Perhaps the BJP forgot that as a party in governance, it is answerable to all citizens, not just those of poll-bound States
Political adventurism shouldn’t trespass reason. And governance is about contextual maturity. Besides, certain issues are just not meant to be politicised, especially something as serious as the Coronavirus vaccine, a hope that’s sustaining the entire nation which could still end up being the worst-hit in the world. That, too, at a time when an effective vaccine is like the proverbial El Dorado, as trials are still going on and there is no proof yet that it would work on a mass scale. Even assuming it does, every citizen, graded according to priority and co-morbidities, has a right to be administered a shot. And any smart Government would try to sound altruistic enough about protecting all citizens, if not mean it, only to reap political gains. Agreed politics is all about making tall claims that are rarely achieved. Still, for all the eloquence, there ought to be some sense of prudence and judgment. Most importantly, no party can advocate anything that is morally questionable. In this sense, the ruling BJP has overreached itself a bit much, promising the voters in Bihar free vaccines, without realising that it is implicitly saying that official benefits will now flow selectively among those who vote for it as a quid pro quo. That sounds as bad as a public threat. Worse, its promise is not just another instance of poll populism — it’s an attempt to manipulate the anxieties caused by the most lethal pandemic to have ravaged the world in more than a century. And when somebody like Union Finance Minister Nirmala Sitharaman makes the announcement, it shows that the Government is desperate about the poll arithmetic of the party it represents than pursuing holistic policies, that it is cavalier about the demands of science and health protocols and is unconcerned about lives, leave alone being compassionate. However, this isn’t the first time the party has made such questionable promises. There was talk that Prime Minister Narendra Modi wanted to launch a home-grown COVID vaccine by August 15 to mark the nation’s 72 years of Independence. Apparently, the Indian Council of Medical Research (ICMR) was under pressure to fast-track clinical trials but widespread criticism about compromising efficacy for the sake of political expediency and pressure from scientists ensured that a life and death question was not made a mockery of. Yet the BJP’s claim of free vaccine doses has already trivialised a grave issue into a point-scoring exercise. A similar announcement followed in Tamil Nadu, where the elections are due next year. AIADMK leader and Chief Minister E Palaniswami promised the shots on the basis of his proximity to the BJP. In other words, tradeoffs of this nature will be made to buy the allegiance of federal parties. One wonders what the BJP’s stand would be in Bengal, where it is seeking to dislodge the Trinamool Congress? But the BJP’s fatal flaw has certainly galvanised the Opposition. Delhi Chief Minister and leader of Aam Aadmi Party (AAP) Arvind Kejriwal was quick to point out the plight of the people in non-BJP ruled States while National Conference leader Omar Abdullah called the announcement a “blatant populism” that “shamefully exploits COVID fears.” He even wondered if the BJP would be paying for these vaccines from the party treasury. So when the Union Minister of State for Health, Ashwini Chaubey, tried to clear the air, it was too little too late. According to him, the Centre had prepared an elaborate plan on distributing the vaccine and identifying those who would be given “preference.” He even added that every State would be given free Coronavirus vaccines. But Amit Malviya of the BJP’s IT cell further complicated matters when he said that like all programmes, the Centre would provide vaccines to States at a nominal rate. And health being a State subject, the Bihar BJP unit had decided to give it free if elected and that other State Governments, too, can decide to do the same. This is not unexpected, as it has become normal for the ruling dispensation to change its stand on what subjects under the State List can be manipulated by the Centre. Except that the Opposition is not buying this narrative with the Rashtriya Janata Dal (RJD) urging the Election Commission to restrain the BJP from “signing a poll deal using the vaccine.”
The larger concern is that the political parties will still get away making wild claims during the Bihar elections, the results of which will be announced in November. And no trial results will be available before December, leave aside the prospect of a rollout by the beginning of next year. Would the voter bet on something that has still not seen the light of day? The Government should instead focus on the vaccine administration process and set up a seamless cold chain infrastructure, both of which are humongous challenges. Vaccine preservation is a tricky business as wide swathes of vials could go bad if safety norms are not adhered to and the temperature controls are not monitored strictly. The COVID vaccine has to be stored at temperatures lower than other known vaccines. The Serum Institute has already raised questions on the Government’s ability to keep aside Rs 80,000 crore for the rollout. Is the Government equipped to handle this without roping in the private sector? If so, how much will the private sector be ready to subsidise costs? Besides, how will those at risk be mapped, considering that most Indians have a heavy disease burden and co-morbidities? Vaccine distribution and administration will be no less of a logistical challenge than the general elections and will require the Centre and States to work together. So before it promises the moon, the BJP should realise that gravity is rude and it alone would land with a thud if it doesn’t pursue collaborative politics on COVID for its own good.
Before I write any further on the topic of Corona, I would like to express my grief at the plight of doctors from the 900hundred bedded Hindu Rao Hospital-a Covid-19 dedicated centre run by North Delhi Municipal Corporation (NDMC).
The non-payment of their salaries for more than 3months and a crossfire of blames and counter blames between (NDMC) and Delhi government is an unfortunate situation, to say the least. This crisis of unbearable financial stress to the team leaders of the frontline workers in the prevailing emergency situations of the pandemic should be sorted out at the earliest possible as it carries the potential of causing a complete breakdown of the system.
It is now around 10months since Covid-19 virus made its gatecrash entry into almost every corner of the earth, affecting each & every sphere of human existence. India has borne the brunt of this attack both as a part of the rest of the world and as a unique nation of 1300million people , majority of whom were living below the internationally drawn poverty line even before the spread of this disease, as a nation practising all major religions of the world,, having 26 different official languages, a landscape varying from the mighty Himalayas to Rajasthan's Thar desert of 200lakh square kms, a mainland coastline of 5422.6kms, sharing its northern borders on both Eastern & Western sides with hostile countries. Each of these factors hold a moulding effect on the planning and execution of a fight against a disease which has a power of spreading like wildfire anywhere and everywhere. The health delivery system in this adverse situation could evidently not have been self sufficient or one of the best in the world, yet the country's fight for survival has been remarkably bold, result oriented & scientifically based.
Circumstances like these in any other part of the world would have led to a complete crackdown in the official and unofficial machinery which runs a nation, but India has not given any evidence of surrender to the Doom's day predictions about the pandemic.
