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For the first time the number of people vaccinated in a single state in India reaches 40 million. In Maharashtra state in western India, with state capital Mumbai, the vaccinations crossed 40 million on July 20, 2021, according to the state's Additional Chief Secretary for Health. India has vaccinated 410 million people by July 20, 2021. About 3 million people are getting vaccinations daily.

Maharashtra was one of the top 5 states in the first and second waves of the coronavirus in India. About 2 million healthcare and front line workers have been fully vaccinated in Maharashtra. Maharashtra has a 2021 population of about 125 million according to Aadhar and is the second most populous state in India after UP which has an effective vaccination drive. 

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India's vaccination drive accelerates with people over the age of 45 years being vaccinated. Over 3 million people are being vaccinated every day. With the surge in the coronavirus cases more effort is going into the vaccination drive. Lockdowns are in place in Maharashtra state.

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!5,000 of the 25,000 coronavirus cases recorded in India on March 14, 2021 are in the state of Maharashtra, with the rest mostly in 6 other states, including Kerala. 

A team sent by the government in New Delhi to Maharashtra found the increase in cases in the state due to- "lack of fear of the disease," pandemic fatigue, missed cases, super spreading events from recent panchayat elections, marraiges, reopening of schools, and crowded public transport. The report  says that these factors are not unique to only Maharashtra and apply for other affected states also, including Kerala, Punjab, Karnataka.

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The odd situation in India where 50% of 43,000 coronavirus cases on July 28 are in just 1 state in the southwestern side of India on the Malabar coast. The next state is Maharashtra with 6000 cases and other states have about 2000 cases each including Andhra Pradesh.

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India plans to convert 500 railway carraiges into places to keep coronavirus patients in Delhi.  Daily new cases now are over 12,000, with total confirmed cases of 320,000, deaths at 9195. Delhi bed capacity in private and government hospitals  for coronavirus is 9698 wit 4248 beds vacant. Delhi Chief Minister Kejriwal says he expects a surge and is preparing for this as the economy reopens. Delhi, Tamilnadu, and Maharashtra are the worst hit states. The lockdown of March 25 has been lifted and markets are crowded. Many businesses and workplaces are now open. And local flights have resumed.

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As Delhi sees a decline in cases of coronavirus around July 16, it is not clear whether this is a result of more use of less reliable antigen tests where results are produced immediately. From 3000 cases in last week of June cases per day dropped to 1200 to 1600. Mumbai is also seeing a slow decline with other parts of Maharashtra state seeing spikes. Tamilnadu is seeing a gradual decline. Andhra Pradesh and Telengana, Karnataka see a climb in cases.

The federal government requires antigen tests showing negative to be followed up with the more reliable RT-PCR direct test, which takes hours to give results.

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The two waves of the coronavirus in India can be compared looking at the graphs and this report in the Times of India. The case volume and deaths in the worst hit state Maharashtra is shown here. The case volume increased by about 50% in the second wave but deaths were about half that in the first wave. Most of the deaths were in the people over 65 and most of the cases in the ages below 40 years. In the over 65 age only 5% have been vaccinated which means that medical management is still the best way of tackling the coronavirus. Vaccine supplies are the bottleneck and this is beginning to change- so that by August ample supplies of the vaccine should make the difference in bringing down cases and deaths.  Lockdowns are managed carefully so that the economy can recover in the second half of 2021 and in 2022.  Any assessment of the crisis management must take into account the speed of the response, its effectiveness, and keeping in mind the economic recovery needed following the pandemic. ...

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The Indian state of Kerala has experience tackling virus situations. Most recently with a Nipah brain damaging virus in 2018. For cases to double Kerala has 72 days, compared to a national average of 8 days. With total 437 cases and 3 deaths Kerala has shown "the importance of early tracking, screening, home quarantine, strict isolation and public participation," says Dr. B Iqbal, chairman of the Kerala state expert committee on coronavirus in an interview with DW. com. The first case was a medical student arriving from Wuhan on Jan. 24, diagnosed 6 days later. During the Nipah virus crisis Kerala limited deaths to 17. Kerala is an example of the importance of a well funded and well established and organized health care system. The Indian state of Chhatisgarh has taken a proactive approach color zoning districts. Of 28 districts 23 are free of coronavirus. Less cases and zero deaths.The key state health minister says was early preparations and then luck playing a part. Most cases today are concentrated in India in the Mumbai area, state of Maharashtra. ...

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Daily coronavirus cases dropped to the lowest level since March 30, 2021. Cases on June 19 were at 58,000 and deaths at 1154 for India's population of 1.2 billion people. The only state with cases over 10,000 was Kerala, and close to 9000 was Tamilnadu. Karnataka and Andhra Pradesh were at over 5000. All these states are in southern India. Only Maharashtra with about 9000 cases was in northern India. The positivity rate in Maharashtra state was 3% and in Mumbai 2%.  The Indian government has a clear vaccine policy and it is for vaccine supplies and vaccination drive to be under the federal government. This puts responsibility in one place and makes it possible to achieve the target of vaccinating 1.2 billion people by December 31, 2021, with the federal government putting all the resources it can muster into the effort. The economy is also linked to how the vaccination supply effort and vaccination drive progresses in the next 6 months, so that the goal of vaccination is closely linked to economic recovery and progress for India as a whole. A good monsoon rainy season would also help the rural economy recovery. ...

