Covid-19: No Respite; Blame Lies Everyone

Prime Minister Narendra Modi Saturday chaired a high-level meeting on the Covid-19 related situation and vaccination. Earlier, Friday, the Prime Minister came out to share the “pain” of citizens, breaking his silence after several prominent BJP supporters and Right-wing foot soldiers too had lambasted the government’s mismanagement of the crisis. Modi’s comments came at the end of an online event.

Sounding a note of caution to farmers and rural areas, the PM said the pandemic was spreading to villages at a ‘rapid’ pace, but said India will not lose courage and will fight the virus and win.

Modi, however, did not directly mention the shortages of oxygen, drugs, vaccines and hospital beds that have earned him condemnation at home and abroad, choosing instead to give general assurances and a pep talk about not losing “courage”.

India reported 3,26,098 new Covid-19 cases and 3,890 deaths in the last 24 hours ending 8 am Saturday. It also reported 3,53,299 recoveries during the same period. With this, the total number of coronavirus cases has reached 2,43,72,907 and the number of fatalities stands at 2,66,207. Active cases dropped by more than 31,000 cases to 36.73 lakh.

Second weave continues to ravage the country

While official data suggests the number of infections are coming down,  the second surge continues to ravage almost the entire country, urban as well as rural areas. The latter is of greater concern because of lack of information and poor health facilities.    As on mid last week, India’s national positivity rate, or the proportion of tested cases returning positive, is around 21%. 533 of the 734 districts have reported positivity greater than 10%. There are 26 States that had more than 15% positivity, nine with over 25% and 10 with 20%-25% positivity. And with the faltering vaccination drive, and the picture is dismal.  Ever since the vaccine drive was expanded to all adults over 18, on May 1, the maximum number of daily doses administered has been 2.4 million, down from 3.7 million doses on April 12. This, even as daily new cases added continue to be above comfortable levels. The oxygen crisis continues and the pandemic has now established itself in rural India in lethal proportions, with macabre reports of bodies surfacing in the Ganga  in the stretch from Uttar Pradesh to Bihar. All of these point to the fact that there is a very large pool of those infected and prone to infecting those around, bringing up the question of whether a national lockdown should be reimposed.

Almost 18 States have imposed various grades of lockdown or curfews. These restrictions are expected to be in force at least till the third week of this month.

Factors behind Covid-19 spike: WHO

The World Health Organisation in its COVID-19 Weekly Epidemiological Update, published Wednesday, has said a recent risk assessment of the situation in India found that “resurgence and acceleration” of Covid-19 transmission had several potential contributing factors, including “several religious and political mass gathering events which increased social mixing”.

The pandemic has raised questions on the role of B.1.617 and other variants (e.g., B.1.1.7) in circulation” with “potentially increased transmissibility.” The update said that “the prevalence of several VOCs (Variants of Concern) including B.1.1.7 and B.1.612 sublineages increased concurrent to the surge in COVID-19 cases reported in India.”

“Since the identification of these variants through late April 2021, B.1.617.1 and B.1.617.2 accounted for 21% and 7% of sequenced samples from India,” the update said, adding that preliminary analyses conducted by WHO using sequences submitted to GISAID suggests that B.1.617.1 and B.1.617.2 have a substantially higher growth rate than other circulating variants in India, suggesting potential increased transmissibility compared.

“While India continues to account for 95% of cases and 93% of deaths in the South-East Asia Region, as well as 50% of global cases and 30% of global deaths, worrying trends have been observed in neighbouring countries,” it said.

Peak in sight?

Interpreting latest statistics,  Amitabh Sinha (Resident Editor, Pune, The Indian Express) discusses whether the number of cases have either already  reached a peak, or will peak in the next few days. The end of the second wave may still be a long distance away, though, he says.

After reaching a high of 4.14 lakh, the daily count of cases has dropped significantly in the last one week. Significantly, “the seven-day average of the case count, which adjusts for daily fluctuations, has begun to decline for the first time during the second wave. The seven-day average peaked at 3.91 lakh on May 8, and has begun to decline after that. On Wednesday, this average had slipped to 3.75 lakh.”

Decline in surge states: In addition, Maharashtra, which at one point was contributing more than 60% of daily cases at 68,631 a day, is now  showing declining daily case count in the 40,000s.