The earliest days of the pandemic brought forward a depressing picture of millions of migrant labourers, literally walking down 1000s of kms back home after losing their meagre livelihoods, carrying their children & heavy baggage on frail shoulders, which more often than not belonged to ladies, running hungry for days, getting crushed under trains and buses, but continuing their march till they reached their destinations. Many died on the way but the country survived with the strength they imparted to it.
The complete lockdown stretching over months led, as we all are painfully aware, to a halt of all human activity; businesses and markets were closed, educational institutions were shut sine die, all means of transport were stopped from running, roads wore the bare empty look which no eyes had seen before, visit to religious places & cinema houses, sports, cultural events were all stopped and cancelled. This last part of the scenario was the only thing India shared with the world-the rest of the story being totally different for our land of miracles and awe.
The first confirmed case of Covid-19 was recorded in Kerela's, Thissur district on 30th January'2020, the country has come a long way from this Wuhan exported case, reaching 75,49,162 number of the total affected individuals & 1,14,623 national death figure as of today the 19th October'2020. Till mid-May we were nowhere in the list of 10 most affected nations, but from then on we steadily climbed this chart to reach our present 2nd position in it & are stuck there for more than a month now; 8th September'2020 is the date of reaching this world record when our numbers exceeded those of Brazil and remained less compared to only one country, USA.
Our consolidated efforts to fight the disease have been inundated by (1) the wreckage caused from repeated sea storms at the Eastern as well as the Western coasts, (2) a locust invasion on the north western states, (3) military scuffles with China, continued irritants from Pakistan, and even Nepal, which till date had been a friendly nation, (4) serious social disruptive incidents occurring as a result of religious intolerance, (5) state level elections and by elections & Rajya Sabha elections-to name a few of these factors, which also included (6) protests against various constitutional amendments, and (7) our multitude of festivals and finally last but not the least (8) especially in the NCR the return of the pollution problem, which in itself can be a cause of an epidemic of allergic respiratory diseases.
In this chaotic social scene, a scientific thought, leave alone a scientific action of such mass scale connotations would seem unimagineable, but India is India and we have done it!! Behind this grim facade of a hazy cover, a probe into the reality of the results of our struggle against the disease would read as a big success story.
Much before the actual declaration of the pandemic being made at the UN level and almost coinciding with WHO's declaration on 12th January'2020 that a novel Coronavirus was causing a respiratory illness in a cluster of people in the Wuhan city of district Hubei in China, India began thermal screening of passengers arriving from China and a few other countries on 21st January'2020. This exercise was initially carried out at 7 airports and by the end of January was extended to 20 airports. The countries from where arrivals were being screened initially included China, Thailand, Hong Kong, Singapore, Japan and South Korea- this was in the earlier part of February'2020, by the end of February Nepal, Vietnam, Malaysia, & Indonasia were also included in the list. However, in February only, the ICMR admitted that airport screening alone was insufficient to control the impending threat.
The actual plans to deal with a worsening of the pandemic in the country were only drawn in mid-March for which seven ministries were roped in to set up additional quarantine and treatment facilities. While spreading information about these plans care was taken to caution all concerned to avoid a panic-like situation. I believe that this small step provided a big boost to the morale of the workers at all levels. Social distancing advice to be announced by all states was issued on 17th March and was the first step of the preventive strategy to which later wearing masks and frequent hand washing for 20seconds and use of sanitizers were soon added.
Countrywide lockdown for 21days was declared by the PM from 25th March & was preceded on 22nd March by a single day exercise of similar nature in 82 districts of 22 states and union territories, where confirmed cases had been reported. This was followed by barring of interstate travel and sealing of state borders. The positive effect of this measure was that the doubling time for the number of cases increased from the earlier three to six days. A complete lockdown of the entire nation was thus in place from 25th March till 31st May, but declarations to this effect were made in steps and phases. For the red zones or the containment areas this situation was to prevail till 30th June. This essential step of locking down the entire nation for a prolonged 2 & 1/2 month period made every single citizen of the country aware of risk factors associated with the illness and thus comply with the instructions and government advisories.
Under the WHO guidelines, the country adopted an epidemiological approach involving mass scale detection-covering maximum population, adequate testing for the disease, isolation of the affected individuals, care for every positive case and sincere tracing of contacts. (Please refer to my previous article "Making Sense of World Corona Figures-Chapter20-WHO on Corona" dated 13th October'2020)
With these dedicated efforts we have reached today's date of 19th October when 5days back on 14-10-2020 the total samples tested were '9 crore 90 thousand 122' of which those who tested positive numbered 72 lakhs 39 thousand and 389, this was equivalent to a (test/million figure of of 65,289 & a positively percentage of 8.04). The union health ministry has set up a war room from where the policy making team with members from different government organisations work to decide about the policies to be adopted to tackle the prevention and spread of coronavirus.
The National Institute of Virology has been providing leadership and guidance under which the initial 15 labs, as on 17th March, increased to 65 labs for testing of the virus. The visionary decision taken in mid-March to allow the NABL accreditation attained private labs to conduct tests on suspected individuals has helped the workers cover a population of roughly ten crores for Covid-19 tests.
Rapid antibody tests, pool testing which are capable of handling around 90 tests at a time, RT-PCR tests, low cost paper strip tests developed by the Institute of Genomics & Integrative Biology of Delhi are the various types of tests being used for detection of the affected individuals. At this point it might be imperative to mention the ridiculous experience with the Chinese test kits, 6,50,000 of which arrived in India on the 16th April'2020. Over 2 million more were to be delivered within the next 15 days. These were rapid antibody tests and RNA extraction kits which were distributed by ICMR & NICED to various states for their use. On 21st April the health department of West Bengal alleged that these kits were yielding inconclusive results and a low accuracy of 5.4% as compared to the expected 90% was found in relation to these kits, so the ICMR stopped their uses all over the country and cancelled orders for the remaining kits.
Another very important achievement of the scientists of this nation, was the isolation, as early as on 14th March, of a strain of the novel Coronavirus. By doing this India became the 5th country to isolate a pure sample of this virus after China, Japan, USA & Thailand.
India has played an important role in the treatment and research aspects of the global Covid-19 control programs too. Hydroxychloroquine-sulfate a refined form of the 400 year old antimalarial drug chloroquine, is a part of four drugs Solidarity Trial for Covid-19 treatment, initiated by WHO and India participated in it by sending it in bulk to USA and other countries where malaria had long since been eradicated. The other three drugs in this scheme are Remdesivir, Lapinavir & the interferon.
