder. “Having a lockdown is a recipe for death and starvation and collapse.” 

But India’s problem is not wholly of India’s making, just as its ramifications will never be constrained by imaginary lines on the map. For all its failings, India’s government requested a vaccine patent waiver, enabling domestic manufacturing all the way back in October 2020. The Biden Administration only pushed for this last week, and our European partners in the World Trade Organization are either hostile or lukewarm. This, at best, indicates a need for lengthy wrangling and delays — and delays are now measured in funeral pyres. 

“The global vaccine inequity is just horrific,” says Rep. Pramila Jayapal (D-Seattle). “Out of 1.1 billion doses administered so far, only 0.3 percent have gone to low-income countries.”

Jayapal, who was born in Chennai, India, is the first Southeast Asian woman elected to the House of Representatives. She flew to India in April in the hope of seeing her elderly parents for the first time since the onset of the pandemic. But, by then, her father was already hospitalized, and her mother was diagnosed with Covid five days later. 

“I never did get to see my father,” she says. Her parents have both recovered, but “had they gotten Covid even a week later, I’m not sure my dad would have received the oxygen he needed. So, in a strange way, I feel fortunate.” 

She tells me that the Biden Administration “is going to advocate hard. This isn’t just a change of position. They’re going to really push for it.”

But, she continues, “this could still take several months. It isn’t necessarily a quick option.” 

Jayapal concedes that the quickest way to get Covid shots into arms in India is to work within the system we have: Pay for those shots. “I am pushing for $25 billion in the next package so we can quickly get doses to the rest of the world,” she says. “I fear other things will take too long.” 

“I am pushing for $25 billion in the next package so we can quickly get doses to the rest of the world. I fear other things will take too long.” 

Rep. Pramila Jayapal (D-Seattle)

The United States has announced it will donate the 60-odd million doses of the AstraZeneca vaccine it has stockpiled, which has not been approved for domestic use. But clearing safety and regulatory hurdles may also require additional months. 

“This perplexes me,” says Dr. Adithya Cattamanchi, a UCSF epidemiologist. “We all know those hurdles can be cleared instantly, if we want to make that happen. On the one hand we look good announcing we’re going to clear this stockpile, but we’re not moving fast enough to give these vaccines away.” 

We countenance these delays, he continues, at our own peril. We should be ramping up global manufacturing capacity, and we should be doing it yesterday.

“Not only is this a humanitarian disaster, but it has implications for the U.S.,” says Cattamanchi. “The variants haven’t been fully characterized. I have a suspicion, epidemiologically, they are more transmissible. Whether or not they’re more deadly, the potential is there for them to continue to develop mutations that evade vaccines and cause more illness.”

Well, that would be a disaster. That would be a disaster on top of a disaster on top of a disaster. 

“It’s taken us this long to vaccinate 40 or 50 percent of Americans,” Cattamanchi says. “If a strain emerges that is able to escape vaccines, we’re back to Square One.” 

We’d have to go back into remote work and Zoom school and all of that. We’d have to develop a new vaccine. We’d have to manufacture it. And we’d likely hoard it all for ourselves, again, while poorer nations suffer. 

“And that,” says Cattamanchi, “is a dreadful thought.”

Rep. Pramila Jayapal (D-Seattle), seen here in 2017, is pushing for $25 billion to buy vaccine doses to be sent internationally. ‘I fear other things will take too long,’ she says. Photo from Wikimedia Commons.

So many of the thoughts these days are dreadful. Even well-connected and well-educated doctors find themselves coping with feelings of guilt and powerlessness. 

Dr. Poonam Vohra is a UCSF pathologist who was born in the north of India. “Every few hours, I get calls or texts from friends or relatives who are very ill or [informing that someone] has passed away,” she says. “So many people are dying in ambulances or cars or waiting for a bed or oxygen or even the availability of medicine.” 

And when they call asking for help, there’s only so much she can do. 

“I am a specialist in pathology. My main specialty is diagnosis. I am not a treating physician.” 

She is often reduced to sending along “positive thoughts or prayers — I feel helpless.” 

“Not only is this a humanitarian disaster, but it has implications for the U.S.”

Dr. Adithya Cattamanchi

Vohra is far from alone, even among doctors. But a number of Indian American and Canadian physicians and scientists have banded together to form India Covid SOS, which is led by professor Manu Prakash of Stanford and professor Madhukar Pai of McGill University in Toronto. 

