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How India's second Covid wave started, what went wrong, and what can be done: Top virologist answers
www.indiatoday.in
How India's second Covid wave started, what went wrong, and what can be done: Top virologist answers
Since April, India has been witnessing a surge in Covid-19 infections with the country seeing over 3 lakh fresh cases of Covid-19 daily. Amid this massive surge, which has caused a visible strain on the healthcare system, India’s top virologist Dr T Jacob John tells India Today what went wrong and what measures can be taken to tackle the situation.
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Priyamvatha P. ChennaiApril 28, 2021UPDATED: April 28, 2021 11:39 IST
A person with a breathing problem receives oxygen support inside her car at a gurdwara amidst the spread of coronavirus disease, in Ghaziabad. (Photo:Reuters)
Amid the second wave of Covid-19, healthcare personnel in India have been trying to do their best under trying circumstances. Stretched to the breaking point, the pressure of work and shortage of material during the second wave may cause deaths that could have been avoidable, India’s top virologist Dr T Jacob John has said.
In an email interview to India Today’s Priyamvadha P Vijayakumar, Dr T Jacob John, former professor and head of the department of clinical virology and microbiology at Chennai Christian College in Vellore said, “The so-called UK variant was detected in September 2020. That was an alert for India to be on guard and look systematically for variants of concern. In December, the lab consortium was networked but the goal of gene sequencing in 5 per cent of all cases was not taken seriously.”
In this detailed interview, Dr John analyses how India ended up in the present crisis. How it started, where we went wrong, and what can be done. Dr John also clears myths about vaccination in this tell-all interview.
Here are the excerpts from the interview:
India Today: What does the surge in Covid cases in India indicate? How bad is the second wave?
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Dr T Jacob John: Like in earlier pandemics of influenza and like in other countries, the second wave of Covid-19 has happened in India. The second wave is different and more worrying than the first.
India Today: Lancet's study indicates that there could be over 1000 deaths per day in June. What is your view?
Dr T Jacob John: Deaths are proportionate to infections and that proportion may not necessarily be any different than the first wave. But we will have to wait and see. As of now, the infection-fatality or case-fatality seems to be unchanged. Infection-fatality and case-fatality are not easily dissected in India because of the way numbers are reported. But consistently it has remained below two. More infections will cause more deaths. While healthcare staff is better informed, sheer pressure of work and shortage of resources may cause more deaths.
Also See: Covid-19 vaccination FAQs: Your questions about coronavirus vaccine safety answered
India Today: Which age group is going to be most affected due to new mutant variants?
Dr T Jacob John: The system was slow to look for and detect mutant variants of concern. Reports in the media indicate that younger age groups, largely unaffected in first wave, are now getting infected. Whether this is indicative of higher infectiousness will be known as studies are reported. Probably the higher infectiousness alone may explain this change.
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India Today: Do you think the government should step up vaccination process?
Dr T Jacob John: Vaccination is a very important intervention. But an impact on epidemiology can be had only after two doses and a sizeable proportion are vaccinated to give a guess, at least 25-30 per cent. As of now, around 2 per cent has been given two doses. Stepping up vaccinations will not affect the rise of second wave, but it will definitely save many lives. I do not think India can conduct mass vaccinations in order to make an impact on epidemiology now, as vaccine supplies will not meet this demand.
India Today: Was India well-prepared for the second wave?
Dr T Jacob John: No, the government and scientific community did not expect a second wave, or a wave of this magnitude, as the first wave was a one-year affair. It took six months to reach the peak and six months to decline to steady and low numbers. From December 27 till March 11, the daily numbers were around 20,000 and that pattern was assumed to continue. However, that is no excuse for not being ready for an increase until at least 30% of the population was vaccinated.
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Also See: Fully vaccinated Americans need not wear masks outdoors unless in big crowd, says US CDC
India Today: Could we have been more alert looking at the trend in UK and Europe?
Dr T Jacob John: The so-called UK variant was detected in September 2020. India was asked to be on guard and look systematically for variants of concern. In December, the lab consortium was networked but the goal of gene sequencing in 5 per cent of all cases was not taken seriously. I hear that labs were not given the necessary funds for additional personnel and reagents. So, India was slow to understand the importance of mutants. Even now, less than 1 per cent of cases are studied for genome sequencing.
India Today: Is the virulence worse in the new variants? Should we expect more mutant variants?
Dr T Jacob John: Mutant variants are a function of the magnitude of infection a greater number of people infected means more chances of variants of concern. So, more mutants were predictable, but would the mutants be of concern or not have to be specifically investigated?
India Today: What impact will double mutants have in India?
Dr T Jacob John: The double mutant was a variant detected late last year, but its impact was not investigated until the second wave threw up questions. The classification of the double mutant is B.1.617 and it seems to be the dominant virus in Maharashtra. Not sure where else it has been detected.
India Today: Is there a need for genome sequencing?
Dr T Jacob John: UK variant B.1.1.7 was detected in September 2020, only because of routine genome sequencing. Similarly, South African variant B.1.351 was found in October 2020. The Brazil variant P.1 was detected since Japan was doing routine gene sequencing; in Dec 2020, Japan picked up a variant in four persons. All had travelled from Brazil then Brazilian viruses were analysed and P.1 was dominant there. Genome studies are very important for the management of the epidemic.
India Today: Despite the vaccination drive, people seem to be hesitant about taking the shot. Can you clear myths surrounding vaccines?
Dr T Jacob John: Myths are man-made. The usefulness of vaccinations to save lives (prevent severe disease) was not drilled into people. Lack of transparency of serious adverse events following immunisation added to the fear of educated people. The vaccine roll-out, its rationale was not explained to people. People invent imaginary theories to fill the vacuum of authentic information. Many deaths after vaccination were reported in the press but the government did not move fast in explaining the causality. That made many suspicious. Lack of trust and suspicion of non-scientific motivations added to the confusion. Health ought to be non-partisan above politics and all political parties should be on board for decisions on health. If that does not become visible, people lose trust. All political parties were not aligned against the common enemy. The lead should be the ruling party.
India Today: There have been unconfirmed reports on the side effects of vaccines.
Dr T Jacob John: In all developed countries, all vaccine side-effects (called AEFI, adverse events following immunisation) are listed and serious ones investigated, and information made available in the public domain. This is not done in India. So reports remain unconfirmed.
