> You may not believe it, but India's response to the pandemic has been nothing less than fantastic

Come on, India was probably the only country in the world where there were dead bodies floating in rivers. https://www.bbc.com/news/world-asia-india-57154564

During the second wave in April-May 2021, which India had ample time to prepare for, hospitals just didn’t have oxygen.

https://www.tribuneindia.com/news/haryana/ex-envoy-dies-wait...

https://www.washingtonpost.com/world/2021/04/21/india-hospit...

States purposely undercounted their death tolls by vast amounts.

https://twitter.com/deepakpatel_91/status/139341986118379930...

That said some states like Kerala and Maharashtra managed the pandemic much better than others like UP and Bihar, so your experience could be based on one of the better performing states.

To be fair, there is no country in the world operating with as little resources for as many people as India. The scale of administrating a pandemic response in India is mind-boggling.

The dead body floating thing happened in 1 or 2 states. My understanding is that dumping the body in Ganges is a cultural thing in some towns in those states. Someone from there told me that the older generation wants their body to be thrown in Ganges or buried on the shore so that they can get 'moksha'.

It is NOT a cultural practice in either of these states to simply "dump the body" in the Ganges. The tradition is to scatter the ashes in the river. Wood burnig open air cremations along the river bank is the norm, which takes several hours to reduce a body to ashes & bone fragments. Under usual conditions, a family member would remain with the pyre till the end, and would collect the bone fragments, mostly the next day. A lot of the leftover material is wood ash, which would be deposited in the river directly by the crematorium workers. Historically when resources have been tight & crematoriums overwhelmed by epidemics in the past, a family member would not be present, and unscrupulous crematorium workers would overturn partly cremated bodies in the river to ensure fast turnover, which is what seems to have happened in 2020. Desperate families might also inter the bodies directly in the river.

Unless I misunderstood, someone I know from one of these 2 states recently told me their grandparent wanted to be disposed of like that. They said their generation or their parents don't believe in such practices.

According to the below article, some communities do practice dumping body in Ganges.

"He further informed that the practise of dead body being disposed in the rivers is prevalent in two particular stretches in central/eastern U.P. and the epicentre of which is in Kanpur Unnao region in central U.P and Banaras-Ghazipur area in eastern U.P"

https://indianexpress.com/article/india/practice-of-bodies-b...

There was also another incident in 2015 from the same Unnao region where they found more than 100 bodies in Ganges.

https://en.wikipedia.org/wiki/Unnao_dead_bodies_row

Like I mentioned at the end of the initial comment, some families do indeed inter the bodies directly in the river, unable to afford the cost of cremation - this is also mentioned at the end of the wiki article you linked. This isn't new or surprising information. If there are communities that do this as a matter of routine, it's certainly not a significant source considering the 100s of millions who live along the river, where these community's dead mostly disappear without record into the river. For what its worth, it's certainly not a standard practice for the region. If bodies were present at significantly larger numbers in 2020, it suggests that either communities that do not traditionally practice interring in the river were doing it out of desperation, or that the traditional communities suffered significantly more deaths in the Delta wave, both of which are troubling concepts. The other possibility is that these were unclaimed bodies unceremoniously discarded by the civic administration, and the angle perhaps most appealing to those opposed to the current political dispensation.

EDIT: regarding the anecdote about a grandparent asking for this, there's a lot of context we don't know. Rather than a traditional practice, it might simply be a comment based out of frustration about the expense & bother to the family for a "standard" funeral. I also have family from the region and I've never heard of this as a standard routine widespread practice. For the most disadvantaged communities, I can understand it.

Regarding the grandparent comment, they are definitely not poor. They have a lot of money.

One of the comments below linked to a couple of videos, one of which is this: https://www.youtube.com/watch?v=8DWWeOt4jWM

In this, Burka Dutt is interviewing a local pandit. He says he is not sure if these are all covid deaths. He gives 2 reasons for the increase in number of bodies:

1. fear of covid

2. increase in cremation costs due to increase in covid deaths.

So, those bodies are not necessarily all due to covid deaths.

The video shows a lot of bodies cremated on the river bank. Once the water level rises during rain, the pandit says they will all float into the river.

