India reports more than 357,000 new Covid cases as total crosses 20 million

India crossed 20 million reported cases of Covid-19 on Tuesday.

There were 357,229 new cases reported over a span of 24 hours, bringing the total to 20.28 million, according to health ministry data.

India’s first cases were detected in late January last year and the country’s total did not cross 10 million infections until December, according to Johns Hopkins University data. But the next 10 million cases were reported in the span of just under five months, mostly in April.

So far, at least 222,408 people have died from the disease, but that number is likely lower than the actual death toll. Media reports suggest crematoriums and burial grounds are overwhelmed with bodies of those who died from Covid-19.

“The pandemic has now entered the small towns and the villages, and we are now quite worried about how much of a devastation it will cause in those areas where the health systems are not well developed enough to provide support, when even some of the big metros are struggling with the case load on hospitals,” K. Srinath Reddy, president at the Public Health Foundation of India told CNBC’s “Capital Connection” on Monday.

During the first wave last year, India imposed a strict national lockdown between late-March and May, which derailed the country’s growth trajectory and left millions without a source of income.

While the central government appears reluctant to impose a second nationwide lockdown, several states have stepped up restrictions in recent weeks, including local lockdowns and curfews. That includes Maharashtra, which is India’s worst-hit state, Delhi, West Bengal, Uttar Pradesh, Rajasthan, Karnataka and others.

Some health experts have suggested that India needs a national stay-at-home order and a medical emergency declaration to address current health-care needs.

India’s health-care system has been overwhelmed by the sharp rise in cases as it faces a shortage of hospital beds, oxygen supply and medicines to treat patients.

Public Health Foundation’s Reddy told CNBC that India needs a two-pronged approach to fight the second wave. First, efforts to vaccinate more than 1.3 billion people must continue.

India faces at least near-term vaccine shortages and just over 2% of the population has received both doses. Starting in May, India is opening vaccinations to anyone age 18 and older.

Second, India needs a “very strong” containment strategy to reduce the spread.

“What we need to do immediately is to cut down the transmission from person to person, by ensuring that there are no large crowds,” Reddy said, adding that India should not allow more than four people to gather in public places and areas with high positivity rates should be put into full containment mode.

He added that India needs to ensure adequate social support for people who are recovering at home from milder symptoms.

India’s second wave began some time in February when cases started rising again. Before that the country reported about 10,000 infections a day, on average. April saw a steep spike in the curve, with nearly 7 million reported cases.

The Indian government is facing criticism for letting large crowds gather for religious festivals and election rallies earlier this year. Those mass gatherings likely turned into super spreader events.

Scientists say the spike in cases is also partially due to variants of the coronavirus circulating in India at the moment. That includes a local variant called B.1.617 that has multiple sub-lineages with slightly different characteristic mutations.

Reddy explained that in its desire to put the economy back on track, India ignored the looming threat of a second wave.

“I think by early January when the daily case counts, the daily death counts and the test positivity rates plummeted, widespread impression gathered ground that we had ended the pandemic forever,” he said, adding, “We had turned our back on the virus, but the virus did not turn its back on us. And now we are paying the price.”