There is an AEFI monitoring committee in Delhi, but it can only work if data is made available to it. And when it comes to investigating serious AEFI, local standards vary widely. There were media reports of many deaths, but details are not given out by the AEFI Committee.
This lack of transparency has two components systemic competence and deliberate secrecy. These lead to vaccine hesitancy also. We have Western data on the AstraZeneca vaccine, called Covishield in India, and some media reports seem to corroborate with Western information. We do not have any more information.
My impression from such reports, and from the Phase 3 trial data available in the public domain, that the other vaccine, Covaxin, does not have any reported serious AEFI including death. But please don’t take my word on that, we do need authentic data the AEFI committee alone can provide.
India Today: Are vaccines working on the new variants of the virus?
Dr T Jacob John: That is not a matter of opinion but clinical observation. I hope we soon have information from ICMR or major medical centres on the “breakthrough” cases. In general, from two weeks after the second dose of either vaccine, no one has developed severe Covid so vaccinate, protect life.
India Today: Are there breakthrough infections after vaccination in India?
Dr T Jacob John: Immune protection is against disease, measured in Phase 3 against disease confirmed with RT-PCR. Asymptomatic infection is not on the radar screen. However, we know that even one infection is occasionally ‘broken through’ with infection and disease. But the second infection is always mild. The earlier question of keeping a tab on breakthrough infection/disease and whether there are more variants in such instances will be known after study reports.
India Today: There are reports of a lack of hospital beds for Covid patients in various parts of India. How robust is the health care mechanism in India? What kind of change is required?
Dr T Jacob John: Human health has never been given the attention that it deserves in India. There are several reasons. I am not going into them here. There are two pillars of “health management” that are dutifully maintained in all western democracies, but not in Indian democracy. One is semi-autonomous public health and the second is universal healthcare. The USA is the “Mecca” of public health, but their healthcare is not as good as Canada’s or the UK in terms of equitable reach. India imitates the USA in healthcare but ignores public health altogether.
Our healthcare is divided by under-budgeted public sector healthcare (often misunderstood as public health) and the profit-motivated private sector. In either way, quality assurance is not mandatory.
The general standard is 300 hospital beds per lakh population; India has 50/lakh, in company with the poorest countries of the world. Bangladesh has 80/lakh. By bed availability, India’s rank is 155 among 167 countries.
India’s health management system deserves a very thorough review and revision. But I am not hopeful India will do that. I have been advocating a full-fledged commission of inquiry into India’s needs in health management, not merely in healthcare.
India Today: India has exported over 5.84 crore Covid-19 vaccines to 70 countries against 3.48 crore it administered. Now, Indians are in dire need of vaccines. What went wrong?
Dr T Jacob John: My views are my own, but that does not mean it is off the mark. The pandemic response approach of the government of India had two arms disaster management and the 1897 obsolete Epidemic Diseases Control Act. I had always thought that such British Raj acts had been removed or revised. But no. Neither arm could imagine the need for vaccines their objectives were “responding”, meaning “reacting to” the problem. To be “proactive”, we needed a “public health” approach of projecting future needs and planning for the most likely needs. Vaccines were neglected. Two entirely private sector companies rescued India’s reputation by investing their own private funds in vaccine manufacturing.
India Today: How long will it practically take to vaccinate the entire population in India?
Dr T Jacob John: I am not aware that anyone has calculated the country’s needs in vaccine volumes. Vaccines have two purposes: healthcare's purpose is to prevent deaths, severe disease, hospitalisation and the need for ICU beds. The doses needed for this purpose is different from the one below. Those who are vulnerable need vaccinated, not everyone. The purpose of public health is to reduce the burden of disease by population-based vaccination. Here the target has to be defined and vaccination strategy planned. I have not heard anyone doing that either. That strategy must say what proportion of people and what age groups must be vaccinated.
India Today: How promising is the Sputnik vaccine?
Dr T Jacob John: Seems to be no less than Astra Zeneca, but probably more immunogenic as the two doses are with two different adenovirus vectors.
India Today: Fitch Solutions has said India is badly placed to tackle the third wave of Covid -19 infections. Do you agree?
Dr T Jacob John: Shall we get over the second wave first? The way the two waves have behaved, almost saturating the population, I do not expect a third wave and in any case, it will not be as bad as the first or second. We have vaccination also.
India Today: We are in the midst of elections, cricket matches and Kumbh Mela. Do you think these should have been avoided? Did the government get a warning about the second wave?
Dr T Jacob John: The decisions to allow or promote these were political and done without consulting public health experts. In the absence of division of public health, where are the experts? But if we had been systematically looking for mutant variants and had we found them on time, perhaps more caution might have been applied.
India Today: Why are states like Uttar Pradesh, Maharashtra and Chhattisgarh recording a higher number of cases?
Dr T Jacob John: There is a lag time of 10 days to two weeks before the arrival of a virus, in our case most probably one of the variants, before cases show up.
India Today: Do you think that election priorities could have led to underreporting?
Dr T Jacob John: The second wave is catching up everywhere. India is not spending much on research and development. Less than one percent of GDP is spent on R&D. We have less than 400 researchers.
India Today: What is the need of the hour?
Dr T Jacob John: Science and respect for science are cultural elements. The very understanding of science in our culture is warped. Japan has its own unique culture, but post-World War II Japan accepted and embraced science and we know the outcome. India should have learned from that history, but we think, culturally, science and Indian culture are incompatible with each other.
India Today: For now, India is doing micro containment. Do we need a complete lockdown?
Dr T Jacob John: I am not in favour of complete lockdown because we can predict it will not be complete but leaky. Restrictions at local levels are okay. Mask-wearing is a must.
India Today: People have become complacent over the months. What is it that people should learn from the new wave?
Dr T Jacob John: Any gap given to any infectious agent is risky. And we gave three not looking for variants and their dynamics; allowing huge crowds for various reasons; not maintaining Covid-appropriate behaviour.
India Today: Will India develop herd immunity now? Will that help in tackling Covid?
Dr T Jacob John: You are right, herd immunity threshold will be reached soon and that will turn the tide.
India Today: How long do you expect this wave to last?
Dr T Jacob John: By the looks of the graph, the peak is around now and the wave will last until the end of May/early June. After that, we should reach an “endemic” infection level.
