July 1, 2021

Covid-19: Preparing for The Third Wave

Written By: Dhruv C Katoch

Introduction

The Covid-19 pandemic, which spread across the world since the beginning of 2020, had its origin in the SARS-CoV-2 virus, which originated from the city of Wuhan, the capital of the Hubei Province in Central China. Coronaviruses are a family of contagious viruses that can cause a range of mild to severe respiratory illnesses. A mutation of corona virus resulted in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was detected and identified in China in December 2019. The disease was named Covid-19, Covid being a shortened name for Corona Virus Disease and 19 reflecting the year of detection.

Much of the misery of the world could have been avoided had the Chinese government been upfront with the outbreak, but there was a massive cover up, which strangely, was glossed over by the WHO. The first official confirmation for Covid-19 came on 31 December 2019, when the WHO China Country Office was informed about a cluster of 27 pneumonia cases of unknown etiology, detected in Wuhan.[1] The Chinese claimed that the outbreak originated from live bats, sold in a seafood market in Wuhan. This version has very few takers today, and the possibility that the virus came from a leak in the Wuhan Institute of Virology (WIV) is gaining increasing salience.

The WHO chief, Tedros Adhanom Ghebreyesus, while addressing a media gathering in Geneva on 11 March 2020, said that the WHO has been assessing this outbreak around the clock and was deeply concerned by the alarming levels of spread and severity of the disease. He then said that “We have therefore made the assessment that Covid-19 can be characterised as a pandemic.”[2] By this time, however, the disease had spread to much of the world, raising questions about why the WHO delayed such an important announcement, with some alleging that the WHO was deliberately covering up for the Chinese.

The Lab Leak Theory

While China and the WHO were propagating the theory that SARS-CoV-2 originated from a sea food market in Wuhan, a group of researchers from Indian Institute of Technology (IIT), Delhi, in February 2020, published a paper to the contrary. Their report was based on finding four unique inserts in the virus, which were unlikely to be accidental in nature.[3] For the first time, a view stating that the virus did not originate from a sea food market, but likely had its origin in a laboratory was expressed. Their work provided a new insight into the evolution and pathogenicity of the virus, with important implications for diagnosis, but strangely, their work was trashed by virologists, and they were forced to withdraw their paper. Today, evidence is increasingly mounting to indicate that the virus originated from a laboratory. Dozens of samples from the earliest Wuhan patients in China have been deleted by China, which, as per an American professor who spotted their deletion, and who recovered and analysed 13 files, found viruses which were much more evolved than would be expected of a new pathogen.[4] Obviously, a massive cover up by China has taken place, considering how data, which was earlier available in the web, now stands deleted. A group calling itself D.R.A.S.T.I.C. (Decentralized Radical Autonomous Search Team Investigating COVID-19), a collection of people from across the globe, have done yeoman work in this regard, to disprove the theory that the virus originated from a seafood market in Wuhan. Their work suggests that the virus likely escaped by accident or design from the Wuhan Institute of Virology.[5] The cover up by the Chinese government is perhaps an attempt to avoid world censure and to obviate being held liable for paying the cost of vaccinating the world along with other punitive damages.

The First Wave

The first wave of Covid-19 hit India after it had already impacted countries in Europe and other parts of the world. It was fortuitous that the Indian Prime Minister took the onus on himself to sensitise the Indian public on the impact of the virus and what action the public needed to take to reduce the impact of the pandemic. This was essential as very little was known about the virus and the spread of the disease. A countrywide lockdown was imposed for three weeks from 25 March to 14 April 2020, which was later extended up to 03 May, then further extended to 17 May and finally to 31 May before the restrictions across the country were gradually lifted. The impact of closing down the whole country had a severe economic fallout, with the economy shrinking by 7.3%,[6] but in hindsight was the correct decision as it limited the spread of the disease. India’s health infrastructure, as indeed the rest of the world’s too, was not geared to take on a pandemic and even basic items like face masks and sanitisers were not available in the quantity required. More importantly, it gave the people of India time to adjust to a new normal and for the states to gear up their medical infrastructure requirements for dealing with the pandemic.

