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. The long and the short of COVID in India .
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre,
Perundurai, Tamil Nadu, India.
Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052. drtramaprasad@gmail.com WhatsApp +91 98427 20393 BLOG https://drtramaprasad.blogspot.com
WEBSITE www.rama-scribbles.in Twitter @DrRamaprasadt Facebook T Rama Prasad
Telegram Dr T Rama Prasad
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A MONTHLY JOURNAL OF MEDICINE AND SURGERYSN
Vol. 119 No. 6 June 2022 ISSN 0003 5998
Indexed in IndMED Email: admin@theantiseptic.in www.theantiseptic.in
. The long and the short of COVID in India .
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre,
Perundurai, Tamil Nadu. Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052.
Specially Contributed to “The Antiseptic” Vol. 119, No. 6
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ABSTRACT
Two years on, different countries are facing different Covid situations. At one end of the spectrum, some countries are ‘feeling’ normal and lifted all the Covid restrictions, while at the other end, some are facing new surges of cases and imposing stringent restrictions. In between, some are torn between taking steps to step up economy and committing for communal safety. Public pressure is mounting for a return to normalcy. Governments are in a fix. India’s boat is smoothly sailing now in placid waters, but nobody knows for sure whether a ‘second-wave-like tsunami’ would violently rock the boat. Uncertainty prevailed over the past two years of the Covid journey by India. Some of the aspects of the peregrination which are India-specific are highlighted in this article in a semi-formal way.
Key words: COVID-19 in India, Covid waves in India, Indian immunity, SARS-CoV-2 variants, COVID pandemic, COVID endemic
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“Change the way you look at things and the things you look at change.”
-- Wayne W. Dyer
Introduction
Now, in April-May 2022, after the gruelling experience of being ‘imprisoned’ in their own homes and their own country for over two years, people seem to be in agreement with the above quote and also with another quote of Wayne W. Dyer: “Go for it now. The future is promised to no one.” People changed their way of looking at things and got emboldened to ‘punch’ the Covid (SARS-CoV-2 / COVID-19) and “going for it now”, despite warnings by the authorities that the perilous pandemic is not yet over. Released from ‘prisons’, after serving a sentence of two years, for no fault of theirs, people are now crowding at airports, tourist spots, night clubs, sports clubs, massage parlours, and what not !
Covid could have just been another viral disease except for its shocking kill power: (1) killing half-a-million to 4.7 million Indians (a fierce fight over the validity of these numbers is going on between the Government of India (GOI) and the World Health Organization (WHO)); (2) killing Indian economy (of inestimable figures).
It's now amusing to read what I wrote on January 24, 2020 of what now is called Covid: " … The death toll has alarmingly increased to 26 in China. Korea, US, Taiwan, Hong Kong, Singapore & Vietnam have also identified cases. The total number of cases reported has quickly risen to a huge 834, ..." At that point of time, we thought that 26 deaths due to the novel coronavirus was an 'alarming' number, and that the number of 834 cases was a ‘huge’ figure. The toll now, globally, two years later, is over six million, and the number of cases stood at more than 500 million ! The world is upended !
At that point of time, we thought that the problem with the new virus was that of China and some other foreign countries, not of India. A week later, on January 30, 2020, the first case of India was reported in Kerala. The next two cases were also detected in Kerala, on February 2 and 3 of 2020. Even then, we thought that the cluster of cases would vanish in a month or so just like the episode of the ‘great killer’ Nipah virus in Kerala earlier. The cases had increased to 500 and 10 people died when India was shocked and ‘locked down’ on March 25, 2020. We thought that these were ‘big’ numbers. A couple of weeks later, on April 10, 2020, I wrote: “… It is heartening to see that the Indian government and the Indian people are coming together to fight the monumental and formidable public health crisis through a 'lockdown'. But, India is highly vulnerable to an outbreak, given its large population and the creaky health infrastructure. There are critical weaknesses in India's health care system that may prevent a credible response to our efforts to contain COVID-19. …” Consistent with what I prophetically wrote, in spite of the stringent ‘lockdown’ in India, the cases had increased from around 500 to around three million and the deaths from around 10 to around 65,000 in just about five months. Now, two years later (May 2022), the cases are more than 40 million and the deaths are more than 5 lakhs.
