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Blame game at this juncture is suicidal

By VIVEK GUMASTE
May 12, 2021 17:25 IST
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To build one's political and ideological arguments on the dead bodies piling up outside our crematoriums is despicable and breaches the basic tenet of human civility, argues Vivek Gumaste.

IMAGE: People queue to get vaccinated in Patna, May 10, 2021. Photograph: Pappi Sharma/ANI Photo
 

In the tense, panic-stricken environment of a raging global pandemic, emotions are apt to run riot. Anger, fear and a sense of apathy cloud the perception. To vent their frustration, the public lashes out at the most visible target to heap blame -- namely, the government.

But how valid is this blame game being played out in newspaper columns?

Are the critical excoriations rampant in television accurate and is there any truth in the harsh rhetoric of the political Opposition?

And was this second wave of COVID-19 really the consequence of the Modi government's complacency and ineptitude?

These are the burning question that cry out for answers.

By February 2021, it deceptively appeared that India had successfully contained the virus. COVID-19 cases were down to a mere 110,00 cases per day from a peak of nearly 100,000 in September 2020.

Then all of a sudden, the tide turned. The case load began to increase, slowly at first and then skyrocketed.

In just over one-and-a-half months the cases escalated sharply from 24,882 per day (March 13) to an astounding 401,993 cases (April 30) -- nearly four times the previous peak reached in September and highest level recorded by any country in the world. The highest number of daily cases recorded thus far in the US was 249,000 in January 2021.

The speed of this surge was excruciatingly rapid and the scale astronomical. The slope of the second wave in India was the steepest documented since the inception of the virus; no other country had recorded such a near vertical slope in either the first or second wave. 

Any health system in the world would be challenged in the face of such a massive onslaught. India's healthcare infrastructure, shaky and deficient even at best of times, was expectedly pushed to the brink: Oxygen supply dwindled, hospital beds became scarce and essential medications ran low.

India's predicament is no different to what even New York, a city with a robust health network, underwent in March last year. Stretchers lining the corridors of hospitals, cafeterias taken over to accommodate critical care beds, ventilator shortages, dearth of medical supplies and refrigerated trucks serving as impromptu morgues became commonplace.

Therefore, to expect complete preparedness for such a catastrophic calamity is a bit too over-optimistic and unrealistic.

The second question: Was this rapid surge a direct result of the government's laxity in allowing the Kumbh Mela to proceed and to hold assembly elections in various states?

I would like to interject another factor -- the farmers' protest -- into this equation.

Let us look at the timeline of this second surge in relation to these events.

The farmers protest that began in late September last year reached a crescendo on Republic Day (January 26) when hundreds of thousands of farmers converged on to the capital; as per some claims there were 200,000 tractors alone. The protest continues till today with thousands of farmers camping along the border of Delhi.

Now examine the COVID-19 wave in India's capital.

For the most part of February, Delhi had registered less than 200 cases. But on February 24, the capital registered 200 cases which then began to mount steadily reaching nearly 28,000 cases by April 20.

Coronavirus has an incubation period of approximately 14 days in the majority of cases; in some instances, it may extend up to 24 days. Using these numbers, one sees an almost direct correlation between the January 26 congregation and the second wave in Delhi.

With regards to the Kumbh Mela, there was no justification to proceed with it in the face of rising coronavirus cases and the government must be held responsible despite the abbreviated version this year that cut down the Mela to a period of one month starting April 1 as opposed to the normal three-month period.

But in terms of cause and effect the Kumbh Mela does not stand out as the putative factor: The second wave was already in progress when the Kumbh Mela began.

Similarly, the elections do not bear a direct causal relationship to the beginning of the second wave which was already under way when the ECI called for the elections via its press release of February 26. That the elections aggravated the situation is undeniable and government should have shown more caution.

To be fair, if we are going to fault the government for the Kumbh Mela and the elections then we should also haul up those who supported and encouraged the farmers' protest which has a direct causal relationship to Delhi's second wave.

Additionally, when one scrutinises the two epicentres -- Maharashtra and Delhi -- which led the second wave, one finds that they are far removed from the gatherings facilitated by the government, namely the Kumbh Mela and the elections held in Assam, West Bengal and Tamil Nadu, Puducherry and Kerala.

