Missing in action
The fact that India does not know the names of the 21 members of its National Task Force for COVID-19 is emblematic of the colossal failure of both the task force—whose only job seems to be to endorse the decisions of its political masters—and the government to prepare for or take steps to mitigate the inevitable second wave of the pandemic. Should such a task force not be taken to task for its laxity and negligence?
WHO is the Indian equivalent of Anthony Fauci, the chief medical adviser to the President of the United States? One would be hard-pressed to answer this question. Fauci’s measured response to the pandemic and his spot-on advice to the U.S. administration have been always based on data—witness his warning in early April of a possible third COVID-19 wave based on the high plateau in the number of cases—even in the face of constant rebukes from former President Donald Trump. In spite of ridicule from the high executive, Fauci stood his ground and, more often than not, was proved right.
India has a Principal Scientific Adviser (PSA) to the government, not specifically a medical adviser. The incumbent PSA, K. Vijayraghavan, has a research background in biology, but he is no medical scientist by any stretch of the imagination. So, it is not surprising that he was not designated as the adviser on COVID-19.
In response to the pandemic, the government set up a 21-member National Task Force (NTF) for COVID-19 in March 2020. Constituted by Balram Bhargava, Secretary, Department of Health Research (DHR) and Director, Indian Council of Medical Research (ICMR), the NTF is chaired by Vinod Paul, Member (Health), NITI Aayog, and co-chaired by Secretary, Ministry of Health and Family Welfare (Rajesh Bhushan), and Secretary, DHR (Balram Bhargava). In keeping with the government’s penchant for not sharing information, the names of the other members of the NTF have not been made public. If at all there is any government body, if not an individual like Fauci, to advise the government on the pandemic, it would be the NTF.
Right from the beginning of the pandemic, the NTF has been found grossly wanting in discharging its responsibilities with the scientific integrity required of such a panel. That the higher executive arm of the government wanted it to say only the things it wanted to hear became clear in March 2020 when the government announced the countrywide lockdown. It was done without consulting the NTF even as its members apparently held contrary views given that at that time the caseload in India was only around 500 and a more calibrated regionwise response based on epidemiological data would have been more prudent, but none of them spoke out. The NTF’S silence on the matter would imply that it implicitly endorsed the decision.
NATIONAL SUPERMODEL COMMITTEE
And to boot, clearly at the government’s behest, the Department of Science and Technology constituted a National Supermodel Committee in May 2020 to develop a mathematical model to project the spread of infection to assist policymakers. In retrospect, its sole objective seems to have been to say that the steps taken by the government to stem the transmission were absolutely right. The research paper about the model was hurriedly published in October 2020 in The Indian Journal of Medical Research, a publication of the ICMR, and it said
that without a lockdown there would have been more than 2.6 million deaths and that the epidemic would end by February 2021. This is similar to dubious projections about the disease spread in the country made by the Boston Consulting Group, U.S., which showed the government’s actions in a good light and which the government frequently liked to quote.
The NTF’S scientific integrity was also called into question when it did not voice dissent over the unethical Emergency Use Authorisation (EUA) given to Covaxin in January in the so-called “clinical trial mode” even as the Phase 3 trials of the vaccine were ongoing and there was not even interim data on its efficacy. It is fortuitous that the interim results of the Phase 3 trials showed that its efficacy is about 81 per cent. And after the vaccine campaign got under way in January, the NTF also does not seem to have advised the Health Ministry to be transparent with regard to the data on adverse events following immunisation (AEFI) or implications thereof on the ongoing vaccination drive (“Trials & errors”, Frontline, May 7).
The colossal failure on the NTF’S part is even more glaring now, with the second wave raging across the country with ferocity since the beginning of March. It is really hard to imagine that the government’s handpicked experts on the NTF would not have anticipated a second wave coming when other countries of the world had already experienced it. It was also epidemiologically known from those experiences that the second wave would be invariably worse than the first. The overall seropositivity rate of 21.7 per cent that the third ICMR national serosurvey found also meant that nearly 78 per cent of the country’s population was still susceptible to the virus. The NTF should have been especially concerned when the more infectious variants of the virus, particularly from the United Kingdom, were already being detected among the new cases in the country, and it should have advised that appropriate control measures be put in place.