The long and the short of Covid in India in our journey so far are briefly mentioned in this article albeit ‘semi-formally’. ‘Semi-formally’, because a million non-medical people are likely to read this on the Internet, though they may not be much interested to read ‘non-Covid’ subjects in medical journals – this type of readership is one of the characteristics of this enigmatic pandemic. People are curious to know the ‘known unknown’ ! The peregrination seems not to have come to an end as could be seen by the reports of popping up of multiple clusters in India in April-May 2022. More details about the Covid may be found in the 21 articles published in 21 months, and written by a single writer (T. Rama Prasad)) on a single subject (Covid), and published by a single establishment in The Antiseptic, a journal of Medicine and Surgery (indexed in IndMED), and in Health, a journal devoted to healthful living 1,2,3,4,5,6,7,8,9,10,19,12,16,14,15,13,17,18,11,39 (which is a world record in medical journalism). Some more related information may be found in the cited articles in other media. 21,22,28,24,25,26,27,23,29,30,31,32,33,34,35,36,37,38
Birth of Covid in India
Officially, the first case of Covid in India is that of a 20-year-old woman medical student who came to the General Hospital in Thrissur of Kerala State on January 27, 2020 with the symptoms of sore throat and cough of the duration of one day. She was treated and the case was studied at Thrissur Medical College Hospital, and she was discharged on February 20, 2020. She travelled back to India from China on January 23, 2020 owing to the Covid problem there. She didn’t visit Huanan Seafood Wholesale Market, but travelled by train from Wuhan to Kumming. On arrival in India, she was alerted by Indian officials to report if any symptoms develop. Hence, she approached the hospital.22 It may be interesting to know that this woman ‘tested positive’ for Covid again after 18 months in July 2021 with almost no symptoms. We have to presume that she was protected for such a long period by the antibodies produced naturally by the first infection, as she was not vaccinated. And the T-cell activation might have prevented the second infection to progress. Some experts cite this case to say that natural infection confers better immunity than that of a vaccine.
First Indian Covid wave
The ‘Covid infant’ in India had since grown up by leaps and bounds, especially from April 2020, to attain ‘maturity’ at the peak of the ‘first wave’ in India, around September 2020 (90,000 cases in one day). During the ‘first wave’ disinfectants were sprayed on people, newspapers were kept in sunlight, currency notes were ironed, millions of tablets of unproven prophylactic value went down the throats.7 Fear ruled the roost. Patients were afraid of visiting doctors out of fear of quarantine. And doctors closed their doors out of fear of infection and the reluctance to follow the stringent Covid regulations imposed on medical practitioners at that time.5 Then, Dr. WhatsApp and Dr. Google took over, and the 313 million illiterate people in India also could be treated at home ! Eric Schmidt once called social media an ‘amplifier for idiots’. Servant maids were instructed not to come for work. No guests were allowed inside homes. Caution meant cutting off communication.
After taking its pound of flesh, the virus left quietly. The following few months witnessed a gradual return to some semblance of normalcy. India took pride in containing the scourge, and sung the lullaby of victory before the war was over. People let the ‘superfluous’ guard down, and, just as a further guarantee, they started taking the vaccine casually and hesitantly. Experts could not explain what caused this stroke of serendipity – the unexplainable decline in cases and fatalities from October 2020 to January 2021 though people were reckless and indulged in all sorts of activities with impunity.
Second Indian Covid wave
Alongside the calmness after the storm of the ‘first wave’, celebrations, gatherings, meetings, ‘melas’, and ‘elections’ followed. Everybody downed the guard, including the authorities. Between October 2020 and January 2021, when Covid was at a low ebb in India, there was ample time and scope to deliberate and prepare to deal with a possible ‘second wave’. But most of the people including authorities didn’t take the issue seriously because of the prevailing perception of substantial gain in immunity produced by the infections of the ‘first wave’. This hubris was elevated by the ‘favourable’ results of the serosurveys and the arrival of vaccines. Even the epidemiologists and advisors to the government had dilly-dallied, and didn’t strongly predict and warn about the ‘second wave’.4 The wave soon took to surreal dimensions, leading to tragic incandescence of funeral fires. We were like a deer caught in the headlights.