Also, an unexpected jump in the cases reported by Karnataka and Kerala, “is showing signs of waning.”  Even in Uttar Pradesh,  where the daily case count rapidly progressed to 35,000 at the end of April, “for more than one week, now, the state’s daily tally has remained well below 30,000, and is showing signs of declining.” Delhi too seems to have reached a peak, and appears to be in a declining phase with  around 10,000 a day.

However, there have been major rise in Tamil Nadu (above 30,000), Andhra Pradesh and West Bengal (both above 20,000) could give anxious moments.

Active cases: Other pointers to a possible plateauing of the curve are the number of active cases increasing by less than 10,000 a day. Current trends, writes  Sinha “indicate that active cases could peak well under the 40-lakh mark.”

Positivity rate:  During  the first wave, India’s overall positivity rate remained between 5% and 6% during the first wave, although there were small phases where it rose to more than 12 per cent. In the second phase, however, the positivity rate has exceeded 20%. In some states, it even went past 40%. There are now “signs that it might be stabilising,” although the “stability in the positivity rate could also be a result of India’s testing capacity having reached its limit……While the daily case count increased five-fold in April, testing numbers grew only 1.8 times. As a result, testing as a tool to control the spread of the disease — by forcing the known infected cases into isolation — was never very effective during the second wave.”

Death count: Sinha notes there has been a tenfold rise in the daily count of deaths in the last 45 days. “But as the case count has stabilised in the last two weeks, a further rise in number of deaths is getting arrested. But since it is a lagging indicator, there is a possibility that the deaths could still go on rising for a few days before coming down. As of now, about 4,000 deaths are being reported every day.”

Conclusion: Although there are hopeful signs, an end to the second wave appears a long distance away. “The daily count is moving up and down, so that we are not even sure whether cases in India have reached a peak…”

The inevitability of coronavirus waves: expert views

Even as the centre downplays the inevitability of a third wave, experts say recurring waves of infections are inevitable if existing practices such as expanding India's vaccination drive and following COVID protocol are not adhered to. Earlier, Principal Scientific Advisor K. VijayRaghavan had said, “A phase three is inevitable, given the higher levels of circulating virus.” Later, he qualified his statement saying that such a wave wasn't a foregone conclusion. “If we take strong measures, the third COVID wave may not happen…”

With less than 2 million doses being administered a day,  supplies of both Covishield and Covaxin unlikely to significantly pick up before July.

Gautam Menon, modeller and Professor, Ashoka University said he believed a 'third wave' wasn't inevitable if “the powerful lessons of what is happening now will not be forgotten in a hurry. Social factors, more than even the biology of the virus, govern how epidemics proceed.”

Shahid Jameel, virologist and advisor to the Indian Scientists SARS-COV2 Genome Consortium (INSACOG), however, said waves would keep happening until actions were taken. “We know some variants are more transmissible. We should be testing the India variants against vaccines, in labs and in real world settings.”

Warning by scientists ignored: Reuters, in a story released on May 1 quotes  Shahid Jameel as stating “As scientists we provide the evidence, policymaking is the job of the government”. The Reuters story headlined “Scientists say India government ignored warnings amid coronavirus surge”, claimed five scientists from the government-appointed consortium of national laboratories tasked with genome-sequencing, INSACOG, had “warned Indian officials in early March of a new and more contagious variant of the coronavirus taking hold in the country”. The story added: “Four of the scientists said the federal government did not seek to impose major restrictions to stop the spread of the virus”. So, in a nutshell, writes Karan Thapar (television commentator and anchor) “the government had been effectively forewarned to expect a possible exponential rise in cases but did virtually nothing.”

Pandemic in rural areas where health care is minimal

Amongst the bigger worrying aspects is the speed at which the virus has spread to rural areas. According to a report released last week by the State Bank of India, 48.5 per cent of the caseload burden is borne by the rural districts. The number of deaths has quadrupled compared to the peak of the first wave in September 2020. Even then, these disconcerting figures may not convey the scale of the tragedy since reporting of Covid cases is low and because of a dearth of testing facilities.  Away from the media spotlight, and with few participants in social media, The Indian Express writes “a crisis more serious than that suggested by official records seems to be playing out.”