Also learned that some inter the bodies of infants and unmarried women directly into the river. This may explain the 2015 incident where they found more than 100 bodies, mostly of unmarried girls and children.

> He says he is not sure if these are all covid deaths

Yes, though he's speculating, as are we all. The reality is that bodies turned up in the river at an unprecedented rate just as the rest of the country was struggling with Delta. Bodies floating into the rising river is not something that only happened in 2020. Indeed, if rains are a known issue why cremate so close to the rising river? Pyres were so close to the river because there an unusually high number of them. Nobody would suggest that 100% of them were COVID deaths, but it seems likely a very high proportion of them probably were. Indeed, as the top level headline notes that excess deaths, regardless of the official cause of death is what we need to watch out for as a signal.

> Also learned that some inter the bodies of infants and unmarried women directly into the river

This is actually in line with the standard practice in other parts of the country, ie, burial, rather than cremation, for children and maidens.

> Regarding the grandparent comment, they are definitely not poor. They have a lot of money.

The point is that there is context to the comment we're not privy to. The elderly say many things out of frustration and as a commentary on their own families sometimes. For example, I had a relative remark several times that when he died he wanted to be 'thrown to the dogs', or in the trash. Does it imply that this was a traditional practice in the family? No, but it was a comment on the perceived indifference of his family. Are there communities that practice interring in the river as a traditional practice, and not simply as a cost saving measure, and your friend is from one such group? Perhaps, but if there are they are a vanishingly small group, otherwise the river would be choked with bodies on a regular basis. A body showing up once in a while would not be noteworthy. That so many did in a very short window in the summer of 2020 says that the traditional practitioners probably aren't the source.

From the link that you pointed to

    Police officials of Unnao have offered an explanation that the bodies were
    of "people who were dumped in the river or buried on the banks after their 
    families could not afford a proper cremation."

You are trying hard to give the story a spin that dead bodies in the river in such numbers is nothing notable.

Government contractors pressed into removing commemorative burial markers less they be counted by drones

https://www.youtube.com/watch?v=ZiLzIuMsnW0

Let me find something in English to give context on these shallow graves

https://www.youtube.com/watch?v=6Q6hYu3EsC0 (will give viewers an idea of the mindboggling scale of the phenomenon)

The following videos are not in English but you should be able to get a sense of the numbers by looking at them

https://www.youtube.com/watch?v=ALO0VjfxXDA (pardon the annoying and unnecessary dramatization music)

https://www.youtube.com/watch?v=8DWWeOt4jWM

I am not disputing that people were interring the bodies because they cannot afford cremation. But is that proof that all of them died of covid? In the last video you linked (Burka Dutt one), the pandit gives 2 reasons for more bodies on the river bed: 1. fear of covid 2. cremation charges went up due to covid, which in turn caused people to inter the bodies of non-covid deaths as well.

My point of replying to the original comment which used dead bodies in India's river as a sign of under counting was to question the idea of comparing the current situation to Spanish flu (which killed upto 17-18 million in India). What happened in UP/Bihar (news says up to 2000 bodies were found) is an isolated incident, specific to those states. Can that be used as an indication that the remaining 26 states are hiding, since these 2 are one of the most poorest states in India? I should be hearing news about discarded bodies from other states also right?

> Government contractors pressed into removing commemorative burial markers less they be counted by drones

Since you posted local YouTube channels, do you know how they handled the new dead bodies after the news about this incident broke out?

> But is that proof that all of them died of covid?

All was never even the hypotheses, that is a strawman argument. The hypotheses is that this incident, of thousands of bodies floating down the river and buried on the sand bars, is a striking, once in a century phenomena given the numbers. If this was normal we would have seen such numbers prior to covid.

The major reason, as you had noted as well, is the breakdown of the infrastructure for dealing with deaths by a state that is not competent enough to prevent them. Some state did far better than others. You had mentioned two, Tamil Nadu and Kerala.

Note that the population of UP + Bihar is the same order of magnitude as a middle sized European countries. One does not need other states to contribute if these two are badly hit.

> The dead body floating thing happened in 1 or 2 states.

Those were the worst hit states - UP and Bihar. What was observed during the second wave was not normal, something like that last happened in 1918 after the Spanish flu:

https://www.bbc.com/news/world-asia-india-57068503 "This is not the first time bodies have floated up in rivers in India during a pandemic.