India Today: When will the world come out of the grip of Covid?
Dr T Jacob John: The epidemic phase of the pandemic should be over within a few months and thereafter the infection will perpetuate itself as endemic. Very much like seasonal flu.
India Today: Studies have proved that Covid is not dangerous for children. But we see a surge in paediatric cases. Is that something to worry about?
Dr T Jacob John: In general, yes. However, severe and fatal paediatric Covid was reported in many countries including India. It is called ‘Multi-system Inflammatory Syndrome in Children’.
India Today: Have you sent any recommendation to WHO on tackling the new variants? What is your suggestion to the Indian government?
Dr T Jacob John: I have requested WHO to consider a future plan to eradicate coronavirus.
India Today: What is your suggestion to manage the lack of oxygen and hospital beds?
Dr T Jacob John: I don't have an opinion on that. Why don’t all big hospitals have oxygen generators in the house? Why didn’t the government give duty exemption to buy them from overseas, not just now, but in the past? This is my personal opinion.
India Today: Will vaccines lead to hyper thrombosis in some cases?
Dr T Jacob John: The blood clotting problem with some vaccines has been called thrombotic thrombocytopenia syndrome (TTS). It is a very rare adverse event following immunisation with the Oxford Chimpanzee adenovirus vector (Astra Zeneca) vaccine. Very rare means in the order of 1 per million or thereabouts. It is almost always in women, particularly below 50 years. However, I do not have data on the risk in women below 50 vaccinated -- so the rate of 1 per million general population has to be reworked to know the actual risk exclusively among women below 50. Obviously, the risk will be higher in frequency. One European country found 1 per 40,000, I believe.
Under such circumstances, if you have a choice between this vaccine and another, the latter should be preferred in women below 50. If there is no choice but only the Oxford vaccine is available, the risk of severe disease from Covid is far greater than the risk of clotting disease after vaccination.
India Today: Some have raised doubt about the death of actor Vivek after the vaccination. Should it have been analysed?
Dr T Jacob John: There are extremely important lessons here. The death within a day after vaccination due to a block in the coronary artery detected by angiography could not have been caused by the vaccine, directly or indirectly. TTS takes a few days to develop. There is nothing in any vaccine that will affect coronary blood supply within such a short time as one day. Sequence alone cannot be evidence for consequences.
The actor was a walking candidate for a "massive heart attack" because of the coronary artery blocks that had developed over time, perhaps a few years. Lack of chest pain previously or breathlessness when climbing stairs -- the usual symptoms of coronary artery block, may not occur in some people and they are the ones who develop heart attack out of the blue.
The lesson is that all above 45 years must undergo periodic heart checks, including the treadmill test. If caught prior to a heart attack, the condition is eminently treatable. Periodic means, perhaps once in three years.
India Today: Some experts believe elections have been a major trigger for surge in cases. Do you accept? Should elections have been allowed?
Dr T Jacob John: Elections, if conducted with all due precautions, are not likely to trigger surge in cases. But what preceded elections in India, the rallies and massive meetings, definitely put a huge number of people at risk of getting infected and worse, spreading it. Elections were announced when the coronavirus infections were occurring daily in large numbers. During February-March, it was in the range of 20,000 per day over a few weeks. Everyone knew that it was like a smoldering fire, which would flare up.
I have no opinion about the constitutional requirement for elections when the pandemic was raging, even though in India we had passed the peak. If it was constitutionally mandated at that time, the governments (Union and state) and Election Commissioners should have strictly stipulated all Covid-appropriate disciplined behaviour. Not stipulating such conditions was unfortunate and inappropriate on the part of the three parties mentioned above.
An important lesson: A pan-India epidemic, under the enforced 1897 Epidemic Diseases Act, should have been a national problem, above politics. I firmly believe that at times of such a crisis, even called "disaster", all-party decisions had to be made. The Union government and Chief Election Commissioner should have arranged, as soon as dates of elections were decided, to have all party meetings to agree upon conditions of electioneering when the nation was under disaster management modalities and the Epidemic Diseases Act. I don’t think the disaster management agency alerted all political parties. I don't think the Health Minister blew whistle either.
India Today: According to you, when is the human race likely to come out of the grip of Covid?
Dr T Jacob John: Covid is now in pandemic form -- all countries having epidemics. The epidemic phase will get over with and all countries will continue to have "endemic" (low and stable) presence of the disease and its infection. With the majority getting infected, and vaccines getting rolled out, I hope that we will be reaching endemic phase (staggered country-by county), sometime in last quarter 0f 2021 or early 2022.
That is not exactly very good news because all vulnerable folk, seniors and those with co-morbidities, and other diseases and immunosuppressive treatments (cancers, transplants etc) will always live with the risk of severe COVID or at least fear of such risk. By then I expect some recommendations for periodic booster vaccinations of previously vaccinated people and regular vaccination of all previously unvaccinated people, children or children growing up as adolescents/adults will be in place.
These predictions are based on our experiences with pandemic influenza in the past. If we want ‘to come out of the grip of Covid’, eradication, like smallpox and polio, is the ideal way -- in my personal view, the only way.
When I speak of "eradication" at this point of time, hardly anyone in her/his right mind can take it seriously. People may even laugh at it. But "all truth goes through three phases -- first it is ridiculed, then it is vehemently opposed and finally it is accepted as self-evident" (Arthur Schopenhauer). After some years, people may desire eradication but there will be problems -- now is the best time to consider this seriously.
India can offer leadership since we have two Indians at high positions in WHO. Planning costs nothing: when a strategy and tactics are defined, practicalities can be enumerated and taken up one by one. If we miss the most opportune time, that is now, future generations may fault us for having missed the best opportunity.
Also Read | Vaccine registration on CoWIN for those above 18 begins on April 28
Also Read | Sputnik V arrives on May 1. What makes it different?
How India's second Covid wave started, what went wrong, and what can be done: Top virologist answers
Since April, India has been witnessing a surge in Covid-19 infections with the country seeing over 3 lakh fresh cases of Covid-19 daily. Amid this massive surge, which has caused a visible strain on the healthcare system, India’s top virologist Dr T Jacob John tells India Today what went wrong...
