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By Dr Suresh Singh
India is now in a very unfortunate situation. From an image of one of the best countries in the world to handle Corona 1st wave of pandemic, the country is now going down as one of the worst managed in the 2nd wave. In the 1st wave, there were many shortcomings. However, those are tolerable in view of the vastness of the country, its severe population size and lack of experience.
But in the 2nd wave, one expected the country to manage far better as we have enough experiences from the 1st wave. But this is not to be, there are many missing linkages. One can see it in the following variables in India’s Corona control measures:
Lack of general but essential facilities – Lack of hospital beds, lack of testing facilities, testing results taking long time, lack of ICUs, lack of oxygen, lack of ventilators, live saving Remdevisir, less cremation grounds, patients dying without doctor’s attendance, non-availability of medical staff etc. and etc. One can add and add in the list. All these are shown in various national live TVs/journals/write ups etc. Hence, states/Central Govts. can’t hide these. That would be an exercise in vain. What I am trying to emphasize is that we learned nothing even in these small but important things from the 1st wave.
Inability to timely grasp 2nd wave– For practical epidemiology, daily increase of corona +ve cases are the hallmark of monitoring. India’s gradual decline started from November last year and reached its peak on 10th March this year with < 20,000 cases. The gradual ascent starts from 11 March with > 20,000, then with double-fold increase to > 40,000 in 10 days on March 20 this yr. In another week, there is a 3-fold increase with > 60,000 daily. Again in another 1 week, 4-5 fold increase in the range of 80,000-1lakh is seen. The subsequent rise is >1 lakh since 5 April (except 1 day) touching 7-fold increase on 10 April with 1, 45,384. The magic 10-fold increase figure of >2 lakhs is on 15th April and continuing so. By mid-March, proper treatment would have been advised and administered accordingly both by the states and by the centre. However, there is a blame going on. Indians would like all political parties/ politicians to unite together and fight this menace on a war footing.
Gap between demand and supply of vaccines: Definitely there is a gap between demand and supply of vaccine doses. When 2 vaccines were approved in January this year, we found miscalculations of required vaccine dose. Covaxin and Covishield companies would have been given a timeline for a clear production target based on sound material management technique. This was not so and is still not happening. Now, there is a tussle between states and centre regarding less supply and adequate supply openly blaming each other.
Gap in vaccine choice: When less populous states like the USA and UK etc. have demanded from the approved companies huge vaccine doses indicating their timeline target of vaccination, we are just left far behind in this field. Of course, our 1st and 2nd targets are reasonable and worth praise. But once we saw the target fall, the country should have gone for universal immunisation with vaccine choice. I have given detail analysis of 4 vaccine choice i.e. Covaxin, Covishield, J&J and Sputnik V in the previous column and won’t repeat again.
I am satisfied that Sputnik V` is already approved and J&J is on the pipeline for import.
Vaccine coverage in terms of population percentage: In terms of total population covered who received all doses prescribed by vaccination protocol, (source: Our World in Data-April 16 current yr.), India is on 18th chart among the world countries with 1.1%. Compare it with 24.1% USA, 13.2% UK, 5.5-8.4% EU countries and 3.9% Russia. In terms of population who had received at least 1 dose, India has covered 7% of population, when compared with 48% UK, 38% USA, 20% Germany and 5% Russia. The US expects to cover 50% of the population by 10 May and 90% by July 26.
However, in terms of vaccine load administered, India is on 3rd with 119.94 million next to China (187.36m) and US (202.28m). Our Corona managers, fancied to European and US style, should not boast about it as it is the least sensitive datum. Remember, out of 7.86 world population, India has 17.5% compared to China’s 17.9%, USA’s 4.22%, Germany’s 1.07%, UK’s 0.87% and France’s 0.84%.
Sensitive data: Actual population covered either by total dose or by single dose is the most sensitive variable and can be taken as such. I have repeatedly emphasised that God will only know how long the country will take to cover 70% of the population to have a semblance of herd (community) immunity.
Positive & Negative side: Lately, India has enhanced its vaccination population lately by around 20-40 lakhs per day beginning of April, a good indicator indeed. Luckily and surprisingly, people have started rushing to vaccination centres after the 2nd wave because of fear psychosis and forgetting clotting side effects. However, testing remains static with around 11-15 lakhs per day this month in spite of PM’s call to enhance it especially by RT-PCR test. It indicates more hidden and asymptomatic cases thereby spreading more and more.
Not sharing data with public: According to a virologist working as Professor at CMC, Vellore, taking European standard, India should have 320 blood clots out of already used 80m Covishield and 3,000 clots out of the targeted 300m doses. According to one source, a team of Kerala doctors conducted a survey 5,000 healthcare workers in India over a week and found that 65.9% i.e. (66%) had at least one post vaccination syndrome. Most are related to Covishield vaccine. As on 4 April 2021, a total of 222 clot cases (169 CVST and 53 Splanchnic VT were reported out of around 34m pop vaccinated with 18 deaths in European Economic Area. Level of risk is 1 in 1-2.5 lakh. In Australia, 2 cases of blood clotting was found @ 1 in 3.5 lakh.
In respect of the J & J vaccine, the US found 6 women with low platelet count out of 6.8m doses, hence authority put a pause on 13 April.
However, benefit far outweighs the side effects. I can’t see any region not to share side effect data including death. This will enable people to have vaccine choice and subsequently enhance vaccination process. And the lingering doubts be cleared once for all.
Inability of various Specialist associations to crystallise independent opinions: In critical areas, various doctors associations like Public Health, Epidemiological, Hospital Administration, Microbiology, Virologists, paediatricians etc. have completely failed to crystallize independent opinion in critical areas and utterly failed to influence Government’s decision making process. Why blame the bureaucrats only.
Treatment outline: Having given a brief outline of present scenario, Let me give a treatment outline as below:
“Heads must roll”: For the present 2nd wave mess, it is time for “heads to roll” both at centre and states; it applies to both bureaucrats, doctors and drug regulators alike. Though these advisory team at states/centre (call them any name) have done immense praiseworthy works, the nation’s loss far outweigh the gain. Otherwise, India would not have been in such a mess.
Only objective–vaccinate as many as possible. For that, give vaccine choice, open vaccination to all above 18 (15 & above may also be considered in view of increase no. of children affected) and 24×7 services where facilities are available. Four vaccine choices, I have already analysed 4 vaccines earlier, giving reasons. In fact, this is our fundamental right. I often wonder where are our country’s legal luminaries who can emphasis it to our PM/concerned authorities!
Short term objective: Declare 14 day lockdown in a corona hotspots – cities, towns, localities. In short, it is nothing but declaring a quarantine zone and doing SOP. By this, I mean total survey, total testing, appropriate treatment at appropriate place and proper preventive measures, the so called trace, test, treat & SOP. By this alone, we can save another country lockdown. At present, only 2 states/ places are having total shutdown. By not doing it in time (mid-March), the virus had already spread to many states and will continue to spread. It is in front of our eyes, one can easily see it. This also is the only means to prevent total country lockdown.
Hope authorities take it as a feedback, and not criticism, so as to re-plan the whole National Corona Control Programme.
(The author is former Director, Health, Manipur, a public Health Specialist and WHO Fellow (Holland & UK). Email: email@example.com. Views expressed are personal and do not reflect the official position or policy of Financial Express Online.)