The disease that kills us

There is no escaping the death and destruction of the SARS-CoV-2 pandemic that is upon us in a second disastrous wave. Experts tells us we will hit a peak soon. The numbers will then begin to climb down as a majority of Indians are exposed to the virus and/or the variants that are thought to have caused the havoc in this round. With nothing more left to burn, even the wildest of fires die. Nature would have found a way to bring some calm – we did precious little, and can only pray that there will be no third wave.

But right now, we are submerged. And yet, we may ask: is it Covid-19, the disease caused by SARS-CoV-2, that is killing us? Or is it something more that has left us so exposed, so vulnerable and so helpless? Images of ordinary people begging for a hospital bed, queues for Remdesivir and a shortage of oxygen and vaccines have become all too common. In neighbourhoods across the nation, the myth of India as a would-be superpower in charge of its destiny stands busted as a defeatist resignation takes hold. The virus has exposed us as the backward, bottom-of-the-heap and almost irrelevant player we have been, unable to respond to a crisis that has come upon us not once but twice in the last 12 months.

Images of ordinary people begging for a hospital bed, queues for Remdesivir and a shortage of oxygen and vaccines have become all too common. In neighbourhoods across the nation, the myth of India as a would-be superpower in charge of its destiny stands busted as a defeatist resignation takes hold.

Even if we may excuse the poor response during the first hit last March, there can be no excuse for doing worse the second time around. Consider that we can claim to fight at the borders but die in the tens of thousands within our borders. The nation has been described in recent days by senior functionaries of the government varyingly as a space superpower, knowledge superpower, economic superpower, manufacturing superpower, even a vaccine superpower. We can get people to come together to beat empty vessels and light lamps and lakhs march out with a leap of faith to the kumbh mela but we can’t arrange hospital beds when a pandemic we know is around and flares up.

Examples of how badly we fought this war come from all directions. It is difficult to get ambulances.  Remdesivir is being black-marketed, the latest being the BJP seeking to procure these vials in a private operation in Mumbai, leading to the arrest of two directors of a manufacturer company. The distribution of vaccines has become a bone of contention between the Centre and non-BJP ruled States. In Maharashtra, for example, no one can miss the fact that vaccines are in short supply. Several vaccination centres have closed. Yet, this has led to the lowness of a Trumpian twitter war, not a fix of the problem at hand. New Delhi is as fast as ever with tweets, and terrible with building trust.

The former Prime Minister Dr. Manmohan Singh has offered a simple and wise solution: distribute vaccines transparently using an agreed formula so that States know how much is coming, when to expect stocks and can plan their roll outs. Coupled with advance orders to vaccine manufacturers and compulsory licensing, we should set the course for a swift coverage for a wider age group, not just those above 45 years of age. The second round of the pandemic already indicates that the virus is no more sparing the young, many of whom have landed in hospital with respiratory distress.

New Delhi is as fast as ever with tweets, and terrible with building trust.

What does it take to keep away pettiness, to take decisions that are simple yet bold and to let the nation see and feel that this is a government geared to fight the pandemic, not merely to win the next election round the corner? We can see Covid-19 is the disease but just beneath the surface is the real disease that kills us -- narrow mindedness, one upmanship and the turning away from an evidence-based approach that allowed the government to endorse a holy snaan and a gathering of lakhs – devotees duly facilitated with 12 pairs of special trains and welcomed with front page ads featuring the Prime Minister of India and the Chief Minister of Uttarakhand. The announcement to end the mammoth kumbh mela gathering came over the weekend -- too late in the day. The announcement is significant because it tells us that belief, faith and ritual are not contradictory to the scientific approach. Yet, the former has been put to work and exploited at the cost of the latter.  

An Associate Professor at the All-India Institute of Medical Sciences, Rishikesh, has been funded by the Department of Science and Technology to run a pilot to study the “effect of gayatri mantra and pranayama in terms of inflammatory markers in hospitalised Covid-19 patients.” The official record states: “…Scientists are racing against time for a miracle cure/vaccine to fight this pandemic which has gripped the world. In this scenario, role of pranayama and gayatri mantra chanting which has been used in other diseases and has shown promising effects becomes vital.” Millions of Indians who chant the Gayatri mantra, Hindus and non-Hindus alike, will understand that this is not the best way to respond to the pandemic.

We can get people to come together to beat empty vessels and light lamps and lakhs march out with a leap of faith to the kumbh mela but we can’t arrange hospital beds when a pandemic we know is around and flares up.

On the other hand, the Indian SARS-CoV-2 Genomics Consortium (named ‘INSACOG’) comprising 10 labs identified to study variants of the virus in India, launched in December 2020, had received no funds till at least as late as March-end. This was critical activity because variants are thought to have delivered the new wave. Yet, the nation has been too slow to launch this kind of sustained, planned and coordinated activity to sequence the virus genome. On 24March, the health ministry reported that “though VOC (variants of concern) and a new double mutant variant have been found in India, these have not been detected in numbers sufficient to either establish or direct relationship or explain the rapid increase in cases in some States.”

That begs the question: What has caused the current spike? Where is the epidemiological insight? As of 16April, only 13,614 Whole Genome Sequenced samples were processed at the 10 designated INSACOG labs. The ministry of health reported that of these, 1,189 samples tested positive for VOC (1,109 UK variants, 79 South African variant and one with the Brazil variant). We appear to not well understand the role and mix of variants even at this late stage into the second wave. Sequencing was targeted for 5% of total positives beginning December 2020; what was sequenced cumulatively as of mid-April is barely 5% of daily rise in infections!

Barely 1.2% of India is fully vaccinated. This compares to 25% fully vaccinated in the US, 14% in the UK and 3.8% in Brazil, which India overtook this month to have the second largest number of infections in the world, after the US.

This is not to speak of the dynamic, known to insiders, of the historical rivalry between National Centre for Disease Control, the proposed national hub for samples, and Indian Council of Medical Research and its wing, the National Institute of Virology, which has done early sequencing but has already been accused of not sharing data with others in the consortium.

Meanwhile, there is a daily release on vaccination numbers that look large in absolute terms but offer the true picture of the task at hand when we see that barely 1.2% of India is fully vaccinated, according to data from the University of Oxford. This compares to 25% fully vaccinated in the US, 14% in the UK and 3.8% in Brazil, which India overtook this month to have the second largest number of infections in the world, after the US.

It is true that COVID-19 is a terrible disease that is killing us but the disease that allows this disease to thrive and spread with impunity is the disease that we have had for long – a longing to live by a mythical story of a much-told greatness of yesterday to bring on an air of celebration today before we go crashing down tomorrow.

(The writer is a journalist and faculty member at SPJIMR. Views are personal)