"The River Ganga was swollen with dead bodies", the famous Hindi language writer and poet, Suryakant Tripathi, better known as Nirala, wrote about the 1918 outbreak of Spanish flu in his village in a province which is now India's Uttar Pradesh state."

While I agree that we shouldn't be seeing bodies in rivers, I am not entirely convinced if Covid and Spanish flu in India are comparable.

The below links say bodies were found in many rivers, not just Ganga.

"A report released by the sanitary commissioner in 1918 later documented that it was not just Ganga that was clogged up with bodies, but all rivers across India."

https://economictimes.indiatimes.com/news/politics-and-natio...

https://en.wikipedia.org/wiki/1918_flu_pandemic_in_India

I don't think if scenarios such as below are happening in India, the leftist Indian media would stay silent.

“India perhaps never saw such hard times before. There is wailing on all sides. … There is neither village nor town throughout the length and breadth of the country which has not paid a heavy toll.

Elsewhere, the Sanitary Commissioner of the Punjab noted, “the streets and lanes of cities were littered with dead and dying people … nearly every household was lamenting a death, and everywhere terror and confusion reigned.”

https://theconversation.com/1918-flu-pandemic-killed-12-mill...

Just found out that there was a similar incident back in 2015 where they found more than 100 dead bodies in Ganges in the same region. It was also reported by BBC. Now I am wondering if BBC conveniently forgot that and went far back to 1918, just so that they can compare India's current situation to Spanish flu?

https://www.bbc.com/news/world-asia-india-30808745

https://en.wikipedia.org/wiki/Unnao_dead_bodies_row

I have seen dozens (probably hundreds in my overall life) of dead bodies in the Ganges long before Covid. It's disgusting but try telling the people to change their traditions and you will cause a riot.

The way the comment you are responding to was written and explicitly quoted, and yet said the commenter was still trying to get their parents to go despite the multiple objections, made it to me sound like they were not claiming the things you are defending against but merely restarting them as something the parents said.

Thanks for the comment. Are you able to elaborate on the big pharma profits most on baby powder, insulin and pain killers? In the world I live in, they pushed those markets to the brink in the form of baby powder lawsuits, an epidemic of obesity and the opioid crisis. Also, have you looked into Pfizer's profits for 2021?

https://www.cnn.com/2021/11/02/business/pfizer-earnings/inde...

Edit: Baby Powder Lawsuit - https://www.nytimes.com/2020/06/23/health/baby-powder-cancer...

Obesity Worldwide - https://www.who.int/news-room/fact-sheets/detail/obesity-and...

Opioid deaths began with increased prescription - https://www.cdc.gov/opioids/basics/epidemic.html

Hey. A lot to unpack here. But, first, THANKS!! for everything you do and the care you have for doing things right. Please don't take criticisms such as mine to mean that "everything is wrong and everyone is wrong" instead of its actuality where there is something wrong amidst several right.

With that out of the way, I did try to explicitly say that my experience is not first hand and that it is of that from my parents and my frustration that they cannot get tested as often as I can in the NL, and trust the local healthcare setup as I do here.

I for one am a lot relieved to hear from you that the digital systems are put to good use in verifying COVID tests, administration of vaccines, treatment, bills etc. Unfortunately, my parents concerns were still not addressed by these re-assurances. One may still test positive for COVID, but not really need the excessive medical procedures that the private hospitals/doctors do with monetary aims. Even worse, a doctor could simply admit someone for a couple of days and run all the tests only to come up and say after 2 days and a bill of several thousand rupees, - "your covid test was negative", please be careful about your other problems we took care of.

Secondly, if the regional testing centers or doctor's offices are as badly managed and under-staffed as my dad claims in his region, it is hard to trust the rest of the system to work, and not be scared of contracting covid just by visiting the test centre. I realise that India is big, diverse and unequal so it may not be the case where you are.

One of the reasons, I am stupefied, angry and scared is also from your list...

> our hospitals lost a lot of money and our entire budget.