India's experiment with convalescent plasma therapy wherein a recovered patient who has developed IgG antibodies in his blood, donates his plasma to a Corona ill patient, has also been tried elsewhere and is slowly gaining popularity after the four preconditions which ensure its success have been discovered.
As for the anti-corona vaccine, a latest advisory on it has been released from the PM's office which has emphasised on 17th October'2020, after Mr Narender Modi chaired a special meeting on the subject. that (a) no intranasal Covid-19 vaccine is under clinical trial in India, today (b) 3 indigenous vaccine candidates are in advanced stages of development out of which two are in stage (ii) and one is in stage (iii) and (c) that the country's health delivery system has to gear up its preparedness for vaccine administration by ensuring advanced planning for (i) cold storage chains for the vaccines (ii) distribution network (iii) monitoring mechanism and (iv) advance assessment & preparation of ancillary equipment required such as vials & syringes. Detailed blueprint for this plan was presented in that meeting which was attended by the Union Health Minister Dr Harsh Vardhan, & NITI aayog's principal scientific advisor besides senior officers from various concerned agencies.
It was further said here that Indian scientists & research teams were collaborating and strengthening the research capacities in neighbouring countries such as Afghanistan, Bangladesh, Bhutan, Maldives, Mauritius, Nepal, and Srilanka. Besides this, Myanmar, Bangladesh, Qatar, & Bhutan have requested India to help in the clinical trials in their respective countries.
It is a result of such hard work and team efforts that today, the leading daily newspaper Hindustan Times carried these two headlines on its front page, "Covid could be under control by February" as a quote from a panel of experts appointed by the government, and WHO has welcomed India's stance against vaccine nationalism.
The above mentioned applause from WHO has come our way because of our strategy on anti-corona vaccine, wherein, besides promoting and fully utilising our own products in this capacity we have accepted proposals from many of the foreign companies to allow the use of their products too in our country.
India may be just about flattening its pandemic curve but all depends on how we handle the festival gush
There is some good news for India at last where the pandemic is concerned. The number of new Coronavirus infections and casualties has declined in the last three weeks and the spread curve of the pandemic has flattened in most States, except for Kerala, Karnataka, Rajasthan, Chhattisgarh and West Bengal. The Government may have finally admitted to community transmission but we had quite internalised the possibility way back given the stiff peaks and high infectivity. Yet we cannot afford to be complacent about the disease right now as in Europe, too, the cases spiked exponentially after the spread slowed down for a bit, giving people a false sense of security, and the dry winter weather aggravated susceptibility to the virus. The UK is in a serious lockdown mode again. Besides, with economic activity opening up as part of the country’s unlocking efforts and cinema halls, multiplexes, entertainment parks, swimming pools for sportspersons functioning, the festive bonhomie this weekend could just about trigger a viral storm that could reverse the situation in no time. One has to look at Kerala, which was seen as a model of virus containment at one time, sliding disastrously post-Onam. In a State, where 90 per cent of the reported cases were from outside, the trend reversed to 90 per cent of the infections being locally transmitted July onwards.
We may slow down, tire out and chase the virus but have a long way to go because 70 per cent of the people are still susceptible to infection. So in short, there is no room for complacency or laxity. In this respect, the Calcutta High Court ruling that puja pandals in the city, which have been mounted on the usual lavish scale, cannot allow any visitors inside except the organisers, is much needed to avoid a mass contagion. Only then can we flatten out by February. Because, the socio-economic impact of the second wave of the virus on an already overwhelmed, weakened and tottering healthcare infrastructure and economy will be too great. We have to stop pointing fingers at the Government and everyone else on the planet for our plight. We need to grow up as a nation and take responsibility for our own actions. True, the Government and other stakeholders in it are responsible to a very large extent for management, but it is time we hold ourselves accountable, too. If this means becoming online celebrants for one season, so be it.
The feedback surrounding the myths and legends on managing the pandemic also borders on the weird
There was a deliberate smashing of pots; people making a clamour. This may be an illustration of a population experiencing traumatic shock. It might have been done in panic but also might have been done to somehow disturb and clear the air,” Hays wrote about a supposed act of an angry God when he described the plague in his book Epidemics and Pandemics: Their Impact on Human History. But he could have been writing about us in the present day and our initial attempts to keep away a disease that has yet not been properly understood.
“The mask is a tool to make us weak.” Our attention turned towards the driver as he detailed the complex inter-relationship between carbon dioxide (CO2) and the mask. His logic was, as we exhale CO2, the mask forces us to inhale it back, thereby weakening our body’s immune system. This was a novel conspiracy theory in a world filled with absurd theories about the pandemic.
Over ten months into the outbreak, the inventory of rumours related to the contagion has managed to transcend boundaries. Creative and inane, such stories multiply as the pandemic refuses to release its grip. While in the early days, most conversations veered around the potency of the virus and the multitude of ways to cure oneself of this dreaded pandemic, they now tend to dismiss the disease as “just another flu.” The apparent casualness flies in the face of conventional analysis as awareness about the disease is immense and Indians who lived through the difficult times of the lockdown are cognisant of its life-threatening effects.
However, the current predilection of not wearing masks also comes associated with the sense of fatality and fatigue, having undergone painful job losses and social stigma for the past few months. Varying from, “It is all God’s will” to “Nothing will happen to me” to “We have all caught the disease” to “God cannot kill all the poor” to “If it happens, it happens” to “We don’t have money to buy a mask” and a multitude of other reasons, the almost universal lack of interest in wearing a face cover hides an important detail about our social lives. People have been hit hard by the economic impact of the crisis and most have no other option but to step out. They cannot stay in and worry about wearing a mask or maintaining social distancing. They are more concerned about filling their stomachs and meeting their financial needs.
In many ways, the fear of the pandemic, coupled with the spread of fake news in this era of social media and messaging platforms, have led to revisionist theories that at once declare the impact of the Coronavirus a hoax while also pandering to the fear of its supposed effects.