While the health infrastructure in urban areas, though inadequate, is still tolerable, “rural centres continue to make do with under-staffed and under-equipped primary health centres…….The country’s flagship healthcare insurance programme, ‘Ayushman Bharat’ (insurance based health care project), means nothing when there aren’t enough beds or oxygen cylinders.”

Blame lies with everyone

There is enough blame to go around, not just with the  Uttar Pradesh government, including a government that allowed the ‘Kumbh Mela’ (Hindu religious festival)  and elections rallies to proceed. Citizens who chose to attend the ‘Kumbh Mela' and election rallies in the midst of a pandemic should have known better too, writes Ram Kelkar (Chicago-based columnist who works for a privately held investment firm). “These policy failures hardly explain the jump in cases in states far removed from the event location, such as Maharashtra and Karnataka.”

Thus, “while the ruling party is being blamed for its decisions, the opposition parties in power in many states have hardly been blameless. In the early days of the pandemic, both the ruling party and the opposition were emphasising that everyone follow the rules, such as masking and distancing. However, over time after it appeared that India had avoided the worst of the pandemic, leaders of all parties became less concerned about setting a good example and often acted in very partisan ways.

Inadequate Covid data will make crisis worse

Among the problems, is data reliability.  Moderating newspaper reports from  parts of  Gujarat, Madhya Pradesh, Haryana, Karnataka, UP etc, Aakar Patel (columnist and former executive director of Amnesty International India) estimates it is reasonable to assume the death rates “twice and perhaps three times the official one…If we take that into account, our official death toll of 2.3 lakhs, the third-highest in the world, actually looks like 5.6 lakh or more than seven lakh and easily the highest in the world…..”

Patel acknowledges  “that the fudging of the numbers is not entirely because of governmental fraud. It has happened in part because most people are dying at home, unable to access medical facilities or unable to afford them and they have not been tested. Second, how a death is classified depends a lot on the state government and the people making out the certificate. A person who has Covid-19 but also has another disease can be classified either as a Covid death or as something else……..”

Nevertheless,  “hiding the number and not actively promoting the fact that things are much worse is dangerous for us all. The first reason why the government should come clean and say that its numbers are an undercount is public safety. If people are fed nonsense like ‘recovery rate’ (a meaningless number for a disease that has no cure), then they will be less alert and more prone to carelessness about masking and social distancing…….

“The second reason is our shortage of oxygen…..The Central government says that it has enough oxygen but this is untrue. We do not. And we will make our jobs more difficult if we continue to be in denial.

“The third reason is credibility. The world is reporting the Indian numbers and saying that these cannot be believed…..”

India got over crisis in the past: today it is better placed

Hope lies in the ability of governments to overcome serious crises in the past. They accepted mistakes were made and took prompt correctives. In 1962, when an ill prepared Indian army lost to the Chinese, the then PM Nehru accepted failure and replaced the erring Defence Minister. In the 26/11 when the massacre of thousands of civilians took pace in Mumbai by Pakistan based terrorists, the then government sacked the Home Minister. In the 1990s when India’s foreign exchange reserves dipped to a few days, PM Narasimha Rao inducted a complete outsider Manmohan Singh to usher in reforms that changed the face of India globally.

Green revolution: The most classic example was however, in the mid-1960s when two consecutive years of drought resulted in a severe shortage of food. The U.S. assistance arrived but grudgingly, for India had not supported the West during the Cold War. President Lyndon Johnson had directed: “Send food to India by the shipload, so that she is kept on a short lease”.

The then government stirred the scientific and bureaucratic communities to bring about a quantum leap in food production. This was achieved within a few years.  “The Green Revolution stands out in Indian history as a display of extraordinary accountability by the political leadership, combining resolve, humility and intelligence,” writes Pulapre Balakrishnan (teaches at Ashoka University, Sonipat). India  misses this today.

In many ways, writes  Balakrishnan “the task is far easier today. Now India has something that it lacked in the mid-sixties, namely, industrial muscle. It should not be too difficult to ramp up hospital beds, ventilators and oxygen supply within a reasonable time…… An additional feature today, again in contrast to the mid-sixties, is the considerable foreign exchange reserve. Therefore, some crucial medical inputs can be imported, especially vaccines….” More importantly,  “to avert a health crisis in the future the States would have to raise the level of spending on health very substantially….”

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