Sunday Times 2
The curious case of COVID-19 and India
It is indeed axiomatic that pandemics have differential impact across geographies. The same applies as much to COVID-19 as it does in respect of countries. At a broad level, there is consistency in terms of general principles applied by countries across different waves (after discounting wave-specific steps). This is particularly true in cases where the leadership does not change. However, there is considerable variance in the nature of impact of each wave.
India makes a classic case on this front. India and its impressive handling of the first wave of COVID-19 made news world over. The ‘Indian model’ was widely hailed and deployment of her capacities in vaccine manufacturing for the larger good of humanity under Vaccine Maitri won the hearts of many. More than 66 million doses of made in India vaccines have been supplied to 95 countries till date. For Sri Lanka, the arrival of a gift of 500,000 doses from India enabled roll out of the vaccination program ahead of the original schedule.
The mortality rate of 1.11 % (one of the lowest in the world) and daily recoveries of around 300,000 during the ongoing second wave are not talked about precisely because of the difference in impact.
The sudden metamorphosis within a span of a few weeks is indeed intriguing and demands a threadbare examination. Essentially, the curious case of India begs an important question –whether India became complacent after her success in tackling the first wave? A crucial factor that needs an in-depth assessment in this context is India’s extent of preparedness, which could be gauged by some of the recent measures that were taken.
India was prepared with a three-tier COVID-specific infrastructure which consists of 2084 dedicated COVID hospitals, 4043 dedicated COVID health centres and 12,673 COVID care centres. Jointly, they have close to 1.8 million beds.
The country conducts around two million tests every day. Domestic production capacity of Remdesivir injections has been ramped up to almost ten million vials per month from the earlier 3.8 million vials. Imports of COVID-related equipment and medicines have been relaxed with several associated duties and charges getting waived. Innovative steps like use of railway coaches as COVID facilities are being resorted to as means to deal with the challenge. Indian Railways have already made nearly 4,000 COVID care coaches with 64,000 beds.
More than 150 million doses of COVID-19 vaccine has already been administered in India at quick pace. In fact, India ranks right on top of the ‘number of days to administer 100 million doses’ list of countries. A fast-tracked regulatory pathway for COVID-19 vaccines is in place which facilitates quicker access to proven vaccines from outside India for emergency use and also paves the way for imports of bulk drug material, which in turn boosts the vaccine manufacturing capacity and total vaccine availability in India.
Focused financial schemes are being provided to vaccine manufacturing companies for augmenting their production capacities. An end-to-end vaccine development ecosystem is being envisaged. Combined with various other measures, production capacity of indigenously developed Covaxin vaccine is estimated to swell to 60-70 million doses per month in July – August, a six-to-seven-fold increase from the current level of ten million.
If all the right chords are being struck, why is the impact so different? Well, there is no simple answer to this. It is beyond doubt that the scale of the surge was clearly beyond the predictions made by the scientific community. Even the Institute of Health Metrics and Evaluation at the University of Washington and Los Almos National Laboratory in the US did not forecast a wave of such vehemence.
This begets another question. Would the outcomes have been different had the scale been forecasted accurately? There are limitations in amplifying capacities of any public health system to a level which is sufficient to cope with the extent of infections India is experiencing now. No health system in the world could possibly be prepared with ICU beds for close to one percent of its population as is the case in certain pockets in India. In the hypothetical event of augmenting the infrastructure to such level, there should be trained medical personnel to manage it. This too cannot be done overnight. Evidently, there is a cap on absorptive capacities of all medical systems and dealing with a pandemic which is beyond these ceilings requires time-taking massive overhauls.
Certain sections of the population were more exposed than others during the first wave. Hence, the less-exposed groups were shielded. In contrast, newer sections got exposed in the second wave. This resulted in increased susceptibility of the population. In addition to the more potent variants of the virus which were at work during the second wave, there could also the problem of diminishing immunity. Contrary to the persistent seropositivity, a survey conducted in February suggested a reduction of neutralising antibodies in previously infected people.
While experts and academicians could continue to deal with reasons behind the surge and inter-play of these factors, common man could easily relate to the irreparable loss of families of the COVID-19 victims. Dark memories of the death of dear ones in a tragic fashion at times in own hands would never fade. Cries for help would ring loud in the ears of people who were witness to these episodes.
These disturbing developments should be a stark reminder – a strong warning – for all of us. No one is and no one could possibly be fully immune to the virus. Vaccinations do not come with full guarantee either. Those who choose to ignore COVID-appropriate behaviour may not have suffered themselves but could have transmitted the virus to others, who paid the price on their behalf (with own lives in many cases).
Neither the systems nor the individuals can afford to relax and get complacent after a wave passes. As in case of India, what awaits ahead cannot be predicted. This universal rule applies evenly to countries which managed as well as mismanaged the earlier waves. For the former to repeat their success and the latter not to repeat their failure, the guard should never be lowered. As we long for a better tomorrow, mask up and stay safe!
(With inputs from Dr. Rakesh Pandey. Eldos Mathew Punnoose is Spokesperson of the High Commission of India.)