With millions falling prey, there is an outcry that this generation is paying for its sins. However, William Dunbar said it best when he wrote that, “The fear of death disturbs me” in the Lament for the Makers, suggesting perhaps that the human race has faced such threats throughout history. And those dark moments were unique as humanity did not have an answer then just as it doesn’t have one now. People in those dark days were prone to succumbing to fear as the rise of a disease, cutting through society without any discrimination, results in helplessness among the rich and the poor alike. This causal relationship between disease and sin is seen also in Greek literary texts, such as Homer’s Iliad and Sophocles’ Oedipus the King. Iliad opens with a plague visited upon the Greek camp at Troy to punish them for Agamemnon’s enslavement of Chryseis.
Humankind has time and again let this fear turn into panic, overwhelming all traces of rationality. This facilitates easier propagation of fake news in the community. The feedback surrounding the myths and legends over managing Covid also borders on the absurd. Just as the CO2 theory propounded by the driver, more such theories abound in the markets of Bengaluru, Chennai, Pune and Delhi, ranging from guzzling copious amounts of alcohol, to being safe in one’s locality, to stopping the consumption of fruits as they are known to carry the virus. The list is endless, and each country, State, city and locality has added a twist to these stories. The challenge for people working in the frontline is to sift through the rumours and convey basic truths about the pandemic and its causes.
However, as we see more complacency creep in, it would do good to understand the underlying fear and weariness that communities are suffering from. For the moment, they face a gun-shaped thermal scanner, an oximeter and endless surveys that have fatigued them. Then there is the unfortunate spread of stigma of an uncommon but not unmanageable disease and the mishandling of dissemination in this very real public health crisis.
The need of the hour is to aggressively push for an overarching campaign that involves all stakeholders and myriad activities such as posters, stickers, banners, wall paintings, murals, street theatre, songs, tableaus, announcement from religious places, radio campaigns, television ads and as many creative outlets as possible.
As we learn from this crisis, it will bode well to recall that literature has been humanity’s constant companion though long periods of uncertainty. And often, when a pandemic hit humankind, there was not much that could be done then as it is now.
The only effective measure back then was what is known today as social distancing and quarantine of the sick which, according to Procopius, the principal Byzantine historian, was done voluntarily by individuals. In this current age, we can strive to be a step ahead, promote social distancing, wear masks and ensure better hygiene in a manner that was not possible in ancient times.
(Sharma is a faculty at Azim Premji University and Bhaskar is an independent researcher)
J&J halts trials after a participant falls ill. This shows why developers must not cut corners under political pressure
Before there is a sense of desolateness, let’s go by certain facts. First, vaccine trials are a time-consuming process of trial and error, of meticulous checks and balances and a constant re-assessment of risks and formulaic tweaks if any to ensure that the final product is safe and effective for the human body. Second, there are a lot of vaccine candidates being tested at various advanced stages of trials with encouraging outcomes so far and there is no reason to lose hope. Which is why Union Health Minister Harsh Vardhan said that India would have a vaccine for the novel Coronavirus from maybe more than one source by early next year. Currently, two indigenously-developed vaccine candidates, one by Bharat Biotech in collaboration with ICMR and the other by Zydus Cadila Ltd, are in phase II of the human clinical trials. The Pune-based Serum Institute of India, which has partnered with AstraZeneca for manufacturing the Oxford Covid-19 vaccine candidate, is conducting phase II and III human clinical trials. So though pharma major Johnson & Johnson (J&J) has halted clinical trials of its variant after a participant fell ill, probably slowing down US President Donald Trump’s ambition of rolling out a vaccine commercially before the November polls, there is still hope. The company said that the participant’s illness is being evaluated and that it would share more information after a further study into the cause for the adverse reaction to the trial vaccine. This comes on the back of British pharmaceutical firm AstraZeneca stopping its vaccine tests after a volunteer fell sick. Though the tests have resumed in a number of other nations like UK, Brazil and South Africa, they are still on hold in the US for further scrutiny. Why people are upset about J&J’s sudden halt is because it is among a small group of vaccine makers which has progressed into final-stage human studies. The firm is dosing thousands of volunteers in the first big trial of a Covid-19 inoculation that may work after one shot. Others probably need more than one.
Though J&J is in a mad race to find the silver bullet along with rival drug firms from around the world, both scientists and the healthcare fraternity have time and time again cautioned that pharmaceutical companies must balance time pressures with safety considerations in the crucial last stage of testing. And the fact that two of the frontrunners for the vaccine have halted work on their samples is actually a good sign that developers are not throwing caution to the wind in order to claim the highest price that awaits the one who comes out with the vaccine first. Plus it is a sign that companies are not giving in to political pressure that they are under to deliver a cure fast as the contagion continues to spread and sicken people and economies. No compromises can be made to meet the improbable timelines that are being set by Governments keen to reassure their citizens. Developmental processes that usually take years have been compressed into months, raising genuine concerns over the safety and efficacy of the quick fix shot that will come out eventually. However, the people’s faith in the vaccine that comes out eventually will be vital if health authorities hope to be able to convince millions globally that they must get a shot. That’s why developers have publicly pledged not to compromise on any scientific requirements for the vaccine. Microsoft co-founder Bill Gates gave voice to people’s concerns when he said that normalcy would return to the world “when we have not the first generation of vaccines, but one that is super-effective and widely available. Only then all the problems created by Covid-19 can be solved.” Then there is the politics of distribution, what with rich nations having already booked the lion’s share of an expected rollout and poorer nations having to wait in the queue. For a country like India, it needs to ready a cold chain infrastructure real soon to preserve the vaccines so that they don’t lose their efficacy. In that case, normalcy will be a long time coming because we have not even got the first generation of vaccines yet. Till then prevention is the best cure.
WHO on Corona
On 20th April 2020 WHO held a historically important press conference at its headquarters in Geneva. The main theme of this was Covid-19 with only a passing reference to some other issues like Ebola cases and violence against health care workers.
Of the two events which emphasized the importance of this conference, the first one preceded it by two days. It was an eight-hour-long musical evening with participants of international fame. The show was named as " One World Together at Home" and was a fundraising event. A whopping US $ 127million was the total yield from it, including the US $ 55million for WHO's Solidarity Response Fund. This fund within the next two days had collected a total of US $ 194 million from more than 270,000 individuals, corporations and foundations.
This date 20th April 2020 was also the date on which WHO for the first time held a press conference with instant facilities for translation, interpretation, and questioning, available to both Zoom and live attendees in all its six official languages: English, French, Spanish, Russian, Arabic & Chinese.