How India's second Covid wave started, what went wrong, and what can be done: Top virologist answers
Since April, India has been witnessing a surge in Covid-19 infections with the country seeing over 3 lakh fresh cases of Covid-19 daily. Amid this massive surge, which has caused a visible strain on the healthcare system, India’s top virologist Dr T Jacob John tells India Today what went wrong and what measures can be taken to tackle the situation.
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Priyamvatha P. ChennaiApril 28, 2021UPDATED: April 28, 2021 11:39 IST
A person with a breathing problem receives oxygen support inside her car at a gurdwara amidst the spread of coronavirus disease, in Ghaziabad. (Photo:Reuters)
Amid the second wave of Covid-19, healthcare personnel in India have been trying to do their best under trying circumstances. Stretched to the breaking point, the pressure of work and shortage of material during the second wave may cause deaths that could have been avoidable, India’s top virologist Dr T Jacob John has said.
In an email interview to India Today’s Priyamvadha P Vijayakumar, Dr T Jacob John, former professor and head of the department of clinical virology and microbiology at Chennai Christian College in Vellore said, “The so-called UK variant was detected in September 2020. That was an alert for India to be on guard and look systematically for variants of concern. In December, the lab consortium was networked but the goal of gene sequencing in 5 per cent of all cases was not taken seriously.”
In this detailed interview, Dr John analyses how India ended up in the present crisis. How it started, where we went wrong, and what can be done. Dr John also clears myths about vaccination in this tell-all interview.
Here are the excerpts from the interview:
India Today: What does the surge in Covid cases in India indicate? How bad is the second wave?
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Dr T Jacob John: Like in earlier pandemics of influenza and like in other countries, the second wave of Covid-19 has happened in India. The second wave is different and more worrying than the first.
India Today: Lancet's study indicates that there could be over 1000 deaths per day in June. What is your view?
Dr T Jacob John: Deaths are proportionate to infections and that proportion may not necessarily be any different than the first wave. But we will have to wait and see. As of now, the infection-fatality or case-fatality seems to be unchanged. Infection-fatality and case-fatality are not easily dissected in India because of the way numbers are reported. But consistently it has remained below two. More infections will cause more deaths. While healthcare staff is better informed, sheer pressure of work and shortage of resources may cause more deaths.
Also See: Covid-19 vaccination FAQs: Your questions about coronavirus vaccine safety answered
India Today: Which age group is going to be most affected due to new mutant variants?
Dr T Jacob John: The system was slow to look for and detect mutant variants of concern. Reports in the media indicate that younger age groups, largely unaffected in first wave, are now getting infected. Whether this is indicative of higher infectiousness will be known as studies are reported. Probably the higher infectiousness alone may explain this change.
ADVERTISEMENT
India Today: Do you think the government should step up vaccination process?
Dr T Jacob John: Vaccination is a very important intervention. But an impact on epidemiology can be had only after two doses and a sizeable proportion are vaccinated to give a guess, at least 25-30 per cent. As of now, around 2 per cent has been given two doses. Stepping up vaccinations will not affect the rise of second wave, but it will definitely save many lives. I do not think India can conduct mass vaccinations in order to make an impact on epidemiology now, as vaccine supplies will not meet this demand.
India Today: Was India well-prepared for the second wave?
Dr T Jacob John: No, the government and scientific community did not expect a second wave, or a wave of this magnitude, as the first wave was a one-year affair. It took six months to reach the peak and six months to decline to steady and low numbers. From December 27 till March 11, the daily numbers were around 20,000 and that pattern was assumed to continue. However, that is no excuse for not being ready for an increase until at least 30% of the population was vaccinated.
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Also See: Fully vaccinated Americans need not wear masks outdoors unless in big crowd, says US CDC
India Today: Could we have been more alert looking at the trend in UK and Europe?
Dr T Jacob John: The so-called UK variant was detected in September 2020. India was asked to be on guard and look systematically for variants of concern. In December, the lab consortium was networked but the goal of gene sequencing in 5 per cent of all cases was not taken seriously. I hear that labs were not given the necessary funds for additional personnel and reagents. So, India was slow to understand the importance of mutants. Even now, less than 1 per cent of cases are studied for genome sequencing.
India Today: Is the virulence worse in the new variants? Should we expect more mutant variants?
Dr T Jacob John: Mutant variants are a function of the magnitude of infection a greater number of people infected means more chances of variants of concern. So, more mutants were predictable, but would the mutants be of concern or not have to be specifically investigated?
India Today: What impact will double mutants have in India?
Dr T Jacob John: The double mutant was a variant detected late last year, but its impact was not investigated until the second wave threw up questions. The classification of the double mutant is B.1.617 and it seems to be the dominant virus in Maharashtra. Not sure where else it has been detected.
India Today: Is there a need for genome sequencing?
Dr T Jacob John: UK variant B.1.1.7 was detected in September 2020, only because of routine genome sequencing. Similarly, South African variant B.1.351 was found in October 2020. The Brazil variant P.1 was detected since Japan was doing routine gene sequencing; in Dec 2020, Japan picked up a variant in four persons. All had travelled from Brazil then Brazilian viruses were analysed and P.1 was dominant there. Genome studies are very important for the management of the epidemic.
India Today: Despite the vaccination drive, people seem to be hesitant about taking the shot. Can you clear myths surrounding vaccines?
Dr T Jacob John: Myths are man-made. The usefulness of vaccinations to save lives (prevent severe disease) was not drilled into people. Lack of transparency of serious adverse events following immunisation added to the fear of educated people. The vaccine roll-out, its rationale was not explained to people. People invent imaginary theories to fill the vacuum of authentic information. Many deaths after vaccination were reported in the press but the government did not move fast in explaining the causality. That made many suspicious. Lack of trust and suspicion of non-scientific motivations added to the confusion. Health ought to be non-partisan above politics and all political parties should be on board for decisions on health. If that does not become visible, people lose trust. All political parties were not aligned against the common enemy. The lead should be the ruling party.
India Today: There have been unconfirmed reports on the side effects of vaccines.
Dr T Jacob John: In all developed countries, all vaccine side-effects (called AEFI, adverse events following immunisation) are listed and serious ones investigated, and information made available in the public domain. This is not done in India. So reports remain unconfirmed.
There is an AEFI monitoring committee in Delhi, but it can only work if data is made available to it. And when it comes to investigating serious AEFI, local standards vary widely. There were media reports of many deaths, but details are not given out by the AEFI Committee.
