India sees 100,000 COVID-19 deaths: What happened and what now?

India has crossed the grim milestone of 100,000 coronavirus deaths, the third-highest in the world behind only the United States and Brazil.

Despite the South Asian nation’s attempts to control the spread of the COVID-19 disease, which included one of the world’s strictest lockdowns, infections have surged at an alarming pace.

To date, India has more than 6.6 million cases, second only to the US. On Monday, it registered a single-day spike of 74,442 new cases, while 903 virus deaths in the past 24 hours took the total fatalities up to 102,685.

However, the country’s recovery rate stands at 84 percent, the highest in the world, with more than 5.5 million people recovered from coronavirus so far, according to the health ministry.

Al Jazeera spoke to four leading health experts on India’s handling of the crisis so far and what can be done in future to mitigate the spread of the respiratory disease.

As per the recent serological surveys done in the capital New Delhi and the financial hub of Mumbai, the ratio of infections to recorded cases are 20:1. Thus, India has more than 120 million COVID-19 infections, instead of the recorded 6 million.

It is also evident the infection-fatality rate (IFR) is as low as one per thousand. COVID-19 deaths add up to less than 1 percent of annual deaths from all causes in India. There have been 38 coronavirus deaths per million population, compared with more than 500 in the US.

Mortality will spurt because routine health services including antenatal care and immunisation have been disrupted due to the pandemic. The COVID-19 hotspots have dispersed from prosperous metropolises such as New Delhi, Mumbai, Chennai, Bangalore and Hyderabad, which have better health systems, to the hinterlands where health services are very weak.

India’s prolonged lockdown devastated livelihoods, causing acute food insecurity, translating into higher mortality and malnutrition, especially among children. The monetary relief from PM Cares fund – set up by federal government to fight coronavirus – and announcements by the ministry of labour and employment to safeguard jobs, wages and support the self-employed remain to be implemented.

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