The main speaker of this session was no less a personality than the secretary-general of WHO himself Dr. Tedros Adhanora Ghebreyesus who as a part of his declaration of the importance of the upcoming event, a day before the said meeting, addressed the health ministers of the G-20countries. The effort of these participating G20 nations was to accept the WHO's coordinating role and seek technological guidance from the world body. The G77 and the NAM member countries too had sent their vote of confidence on the occasion.
Yet another pointer to the importance of this session was the cancellation of the regular monthly press conference in the previous month of March'2020, evidently because everyone must have been busy preparing for this mega event. In May-June'20, though the meets did take place, they were lackluster events compared to the April'20 affair as the point by then had already been made.
My purpose in pointing to the emphasis factor of this conference is to remind all working in the field, that as world leaders in health management WHO meant to warn the whole world in no uncertain terms, of the fast-spreading disasters of the pandemic and to provide direction and stimulus to decision-makers in every corner of the globe to buckle themselves up to face the hazards expected from the disease. It (WHO) seemed to be telling us that a sluggish approach of acting within the available means would fetch tragic results, the time had arrived for upgrading the health delivery systems; starting from a lifestyle change of every single individual of the society to analyzing the genome sequence of the virus and finding effective vaccines and treatment for the infection.
The path chalked out by WHO for fighting the pandemic and reducing its spread & deadly effects was one that required sustained efforts on the part of individuals, communities and governments to continue suppressing this mortally pathogenic virus. An epidemiological approach, it was said, would ensure mass scale detection-covering maximum populations, adequate testing for the disease, isolation of affected individuals, care for every positive case and sincere tracing of contacts.
Validation of tests to detect Covid-19 antibodies which guide us to understand the extent of infection in the population was another development which was welcomed.
Though as per the analysis of data available till then, the suggestion was emerging that only small percentage of populations may have been infected even in heavily affected areas (not more than 2-3%), the organization (WHO) declared its commitment for providing technical, scientific and financial support to projects on seroepidemiological surveys across the world.
Differences in the interpretation of the antibody detection test and those that detect the virus (RT-PCR as an example) was also explained in this conference. It was said that while the antibody test only tells us about who is infected, it is the tests which detect the virus in the individual's throat swab sample which provide information on the case being an active one or not (being an active case means a patient who can pass on the infection to others) and also therefore help in the exact diagnosis, justification and therefore effectiveness of isolation and finding correct treatment. Here it was added that one of WHO's priorities was to work with partners to increase the production and equitable distribution of diagnostics to the countries that need them most. Foundation for Innovative New Diagnostics (FIND) and the Clinton Health Access Initiative, it was told, were working with WHO to identify and validate five tests that can be manufactured in large quantities. UNICEF, Unit Aid & Global Fund were helping WHO in making these tests available to the needful countries.
The World Food Program and the UN supply chain had come forward to help WHO ship consignments of millions of kits for protection of health care workers and deliver masks, goggles, testing kits, face shields and other lifesaving medical equipment to 120 priority countries (of course most of these were in African region).
To read the first article please visit: https://opinionexpress.in/making-sense-of-world-corona-figures
(In chapter 2b of this series, which would follow soon after, we will take up the most commonly asked questions and other related issues that concern WHO directly.)
Govt, IMA clash on Ayush Covid protocol; doctors say evidence merely anecdotal and a placebo, not clinically proven
When Kerala, the hub of Ayurveda with some of the best practitioners, arrested the spiral of the pandemic in the early stages, its Health Minister KK Shailaja made a crucial observation. That once the disease had set in, there was no alternative to the clinically proven and medically tested protocols. And that traditional systems of medicine, like Ayurveda and homoeopathy, were good for overall well-being and body resistance. So they could be used only as part of a protective or convalescent routine. The deadly virus itself had to be treated with proven drug combinations. This distinction is very important in a country growing up in a culture of naturopathy and home remedies, and, therefore, prone to trusting conventional wisdom. But this is a novel virus we are dealing with. There is no doubt that traditional systems of medicine in India have not only survived but flourished over the centuries and there are virtues embedded in our huge herbal heritage that are good for disease prevention, improving immunity and overall health management. So far, the evidence of their curative potential has largely been anecdotal than empirical. But overplaying our herbs as part of a COVID-19 medicare protocol, when they are yet to cross the threshold of medical reason, comes with the attendant ills of misconception that they are just as effective as allopathic drugs. Particularly in a country where most cannot understand the fine line between preventive care and cure. This is the reason why the Indian Medical Association (IMA) has taken umbrage to Health Minister Harsh Vardhan’s upgradation of protocols on October 6 for managing and treating COVID patients with mild symptoms in Ayush (Ayurveda, Yoga and Naturopathy, Unani, Sidda and Homoeopathy) hospitals and by Ayush practitioners. It asked the Minister to authenticate efficacy claims made from studies done on asymptomatic COVID patients, make them public and available for scientific scrutiny or else be responsible for “inflicting a fraud on the nation and gullible patients by calling placebos as drugs.” In a sharp attack, the IMA asked how many of Vardhan’s ministerial colleagues have so far made the informed choice of getting treated under these protocols. It wondered if the proponents of this claim and his Ministry would subject themselves as volunteers to an independent prospective double-blind control study in the prevention and treatment of COVID. This is a pertinent question considering almost all of our Ministers have chosen private multi-speciality hospitals with advanced allopathic protocols to treat themselves when they got infected. The IMA even asked what was stopping the Minister from handing over COVID care and control to the AYUSH Ministry. The problem with the AYUSH protocol at hospitals is that it legitimises Ayurveda as a line of treatment when fact is that there has not been a sustained trial and a consistent similarity of results to prove that it works in arresting the spread of the disease. Till then, AYUSH treatments can at best be prophylactic in nature and must be emphasised as such in officialese.