This lack of transparency has two components systemic competence and deliberate secrecy. These lead to vaccine hesitancy also. We have Western data on the AstraZeneca vaccine, called Covishield in India, and some media reports seem to corroborate with Western information. We do not have any more information.
My impression from such reports, and from the Phase 3 trial data available in the public domain, that the other vaccine, Covaxin, does not have any reported serious AEFI including death. But please don’t take my word on that, we do need authentic data the AEFI committee alone can provide.
India Today: Are vaccines working on the new variants of the virus?
Dr T Jacob John: That is not a matter of opinion but clinical observation. I hope we soon have information from ICMR or major medical centres on the “breakthrough” cases. In general, from two weeks after the second dose of either vaccine, no one has developed severe Covid so vaccinate, protect life.
India Today: Are there breakthrough infections after vaccination in India?
Dr T Jacob John: Immune protection is against disease, measured in Phase 3 against disease confirmed with RT-PCR. Asymptomatic infection is not on the radar screen. However, we know that even one infection is occasionally ‘broken through’ with infection and disease. But the second infection is always mild. The earlier question of keeping a tab on breakthrough infection/disease and whether there are more variants in such instances will be known after study reports.
India Today: There are reports of a lack of hospital beds for Covid patients in various parts of India. How robust is the health care mechanism in India? What kind of change is required?
Dr T Jacob John: Human health has never been given the attention that it deserves in India. There are several reasons. I am not going into them here. There are two pillars of “health management” that are dutifully maintained in all western democracies, but not in Indian democracy. One is semi-autonomous public health and the second is universal healthcare. The USA is the “Mecca” of public health, but their healthcare is not as good as Canada’s or the UK in terms of equitable reach. India imitates the USA in healthcare but ignores public health altogether.
Our healthcare is divided by under-budgeted public sector healthcare (often misunderstood as public health) and the profit-motivated private sector. In either way, quality assurance is not mandatory.
The general standard is 300 hospital beds per lakh population; India has 50/lakh, in company with the poorest countries of the world. Bangladesh has 80/lakh. By bed availability, India’s rank is 155 among 167 countries.
India’s health management system deserves a very thorough review and revision. But I am not hopeful India will do that. I have been advocating a full-fledged commission of inquiry into India’s needs in health management, not merely in healthcare.
India Today: India has exported over 5.84 crore Covid-19 vaccines to 70 countries against 3.48 crore it administered. Now, Indians are in dire need of vaccines. What went wrong?
Dr T Jacob John: My views are my own, but that does not mean it is off the mark. The pandemic response approach of the government of India had two arms disaster management and the 1897 obsolete Epidemic Diseases Control Act. I had always thought that such British Raj acts had been removed or revised. But no. Neither arm could imagine the need for vaccines their objectives were “responding”, meaning “reacting to” the problem. To be “proactive”, we needed a “public health” approach of projecting future needs and planning for the most likely needs. Vaccines were neglected. Two entirely private sector companies rescued India’s reputation by investing their own private funds in vaccine manufacturing.
India Today: How long will it practically take to vaccinate the entire population in India?
Dr T Jacob John: I am not aware that anyone has calculated the country’s needs in vaccine volumes. Vaccines have two purposes: healthcare's purpose is to prevent deaths, severe disease, hospitalisation and the need for ICU beds. The doses needed for this purpose is different from the one below. Those who are vulnerable need vaccinated, not everyone. The purpose of public health is to reduce the burden of disease by population-based vaccination. Here the target has to be defined and vaccination strategy planned. I have not heard anyone doing that either. That strategy must say what proportion of people and what age groups must be vaccinated.
India Today: How promising is the Sputnik vaccine?
Dr T Jacob John: Seems to be no less than Astra Zeneca, but probably more immunogenic as the two doses are with two different adenovirus vectors.
India Today: Fitch Solutions has said India is badly placed to tackle the third wave of Covid -19 infections. Do you agree?
Dr T Jacob John: Shall we get over the second wave first? The way the two waves have behaved, almost saturating the population, I do not expect a third wave and in any case, it will not be as bad as the first or second. We have vaccination also.
India Today: We are in the midst of elections, cricket matches and Kumbh Mela. Do you think these should have been avoided? Did the government get a warning about the second wave?
Dr T Jacob John: The decisions to allow or promote these were political and done without consulting public health experts. In the absence of division of public health, where are the experts? But if we had been systematically looking for mutant variants and had we found them on time, perhaps more caution might have been applied.
India Today: Why are states like Uttar Pradesh, Maharashtra and Chhattisgarh recording a higher number of cases?
Dr T Jacob John: There is a lag time of 10 days to two weeks before the arrival of a virus, in our case most probably one of the variants, before cases show up.
India Today: Do you think that election priorities could have led to underreporting?
Dr T Jacob John: The second wave is catching up everywhere. India is not spending much on research and development. Less than one percent of GDP is spent on R&D. We have less than 400 researchers.
India Today: What is the need of the hour?
Dr T Jacob John: Science and respect for science are cultural elements. The very understanding of science in our culture is warped. Japan has its own unique culture, but post-World War II Japan accepted and embraced science and we know the outcome. India should have learned from that history, but we think, culturally, science and Indian culture are incompatible with each other.
India Today: For now, India is doing micro containment. Do we need a complete lockdown?
Dr T Jacob John: I am not in favour of complete lockdown because we can predict it will not be complete but leaky. Restrictions at local levels are okay. Mask-wearing is a must.
India Today: People have become complacent over the months. What is it that people should learn from the new wave?
Dr T Jacob John: Any gap given to any infectious agent is risky. And we gave three not looking for variants and their dynamics; allowing huge crowds for various reasons; not maintaining Covid-appropriate behaviour.
India Today: Will India develop herd immunity now? Will that help in tackling Covid?
Dr T Jacob John: You are right, herd immunity threshold will be reached soon and that will turn the tide.
India Today: How long do you expect this wave to last?
Dr T Jacob John: By the looks of the graph, the peak is around now and the wave will last until the end of May/early June. After that, we should reach an “endemic” infection level.
India Today: When will the world come out of the grip of Covid?
Dr T Jacob John: The epidemic phase of the pandemic should be over within a few months and thereafter the infection will perpetuate itself as endemic. Very much like seasonal flu.