This is a good resource for information and instructional materials about the crisis in India, as well as a reputable source for those interested in fund-raising and material donations. 

The doctors interviewed for this story also urged the general public to get involved and lean on their elected leaders to let them know that alleviating the misery in India — out of altruism or self-interest or bit of both — is a priority. 

“It’s a no-brainer. We are so interconnected. It is self-preservation to make vaccines available to everybody in the world in a very quick time frame,” says UCSF’s Shamasunder. “If there’s anything this global pandemic has taught us, it’s that a virus in Wuhan can get to the U.S. damn quickly. This has to be addressed. Scaling up manufacturing around the world is totally possible. But we are already behind the curve.” 

Joe Eskenazi

Joe was born in San Francisco, raised in the Bay Area, and attended U.C. Berkeley. He never left. “Your humble narrator” was a writer and columnist for SF Weekly from 2007 to 2015, and a senior...

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  1. “Could* be our future”

    *Except with extremely good vaccines and annual boosters, that future is super unlikely. Get vaccinated, folks!

    1. @Jar Val — It’s hard to place odds on the likelihood of a vaccine resistant mutation – the point is most people living in India don’t have access to a vaccine, and that fact exponentially increases the likelihood of such a mutation occuring.

      Regardless, the amount of death and suffering in India warrants compassion, urgency, and a perspective beyond one’s own nation. There are numbers in India that can be quantified without using ambiguous adverbs, and those number are *super extreme. There’s nothing to minimize here. Time is of the essence.

      1. @RL E

        Oh absolutely – the situation there is terrible and we should be sending doses, PPE, oxygen machines, whatever is needed. But to be quite frank we already know how fast the virus mutates based on hundreds of millions of cases around the world and how well the vaccine works in response. India needs our help. But the idea that we, a city with over 70% of the population with one dose (and likely to hit herd immunity within 6 weeks) could be like India “tomorrow” strikes me as fear-mongering, especially with increased vaccine surveillance and real-time testing of new variants by thousands of scientists around the world. The answer to not be India? Get vaccinated, ASAP. And don’t defund science when life goes back to normal.

        1. @Jar Val — Yes, that all makes perfect sense.

          Personally, reading about India and Brazil has been a wake-up call for me that other nations are at far different stages of the pandemic than the US. I’d had a lazy perception that global progress was similar to ours.

  2. Thanks Joe. USA has had 10 million more COVID cases than India, and almost twice the number of COVID deaths. Even given testing and reporting challenges in India, the USA sadly (including because it was largely self-inflicted) was greatly impacted by COVID five months ago when the vaccine first became available (India’s surge is relatively recent). Arguably, USA would have been among the first to get vaccine even if there were some all-powerful distributor interested in providing it where most needed. December and January were awful here. Thanks again.

  3. Joe, yes, “India’s today could be our tomorrow“ but America’s yesterday is what we are seeing in India today. You just have amnesia of the scenes particularly from the Big Apple. Don’t worry about India. It is a resilient country. It will come out of this crisis with flying colors as it did in the 5000 + years. You live in Bay Area and you seem to be blind to what is happening in your backyard. Please worry about that. God bless the United States of America.
    Homelessness: Homeless Oaklanders were tired of the housing crisis. So they built a ‘miracle’ village
    Under a highway, beautiful structures offer food, healthcare, showers and a free ‘store’ – as well as a strong sense of community — There are at least 140 homeless encampments in Oakland, — The city is home to more than 4,000 unhoused people, a figure that has jumped 86% over a four-year period — United Nations general assembly after visiting the Bay Area in 2018, reported that treatment of the unhoused was “cruel and inhumane”….unhealthy and unsafe conditions including a lack of access to clean water, sanitation, and health services — “People are not only being evicted from homes they once had, but then they are being evicted from the homes that they create – communities they’ve built for themselves when they had nowhere else to go” — Homelessness disproportionally affects Black Oaklanders, who make up 24% of the general population but 70% of the unhoused population. — “[Covid] exposed those pre-existing cracks in the infrastructure of how we take care of our people, our communities, our neighbors” — “Knowing that the issues people in these communities face around hunger and access to water, access to places to cook – these issues existed before the pandemic and they will continue to exist after the pandemic.”

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