It is true that a few Ayurveda pharmaceutical companies have been working on simulation studies where few plant molecules have shown the ability to halt the alarming multiplication of the SARS CoV-2 virus in an Artificial Intelligence (AI) modelling. Researchers at IIT Delhi, in collaboration with Japanese scientists, have found that properties of the Ayurvedic herb Ashwagandha have “therapeutic and preventive value” against COVID-19 infection. But they are working on more conclusive proof that could allow for pharmacological interventions. Let us not forget that callous official endorsement can lead to outrageous claims like the recent one made by Yoga guru Baba Ramdev that he had found two new medicines — Coronil and Swasari — that had shown a 100 per cent recovery rate in patients within just 14 days. He quoted clinical trials at the Jaipur-based National Institute of Medical Sciences and Research (NIMS) which denied them subsequently. He applied for a licence duplicitously, claiming that his was a cold, cough, fever drug with immunity-boosting properties. And once the licence was got and the time for a rollout came, he claimed it was a cure. Besides, Ramdev’s Patanjali group sidestepped the Drug Controller General of India, whose approval must be sought before a medicine is put out in the market. In our search for a cure among herbs, we are doing a disservice to what Ayurveda stands for. It is not just about COVID prevention but a holistic system of medicine involving herbs, diet, lifestyle and other measures that helps the body fight off all kinds of pathogens and diseases. Ayurveda has never been in conflict with science and is actually about scientific management of life. The IMA statement is all the more significant because it draws attention to the flawed pandemic management in India as we race to become the worst affected country. With the disease expected to see a painful peak by November, in no small part aided by the festive season and the opening up of every sphere of human activity, spare a thought for our overworked healthcare personnel. Most of them are battling depression, exhaustion and pay cuts even as the stream of patients is constant. Hundreds of them have lost their lives while on frontline duty and the IMA has been demanding martyr status for them as they went down fighting a new age battle. The infrastructure, even in bigger cities, is still short of handling a bad winter surge should it happen as predicted. Rather than upgrading AYUSH protocols, we need to upgrade practical solutions.
This is an unfathomably vast subject therefore a summary restricted to the latest figures of affected cases and deaths, along with WHO's stand on the issue and the acrimonious economic outcomes of the pandemic is the least & the best that can be written on the subject, As for, the foremost important issue of human life & health, the best guide to it is the daily 'Virus Tracker (VT) chart of 'Worldometer' which provides the latest daily figures on these. We give here an analysis of these numbers in respect to India & Delhi incidents.
Total Till Date (30-9-2020)
Region Cases Deaths Percentage
World 36,247,199 1,057,656 2.917
USA 7,735,943 Figures not available -----
India 6,832,600 105,572 1.545
Delhi 298,107. 5616 1.883
Last 24hours
India 78,746 978 1.241
Delhi 2871 35 1.219
Though the percentage of national death figures that has emerged from these charts has shown a descending slope compared to the figures of just a week before, (on 30-9-2020 these were national total average of 1.5674 and the same in previous 24hrs was 5.193! while for today 08-10-2020 as we see above both figures have graduated to lower values) it is still not a picture which allows us to relax or think that the pandemic is vanishing and our doubts about the overall situation get worse by the given report from ICMR of 30th September 2020 which says that till date India has tested 7,41,96,722. total samples of which 10,86,688. were done in the last 24hours; that makes the total tested population a mere 5.7%. The final scenario that emerges from these figures is that the tests done are much too less for them to depict correctly the prevalence of the disease in the country and that its control will worsen in the coming months.
Quoting the (VT) chart of today the 30th of September' 2020 the five most affected countries are (1) USA, (2) India, (3) Brazil, (4) Russia, & (5)Colubia The point to be noted in this chart (if you don't count Russia as a European country-because of it being as much Asian as European) is that the entire Europe has managed to wriggle itself out of these charts, when till April- May this year so many names from there like Italy, Spain, France & UK, remained at the top positions in these lists.
Drawing a conclusion from this observation, that Europe has managed to conquer the enemy, will be erroneous, while on 30-9-2020 the fifth position in this list was that of Columbia today a mere eight days away Spain has got back into this list of top five most affected countries and is now on fifth position, displacing Columbia a South American country) Sliding the view back to the early history of spread of the disease from China to the outside world we will notice that this happened at the peak of winter season of December'19 to January'20, and winters are known to be more conducive to the growth and therefore to the spread of the virus, also the exchange traffic & business ties between China, Europe & USA are at a much higher level than they are between India & China, these, thus were the factors responsible for early and fast spread of the disease in Europe. Even the USA was drawn into the field much later. The same reasons which affected Europe first, in reverse order, became the cause of delay in India's appearance on the scene. But once here, with our overpopulated cities, low development status, poor infrastructure & inadequate health services, it was bound to make us catch up with the toppers and then beat them.
Now that the winters are returning news is trickling from various European nations to get back rising trends in their graphs of affected cases. This is not to disregard the advantages they possess of having much better health delivery systems coupled with incomparable low populations, which will make the effects of return of the disease there much more blunt. Even China is seeing a re-emergence of the disease after its initial enviously heroic conquest of it. Returning the discussion to our motherland; we saw a noticeable effect of the pandemic for the first time in March-April which proceeded relentlessly throughout the peak summer season. This means that in previous winters we were spared from the initiation of the Corona attack here, and now that it has found a footing in the country it has not cared for its extreme heat for spreading its tentacles.
All the socioeconomic factors of this land, make it a soft target for any pandemic. However respiratory diseases show their worst effects during winters and are known to exacerbate in that season. Corona being basically a respiratory disease,, by showing its trampling attack during summers here has broken that trend and we should expect its ferocity to get more violent in the approaching winters unless an effective vaccine comes to the rescue of entire mankind and to us as a part of the crowd.
The presence of hormone-disrupting Bisphenol-A in microplastics not only stymies growth and development, it undermines the body’s immunity
Microplastics are harming our health in more ways than one. At a time when humanity is battling the COVID-19 pandemic, natural human immunity is essential and of incalculable importance. However studies have shown that microplastics undermine human immunity. The presence of hormone-disrupting Bisphenol-A in microplastics not only stymies growth and development, it plays havoc with our hormones and severely undermines the body’s natural immune system. Apart from this, there has been an exponential rise in health problems pertaining to the gastro-intestinal tract. Research is increasingly showing that invisible microplastic particles and polymers in our immediate environment, such as drinking water and food, are emerging as a major cause for worsening human health.
