Six years since the first COVID case: What we know now about the origins, global toll and India’s progress | Explained

Six years ago, on 1 December 2019, a man in Wuhan, China, developed symptoms that would later be identified as part of a mysterious new respiratory illness. That patient became what is widely regarded as the index case in the COVID-19 pandemic. The world has since recorded more than 778 million confirmed infections and at least 7.1 million deaths, according to the World Health Organization. Scientists believe the true figures are far higher, since many countries struggled with testing and surveillance in the early phases of the crisis.

The anniversary has reignited conversations about the origins of the virus, the reliability of early reporting, and global preparedness for future outbreaks. The first known case challenges the notion that the pandemic erupted suddenly. Instead, several peer-reviewed studies indicate that SARS-CoV-2 may have been circulating at low levels before December 2019.

A 2021 study published in Nature identified evidence strongly supporting a zoonotic origin, suggesting the virus jumped from bats to humans through one or more intermediate hosts. The study identified close viral relatives in Rhinolophus bat species, with genomic similarities indicating a natural spillover pathway. It also drew parallels with previous coronavirus outbreaks, including SARS in 2003.

Despite this, the origins debate continues to be politically charged. A 2021 assessment by the Office of the Director of National Intelligence in the United States stated that a natural spillover remained the most likely explanation, but it did not rule out the possibility of a laboratory-related incident. The report acknowledged that the lack of complete data from China made it impossible to reach a definitive conclusion. This gap in information has kept speculation alive and contributed to mistrust between governments.

Public health researchers say the death toll may also be significantly underestimated. A 2023 Lancet analysis estimated that deaths in low and lower middle income countries may be undercounted by 30 to 50 percent due to weak health systems, limited testing capacity and delayed reporting. The study stressed that global mortality data during the pandemic was constrained by patchy records, especially in rural regions.

Pandemic specialists argue that such uncertainty underscores the need for stronger biosafety norms. A 2024 analysis by the Observer Research Foundation pointed to a global gap in laboratory regulations, wildlife trade monitoring and early warning mechanisms. It recommended a coordinated international protocol for outbreak reporting and improved access to data for independent scientific review.

India’s preparedness and progress

India, which faced two severe waves of COVID-19, has taken steps to strengthen its public health infrastructure since 2021. The Indian Council of Medical Research expanded its network of virus surveillance laboratories, while genomic sequencing efforts were consolidated under the Indian SARS-CoV-2 Genomics Consortium. These measures were intended to improve the country’s ability to detect variants quickly.

India also became a key producer of COVID-19 vaccines. According to UNICEF and the WHO, over two billion doses manufactured in India were supplied globally through bilateral agreements and the COVAX facility. Public health experts have said that India’s large-scale vaccine manufacturing capacity played an important role in stabilising supply chains at a time when many countries faced shortages.

India’s digital vaccination certificate system, CoWIN, was widely praised. The United Nations highlighted the platform for its ability to manage large populations efficiently and recommended it as a model for developing digital health records in other countries.

Lessons six years later

As the world marks six years since the first known case, scientists and policymakers are calling for vigilance. The WHO continues to warn that COVID-19 remains a public health threat, especially for vulnerable populations. While vaccines have significantly reduced deaths and hospitalisations, new variants continue to emerge.

The pandemic reshaped global health systems, exposed weaknesses in international coordination and raised critical questions about transparency and preparedness. Six years on, the origins debate continues, but experts say the focus must also be on building stronger systems to prevent the next pandemic from taking the world by surprise.