NEW DELHI — At Nigambodh Ghat, the oldest cremation grounds in India’s capital, the bodies keep coming.
One ambulance arrives with five inside. Then another. Then another, in an endless display of death.
As the coronavirus pandemic surges in New Delhi, a public health care system that was already strained might be reaching its breaking point. People can’t get tested. They can’t find a hospital bed. The situation has become so grim that government officials have proposed commandeering some of New Delhi’s fanciest hotels to turn into hospitals.
But ready or not, much of India’s coronavirus lockdown has ended, as have those in other countries struggling to balance economic damage with coronavirus risk. In many places — India, Mexico, Russia, Iran and Pakistan, among others — leaders have come to feel they have no choice but to take the surge of cases on the chin and prioritize the economy.
Some of these leaders, especially those in the developing world, said they couldn’t sustain the punishing lockdowns without risking economic catastrophe, especially for their poorest citizens. So the thinking has shifted, from commanding people to stay indoors and avoid the virus and other people at all costs, to now openly accepting some illness and death to try to limit the damage to livelihoods and to individual lives.
A glimpse from the streets, reported by correspondents in countries especially hard hit, reveals a sharp rise in person-to-person contact in recent days — precisely at the time that the World Health Organization is warning that infections from this highly contagious disease are roaring toward a new peak.
India is now producing more new daily infections, around 10,000, than all but two countries, the United States and Brazil.
“It’s a bit of a mess,” said Indrani Gupta, a health economist in New Delhi. “Our economy is so dependent on labor, millions would have lost their livelihoods and their lives if this lockdown went on for months and months.”
But, she added, the lockdown began too soon.
“We got it in reverse,” she said. “We shut down too quickly and it was too draconian. And I don’t think now is the time to ease up.”
In Russia, politics may be playing a role in the push to reopen.
This week, Moscow’s mayor lifted many of the restrictions in place since March 30, surprising some infectious disease experts who pointed to still high-infection rates. Political analysts said one reason for the abrupt reopening was to pave the way for high turnout at a July 1 referendum that could amend the country’s Constitution to allow President Vladimir V. Putin to remain in power until 2036.
Officials had delayed the referendum, originally scheduled for April, because of the lockdowns.
On Tuesday, grateful Muscovites spilled out of their apartments for walks in the sunshine. Authorities canceled a system of electronic passes for all trips outside the home other than to pharmacies and grocery stores.
“We managed to avoid a catastrophe,” declared Sergei Sobyanin, Moscow’s mayor, in a video blog. Now, he said, the city was “starting to defeat the coronavirus.”
The raw data isn’t quite as rosy. Russia’s number of new infections has hovered around 8,000 to 9,000 each day — far different, than say Italy, where the daily infections have plummeted to a few hundred now from more than 6,000 in March.
Many leaders are taking this same tone. In Mexico, President Andrés Manuel López Obrador ended the country’s quarantine, despite the continued rise in Covid-19 cases, and kicked off the reopening in early June with a tour of the country.
“We have to head toward the new normality because the national economy and the well-being of the people depends on it,” he said, during a stop in Cancún.
Unlike some other nations, Mexico has not offered the sort of large stimulus package to bolster its economy, which may be why its cushion against the economic pain of a strict lockdown was so thin. Mexico’s government has consistently downplayed the severity of the disease though it has conducted, per capita, by far the least amount of testing among the dozens of countries in the Organization for Economic Cooperation and Development.
In Mexico City, hospitals and morgues are saturated. So are the crematories. Some people have defied protocols to bury loved ones in secret, at packed funerals. Mexican doctors fear the worst is yet to come.
“We are still in the first steps of this pandemic, unfortunately,” said Dr. Alejandro Macías, an infectious disease expert. “The perception is that we are much further along than where we really are.”
Pakistan may soon be overwhelmed, but it has relaxed restrictions as well. Outside the cities, almost no one is wearing a mask or making attempts to socially distance. In Lahore, the windy alleyways of the old city are crammed with people. In the past week, Pakistan’s infections have nearly doubled but there’s no way to gauge how prevalent Covid-19 really is because testing has been so scarce.
Pakistan’s prime minister, Imran Khan, a millionaire former cricket star who campaigns as a populist, has called lockdowns elitist, implying that only rich people could afford to be sealed up in their homes.
“We sought a total lockdown without thinking about the consequences for the daily wage earners, the street vendors, the laborers, all of whom face poverty and hunger,” he wrote on Twitter. “May God forgive us our sin.”
Iran, next door, became one of the most alarming centers of the pandemic early on, but thought it had seen the worst. In early May, it decided to open up the country from a brief three-week lockdown in an attempt to salvage its economy, which was already suffering under international sanctions and huge budget deficits. Iran’s leaders said the coronavirus pandemic was a reality that Iranians had to learn to live with.
Health experts warned that opening the country too soon without meeting any benchmarks — such as a sustained drop in the number of new infections — risked a second surge.
Now, a month later, that second surge has arrived. On June 4, Iran reported 3,574 new infections in one day, the highest number of new cases since the pandemic began.
Frequently Asked Questions and Advice
Updated June 5, 2020
Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Will protests set off a second viral wave of coronavirus?
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
How do we start exercising again without hurting ourselves after months of lockdown?
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
My state is reopening. Is it safe to go out?
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Health officials in Iran have blamed the spike on people not observing social distancing, not wearing masks and the government opening up too soon.
Iranians by and large have been going about their daily routine activities shedding their earlier fears of the virus. As in other countries, road traffic is back, shops and businesses have opened and employees of private and government sectors have returned to work.
President Hassan Rouhani continued to insist that the economy must remain open because Iran “did not have a second option.”
And he warned members of his coronavirus task force not to create “anxiety among the public by saying there is a second or third surge.”
In India, many people are anxious that however bad things are right now, they will soon get even worse. New Delhi and Mumbai, the two biggest cities, are overloaded with infections and experts said that the peak is still several weeks away.
As Vikas Khairwar stacked the firewood for his father’s pyre at Nigambodh Ghat, the revered cremation grounds in New Delhi, he spoke bitterly about his family’s experience with the public health care system.
After his father tested positive for coronavirus, Mr. Khairwar said that he begged for him to be put on a ventilator but the hospital didn’t have any available. His father died the next day.
The family then had to wait 24 hours for the body because an elevator in the hospital broke down. Mr. Khairwar, an accountant who just lost his job, wants to get his whole family tested, to see if they have been infected. But government hospitals refused to help him, he said, and he can’t afford to go to a private lab.
“The government help lines are useless,” he said. “They keep redirecting us to different numbers that don’t work.”
He was visibly angry as he finished preparing his father’s pyre.
A few minutes later, Mr. Khairwar stood in front of a fire, a half dozen others burning brightly around him.
Reporting was contributed by Shalini Venugopal and Hari Kumar from New Delhi; Andrew Higgins from Moscow; Salman Masood from Islamabad, Pakistan; Brent McDonald from Mexico City; and Farnaz Fassihi from New York.