India Today: Studies have proved that Covid is not dangerous for children. But we see a surge in paediatric cases. Is that something to worry about?
Dr T Jacob John: In general, yes. However, severe and fatal paediatric Covid was reported in many countries including India. It is called ‘Multi-system Inflammatory Syndrome in Children’.
India Today: Have you sent any recommendation to WHO on tackling the new variants? What is your suggestion to the Indian government?
Dr T Jacob John: I have requested WHO to consider a future plan to eradicate coronavirus.
India Today: What is your suggestion to manage the lack of oxygen and hospital beds?
Dr T Jacob John: I don't have an opinion on that. Why don’t all big hospitals have oxygen generators in the house? Why didn’t the government give duty exemption to buy them from overseas, not just now, but in the past? This is my personal opinion.
India Today: Will vaccines lead to hyper thrombosis in some cases?
Dr T Jacob John: The blood clotting problem with some vaccines has been called thrombotic thrombocytopenia syndrome (TTS). It is a very rare adverse event following immunisation with the Oxford Chimpanzee adenovirus vector (Astra Zeneca) vaccine. Very rare means in the order of 1 per million or thereabouts. It is almost always in women, particularly below 50 years. However, I do not have data on the risk in women below 50 vaccinated -- so the rate of 1 per million general population has to be reworked to know the actual risk exclusively among women below 50. Obviously, the risk will be higher in frequency. One European country found 1 per 40,000, I believe.
Under such circumstances, if you have a choice between this vaccine and another, the latter should be preferred in women below 50. If there is no choice but only the Oxford vaccine is available, the risk of severe disease from Covid is far greater than the risk of clotting disease after vaccination.
India Today: Some have raised doubt about the death of actor Vivek after the vaccination. Should it have been analysed?
Dr T Jacob John: There are extremely important lessons here. The death within a day after vaccination due to a block in the coronary artery detected by angiography could not have been caused by the vaccine, directly or indirectly. TTS takes a few days to develop. There is nothing in any vaccine that will affect coronary blood supply within such a short time as one day. Sequence alone cannot be evidence for consequences.
The actor was a walking candidate for a "massive heart attack" because of the coronary artery blocks that had developed over time, perhaps a few years. Lack of chest pain previously or breathlessness when climbing stairs -- the usual symptoms of coronary artery block, may not occur in some people and they are the ones who develop heart attack out of the blue.
The lesson is that all above 45 years must undergo periodic heart checks, including the treadmill test. If caught prior to a heart attack, the condition is eminently treatable. Periodic means, perhaps once in three years.
India Today: Some experts believe elections have been a major trigger for surge in cases. Do you accept? Should elections have been allowed?
Dr T Jacob John: Elections, if conducted with all due precautions, are not likely to trigger surge in cases. But what preceded elections in India, the rallies and massive meetings, definitely put a huge number of people at risk of getting infected and worse, spreading it. Elections were announced when the coronavirus infections were occurring daily in large numbers. During February-March, it was in the range of 20,000 per day over a few weeks. Everyone knew that it was like a smoldering fire, which would flare up.
I have no opinion about the constitutional requirement for elections when the pandemic was raging, even though in India we had passed the peak. If it was constitutionally mandated at that time, the governments (Union and state) and Election Commissioners should have strictly stipulated all Covid-appropriate disciplined behaviour. Not stipulating such conditions was unfortunate and inappropriate on the part of the three parties mentioned above.
An important lesson: A pan-India epidemic, under the enforced 1897 Epidemic Diseases Act, should have been a national problem, above politics. I firmly believe that at times of such a crisis, even called "disaster", all-party decisions had to be made. The Union government and Chief Election Commissioner should have arranged, as soon as dates of elections were decided, to have all party meetings to agree upon conditions of electioneering when the nation was under disaster management modalities and the Epidemic Diseases Act. I don’t think the disaster management agency alerted all political parties. I don't think the Health Minister blew whistle either.
India Today: According to you, when is the human race likely to come out of the grip of Covid?
Dr T Jacob John: Covid is now in pandemic form -- all countries having epidemics. The epidemic phase will get over with and all countries will continue to have "endemic" (low and stable) presence of the disease and its infection. With the majority getting infected, and vaccines getting rolled out, I hope that we will be reaching endemic phase (staggered country-by county), sometime in last quarter 0f 2021 or early 2022.
That is not exactly very good news because all vulnerable folk, seniors and those with co-morbidities, and other diseases and immunosuppressive treatments (cancers, transplants etc) will always live with the risk of severe COVID or at least fear of such risk. By then I expect some recommendations for periodic booster vaccinations of previously vaccinated people and regular vaccination of all previously unvaccinated people, children or children growing up as adolescents/adults will be in place.
These predictions are based on our experiences with pandemic influenza in the past. If we want ‘to come out of the grip of Covid’, eradication, like smallpox and polio, is the ideal way -- in my personal view, the only way.
When I speak of "eradication" at this point of time, hardly anyone in her/his right mind can take it seriously. People may even laugh at it. But "all truth goes through three phases -- first it is ridiculed, then it is vehemently opposed and finally it is accepted as self-evident" (Arthur Schopenhauer). After some years, people may desire eradication but there will be problems -- now is the best time to consider this seriously.
India can offer leadership since we have two Indians at high positions in WHO. Planning costs nothing: when a strategy and tactics are defined, practicalities can be enumerated and taken up one by one. If we miss the most opportune time, that is now, future generations may fault us for having missed the best opportunity.
Also Read | Vaccine registration on CoWIN for those above 18 begins on April 28
Also Read | Sputnik V arrives on May 1. What makes it different?
Shahzaz ud din
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India: Dying too fast to be counted - Covid funeral pyres burn day and night
Galactic Penguin SST
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The worst is still ahead!
Apr 24, 2021
1 million COVID19 deaths projected in India by August 2021. The model even assumes vaccines will bring it under control by May 17th (peak deaths).
God help us. God help India.