Another decision with far reaching ramifications was the emphasis laid by the government on developing a vaccine against Covid-19. The early impetus given to the development of the vaccine, which was personally monitored by the Prime Minister himself, was indeed very far sighted as India now is in a position to not only cater for its own needs, but to also assist other countries across the globe.

The First Wave of Covid-19 peaked in mid-September 2020, with the seven-day average of new infections receding thereafter from a high of 93,617 new cases (See Figure 1). Thereafter, the drop in cases was gradual till the end of the year, with different states showing variable levels of control over the pandemic. The downward trend continued till 15 February, which recorded a case load of 9139 new infections. The infections started increasing thereafter, with 28 February recording 15616 new infections, which increased to 24,437 new infections on 15 March and to 72,182 new infections on 31 March.[7] Clearly, the first wave was over and the second wave had begun.

The Second Wave

In the first quarter of 2021, there was a general feeling which permeated the medical community and the corridors of power, both in Delhi and in the state capitals, that India had got the better of the virus. While Europe was hit by a second wave, which was far more virulent than the first, there was a presumption that India would not be similarly impacted. Over the previous year, a lot of experience had also been gained about the spread and control of the virus, which perhaps had induced a sense of complacency in the public. This complacency was aggravated by a few factors, all of which were to play a role in the massive outbreak that was to follow.

The farmers agitation for repeal of the farm laws, which began in the last quarter of 2020, was continuing despite the pandemic. Thousands of farmers, mostly from Punjab, Haryana, and western Uttar Pradesh, remained camped around three border points of Delhi—Singhu, Tikri and Ghazipur—demanding a repeal of the farm laws enacted by the Centre in September 2020. While hearing a petition on the subject, the Apex Court said that public roads should not be blocked, come what may, in an indirect reference to the farmers protest,[8] but this has had little impact on the protesters, who remain camped there till date.

The Kumbh Mela, an annual event, witnessed over 9 million pilgrims take the holy dip in the Ganga between January 14 to April 27. Of this, about six million pilgrims congregated in Haridwar in the month of April, which coincided with the worst surge in the second wave of the pandemic.[9] While the state had mandated all protocols to be followed to obviate the spread of Covid-19, the sheer numbers involved made all such efforts a practical impossibility. Restricting, or perhaps even imposing a ban on the sacred event for the year would have been the right option to prevent the spread of the pandemic, but it was a decision which was difficult to take politically, especially since no such ban was placed for the farmers agitation!

Alongside the above, elections to the state assemblies of Assam, Kerala, Tamil Nadu, West Bengal and Puducherry were due and the Election Commission had set the dates for polling, which was to be carried out in phases from 27 March to 29 April. No curbs were placed on rallies as curbs had not been placed earlier on the Kumbh Mela nor on the farmers agitation. A more pragmatic decision, considering the way the pandemic was spreading, was to have postponed the polls and placed the states under President’s Rule, but a decision of that nature would have created huge political turmoil. In the event, India witnessed a huge surge in Covid-19 cases, though the surge cannot be attributed solely to the above spreader events.

Fundamentally, the surge took place because the data was not correctly analysed and actioned. The country was living in a false sense of euphoria, which a simple analysis of data would have punctured. This perhaps was the prime reason for the pandemic assuming deadly proportions. On 01 April, India registered 81,441 new cases of Covid 19, which should have been a wake up call for all the bureaucrats posted in the health ministry of the Centre and the States. The whole of March had seen a constant doubling of cases every ten days, nearing the peak of the first wave and there was nothing to indicate that the trend was reversing. This was the time to have imposed a lockdown across the country, or at least in all the severely impacted states. Not doing so resulted in the number of new cases doubling in 10 days to 1,69,914 on 11 April, then doubling again to 3,15,802 fresh cases on 21 April, till they finally peaked at 4,14,433 cases on 6 May. India’s success story in dealing with the pandemic in the first wave had tragically been reversed, which in turn overstretched the health infrastructure. Oxygen became a short supply item, beds in hospital with ventilators were not available and people were left to fend for themselves on their own. This was an avoidable tragedy.