The problem is not new but the symptoms are exceedingly assuming new dimensions as newer human health and environmental problems are emerging. According to the National Oceanic Atmospheric Administration and the European Chemicals Agency’s classification, any plastic bit that is less than five millimetre in length conforms to the definition of a microplastic. Any ingestion of this directly exposes human organs to a variety of harmful chemicals and pesticides present in them that cause adverse health conditions such as obesity, gastro problems, developmental issues and other body organ related damage. Microplastics that are less than 25 microns are able to enter the respiratory tract and those that are five micron in size are able to get lodged in the lung tissue. This can cause serious health problems. Across the world, microplastics are now considered as the new atmospheric pollutant and the near invisibility of these fragments makes them even more harmful. One can judge this by the fact that at many locations across the world, the average microplastics and fibres in our ambient environment are less than 300 microns in size. The average human hair is of 50-70 microns in diameter, whereas the smallest particle a human eye can see is about 40 microns. This gives us a perspective regarding the pollutant and its size and how this creation of mankind is escaping all global efforts to rein it in.
As we relentlessly create a “plastic planet”, the scale of its generation is growing by leaps and bounds. According to a study published in Science Advances, some 420 million tonnes of plastics were produced in 2015, which is up from just over two million tonnes in 1950. This 65-year period saw nearly six billion tonnes of plastic ending up either in a landfill or in the environment. The oceans, too, have not been spared with nearly 51 trillion microplastics floating in them today, according to a study published in research journal IOP Science. The conditions closer home are not encouraging as studies are showing how India’s coastlines are suffering from the impact of microplastics. In southern-most India, microplastics are emerging as a major pollutant and the marine environment, especially along the Kanyakumari coast, is falling victim. These findings came to light in the recent study conducted by the Department of Remote Sensing, Bharathidasan University, Tamil Nadu. The study covered eight different sampling stations along the 71-kilometre- long coastline comprising both urbanised and non-urbanised natural beaches. The tourist beaches and fishing hotspots saw high incidence of microplastic concentration, thanks to human influence. This study gave baseline data that helped researchers understand the occurrence and distribution of microplastics in near shore sediments.
The role of microplastics can be curtailed through impactful Government regulations and policies. India has both but what is missing is the comprehensive and effective implementation of the same. Even today, at all urban centres, one can still see shoppers and business owners using plastic bags and covers. It is surprising how the Government is unable to come down heavily on the manufacturers of polythene bags and covers. Neither is the Government concerned about waste segregation so that plastic carry bags do not get mixed with recyclable waste. These conditions point to the apathy of the Government towards this rising problem.
In order to flush the system of plastics, the Government must conduct an audit of how much demand exists for these products and identify the suppliers. Then, District Industries Centres (DIC) in areas where these manufacturers are located must ensure that notice is served for ending production. Later, the DIC, along with a financial institution and a technical expert, can work out an alternative and eco-friendly product portfolio for these businesses. The Government must address the concerns of the manufacturers regarding profitability and viability besides addressing technical hurdles. This alone will help prevent them from slipping back to producing plastic products.
(The writer is an environmental journalist)
Besides adding evident scientific challenges to the already confusing and out of control global situation, reinfection by Covid-19 has significant social implications which need to be addressed & given serious thought and attention, a cursory approach can only make things worse.
The question of reinfection is directly related to various social factors which would influence it's spread in the society and therefore to the measures that would be required to control it.
Who is prone to get reinfected, what factors facilitate reinfection, when to label a case as reinfection, what should be the therapeutic approach to manage reinfection, does reinfection cause more,or less, severe symptoms, than primary infection, do these patients need to be quarantined and if so for how long? These and many other related questions have to be answered before proceeding to establish a scientific relationship between the cause & effect. When we are still to find definite answers to questions related to primary infection such as "is it shed only in the respiratory secretions? is it found in the urine? is it found in the blood? is it found in the stool, what is infectious, how long is it infectious, how high the viral loads can get, moving on to statements on reinfection could be a premature exercise which may only yield half baked results. The above questions about the primary disease were raised as early as 1st-2nd weeks of January this year by Alex Greninger a virologist at the university of Washington and still remain mostly unanswered. While these things are enabled by the genome certainly, you can't deduce it from the genome.
Finding effective drugs and vaccines are not just scientific questions, everything in medical science ultimately only has social significance, and so does reinfection with Covid-19, as much as it is so for its primary infection. Revising our lessons learnt from SARS epidemic we can recollect that knowing the source of that epidemic helped in its control and therefore it is not the genetic sequence of the virus which will get us there. Epidemiological analysis of the disease is more likely to fetch us the right answers.
A team of doctors from two Mumbai hospitals, BMC (Bombay Municipal Corporation) run Nair hospital, & Hinduja hospital along with researchers from IGIB (Institute of Genomics & Integrative Biology,& ICGEB Delhi (International Centre for Genetic Engineering & Biotechnology, have concluded from their study on four patients of which three were doctors from Nair hospital and one health care worker from Hinduja hospital that " only whole genome sequencing of the viral isolates from different episodes can confirm reinfection and an RT-PCR positive test does not confirm reinfection" (source: Times Of India 23-9-2020 page 17). The topic of the research was comparison of the severity of symptoms in reinfected patients of Covid-19 compared to the first attack. That all four had more severe infection was another of their inferences drawn from the work. Their study appeared as a preprint published in Lancet journal's website. ( I would like to know if the preprint article appeared in the printed copy too and if so in which edition?)
My observation on this news item is that any statement based on a research study of only four patients of a disease which has caused a worldwide pandemic does not present a case of serious study.
I also have a query related to the conclusion they have drawn from their research: "are we to presume that infection cannot occur by the same strain or genome after it has done so the first time?" If that is the case then its direct implication is that infection with any particular genome sequence confers lifelong immunity which enables only differently sequenced genomic material to penetrate the host cells and create symptoms a 2nd time (or maybe 3rd -4th also; who knows?) Then we also have to consider the question of rejection a RT-PCR positive test as evidence of reinfection. If RT-PCR is not a correct tool for diagnosing reinfection how can it be so for the first time infection! If the test becomes negative after the control of symptoms from the primary infection and becomes positive again after a certain gap of time why should this positivity not be indicative of infection this time too, and if the RT-PCR has continued to remain positive even after the symptoms from the first infection subsided then what is the proof that this new episode is not just an exacerbation of the original attack of the disease--a situation similar to a relapse in our old disease friend typhoid, which could be attributed to various causes, none of which was related to the genomic sequence of the causative bacteria.
Doing a whole genome sequencing is a costly investigation which if prescribed unnecessarily may be an unjustified burden on a poor man's pocket and if selectively prescribed after assessing the financial status of the patient, it will be misuse of scientific knowledge.
