Indian hospitals are struggling to cope with a surge in coronavirus cases as a sluggish vaccination programme fails to curb a second wave.
Infections fell below 9,000 a day in early February from a peak of almost 100,000 in September, but this month there was a fourfold rise in infections.
More than 43,000 cases were recorded on Saturday, the highest daily rise since November, taking the total tally to 11.6 million.
India has the third-highest caseload after the US and Brazil. At least six of India’s 28 states and eight union territories promised to impose new curfews.
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Maharashtra state is experiencing particularly grim case numbers, with five big cities, including Mumbai, recording thousands every day.
On Saturday the state recorded 27,000 cases in its highest single-day figure since the pandemic hit the country in January 2020.
Local authorities in Mumbai said they would perform random Covid-19 tests at public places such as malls and railway stations starting on Monday, even without residents' consent.
They said failure to co-operate would result in criminal prosecution.
Hospitals across the city – the country’s financial centre and home to about 20 million residents – are coping with a deluge of patients as many centres closed Covid-care wards when the number of cases dipped.
Hospital admissions have doubled and the government plans to increase the number of beds to cope with a surge.
"The number of cases have more than doubled in the last three weeks," Dr Hemant Deshmukh, dean of King Edward Memorial Hospital in Mumbai, told The National.
"[In February] the hospital had 20 patients. Now it has doubled to 46.
“We are anticipating 5,000 cases a day by the end of this month because of increased tests.”
The cities of Pune, Nagpur and Thane imposed full or partial lockdowns.
Experts say the sudden resurgence is a direct result of mass disregard for preventive measures such as wearing masks and social distancing, combined with new virus strains and a sluggish inoculation programme.
“There is a loss of Covid-appropriate behaviour and people felt that the pandemic is over because vaccines are here,” said Dr Randeep Guleria, a member of India’s National Covid Task Force.
Prime Minister Narendra Modi last week said quick and decisive steps were needed to halt an emerging second peak.
India imposed a months-long lockdown in March 2020 that slowed infection rates but caused a recession.
The government gradually relaxed prohibitions, leading to growth in commercial and social activity.
India’s Health Ministry warned on Sunday that a major religious event in northern city of Haridwar could become a breeding ground for the infection.
It urged local government to increase testing and enforce Covid-19 preventive guidelines.
About five million Hindu pilgrims have attended the Kumbh Mela festival and an equal number was expected in the city in coming weeks.
Dr Shahid Jameel, a virologist, said the country must not rely on its vaccination programme to defeat the virus.
India needs to enforce preventive measures to curb the rise of infections and halt a nationwide second wave, said Dr Jameel, director of Trivedi School of Biosciences at Ashoka University in Haryana, told The National.
“There is definitely a second wave in some states but others may follow,” he said.
“What would help most is a behavioural change. People must wear masks and wear them properly.
"They must also avoid crowded places and large gatherings should be discouraged."
Dr Jameel said universal vaccination in such a short period was impossible mainly because of vaccine shortages.
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India approved two locally made vaccines to use in the world’s biggest vaccination drive in January. It pledged to inoculate 300 million by the end of July.
But the programme remains open only to select groups, including health workers, people aged above 60 and those 45 and older who have chronic health problems.
Many have skipped the voluntary programme, with only half of the country’s 10 million health workers taking the shots.
So far, about 40 million shots have been administered, covering only 2.3 per cent of India’s total population.
This has sparked scepticism, particularly over the government’s policy to export and donate vaccines globally despite a huge spurt of Covid-19 cases.
India has exported 60 million Covid vaccines, including “gifts” under its “vaccine diplomacy” policy, almost 50 per cent more than its domestic use.