(Projections by the world renowned epidemiology center @IHME_UW)
https://covid19.healthdata.org/india?view=total-deaths&tab=trend
https://archive.ph/6KumA/30b15ba3ad3a7672a53fe4cb79b74dbb1b26ddcd/scr.png ; http://web.archive.org/web/20210427130356/https://twitter.com/DrEricDing/status/1386998523288334344 ; https://archive.ph/6KumA ; https://archive.ph/bDiSB ; https://archive.ph/bDiSB/bdb24fb2bc30346079bee7d4c150259c9a4e35fb/scr.png ; http://web.archive.org/web/20210427131321/https://covid19.healthdata.org/india?view=total-deaths&tab=trend
▲ 4. One million COVID19 deaths projected in India by August 2021. Apr 24, 2021·
1 million COVID19 deaths projected in India by August 2021. The model even assumes vaccines will bring it under control by May 17th (peak deaths).
God help us. God help India.
(Projections by the world renowned epidemiology center @IHME_UW)
https://covid19.healthdata.org/india?view=total-deaths&tab=trend
https://archive.ph/6KumA/30b15ba3ad3a7672a53fe4cb79b74dbb1b26ddcd/scr.png ; http://web.archive.org/web/20210427130356/https://twitter.com/DrEricDing/status/1386998523288334344 ; https://archive.ph/6KumA ; https://archive.ph/bDiSB ; https://archive.ph/bDiSB/bdb24fb2bc30346079bee7d4c150259c9a4e35fb/scr.png ; http://web.archive.org/web/20210427131321/https://covid19.healthdata.org/india?view=total-deaths&tab=trend
▲ 4. One million COVID19 deaths projected in India by August 2021. Apr 24, 2021·
terry5
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Baby Starved For 2 Days As Mother Lay Dead, No One Helped Fearing Covid
A baby was found next to the body of his mother who had been dead for two days inside their home near Maharashtra's Pune -- one of the countless unspeakable tragedies that have emerged in the pandemic.
No one reached out to the family fearing Covid; a stench forced the landlord to call the police to the house located in Pimpri Chinchwad.
On Monday, the police broke into the house and found the woman's body and the infant next to her. The woman was suspected to have died on Saturday, which means the 18-month-old had been without food or water all that time.
Though neighbours shrank from even holding the baby, police constables Sushila Gabhale and Rekha Waze took charge and fed him.
"I also have two children, one eight, one six. The baby felt like my own child, he drank milk very quickly as he was very hungry," said Sushila Gabhale.
Her colleague Rekha said the child was miraculously fine, except for fever.
"The child had a little fever when we showed him to the doctor. He told us to feed him well, the rest is fine. After feeding the baby biscuit with water, we took the child to the government hospital for a corona test," she said.
The baby's Covid test has turned out negative and he was shifted to a government creche.
His mother's autopsy is yet to reveal how she died and it is not known whether she had Covid.
www.ndtv.com
Shocking . How can anyone be so heartless
A baby was found next to the body of his mother who had been dead for two days inside their home near Maharashtra's Pune -- one of the countless unspeakable tragedies that have emerged in the pandemic.
No one reached out to the family fearing Covid; a stench forced the landlord to call the police to the house located in Pimpri Chinchwad.
On Monday, the police broke into the house and found the woman's body and the infant next to her. The woman was suspected to have died on Saturday, which means the 18-month-old had been without food or water all that time.
Though neighbours shrank from even holding the baby, police constables Sushila Gabhale and Rekha Waze took charge and fed him.
"I also have two children, one eight, one six. The baby felt like my own child, he drank milk very quickly as he was very hungry," said Sushila Gabhale.
Her colleague Rekha said the child was miraculously fine, except for fever.
"The child had a little fever when we showed him to the doctor. He told us to feed him well, the rest is fine. After feeding the baby biscuit with water, we took the child to the government hospital for a corona test," she said.
The baby's Covid test has turned out negative and he was shifted to a government creche.
His mother's autopsy is yet to reveal how she died and it is not known whether she had Covid.
Baby Starved For 2 Days As Mother Lay Dead, No One Helped Fearing Covid
A baby was found next to the body of his mother who had been dead for two days inside their home near Maharashtra's Pune -- one of the countless unspeakable tragedies that have emerged in the pandemic.
www.ndtv.com
Shocking . How can anyone be so heartless
ARMalik
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And when you thought things cannot go ANY LOWER INDIA -- they will burn dead people in a Garbage Dump ! No Joke !!
Mavallipura landfill, 30 kms north of #Bangalore will be used as an open air crematorium for #COVID19 victims. This place is a stinking hell hole of garbage. Is this how we reward citizen tax payers in their death? No words for this callousness!
Mavallipura landfill, 30 kms north of #Bangalore will be used as an open air crematorium for #COVID19 victims. This place is a stinking hell hole of garbage. Is this how we reward citizen tax payers in their death? No words for this callousness!
khansaheeb
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India's Covid crisis has revealed the real Narendra Modi | CNN
Meenakshi Narula Ahamed writes that India's prime minister Narendra Modi's handling of the pandemic is endangering the country's public health but also its public institutions and democracy.
India's Covid crisis has revealed the real Narendra Modi
Opinion by Meenakshi Narula Ahamed
Updated 10:59 PM ET, Sat May 1, 2021
'Nothing short of an apocalypse': Indian doctor on Covid crisis 03:48
Meenakshi Narula Ahamed is a journalist and author of "A Matter of Trust -- India/US relations from Truman to Trump." The views expressed in this commentary are her own. View more opinion on CNN.
(CNN)By 2014, when Narendra Modi became prime minister of the world's largest democracy, India had long shed her image being one of the poorest nations teeming with starving and sick people in constant need of foreign aid. Under a team of pro-western reformers, India underwent an economic transformation in the 90's and by the early 2000's was being hailed as an economic powerhouse and an attractive partner for the western alliance.
Today, the image of "India shining" — a publicity slogan the ruling Bharatiya Janata Party (BJP) tried so hard to promote in 2004 when it was first elected — is in tatters as news outlets around the world and social media carry images of Indians dying of Covid-19 in the streets as hospitals have run out of beds and oxygen and have had to turn people away. And then there are the gruesome images of mass cremations in parking lots and on sidewalks.
India's second wave of the pandemic has once again revived images of a country of disease and death. With its health care system collapsing under the strain, the government announced this week that is welcoming foreign assistance, after 15 years of rejecting foreign aid. Countries like Russia, the United States, the United Kingdom and others are sending supplies to India despite the country being a vaccine manufacturing hub. Many blame the Modi government.