VISIBLE COMPLACENCY
As the cases began to decline in January, there was visible complacency among people, and on January 8 the Uttarakhand government announced Maha Kumbh 2021. Just three days later, on January 11, the NTF held a meeting. It neither seems to have taken note of this announcement nor did it issue any strong advice and warning against any compromise on Covid-appropriate behaviour and protocols. There is also no evidence to suggest that the NTF at any moment tried to stop this event, where thousands would gather to take a dip in the Ganges without any physical distancing. Perhaps it chose to ignore this announcement for obvious political reasons.
The Maha Kumbh Mela had been advanced to 2021 from 2022 on dubious astrological grounds. But, clearly, both the Central and State governments saw the political gains in this, notwithstanding the high risks involved in what would undoubtedly be seen as a “superspreader” event. The new Uttarakhand Chief Minister, Tirath Singh Rawat (he became Chief Minister on March 10), promised all the support of his government in organising the Maha Kumbh without any restrictions, unlike his predecessor who perhaps sensing the disaster that such an event could lead to wanted to scale it down.
What is likely to have contributed to the complacency in Covid-appropriate behaviour among the public is the launch of the vaccination drive on January 16 in big celebration mode as if the country had now got the panacea for COVID-19. Also, on January 22, the Bharatiya Janata Party (BJP) passed a resolution announcing victory over COVID-19 and praising the Prime Minister for his leadership in the management of the pandemic. “India [has] not only defeated Covid under the able, sensitive, committed and visionary leadership of Prime Minister Shri Narendra Modi, but [has] also infused in all its citizens the confidence to build an ‘Atmanirbhar Bharat’,” it said. The bugle of victory over COVID-19 had been sounded. Following this, State leaders of the ruling party in their public speeches began to hail the victory; in fact, the Health Minister of Assam went to the extent of saying that there was no more need of masks.
In mid February, when an upward trend of cases could clearly be seen, the Prime Minister continued to sound the victory bugle. “At the beginning of this [COVID-19] pandemic, the whole world was worried about India’s situation. But today India’s fight against corona [coronavirus] is inspiring the entire world…. India is following a human-centric approach to furthering global good,” Modi said on February 16, when the number of cases had already increased by about 2,000 from the minimum of around 9,100 cases on February 9. The message that political leaders were sending to the public through their speeches was that as far as India was concerned the pandemic was over and Modi’s government had successful conquered it. The NTF obviously did not, or perhaps could not, correct this wrong message that was getting across to the people.
And soon afterwards, on February 26, the Election Commission of India announced Assembly elections in
five States in March-april. The NTF said nothing when it should have said in no uncertain terms that this was totally inadvisable as impending elections meant public speeches by political leaders and election rallies, which invariably attract huge crowds where Covid-appropriate behaviour go for a toss. On this day, the number of cases had risen to over 17,000, and this was clearly ominous. But BJP leaders had a total disregard for the imminent risks in the build-up to the elections and displayed an utterly callous and devil-may-care attitude.
On March 7, India’s daily caseload was about 18,600, double the minimum that was reached on February 9, and the imminent surge was evident to anyone who looked at the case timeline graphs. On that day Union Health Minister Harsh Vardhan famously said: “We are in the endgame of the COVID-19 pandemic in India, and to succeed at this stage, we need to follow three steps: Keep politics out of the COVID-19 vaccination drive, trust the science behind COVID-19 vaccines, and ensure our near and dear ones get vaccinated on time.”
If there had been regular interactions between the NTF and the Health Minister and if he had been properly briefed about the imminent second wave, the prevalent ground situation and the looming threat, he would not have uttered what is obviously a mindless statement. He should have also been told that given the vaccine stock, it would be difficult to meet the vaccination targets and there would be significant shortfalls. The fact that he said what he did implied that there were either no such interactions or that the Health Minister paid no heed to them. Was it that the political leaders believed more in the supermodel projections than on what the science of epidemiology was telling the NTF? The supermodel team still believed that cases would come down by the first week of April and that the seropositivity rate of about 22 per cent found by the serosurvey (which is based on the detection of IGG antibodies) did not capture the true immune status of the population, which must be close to 60 per cent, only a little shy of what is needed for herd immunity (“Mutant challenge”, Frontline, April 9).