> Did I tell about the overtime payments to doctors, nurses and paramedical staff? All from the hospital funds. Patients paid nothing

At least from a sample size of two (in a country with a couple billion people), it is not true. My uncle and aunt were hospitalised. for "mild" covid late last year, and came back home after 4 days with a fat bill, lot of frustration from defending against what they perceived as needless tests, and of course COVID. A private hospital could still keep the COVID cost to whatever regulatory maximum is, and still do absurd tests to milk the patient's insurance policies :-(

The only way for this system to gain trust is transparency. For patients to take hospitals to court with trustworthy judicial system. However, here we are where India reports a few lakh people died, and researchers claim it is wrong by several orders of magnitude :-(

I trust the sincere work of yours. But, we have a long way before that can be applied to the majority.

Your reply is disingenuous.

You state that you do not have "first hand" experience and yet are pushing questionable narratives from your Parents/Aunts/Uncles (who frankly seem to belong to the irrational "don't get the vaccine" crowd) as fact. Having lived through it all in India, i can categorically state that your narratives are very much false.

You seem to have no idea of the statistical nature of Covid tests; they are not binary. A Doctor has to make a judgement call on the result of the test (eg. RT-PCR) vs. the results of other tests (eg. Chest Scan) which is not easy. Given our limited resources in everything (i.e. Education/Hospitals/Doctors/Nurses as a percentage of the Total Population) it can become rather difficult to convince people of the costs (tests, time and money) involved. While of course there are many problems/inefficiencies with the system and we did drop the ball in preparing for the 2nd wave (as did the rest of the World) overall i would say we have done a stellar job of managing the crisis with the limited resources we have at our disposal.

I agree with almost everything you say. Hospitals saved my MIL when she caught Covid in 2020 and had lungs affected. She was treated by a Doctor via video and only a nurse (hired a month ago, new to her job) doing the actual physical work.

My only gripe is the shame that is attached to testing positive. The system kicks into extraordinary paranoia when someone tests positive. That is the reason why people refuse to be tested. My MIL did not test for weeks after she started coughing. Thankfully, my SIL traveled from the US forced her to test and admitted her.

I understand the reasons and the struggle of the hospitals, but there is a bit of heavy handedness (nowhere near China, I must admit) that is scaring people away.

I am thankful to the Doctors and nurses of India. They have saved at least two lives in my immediate family.

> Big pharma sure profits, but they profit most off such staple as baby powder and insulin. Their profits, data of efficiency on vaccines etc are under glare of scientific scrutiny, while their pain killers and opioids are where they don't get any investigation.

Pfizer reported that earnings and sales more than doubled in the past quarter, and it raised its outlook for results the full year, thanks greatly to its Covid-19 vaccine.

The vaccine business alone was responsible for more than 60% of the company's sales, as vaccine revenue rose to $14.6 billion from only $1.7 billion a year earlier. The company said its Covid vaccine sales accounted for $13 billion of that revenue. Revenue outside of its Covid vaccine business was up a far more modest 7%.

https://www.cnn.com/2021/11/02/business/pfizer-earnings/inde...

It's the largest part of the business now, and they are protected from downside: Under the PREP Act, companies like Pfizer and Moderna have total immunity from liability if something unintentionally goes wrong with their vaccines.

https://www.cnbc.com/2020/12/16/covid-vaccine-side-effects-c...

large parts of this comment are an appeal to authority. India’s response to the pandemic was an absolute disaster to the poor who incidentally make up the majority of the country and whose voices are rarely heard. This comment reeks of privilege and a lack of information about just how bad the indian medical situation is.

As just one example, india STILL does not have a good handle on WHAT is killing people. Up until 2018, there were annual death surveys to determine the cause of death. Think about that - people go door to door and record verbal responses about how people died. That is how poor data in india is.

These are not anecdotes and you should - respectfully - stop taking anything the indian government says at face value.

Finally, A Voice of Sanity.

A very sincere Thanks to You/Fellow Doctors/Nurses for doing such a fantastic job during the most trying of circumstances.

Nicely explained.

India should be an example of underdeveloped nation managing their covid situation. I'd like these policies to be documented and shared with UN med and shared with the world.

Well, I for once, appreciate your contribution :)

I also appreciate your contribution. Unlike a lot of the so called NRIs, at least you chose to stay and do your part to make India better.

FYI for those wondering - NRI stands for Non-Resident Indian/Not Really Indian depending on how pejorative you want to be.