It would be wrong, however, to blame the surge entirely on the farmers agitation, the Kumbh Mela and the elections, though undoubtedly these events added on to the sickness tally. The top six states with the highest number of Covid-19 cases on 01 June 2021 were Maharashtra, Kerala, Karnataka, Tamil Nadu, West Bengal and Odisha (Figure 2). Of these, Maharashtra, Karnataka and Odisha did not have elections and were not affected either by the farmers agitation or by the Kumbh Mela. 20 days later, on 20 June 2021, the top six states, in terms of total number of Covid-19 cases were Maharashtra, Karnataka, Kerala, Tamil Nadu, Andhra Pradesh and Odisha (Figure 3).

FIGURE 2

SIX STATES WITH 70% OF COVID-19 CASES

 

FIGURE 3

SIX STATES WITH 76 % OF COVID-19 CASES

Ultimately, the prime causative factor for a surge in cases had much to with public apathy, lack of monitoring of the data on daily fresh cases of Covid-19 by the health authorities, both in the States and in the Centre, and in not heeding the warning signals that had come from other parts of the globe, where the second wave had caused huge damage. An unescapable conclusion is that the bureaucrats in the health ministry, both in the Centre and in the States, were culpable in not discharging their mandated functions.

It is also instructive to observe how different states have handled the pandemic. To carry out an assessment based on uniform parameters, the number of active Covid-19 cases per million population base, has been taken. The data has been taken from two time lines—01 June 2020 and 20 June 2020, each time line giving out the number of active Covid-19 cases in each state, per million population. Statistics are a more reliable indicator than gut instincts which are based on individual biases. Looking at the data of 01 June 2020, the top eight performing states in the battle against the pandemic, with the least number of Covid-19 active cases, were Bihar, Uttar Pradesh, Jharkhand, Madhya Pradesh, Gujarat, Rajasthan, Delhi and Haryana, in that order, with the total active cases for that date per million population, being 128, 156, 227, 269, 503, 517, 581 and 652 respectively (Figure 3). The bottom eight states, with the maximum number of active cases per million population for 01 June 2021 (shown in brackets), indicating poor control over the pandemic are Kerala (5758), Sikkim (5744), Karnataka (4594), Tamil Nadu (3844), Goa (3268), Manipur (2747) Mizoram (2516) and Uttarakhand (2487) (Figure 4).

FIGURE 4

COVID-19 CASES IN STATES OF INDIA

(Per million population base

A change observed 20 days later, on 20 June 2020, indicates the eight states with the lowest Covid-19 rates per million population base, as Uttar Pradesh (19), Bihar (25), Madhya Pradesh (25), Rajasthan (37), Jharkhand (40), Haryana (87), Gujarat (95). and Delhi (110). It would be observed that these were the top eight performing states in terms of minimum number of active Covid-19 cases on 01 June, and 20 days later, they remained in the top eight, with a further dramatic reduction of active cases.

On 20 June, the eight states at the bottom of the list were Sikkim (3853), Manipur (3004), Kerala (2943), Mizoram (2777), Goa (2042), Karnataka (1857), Arunachal Pradesh (1582) and Meghalaya (1349). Tamil Nadu, which was part of the bottom eight, had a distinct reduction in the number of active cases during these twenty days, from a whopping 3,844 cases per million to just 884 cases per million.

What is of concern though, are the states which have not been able to register a drop in cases in these 20 days. Andhra Pradesh, which had 37,044 active cases on 01 June, saw a further surge, with the state recording 63,068 active cases on 20 June. Similarly, Mizoram saw a marginal increase in the total number of active cases from 3145 to 3471 and Manipur saw an increase of cases from 8791 to 9613. In all other cases, there has been a decline, though the percentage of decline varies from state to state (Figure 5).  The data for Union Territories of India, is shown in Figure 6.

