India’s ferocious second COVID-19 wave, which began in March 2021, resulted in over 19 million cases and 240,000 deaths (as per official accounts) by June 2021. Many experts believe that India’s Integrated Disease Surveillance Program (IDSP), which relies on COVID-19 reporting from laboratories and hospitals, has vastly underestimated cases and deaths, especially at the peak of the wave when medical facilities were overwhelmed and many deaths occurred outside of hospitals. The true death toll is estimated to be 3 to 10 times higher than the officially reported number.

The second COVID-19 wave ravaged India and the country’s health system collapsed, even for the relatively wealthy upper middle classes who previously enjoyed world class private medical facilities. Basic amenities such as hospital beds, oxygen, and life-saving medicines were in severe short supply. According to official estimates, more than 300,000 people lost their lives, but the unofficial estimates put this number between 3 and 4 million.

Building on already worrying dynamics, misinformation has abounded on Indian social media since the beginning of the COVID-19 pandemic. Claims that the virus was deliberately spread, or that minority groups are conspiring to accelerate its spread, have been common. Recommendations for miracle cures have also dominated online spaces, with fact-checkers debunking an unprecedented amount of false remedies. 

In mid-May 2021, as India’s second COVID-19 wave was reaching its peak, more than 410,000 cases were being recorded each day—the largest daily numbers for any country, at any time in the pandemic. The speed with which case numbers increased led to unprecedented strains on the health care system, both public and private. The media preoccupation with urban India served to hide the more substantial tragedy that was unfolding across rural parts of the nation.

The COVID-19 crisis has exposed care labor at its limits. While often naturalized or attributed to obligations of family and the state, care work in the context of medicine combines the clinical dimensions of medical care with the emotional, bureaucratic, and ethical work associated with making medicine possible. It is frequently undercompensated. As India contends with its second COVID-19 wave, and in the wake of World Nursing Day, such labor remains at the center of the pandemic.

As the huge second wave of the COVID-19 pandemic sweeps through the India, there are widespread cries of distress and suffering. Families are struggling to get hospital beds, hospitals are running out of oxygen, and black-marketing of essential medicines has become widespread. Media stories of over-crowded crematoriums and bodies flowing down the Ganges, linked to serious levels of under-reporting of deaths, have shocked the consciousness of the nation.

Federalism, with its multiple levels of government and complex distributions of power, is sometimes seen as inherently ill-suited to decision-making during crises. Financial crises, world wars, and pandemics have all been used to proclaim the obsolescence of federalism. Such crises generate coordination problems that were not anticipated in many constitutional schemas and can legitimize the use of emergency powers that trample over pre-existing distributions of power. As Harold Laski wrote of the U.S.