And so, the election rallies and the Kumbh Mela went ahead as if the country had truly beaten COVID-19, which was far from the truth. The Prime Minister and Home Minister Amit Shah were seen addressing rallies and moving in processions without wearing a mask. During a public address in Asansol in West Bengal on April 17, when the country’s daily caseload had shot up to over 2,50,000 and the State’s caseload to over 7,000, which was far above its first wave maximum on October 25 of around 4,000 and the minimum of 133 on February 17, the Prime Minister said this in front of a massive gathering where there was just no chance of physical distancing between people and many were not even wearing masks: “I have never seen such a huge crowd in an election rally.” This did not seem to disturb him at all. In fact, he said he was elated to see such a large crowd. The NTF did not seem to be worried by these utterances either. If it was, it did not have the spine to say what needed to be said. What is highly at once surprising and disconcerting is the fact that, as The Caravan magazine has revealed, even as a second wave loomed large and as the number of cases was surging, the NTF did not meet at all in February or March. The January 11 meeting was the last one before the two meetings hastily convened on April 15 and April 21, when the near vertical exponential increase was very much evident and the national caseload was about 2,17,000 and 3,15,000 on the two dates respectively (2.2 and 3.2 times respectively of the first wave maximum of about 98,000 on September 16).
The report in The Caravan quoted one of the members of the NTF, who said: “It became abundantly clear in mid February that India was heading towards a devastating second wave. When things in Maharashtra started going out of hand, some of us tried to flag this issue.” But apparently, the NTF did not meet at that crucial juncture as no meeting was convened (by the Chair). The article quoted another member as adding that the meeting was “not convened” unless the government “wanted us to rubber-stamp some decision already taken by politicians”. This statement by an NTF member lays bare what has been the general perception since the pandemic began: that it is politics, not science, that has been driving the management of the pandemic, and it is the office of the top executive that is calling the shots.
CASELOADS AND CAUSES
Even now, BJP leaders and supporters and other apologists for the government are busy defending the election process saying that there is no correlation between the rise in the number of cases and the elections as States that did not have any election, notably Maharashtra, had the highest and the sharpest rise in infections. This suggestion is highly disingenuous to say the least. There is enormous variability in the distribution of cases and causes of region-wise caseloads across the country. In each region, there are different
factors at work that are difficult to delineate and identify unless there is granular epidemiological data and largescale genomic data available across the country, which are just not there. If they are there, neither is the NTF getting them analysed nor is the country’s scientific community being given access to them.
For example, in Maharashtra, which is now seeing some signs of decline, the major cause seems to have been the new variant, generally called the “double mutant”, that emerged there in October-november 2020. Nearly 50 per cent of the genomes analysed from Maharashtra carried this combination of mutations on the Spike protein, E484Q and L452R. This new variant, which has been named B.1.617, has now spread to Europe and the U.K.
What the apologists’ argument is missing is that all the States where elections/kumbh Mela were held are now displaying sharp rises in cases with the appropriate epidemiological time lag in the spread of the infection. More importantly, neither district-wise epidemiological data has been analysed to identify possible causative factors nor have a fair number of genomes been analysed from each of these States, but simple association would indeed suggest that elections and the Kumbh Mela have played a key role in the rapid spread. The thousands of hosts that election rallies and public gatherings would have presented for the virus to infect and spread would also seem to have helped it to mutate and emerge as a new variant, the Bengal variant or the “triple mutation” variant, now being dubbed B.1.618, though only a large-scale genomic analysis across the State can establish the true extent of the spread of this variant.
An earlier article (“Mutant challenge”, Frontline, April 9) had flagged the extreme slow rate of whole genome sequencing (WGS) as a fraction of the cumulative number of confirmed COVID-19 cases in the country. The WGS is way below the 5 per cent target set by the Indian SARS-COV-2 Genomic Consortium (INSACOG), which was launched on December 30, 2020, and comprises 10 national laboratories. Although the number of genomes sequenced so far has not been made public, according to experts in the know, it is currently around 19,000-20,000. With the total number of confirmed cases at about 18.8 million as of April 30, the number of genomes analysed is only around 0.1 per cent. The NTF, it appears, never flagged this issue either when the need of the hour is to greatly scale up the WGS rate and genomic data analysis because empirical evidence suggests that variants are responsible for the spikes across States. As noted above, the genomic and other epidemiological data are not being shared with the general scientific community.