This leads one to infer that there are other factors involved in this uptick, like virus variants.

A variant in simple terms is a disguised version of the virus; it takes on a slightly different form which may help it to avoid detection, spread more easily and increase its severity.

There are two new variants circulating in India: B.1.1.7 and B.1.617.

The B.1.1.7 variant that ravaged the UK late last year is the dominant form in Punjab and Delhi. According to Dr Sujeet Singh, director of India's National Centre for Disease Control, quoted in the New York Times, the B.1.1.7 variant is rising quickly in New Delhi, and was prevalent in almost half of samples evaluated at the end of March.

The B.1.617 variant appears to be the dominant form in Maharashtra.

These variants do appear to have altered the nature of the diseases to some degree. Dr Sujay Shad, a senior cardiac surgeon at the Sir Ganga Ram Hospital, remarks in the above-mentioned NYT report: 'The current wave of Covid-19 has a different clinical behaviour... It's affecting young adults. It's affecting families. It's a new thing altogether. Two-month-old babies are getting infected.'

At this stage it is difficult to conclude how much these variants are contributing to this second wave as scientific data is sparse. India is performing very little genomic sequencing -- only about 1% of samples are being subject to sequencing due to red tape and lack of resources -- so that the actual prevalence and consequently the clinical significance of these variants is difficult to ascertain.

There is one ray of hope with regards to these variants. Preliminary studies conducted by the Indian Council of Medical Research indicate a low breakthrough rate with vaccination: 0.02 to 0.04 percent and compares favorably with that of the United States (0.008 percent) that uses multiple vaccines.

The causes of the second wave are multifactorial. The humungous scale and rapid velocity went beyond the realm of human predictability and capacity. Human laxity and human greed (hoarding and black marketing) have worsened the situation.

Biological factors may be playing a pivotal role. To what extent each of these factors is responsible is still open to discussion

However, to indulge in blame game at this juncture would be suicidal. To build one's political and ideological arguments on the dead bodies piling up outside our crematoriums is despicable and breaches the basic tenet of human civility.

The need of the hour is a determined united effort to combat the crisis. The government on its part has swung into crisis mode after a period of hesitancy.

To offset the oxygen shortage, non-medical use of oxygen has been banned, the Indian Air Force and Indian Railways have been pressed into service to transport oxygen cylinders and more oxygen is being procured from abroad. Field hospitals have been setup by the military in various places.

Aid in the form of medical supplies from abroad has been pouring in. Hopefully hospitals will be better equipped to treat patients in the days to come.

But the bigger problem that lies ahead is the prevention of the spread of the virus. Central to this goal are increased testing, universal mask coverage and aggressive vaccination.

Modeling statistics paint a grim picture for the immediate future. The Institute for Health Metrics and Evaluation (IHME) (external link), an independent global health research centre at the University of Washington, predicts that the death toll in India will likely double to 665,000 by August 1, 2021.

Universal mask coverage implemented almost immediately will serve to decrease the death toll by 70,000 and aggressive vaccination will reduce the deaths by another 85,000.

As of May 10, a total of nearly 170 million doses of vaccines have been administered (Source: https://www.mohfw.gov.in/).

In terms of percentage this number is rather disappointing: only about 2.5% of Indians have received both doses and about 10 % have received at least one dose.

At the current rate of vaccination, only 30 percent of the eligible population will be vaccinated fully by the end of this year.

If India wants to reach a herd immunity of 80%, it needs to increase its vaccination rate by about 100 million doses/month. To meet this increased demand the government has funded the Serum Institute of India and Bharat Biotech to increase their production and has made arrangements to import vaccines from other countries as well.

With an accelerated vaccination drive coupled with social distancing norms, including universal mask coverage, India will hopefully bring this scourge under control by the end of the year.

Academic Vivek Gumaste, who is based in the United States, is the author of My India: Musings of a Patriot. You can e-mail the author at gumastev@yahoo.com

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The War Against Coronavirus

The War Against Coronavirus