FIGURE 5

PERFORMANCE OF STATES IN CONTROLLING THE VIRUS

FIGURE 6

PERFORMANCE OF UNION TERRITORIES

(Cases per million population)

Preparing for the Third Wave

With the Second Wave having peaked in India, there are indications that the country will be impacted by the Third Wave, with some experts opining that this could take place in the next 12 to 16 weeks.[10] More importantly, it is likely that the virus may become a permanent fixture of our lives and we would have to deal with it. Speaking on this issue, WHO Emergencies Director, Dr Mike Ryan, stated in a press briefing in Geneva on 14 May 2020 that… “this virus may become just another endemic virus in our communities and may never go away.” Dr Ryan then added that “we have to come to terms with the virus, just as we have come to terms with diseases like HIV”.[11]

To deal with the pandemic, Dr Randeep Guleria, Director, All India Institute Of Medical Science (AIIMS), New Delhi, spoke of the need to strengthen the public health system, and focus on the lessons we have learnt from the past. He stressed on the need to upgrade the health system, and asserted that with changing times, we have to change our public health system, through initiatives like the Ayushman Bharat-PMJAY (Pradhan Mantri Jan Arogya Yojana), which have made a huge difference as far as health care is concerned.[12]

The need for the Centre and the States to work in unison on issues of health is now becoming paramount, to enable uniformity of policies and protocols, provision of equitable facilities to all sections of society and to fight jointly against pandemics. As of now, health is a subject on the State List in the Indian Constitution. To deal with the challenges in providing robust and efficient health care across the country and to enable more effective handling of pandemics, the time has come to place Health on the Concurrent List of the Constitution. The States would have to be taken on board before a Constitutional Amendment is mooted, but this is a matter which needs to be addressed at the earliest.

Vaccinating the Nation

Vaccination would perhaps form the backbone of the anti-Covid strategy. On the first day of the Centre’s new Covid-19 vaccination policy, on 21 June, a total of 88.09 lakh people were vaccinated.[13] This was unprecedented and a mention of this was also made by the prime Minister in his “Mann Ki Baat” programme on All India Radio, on 27 June. With this, India’s cumulative COVID-19 vaccination coverage is now over 28 crore.[14] In an affidavit filed before the Supreme Court, the Centre has stated that 135 crore doses of COVID-19 vaccines will be available in India between August to December 2021 from five Covid-19 vaccines.[15] This would enable vaccination of the majority of the country by the end of the year. The challenge to vaccinate the children will however remain, till a suitable vaccine for children of all ages is developed.

Responsibility of Individuals and Society

The fight against the pandemic is by no means over and without the cooperation of the public, it cannot be won. The public has been sensitised on the need to maintain social distancing, washing hands, using face masks etc, but enforcement measures are still lax. There is a need to strengthen the institutional framework to ensure compliance of health safety measures. Merely getting vaccinated is not enough. Each individual is responsible to ensure appropriate conduct and to abide by the restrictions laid down, to prevent and restrict the spread of the pandemic.

An important aspect for individuals, besides personal hygiene and wearing of masks in public spaces is being cognisant of the action to be taken if one contracts the disease. Early detection assumes great importance as that will enable the safe treatment of the disease in home isolation. Cases which have been detected soon after occurrence will rarely require hospitalisation or oxygen and ventilator support. A simple means of early detection is through a check of body temperature once a day with a thermometer. This can be a life saver as other symptoms may take a few days to develop, by which time the disease can take on a more sinister form. If the thermometer shows an above normal body temperature, it would be prudent to check for the virus, the results for which can be made available within a day. A daily temperature check should hence form part of preventive measures in each family. Thereafter, should the test for the virus be positive, then immediate medical assistance should be sought, which can be safely done in home isolation.