Whole genome sequencing maybe providing adequately precise knowledge of the submicroscopic structure of the virus, helpful in elaborating the differences in the pathogenicity of various strains but it cannot get us to the source of infection or reinfection & only a knowledge of this source can help in controlling the disease and preventing its spread.
From the time the start of the pandemic in February till now, Delhi has consistently maintained it's 3rd -4th position in terms of the number of patients of this disease, as compared to other states, all of which are bigger than Delhi. While the total number of cases here till 21st September' 2020 were more or less 2.5lacs, the average number of daily deaths in the week preceding 21-9-2020 has been around 35/day. If Monday's 32 deaths are added to the previous figures we see a total 5147 deaths till 25-9-2020 in Delhi alone.
On Monday the total number of new cases for Delhi was 2548.
All these figures can be seen as markers for the challenges that corona has put before Delhi. To assess the contribution of Delhi in India's fight against corona the first & foremost point which we have to keep in mind is that Delhi is the only state where people from other parts of the country think it to be their right to come for treatment and investigations.
Though this situation has been present since before the advent of corona, the pandemic has made things much more complicated and difficult for Delhi administrators. During the lockdown period when the entire nation was under strict orders not to step out even on to the road outside their houses, Delhi saw innumerable corona cases being brought here from other states for treatment & investigations. This prompted the state government to try and restrict outside corona patients to central government hospitals and reserve Delhi government's and Delhi's private hospitals for citizens of Delhi only. But this stand of the state government was immediately and vehemently opposed by the governor Mr Anil Baijal, who was representing the central government. The resultant differences of the two sides made headlines of all dailies in greater part of June'2020. Following these related news items, a reader could have drawn two conclusions; one that the governor was acting in his capacity of Chairman National Disaster Management Committee and was thus protecting the constitution's that particular item which gives every citizen of India full right to seek treatment &/or investigations for his or her ailments from anywhere they deem it necessary. As for the chief minister's order for reserving Delhi hospitals' covid beds for its own residents-he issued it after taking public opinion and received a 90% support to his proposal for which there were more than 2lacs answers. Not just that he even formed a joint committee of five highly placed senior doctors for consulting on the effects of such a step and they unanimously approved it.
That time in June, interstate transport was prohibited and had this order been fully implemented it would have given Delhi advantage of restricting entry into its premises, but once again impartiality in applying rules was overlooked, with the result that though patients from other states were frequently and unhesitatingly being brought here for corona management, for Delhi vehicles needing to cross its borders into adjoining states even for procuring life saving oxygen & medicines there were unending hurdles.
Delhi administration's efforts to reserve Delhi hospital beds for Delhi residents was not universal. They were only trying implementation of this rule for corona patients, and had made it clear that the rule was not meant for patients of any other disease, Before the lockdown period, at any given time 60-65% of Delhi hospitals' beds were occupied by patients from outside the state.
In the early days of the pandemic the total number of corona beds in Delhi's private & state run government hospitals was '1000' and exactly the same number i.e. '1000' was the availability of these corona beds in central government managed hospitals which are AIIMS, Ram Manohar Lohia & Lady Hardinge Medical College Hospital. In such a situation the obvious conclusion should have been "no room for disputes" but what we get in this politics studded country is a drag into an unconceivable, mind boggling, unexpected bag of controversies for even the smallest of issues.
While analysing the performance of Delhi government in handling corona cases one should keep in mind another very important point, that is that Delhi being the Capital of India, most international travellers coming to this country, have their first stopover on Delhi airport, and since corona has been gifted to us by foreign nations, especially China and the Middle Eastern countries, we in Delhi had an early influx and exposure to the disease. However some southern states like Kerela & Mumbai too had a sizeable number of direct to & fro of international flights, which is why Maharashtra, because of Mumbai is still above Delhi in terms of corona cases.
Of 100 confirmed corona cases two will loose their lives, a study of Delhi numbers tells us, which is much more than the national average of 1.6/100.
As a warning to its people, the Delhi government has issued an information bulletin saying that of the total 3081 state administered ICU beds in the city 67.4% are already occupied and that in a short period of 24hrs between last Saturday & Sunday 7000 corona patients had to be hospitalized here! One aspect of this news which should scare us is that since the big private hospitals, having full facilities for managing corona cases are getting full, Delhi citizens who prefer going to private hospitals are now rushing towards middle sized and small setups which are not fully equipped to manage these cases. This increases the risk of spread of the disease many fold, here in Delhi. Here again we find a situation where residents of Delhi have had to compromise with their safety and rights. To understand the background of this situation one has to realize that people living in smaller towns of other states have prior information about these big hospitals of Delhi and bring over their corona patients for direct admission to these hospitals. This is a glaring example of impingement of our rights as Delhi residents.
The end result of this situation is that 30% of corona cases admitted in Delhi hospitals at any given time are from other states. So the Delhi government's health department, in order to reduce this imbalance, decided on 21-9-2020 to add '1500' new beds to its corona reserved beds in the next ten days.
However there is another side to this situation which is not as encouraging and that is that the total number of tests being done here for corona has fallen from '58000' per day in the week preceding 21-9-2020 to a mere '33733' in the next 24hrs. Another shocking news related to the disease is that in a short period of less than three weeks the number of patients in home isolation have increased from '8119' to '18910' and that these home isolation patients are not taking their containment orders seriously, therefore the chief minister of Delhi has issued strict orders that any home isolation patient found to be flouting the rules, should be forcibly shifted to the hospital and will remain there till he gets corona negative.
THE MESSAGE THUS COMES OUT CLEAR THAT IF THE CITY'S ADMINISTRATORS SHOW LAXITY IN PERFORMING THEIR DUTIES, THE SITUATION IS BOUND TO GET OUT OF EVERYBODY'S CONTROL.
Author Bio: A medical graduate from the King George Medical College of Lucknow and a post graduate in health administration. Has been interested in Urdu poetry writing and reading from an early age. The Corona pandemic has been a stimulus for her to take up the socio-medical impact of the pandemic and write on the subject both in Urdu & English. Lives a peaceful semi retired life in a South Delhi journalist colony with a clinic of her own to practice clinical medicine.
FREE Download
OPINION EXPRESS MAGAZINE
Offer of the Month