This time, last year, India was under lockdown announced by Prime Minister Narendra Modi in a televised address in which he issued several warning messages. He spoke of the need for extreme vigilance and stressed the importance of physical distancing and the use of masks – points he would repeat several times later in the year. Part of the Prime Minister’s speech that is less remembered was a comparison note with countries more prosperous and more resourceful than India. Even these countries are struggling to control the novel coronavirus, he said.
The country fought back the virus through a combination of measures that restricted the movement of people – their socially and economically crippling effects are now well documented – the competence of its medical professionals who took the virus under conditions that demanded resolution unprecedented mental and physical health, and a host of arrangements to increase the health infrastructure. Medical protocols have evolved and policymakers have sometimes made innovative interventions – the Delhi government’s home care initiative for less severe patients that eased the burden on hospitals and quarantine facilities was one of them. A notable feature of the fight was also the use of makeshift facilities – stadiums, hotels, banquet halls were turned into COVID health centers.
Health facilities are again put to the test, a year later, the virus retaliating with vengeance. Several state governments, including those of Maharashtra and Delhi, have reverted to mobilizing “temporary” reinforcements.
The panic that has set in over the past few weeks has prompted a reminder of well-known criticisms and warnings – confessions as well – regarding India’s health infrastructure deficit. There is no doubt that the crown-shaped virus has become several times more infectious compared to last year. But scientists had always warned against the microbe’s arbitrary ways. As governments scramble for medical facilities, oxygen cylinders, ventilators, and critical drugs like Remdesivir, the question to ask is, has the unpredictability factor been enough? appreciated, when we decided – rightly so – to live with an opponent known for his insidious path, most hosts not even showing symptoms?
A virus hijacks cells from its receptor to make copies of itself. But the reproductions are not always perfect. Many of these mutations have little effect on the ability of the small entity to infect humans. Some of these errors even make the virus more benign. But some changes make it more apt to switch from one host to another. In September last year, as India’s first wave reached its peak, British scientists warned of a mutant 50 times more transmissible – implying that the microbe could cause many more deaths. he was not controlled. By the end of the year, more than 4,000 people in different parts of Europe had been infected with this mutant.
Earlier this year, evidence began to surface of the most prolific versions of the virus sneaking into India. In January, double mutants, now known as B.1.617, were found in samples collected in Maharashtra, weeks before the worst-hit Indian state began reporting reversals of gains made in January. last year. But there was no conclusive evidence that these specimens were typical of the recent outbreak of the state. And the jury is still out, about three months later, even as the Pune-based National Institute of Virology found B.1.617 in 60% of specimens collected in Maharashtra. The sample size is too small to show that B.1.617 is now the predominant colonizer. Meanwhile, there is evidence of this rapidly spreading mutant in samples from Delhi, Punjab and Madhya Pradesh.
Scientists say that constant analysis of the genetic information of the virus, combined with epidemiological data, is essential to provide real-time knowledge about the vagaries of the pathogen. Interestingly, the UK and India were aware of this imperative early in the pandemic. India’s enthusiasm, however, seems to have manifested itself – less than 1% of COVID-positive specimens undergo genomic sequencing – while the UK has been able to use this tracking method to alert the world to changes in the biology of the virus. Globally, however, the deployment of this technology has been inconsistent. But as a Lancet editorial in February noted, “the fact that The Gambia, Equatorial Guinea and Sierra Leone have higher genome sequencing rates than France, Italy or the United States suggests that wealth is not the only determinant of capacity ”. India, it seems, has also not made optimal use of its facilities. The Delhi-based Institute of Genomics and Integrative Biology is said to analyze less than 30% of the samples it is able to study.
Home Secretary Amit Shah belatedly admitted the possible role of mutants in the outbreak last week. “Scientists are studying it,” he said. The health ministry, however, remains stubborn over the country’s immunization strategy, developed as the pandemic receded. This time, he had rightly spoken of putting front-line workers, the elderly and people with co-morbidities first. With the virus taking on threatening proportions, the government has changed the priority criteria to include all people over 45. It has also granted emergency use authorization to vaccines that have received approval from the United States, United Kingdom, Japan and WHO. But the main challenge with India’s inoculation project was always going to be the rate at which it protects a substantial part of its population to reduce the severity of COVID – this challenge intensified with the second wave.
Last month, US President Joe Biden pledged to amass enough vaccine stocks to immunize all Americans by the end of May. In India, by contrast, states began to complain about the vaccine shortage. Although the Center vehemently denies such allegations, the CEO of the country’s leading vaccine manufacturing company first requested Rs 3,000 crore to increase production capacity, then pleaded with Biden to end the embargo. on the raw materials needed to produce the vaccine compounds the miasma, and asks questions: Is the government postponing the use of the 35,000 crore rupees allocated for vaccine development in the current budget? Has he hesitated to use his good offices with the United States to intercede on behalf of the country’s vaccine companies?
India’s scientific expertise and vaccine manufacturing capability has been rightly touted as its best bet in the fight against the virus. Have we used these capacities optimally, with sufficient institutional support? Did we learn the right lessons last year? The answers to these questions are essential to lift the gloom that has gripped the country.
This column first appeared in the print edition on April 19, 2021 under the title “Questions in a surge”. [email protected]