SCIENTISTS WRITE TO PRIME MINISTER
In this context, on April 29, over 450 scientists signed an open letter to the Prime Minister, which said: “India is one of the worst affected countries during the prevailing COVID-19 pandemic…. The current situation demands rapid and systematic data collection, reporting and release, so that data-driven mitigation measures can be implemented…. While new pandemics can have unpredictable features, our inability to adequately manage the spread of infections has, to a large extent, resulted from epidemiological data not being systematically collected and released in a timely manner to the scientific community. It is essential now, more than ever before, that
dynamic public health plans be implemented on the basis of scientific data to arrest the spread of infections and save the lives of our citizens….” The letter emphasised the need for large-scale genomic surveillance of the new variants and timely release of data generated from it and the need for systematic collection and timely release of data on testing for better predictions of the spread of infection; the clinical outcomes of hospitalised patients; and the immune response to vaccination in India’s population. According to the letter, INSACOG is currently sequencing only 1 per cent of the infected population. But, going by two recent notifications, one from the Delhi government and the other from the Union Health Ministry, it would seem that instead of scaling up the WGS process, it is being scaled down.
On March 25, the Directorate General of Health Services of the Delhi government sent a circular to all district magistrates and officers asking them to send to the National Centre for Disease Control three samples each of mild cases, moderate cases, severe cases and critical cases, and samples of all cases of reinfection and all cases after two doses of vaccine every week from each district for WGS. The National Capital Territory of Delhi has 11 districts, which means Delhi has to send at least 11 × 12 × 4 = 528 samples every month for WGS. On April 12, the Ministry of Health and Family Welfare sent a letter on the subject of WGS to the Principal Health Secretaries of all States/union Territories asking them to identify five laboratories and five tertiary health care centres as sentinel sites and each of these 10 sites are to send 15 samples every 15 days, which means every State/u.t. has to send only 300 samples every month for WGS. The uniform broad brush State-level advisory to all States, irrespective of their size, as against district-level advisories does not make sense. It, in effect, greatly scales down countrywide WGS efforts. Delhi’s own earlier districtlevel advisory made more sense. Was it done on the advice of the NTF or was the NTF not consulted at all?
There have been major lapses on the part of the NTF in two other critical areas. One is with regard to the use of repurposed drugs in the clinical management of COVID-19 and the other is with regard to having the necessary infrastructure and logistics in place to ensure availability of medical oxygen for severely affected people. In July 2020, the Health Ministry circulated a document called “Clinical Management Protocol: COVID-19” that included an advisory on the use of repurposed drugs (which it termed investigative therapies) such as the antiviral drug remdesivir and the immunosuppressant and anti-inflammatory monoclonal antibody tocilizumab. The document advised administration of these drugs (under EUA) for moderate COVID-19 cases requiring oxygen support. A footnote in the document stated that it would be updated when more data on their efficacies become available.
On October 15, 2020, the World Health Organisation released the interim results of its multicentric trials on repurposed drugs called Solidarity Therapeutics Trials in which India is a participant. On the basis of the interim results, the WHO concluded: “Interim results… indicate that remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon regimens appeared to have little or no effect on 28-day mortality or the in-hospital course of COVID-19 among hospitalised patients.” However, the Health Ministry’s document, on which all treatment protocols in hospitals across the country are based, was not updated until April 2021. If only the NTF had ensured that an updated document was sent out early on, all the chaos, clamour and the mad scramble for remdesivir, the smuggling, hoarding and black-marketing of the drug and the all-round desperation of hospitals and hospitalised patients could have been prevented. Belatedly, on April 21, three doctors, including Randeep Guleria, Director, All India Institute of Medical Sciences, New Delhi, had to clarify that remdesivir had very limited therapeutic potential for patients. Only after this, on April 22, did the Health Ministry update its treatment protocol, which now (“based on limited evidence”) advises use of remdesivir in special circumstances in moderate to severe cases (requiring supplementary oxygen) within 10 days of onset of symptoms.
The NTF has been sadly wanting in being not on the ball and proactive in having the country prepared on the oxygen front. There is no shortage of oxygen in the country. The shortage is because of the lack of adequate infrastructure and logistics to deliver medical oxygen to hospitals. This required infrastructure and delivery logistics could have been built up in the last one year. It was well known that an adequate supply of oxygen would become a critical requirement as the pandemic progressed through its successive waves. Clearly, there was complacency within the NTF, too, that has substantially contributed to the current crisis on all fronts of the COVID-19 situation in the country. Should the National Task Force not be taken to task for its laxity and negligence? m