WORST COMES TO THE WORST

MORE THAN six months into this pandemic, this is not the time for any country to take its foot off the pedal.” When Tedros Adhanom, Director-General of the World Health Organization (WHO), made this statement in his media briefing on June 8, he indicated two worrying developments in the six months of COVID-19’s unabated spread and human toll. First, notwithstanding the claim that many countries are finally flattening the COVID-19 curve, on the day of Tedros’ press briefing, cases reached 7 million with a death toll of over 0.4 million. Second, more worryingly, for nine consecutive days before Tedros made the statement, the world reported more than 100,000 new cases each day; the highest was on June 7—136,000.

Both developments reveal the uncertainty the world has been pushed into by the pandemic. Though the geography of the spread has not changed much, but the explosion of new cases and the degree of infection have certainly brought the focus on Africa and South Asia—India being a curious case of reporting a fast increase in spread despite having undergone the world’s longest national lockdown. In Africa, many new countries are reporting COVID-19 cases, even though in small numbers. The crisis is still unfolding, stretching the world’s capacity to fight it. Tedros, while admitting that the pandemic was worsening, said that in countries (where the spread has slowed down), the biggest threat now is complacency. Studies—to investigate how many of a country’s population have been exposed to the virus—show that most people globally are still susceptible to infection.

CAPITAL FEAR

On June 9, India’s capital, Delhi, offered a peek into the near-future scenario of the pandemic. The source of infection for more than half of the cases couldn’t be traced, said Delhi’s health minister, Satyendar Jain. Then he almost raised an alarm when he said that even though the capital qualified to be a case of community transmission, the Union government was refusing to admit this. This inferred that the national capital was about to witness an exponential growth in spread. Adding to this fear, the Delhi government says that there would be over half-a-million case by July-end in the city-state—from the 31,000-mark on June 10.

On June 8, India lifted the lockdown with a few restrictions. Before this, in May and in the first week of June, there was a huge exodus of workers to their respective states, resulting in a record spike in COVID-19 cases in most states. On June 12, India became the fourth worst-hit nation in the world with COVID-19 cases (see infographic ‘Half a year later’ on The fear that opening up the economy would make the spread unbridled is still hanging heavy over a billion-plus population.

Between June 4 and 9, India reported over 9,500 cases on an average each day in a row. But the government is yet to admit community transmission, even though experts have long speculated that the country might have already entered into this stage a few weeks ago, based on the scientific definition of transmission stage. With the rate of spread increasing, other scary signs are emerging each day.

For example, wastewater samples collected from Ahmedabad, capital

THE FEAR THAT LIFTING THE LOCKDOWN WOULD MAKE THE SPREAD UNBRIDLED IS STILL HANGING HEAVY OVER A BILLION-PLUS POPULATION

of one of the worst-affected states in the country, Gujarat, were “found with a marked difference in the SARS-CoV-2 gene loading between the days the samples were collected”. Manish Kumar, a scientist with the faculty of earth sciences, Indian Institute of Technology in Gujarat’s Gandhinagar conducted the study, in association with the Gujarat Biotechnology Research Centre and the Gujarat Pollution Control Board. Wastewater samples collected from Ahmedabad’s civil hospital—a major medical facility treating COVID-19 patients—on May 8 and May 27, formed the basis of Kumar’s research. The surveillance of wastewater through wastewater-based epidemiology (WBE) helped reveal the spread of the novel SARS-CoV-2 virus that causes the COVID-19 disease.

Kumar says that it is not about detection of live SARS-CoV-2 samples in wastewater. It was, instead, about detecting genetic material (ribonucleic acid) through Real-Time Quantitative Polymerisation Chain Reaction (RTqPCR) followed by gene sequencing and matching with a library of coronaviruses. “We can extrapolate the results of this genetic material estimation to assign it with a probable number of people infected in a given locality or community,” says Kumar. This is the first time an Indian scientist has made a claim like this. Earlier reports of this finding had emerged from different parts of the world during the beginning of the pandemic.

GLOBAL TRACES

In April 2020, the city water authority in Paris claimed minuscule traces of the SARS-CoV-2 virus were found in non-potable water supply. During the same time, Biobot Analytics, a biotech start-up, along with a team from the Massachusetts Institute of Technology (MIT) and the Brigham and Women’s Hospital estimated that at least 440 people were likely to be infected with COVID-19 in areas around the treatment facility, much higher than the reported cases.

SARS-CoV-2 may be present in the water cycle, making the poor and the marginalised more prone to health risks, said an editorial published in on April 2, 2020. Kumar says reports of the presence of molecular SARS-CoV-2 have emerged from countries struggling to curb the pandemic. Questions now arise over whether the pandemic can spread through wastewater. Till date, there is no concrete evidence to prove this. And India is well into its monsoon season, usually considered to be a season of diseases mostly related to water and sanitation.

UNTOLD IMPACTS

The world is at crossroads. The choice between economy and curtailing the pandemic through lockdowns has already been made in favour of the former. But unlike many countries with severe infections, the hope to endure a contagious disease and avoid an economic death has taken over national strategies. India is an exception of registering it’s biggestever growth in spread even through a record lockdown. But

has found that the pandemic’s toll in terms of economy is just getting clearer—into half-a-year since the outbreak of the COVID-19, some 200 countries have become poorer than in December 2019, strictly

(New cases on June 9)

in terms of economic outputs. India will have the largest number of the new poor in the world due to the pandemic, according to the World Bank.

The World Bank’s in June raised the level of poverty due to the pandemic in comparison to its earlier forecasts: in April it estimated 40-60 million people will be pushed into extreme poverty. The latest estimate shows that 71-100 million people would be left poorer. And these poverty estimates will continue till 2021.

There is another untold impact of the pandemic: as a country’s medical systems are overstretched in fighting the pandemic, other killer diseases are not being treated resulting in human casualties. According to a survey carried out in 155 countries in May by WHO: “Prevention and treatment services for non-communicable diseases (NCDs) have been severely disrupted since the COVID-19 pandemic began”. NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. The survey also found that, for instance, 53 per cent of the countries surveyed had partially or completely disrupted services for hypertension treatment. Similarly, about 49 per cent countries reported disruption in treatment for diabetes and diabetes-related complications. Some 94 per cent of the countries say their health ministry personnel working on NCDs have been diverted to COVID-19 duties.

According to GAVI, the vaccine alliance, some 13.5 million people might have missed out on vaccinations due to the postponement of campaigns and interruptions in routine vaccinations. “It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with NCDs,” says Bente Mikkelsen, director of the department of NCDs at WHO. After half-a-year since the pandemic was confirmed, we are still awaiting the grim news of its impacts and its ripple effects. Time, in this case, is not a healer, but a reminder of the deathly future that lies ahead.

PREVENTION AND TREATMENT SERVICES FOR NONCOMMUNICABLE DISEASES HAVE BEEN SEVERELY DISRUPTED SINCE THE PANDEMIC BEGAN