NEW DELHI -- As India hit another grim milestone in the coronavirus pandemic Friday, crossing 2 million confirmed cases and more than 41,000 deaths, community health volunteers went on strike complaining that they are ill-equipped to respond to the wave of infection in rural areas.
Even as India has maintained comparatively low mortality rates, the disease has spread widely across the country, with the burden shifting in recent weeks from cities with robust health systems to rural areas, where resources are scarce or nonexistent.
The Health Ministry reported 62,538 cases in the past 24 hours, raising the nation's confirmed total to 2,027,074. It said 886 more people had died, for a total of 41,585 as of Friday.
But the ministry said recoveries were increasing. India has the third-highest caseload in the world after the United States and Brazil. It has the fifth-most deaths, but its fatality rate of about 2% is lower than the top two hardest-hit countries. The rate in the U.S. is 3.3%, and in Brazil it's 3.4%, Johns Hopkins University figures show.
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The caseload in the country of 1.3 billion has quickly expanded since the government began lifting a monthslong lockdown.
People returned to the streets of the capital of New Delhi and the financial hub Mumbai, which appear to have passed their peaks.
But authorities elsewhere in India were reimposing lockdowns after spikes in cases, including in Uttar Pradesh, a state of 220 million residents where infections in every district are weighing heavily on the fragile health system. After fully reopening in June, the state reimposed a weekend lockdown in July.
Shachindra Sharma, a 60-year-old graphic designer in the state capital of Lucknow, leaves his house only for a weekly grocery shop.
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"I do not fear the disease, but I do fear the government system, which has crumbled," he said.
TWO-DAY STRIKE
Around 900,000 members of an all-female community health force began a two-day strike Friday, protesting that they were being roped into helping with contact tracing, personal hygiene drives and in quarantine centers, but weren't given personal protective equipment or additional pay, according to organizer A.R. Sindhu.
The health workers, known as Accredited Social Health Activists (ASHA), which means 'hope' in several Indian languages, have been deployed in each village on behalf of the Health Ministry. Their work ranges from escorting children to immunization clinics to counseling women on childbirth.
But while their regular work hasn't lessened, they are increasingly being involved by state governments in the fight against the pandemic, Sindhu said.
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"But ASHA workers don't have masks or PPEs or even sanitizers," she said.
She added that although the work has increased and become more dangerous, their salaries remain static at roughly $27 per month And the families of at least a dozen women who she said died from the virus didn't receive compensation from India's federal insurance for front-line health care workers because their deaths were not recorded as covid-19 deaths.
Manisha Verma, a spokesperson for the Health Ministry, did not immediately respond to a request for comment.
India has launched two of the world's dozen and a half prospective vaccines into human trials, with vaccine-maker Zydus Cadila announcing that it had completed Phase 1 trials of its DNA-based vaccine on Thursday.
The country will be vital to global vaccination efforts, regardless of whether its own attempts work. The world's largest vaccine maker, the Serum Institute in the central city of Pune, has ramped up capacity to manufacture as many as a billion doses in development by AstraZeneca and the University of Oxford, which is in Phase 2 trials in India and England, and Phase 3 trials in Brazil and South Africa.
Researchers are hoping to launch the Oxford vaccine for emergency use by October.
The Serum Institute said Friday that with financial help from the Bill and Melinda Gates Foundation, it will be able to provide vaccines to India and other low- and middle-income countries for a maximum $3 per dose.
UNDETECTED CASES
Separately, Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts say the true toll is likely several times higher, reflecting the gaping lack of testing for the continent's 1.3 billion people.
While experts say infection tolls in richer nations can be significant undercounts, large numbers of undetected cases are a greater danger for Africa, with many of the world's weakest health systems. More than 22,000 people have died of covid-19.
The World Health Organization calls the milestone a "pivotal point" for Africa as infections in several countries are surging. The virus has spread beyond major cities "into distant hinterlands" where few health resources exist and reaching care could take days.
African nations banded together early in the pandemic to pursue testing and medical supplies, and advocate for equitable access to any successful vaccine. Swift border closures delayed the virus' spread.
But Africa's most developed country, South Africa, has strained to cope as hospital beds fill up and confirmed cases are over a half-million, ranking fifth in the world. The country has Africa's most extensive testing and data collection, and yet a South African Medical Research Council report last week showed many covid-19 deaths were going uncounted.
Other deaths were attributed to other diseases as people avoid health centers, and resources are diverted to the pandemic.
It's all a warning for Africa's other 53 countries of what might lie ahead. While dire early predictions for the pandemic have not played out, "we think it's going to be here at a slow burn," the WHO's Africa chief, Matshidiso Moeti, said Thursday.
BASIC CAPACITY
Just two African countries at the start of the pandemic were equipped to test for the virus. Now virtually all have basic capacity, but supplies are often scarce.
Some countries have a single testing machine. Some conduct fewer than 500 tests per million people, while richer countries overseas conduct hundreds of thousands. Samples can take days to reach labs. Even in South Africa, turnaround times for many test results have been a week or longer.
"We are fighting this disease in the dark," International Rescue Committee expert Stacey Mearns said. In addition, Africa has just 1,500 epidemiologists, a deficit of about 4,500.
Africa likely has at least 5 million infections, said Ridhwaan Suliman, a senior researcher at South Africa's Council for Scientific and Industrial Research. He believes the true number in South Africa alone is at least 3 million.
The U.S.-based Institute for Health Metrics and Evaluation puts Africa's number at more than 8 million. Resolve to Save Lives, led by Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, estimates it could be 14 million.
Information for this article was contributed by Rishabh R. Jain, Aniruddha Ghosal, Biswajeet Banerjee and Sam Mednick of The Associated Press.
