Focus on the pandemic, not the economy
The big lesson of the second wave is that India must stop trying to prioritise economic recovery over emergence from the pandemic — any such effort is destined to fail
Thedatasuggeststhatthepandemic’sdevastating second wave has peaked in many parts of the country, at least as far as case numbers go. (Death numbers lag cases by a fortnight or more.) The growth rate of active cases is now well into negative territory, and has been for about 10 days, even as testing continues to increase.
This is a fact. It is also a fact that another wave is not just possible but likely. The government — at all levels — relaxed far too much after the peak late last year. This cannot be allowed to happen again. Attention must be focused on what was learned from this wave, and how the lessons can be swiftly implemented to prepare India for what will certainly be a deeply troubled 2021.
The first lesson is this: Virus mutations matter. The B.117 variant, first discovered in Kent in the United Kingdom, and the B.1617 variant, first seen in Maharashtra, have helped drive the second wave in India by increasing the transmissibility of the virus. What this means, simply, is that certain behaviours and safety protocols that were considered acceptable when the “original” variants of the virus were spreading last year are no longer advisable. The government, and various voices across the country demanding openness, need this drilled into their head: Given the presence of these variants, India cannot go back to the level of openness that prevailed in January and February of this year. That is simply out of the question; we will be thrown swiftly into a third wave. There must be no sharp economic recovery. The variants have killed that hope.
We must also recognise that this is a very large country, with a large number of people infected — and thus fertile ground for further mutations. There is no reason to suppose that B.1617 will be the last such problematic variant to emerge. The mistakes of the past months, in which the spread of new variants was ignored by the government, cannot be allowed to repeat themselves.
Recently, a senior scientist on India’s variant-tracking committee resigned, and the indications were that he was severely disappointed that the government had not been listening to the science. That approach must now be revised. In particular, genome sequencing must be stepped up. If India cannot do this quickly enough domestically, it must reach out to international partners, all of whom will have been convinced by recent events that there is more than enough reason to allocate their spare capacity towards genome sequencing of samples from India to identify fast-spreading variants.
The nightmare remains the emergence of a variant that combines mutations for vaccine escape (like B.1351, first found in Port Elizabeth in South Africa) as well as greater transmissibility — and, perhaps, greater lethality. The latter will be particularly problematic, but is also harder to gauge, given that mortality rates also depend upon whether hospitals are overwhelmed, which can happen just with easier transmission. (The emergence and dominance of such a variant is not at all necessary; if anything, previous coronavirus pandemics have ended when less-lethal variants have emerged and dominated, eventually rendering those diseases endemic. This is how the 1918 Spanish Flu pandemic ended; its descendant, H1N1, is still with us today. The 1968 pandemic, called the “Hong Kong Flu”, killed between one and four million people, but its descendant H3N2 strains still circulate today, relatively controlled.)
The science of Covid-19 continues to evolve. For example, it is now generally understood that the disease is airborne, both over short distances for short exposures, and over longer distances in unventilated rooms or for longer exposures. Moving from droplet- or surface-based protective mechanisms to managing aerosol-focused protection must be a priority. Higher quality masks will need to be distributed quickly. Mask hygiene must become universal, and ventilation is essential. Crowded poorly-ventilated or air-conditioned rooms are, in particular, petri dishes. There’s no going back to full offices any time soon without new safety protocols like HEPA (high-efficiency particulate air) filters, universal N95 mask usage, or ultraviolet-c disinfection of circulated air.
Government must also be far more prepared to impose lockdowns than it was this time around. The costs of a lockdown are understood, including to society’s most vulnerable. But surely now the human costs of a wave, particularly in rural areas, have become tragically clear. Lockdown hesitancy must end if a third wave is to be prevented or controlled. Nor can we afford to start ramping down testing once this wave recedes somewhat. Testing remains a crucial tool, especially in countries like India with very limited resources. Testing can tell us where doctors, medicines, and oxygen need to be sent to minimise suffering.
Further, the government’s medical advisors must be quicker off the bat to condemn poor treatment protocols. Overuse of steroids and high-flow oxygen has led to the growth of the black fungus or mucormycosis problem. As another example, it took far too long for India to deprecate the use of plasma. Time and effort was wasted hunting up convalescent plasma for patients, and relatives and friends suffered pangs of guilt if they could not provide this eventually useless therapy. Clear, coherent, centralised, and science-driven medical advice for harried practitioners and families is a must. A simple warning against using tap water for oxygen therapy could have controlled the spread of mucormycosis infections considerably.
And, finally, we must recognise that vaccines remain our only hope for exit from this pandemic. Already in this wave, there appears to be some evidence that older patients are less at risk because of higher vaccination rates in that demographic. Government must put aside all its standard protocols. Stop complaining about vaccine makers asking for protection from liability lawsuits, for example. If that prevents the entry into India of highly effective MRNA vaccines, it would be remarkably stupid. Do whatever is needed to beef up the supply chain. If the state overpays private providers, so be it. Europe paid very little for its vaccines, bargaining hard; the US overpaid. Whose economy is doing better?
Finally, the last chain is distribution. And here it is clear that vaccine hesitancy will be a real problem. A Facebook survey suggested that over 40 per cent of respondents in Tamil Nadu did not want vaccines. Even in hotspots like Uttar Pradesh, vaccines are viewed with suspicion. The economist Shamika Ravi reported that at a door-to-door vaccination camp at a village in Kannauj district, not a single person turned up for a vaccine. In many states, rural health centres with vaccines are a sea of green on the COWIN app. The government needs an immediate plan to address vaccine hesitancy. Many countries are offering incentives. In China, a focused effort to reduce vaccine hesitancy and increase supply meant that it handed out 100 million doses in just nine days. These are numbers that should shame us. Countries that lock down sharply when needed, get the right medicines and vaccines out swiftly, are those who recover economically as well. The big lesson of the second wave is that India must stop prioritising economic recovery over the emergence of the pandemic.