Within groups, it is important to create an environment where Covid protocols are followed and their breach is frowned upon. Help groups need to be formed to assist those who are old and who are living without family support. Health workers and the medical staff need to be given the full unstinting support of individuals and groups, as they form the spearhead of the fight against the pandemic.

Action by the State

Each state government must get its act together and be prepared to combat the third wave of the disease. The states have time now to rectify the shortcomings observed in tackling the second wave, and they must do so on a war footing. They cannot abdicate their role and pass the buck to the Centre when things get difficult for them.

Data analysis at the national, state, and lower levels must be done by the respective officials responsible for health, both in the Centre and the States. The Centre must lay down a policy for declaring various stages of health emergencies, from Stage 1, which would be cautionary, to Stage 5 which would require maximum restrictions. This should be based on the number of Covid cases occurring in a state, for a population base of 100,000. The data of individuals impacted with the pandemic must be kept at the district, state and national level, to ensure coverage at the lowest level, and enable prompt action to be taken to isolate the areas that are impacted. The advantage of such a system is that the concerned health officials and the political authority would be forced to take action as the cases in a state, district, tehsil or village level start rising. Failure to do so would imply abdication of duty, for which concerned individuals would be held accountable.

Role of the Media and Political Parties

Both the media and the political parties have an important role to play in dealing with the pandemic. For the media, it is important that sensationalism is avoided as it creates unnecessary fear and panic in society. It is also the job of the media to keep a track of Covid cases and to highlight those areas where the officials responsible for health are falling short of performing their duties.

The Political parties also need to fight the pandemic as one and not resort to unnecessary mudslinging at each other. The fight against the pandemic must be taken as a national priority, and not for political one-upmanship. For a period of one year, if not more, there is a need to ban all political gatherings above 50 people, and to similarly restrict all religious and social events, as also prohibit any strikes or dharnas. This would require all political parties coming together and lending their support on this issue, if it is to become a reality. Through such action, the pandemic can be controlled in a faster time frame.

Conclusion

India is passing through a critical phase in its history, being impacted with a pandemic, while facing huge challenges on the security front from two inimical neighbours and at the same time, having to deal with a severe economic and human crisis. This is a time for unity and putting our differences aside. History will judge us whether we, as a society, were wise enough to rise to the occasion.

References:

[1] World Health Organization. Novel Coronavirus (2019-nCoV) Situation Report – 1. 2020. Available from: https://apps.who.int/iris/handle/10665/330760. (The report is no longer available on the internet).

[2] https://indianexpress.com/article/world/who-coronavirus-pandemic-6309685/

[3] https://in.news.yahoo.com/researchers-iit-delhi-found-covid-055459485.html

[4] https://www.dailymail.co.uk/news/article-9716531/More-proof-support-lab-leak-theory-China-DELETED-samples-earliest-patients.html

[5] The details of the work done by this group are available in their website https://drasticresearch.org/the-team/

[6] https://www.livemint.com/economy/gdp-shrinks-7-3-in-fy21-on-covid-first-wave-impact-11622463848438.html

[7] Data for the month culled from Worldometer, available at https://www.worldometers.info/coronavirus/country/india/

[8] https://www.ndtv.com/india-news/farmer-protest-roads-should-not-be-blocked-say-supreme-court-2410018

[9] https://www.hindustantimes.com/cities/dehradun-news/91-million-thronged-mahakumbh-despite-covid-19-surge-govt-data-101619729096750.html

[10] https://www.bbc.com/news/world-asia-india-57577138

[11] https://www.bbc.com/news/world-52643682

[12] https://www.india.com/news/india/aiims-director-randeep-guleria-warning-third-wave-of-covid-delta-plus-variant-covid-19-cases-in-india-4773880/

[13] https://www.ndtv.com/india-news/india-vaccinates-record-52-lakh-people-in-one-day-2468935

[14] Ibid

[15] https://www.indiatoday.in/coronavirus-outbreak/video/only-135-crore-vaccines-to-be-available-by-december-says-centre-1820036-2021-06-27

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