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The NYT provides a good look at the situation in India in September where cases are over 4.5 million, the world's second largest after U.S. During the lockdown in April and May India had successfully stemmed the coronavirus. After reopening in June a lot has changed as can be seen in this look at the steep curve in June, July, August and September. Cases are now at the rate of 95,000 daily and deaths at 1172 daily as of September 9. The deaths are up 16% and cases up 29% over 2 weeks. Maps show the situation in the states with Maharashtra, Andhra, Tamilnadu, Karnataka, and Uttar Pradesh showing the highest cases. Maharashtra has about 1 million cases and the two states in the south east Andhra and Tamilnadu have about 1 million combined with Uttar Pradesh at about 250,000 cases. Delhi has about 200,000 cases. So that about half of the 4.5 million cases are in three states in the southeast and the western state where Mumbai (Bombay) is located. The increase was seen after increased testing from 200,000 a day to 1 million a day by the end of August, a steep jump being seen in late August and September. At the end of July the coronavirus recovery rate of 70% in India and 90% in Delhi were the favorable signs, until things changed in August with increased testing and the spread to rural areas. India is doing over 1 million tests daily. On September 3, 1.1 million people were tested, taking the total to 45 million tested throughout India.  As in Europe and America the reopening which is essential for the economy and jobs has resulted in a big jump in cases. The laws for lockdown were carefully obeyed without many of the problems seen in America and Europe, the early complete lockdown was implemented with success, and Indian pharmaceutical companies are some of the largest in the world giving the public wide access to essential medicines and drugs. The postal service has functioned remarkably well during the lockdown for delivery of essentials throughout the country, and earlier action to establish bank accounts for each and every individual in the country, has enabled rural Indians to get through this most difficult period. This has given the government some breathing room as it faces the cases from reopening in a vast country of 1380 million people.   ...

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As farm product rotted on farms because of a lack of buyers, India has come up with new ways of getting farm agricultural product to buyers in urban areas. The Indian government has approved online sales direct from farmers to buyers outside the country. Within the country enterprising farmers  and app developers for farm produce sales directly to consumers in cities are changing the way agricultural produce distribution works. This report in the Guardian shows how sales are being made from remote Meghalaya state to buyers in cities for product ranging from turmeric, pineapple, jackfruit, and cashew. Prices are about 70% higher helping boost farmers incomes.  Several states have relaxed rules allowing farmers to sell anywhere in the country.  In other parts of the country this is happening with a proliferation of such apps creating a virtual marketplace. Other examples are a grape orchard farm in Gudahalli with sales made in Bengaluru at 30 apartment complexes. One site founder in Chandigarh says he has in 2 months sold 20,000 tons of produce ranging from avocados of the Nilgiris to papaya from Chattisgarh. His app Harvesting Farmer Network also helps with packaging and delivery. In other developments Gaia Agritech is helping farmers on the Konkan coast in Maharashtra hit hard by a pause in exports, sell to housing societies in Pune and Mumbai. This is part of a broader debate in India after coronavirus pandemic. One idea is that people have a family farmer just like they have a family doctor, encouraging organic agriculture, fresh produce for healthier living. By helping farmers it makes for a better economy, as about a sixth of India's GDP comes from farmers and most of the jobs are in farming and agricultural economy. ...

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Gujarat has a mortality rate of 6.2% compared to 2.8% for India. In total number of confirmed cases Gujarat comes fourth after Maharashtra, Tamilnadu and Delhi, with 21,500 cases. Most of the deaths are in the city of Ahmedabad and mostly at the city's large Civil Hospital. This report in the BBC says the deaths can be attributed to the reluctance of people in the city to go to the Government Civil Hospital because the quality of care is not good. Many patients come to the Civil Hospital only after failing to find a bed at other private hospitals. This means the patients condition is getting worse as he is not admitted rightaway but days afterwards when his condition has deteriorated. The weak health infrastructure of the state and the lack of quality care at the Ahmedabad Government Civil Hospital say experts has led to increasing number of deaths in Gujarat from coronavirus. Gujarat has been known for its improvements in transportation and roads infrastructure. This has not happened with health infrastructure. This situation is being seen also in China where not enough money is being invested for quality health care. Ahmedabad's Government Civil Hospital is one of the largest in Asia providing low cost care to a large population. ...

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India has learned lessons from past health epidemics- the plague Gujarat 1994, avian flu H5N1 in 2005-2006 Maharashtra, Madhya Pradesh, swine flu H1N1 Pune, and more recently MERS. The Indian Express looks at past epidemics, how they were tackled and what India learned from them. Major improvements in sanitation and hygiene since then and advances in medicine, public health.  Experience was gained. The municipal commissioner of Thane near Mumbai was district collector of Jalgaon during the avian flu epidemic. He used quarantine to restrict transmission of infected material. He shifted bus stands, closed weekly markets, and had health workers check symptoms in a 3 kilometre radius area. His message for today- have a contingency plan, track, test and treat people, stay focused, not panic, and know exactly what has to be done. Moving migrant crisis today was also seen in Surat, 1994, with the plague epidemic when migrant workers left the city. The government had to use paramilitary units in 1994 to quarantine the entire area. During these earlier epidemics the Indian Council of Medical Research and other medical organizations played a significant role. One of the lessons learned from the H1N1 epidemic that originated in Mexico was the need for effective surveillance and real time reporting so that the pathogen can be recognized in real time and tests done at labs to determine what it is, followed by effective response through isolation of region and patients. Dr. Pradeep Awate, Maharashtra's surveillance officer, says robust surveillance systems are important to understand the magnitude of the problem and strategically place resources. The strategies put in place for the Nipah virus in Kerala state by its Health Department in 2019 are the same ones now being used for cornonavirus - contact tracing and management of persons under quarantine. ...