In March 2020 when the news of a possible global pandemic made headlines, Modi acted swiftly and ordered a national lockdown and mandated masks and social distancing. As a consequence, the covid rates in India remained manageable until early in 2021. What went wrong?
Modi has offered little more than hollow words amid India's horrifying covid crisis
While the prime minister can be congratulated for acting decisively during those first few weeks, his implementation was flawed and contingency planning for a future resurgence negligible. Several governments have made mistakes during the pandemic, but in India the mistakes proved to be disastrous due to the sheer scale of the population.
When Covid first hit, India faced a vacuum of leaders that previous governments had been able to rely on to provide the sort of contingency planning necessary to weather a crisis. Throughout his tenure as prime minister, Modi has consistently accused former public officials and previous administrations of being out of touch and corrupt. He has undermined the institutions of democracy by compromising the independence of the judiciary and has suppressed protests over the controversial 2019 Citizenship Amendment Act which fast-tracks citizenship to immigrants from neighboring countries — but not if they're Muslim.
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The handful of US trained Indian American professors who returned to India to serve under Modi's government, like Viral Acharya and Raghuram Rajan, have left the administration.
Despite being one of the major vaccine manufacturers in the world, the government has failed to provide adequate funding to ramp up the needed supply of Covid-19 vaccines. Instead, 60 million vaccines manufactured in India were exported to other countries as part of a "vaccine diplomacy" initiative. Although the exports were stopped in March, it was insufficient to make up for the shortages. These measures have had consequences.
As of Saturday, only 1.9% of India's nearly 1.4 billion population had been fully vaccinated. By comparison 30.3% of the US population is fully vaccinated.
But lulled into complacency by the declining rates of infection last year, Modi acted as if the battle had been won and made a series of critical mistakes. Instead of focusing on getting the country vaccinated and making sure the health care system had adequate supplies, the prime minister turned his attention to winning state elections. Amid an election year, massive political rallies were allowed to take place without ensuring Covid protocols.
What makes Andrew Yang appealing to New Yorkers?
Modi's minister of home affairs, Amit Shah, who he relied on as his political strategist was on the campaign trail rather than fulfilling his duties handling the pandemic, as several news outlets in India reported. They pandered to their Hindu base and allowed the Kumbh Mela to take place, a Hindu festival where millions gathered to pray over two months defying social distancing as Covid cases spiked. Thousands contracted the virus as a result and the events were deemed super spreaders.
The prime minister's reputation as an efficient administrator when he was chief minister of the state of Gujarat convinced people he would bring the same skills to Delhi, but the pandemic has revealed his shortcomings in managing a vast and complex nation with its multicultural population. He also failed to protect the Muslim minority when his party blamed Muslims for spreading Covid in India last year.
Back then, the public was given just a few hours' notice before the first lockdown, creating weeks of domestic havoc and enormous hardship to the thousands of poor migrant workers in big cities. Many of them were unable to return home when public transportation shut down and no public assistance had been provided for them.
Modi promotes himself as a man of the people, but his policies, from demonetization in 2016 and the 2020 lockdown, have adversely affected the most vulnerable population, displaying a remarkable lack of empathy for the very people he claims to represent.
The prime minister indulges in dramatic but empty gestures such as ordering the population to light candles and bang on pots and pans at a selected hour across the country to boost morale to convey that he is in charge.
He dresses in elaborate headgear and coats with his name embroidered on them and surrounds himself by religiously motivated people like him, disregarding science and experts. His health minister appalled the scientific community by suggesting cow urine as a potential cure for Covid.
Doctor: The secret weapon for ending the pandemic
Modi's defiant march to reconstruct India into a Hindu nation, uprooting it from its secular constitution as conceived by the founders of modern India, has been a priority for him and his key advisers.
The extent of the damage to the basic institutions of government under Modi is becoming increasingly visible. With his authoritarian tendencies, he has become intolerant of dissent within the government. Ideas that run contrary to the party line are suppressed. Vigorous debate on policy issues is no longer permitted. The attempt to cripple India's democratic institutions is evident everywhere. The BJP has intimidated the domestic press and has tried to have Twitter and Facebook remove posts critical of the prime minister. Modi even slammed Australian newspapers for criticizing his handling of the Covid crisis.
In response to this growing humanitarian crisis, President Joe Biden pledged to the prime minister that the US would provide "a range of emergency assistance, including oxygen-related supplies, vaccine materials and therapeutics" to India. The first US shipment arrived in India Friday morning. Europe is also rushing to help with personal protective equipment, oxygen and ventilators.
Pleasing the US is one of Modi's core foreign policy values. He was a constructive partner to President Barack Obama on climate change and catered to President Donald Trump's ego by organizing a welcome ceremony that drew a massive crowd during his visit to the country in February 2020.
As defense cooperation between two countries continues to grow and their convergence of interests over an aggressive China find common ground, the partnership has enormous potential. The Biden administration is hoping that India will play a significant role in containing China in the Indo-Pacific as a member of the Quad group, comprising Australia, Japan, India and the US.
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One of the key reasons why Presidents Bill Clinton and George W. Bush courted India and changed the relationship into the partnership it is today was their admiration for India's commitment to democracy.
During the many ups and downs in relations through the past 70 years between the two countries, it was the tie that bound them together. But as Modi becomes increasingly Trumpian, dividing the country, pursuing religious majoritarianism, suppressing dissent, and poorly handling the pandemic it could result in instability and make India not only a less reliable ally but a less desirable geopolitical partner.
pakdefender
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such a terrible situation in India , its citizens literally cannot breathe , still on Indian forums and twitter the gangus are more concerned about Pakistan and China and how to inflict damage on us, such a pathetic bunch , even if one feels sorry for their plight due to COVID one read of their comments makes all that sympathy go away , truly a very wretched people these Indians are
Shahzaz ud din
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A Virus has punctured the Pretentious Bubble of a Nation Full of Hubris!!!
Shahzaz ud din
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India’s ‘invisible and unwanted’ will suffer most from Covid - sculptor Sir Anish Kapoor
India is starting to be the spreader of the black plaque so to speak. Will the Indians become an extinct species like the dinosaurs? Is there still time left for salvation? China is doing what it can but the core solving solutions lies within the Indian government and the Indians.
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And to add to this, a rare and deadly black fungus pandemic has just strike India today.
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