The bewildering fact is that the hard-hitting ‘Joint Task Force’ official statement issued by the Indian Public Health Association (IPHA), the Indian Association of Preventive and Social Medicine (IAPSM) and the Indian Association of Epidemiologists (IAE) bluntly blamed the government for relying more on bureaucrats than on experts in the field ( https://www.iphaonline.org/wp- content/uploads/2020/05/Second- Joint-Statement-of-IPHA-IAPSM-and- IAE-on-COVID-19-containment-plan- May-25-2020_Shorter-version-final.pdf -- the statement, regrettably, offers a pretty damning critique).40, 5
Meanwhile the ‘Indian Covid child’ had grown, especially from February 2021, into a ‘robust Covid adult’ andcrash-landed on India causing terror. It unleashed its might, lashing the country, and peaking as a ‘second wave’ around April 2021 and logging 4.2 lakh fresh cases, 10,000 higher than the peak of the first wave and killing about 4,000, in a day (May 5, 2021). The wave took to surreal dimensions, leading to tragic incandescence of funeral fires. We were like a deer caught in the headlights. Even after the onset of the devastating and speeding ‘second wave’, everyone seemed to think of the problem, like ostriches, as only limited to some zones in the country. It presented a strange blend of panic and recklessness.
It was not realised until the end of the ‘second wave’ that the devastating ‘Covid power’ came from the ‘Delta variant’ (B.1.617.2).13 The WHO added the so-called ‘Indian double mutant’ (B.1.617) to the trio of ‘Vaccines of Concern’(VOC) at the global level on May 10, 2021. This variant is believed to have played a significant role in the genesis of the devastating second wave. Much more damage was done to India during the ‘second wave’ than during the earlier wave. There were shortages of vaccines, hospital beds, oxygen cylinders, other medical supplies and even burial space in some parts of India. Swamped by an avalanche of cases, the empathy of caretakers took the back seat. The surge of the ‘second wave’ which wreaked havoc on the country had driven everyone into a paralysing sense of fear, anxiety, tension and panic. The fear and paranoia percolated into everything – humongous amounts were spent on injections of unproven value.4, 39 Read my article titled “COVID Fear and Paranoia” in The Antiseptic journal of May 2022. 39
The injections, oxygen cylinders, ambulances and hospital beds were in the black-market as the fearful and paranoid public consumed them needlessly, depriving the needy. The desperate needy were exploited mercilessly, even by medical and paramedical personnel. 22,25 Fear among the public paves the way for profiteers. One Covid patient was billed $1.1 million in the US and another was billed Rs.16 lakh in India. These two bills may be genuine and reasonable for the service rendered, and the “seemingly high charges” may be necessary to make the hospitals economically viable and sustainable. But the General Insurance Council moved the Supreme Court against alleged 'profiteering' by private hospitals in India.22 It was mentioned that, when objected, in one case, the bill of Rs.14 lakh was brought down to less than 4.5 lakhs ! 22 (https://www.thenewsminute.com/article/full-list-hyderabad-hospitals-forced-refund-patients-after-hefty-covid-19-bills-164312) And it was reported that some laboratories and some private hospitals had an unholy nexus to promote hospital admissions -- by generating fake ‘Covid positive’ lab reports to drive patients, terrified by the lab results, into hospital beds for exploitation !22 On the positive side, there were plenty of private hospitals and numerous doctors who did yeoman service and sacrificed their lives too during the pandemic. More information on the ‘second wave’ may be found in my article titled “Disastrous Second Covid Wave in India” in The Antiseptic journal of June 2021. 4
Third Indian Covid wave
Some lessons were learnt, and the ‘pre-emptive and pro-active’ regimen of the ‘first wave’ was brought back into force more vigorously to tackle the expected ‘third wave’. But the BA.2 Omicron-powered ‘third wave’ didn’t bother India much to make use of the elaborately arranged ‘emergency beds’, though it infected the Indian population speedily and widely (incidentally promoting ‘herd immunity’), and quit as hastily as it came – just a couple of months, late December 2021 to March 2022; peaked at the end of January 2022 before beating a retreat.16,17,19
All had heaved a sigh of relief except some drug manufacturing companies which had stockpiled enormous quantities of ‘Covid drugs’ in anticipation of a deluge of seriously ill cases during the ‘third wave’. Saddled with the unwanted stock, the Indian drug industry may need to write-off an estimated Rs 1,000 crore. During the ‘second wave’, a humongous consumption of several needless drugs caused their artificial shortage. 25 Indirectly, the fear pushed up the sales enormously. For example, the anti-viral drug, favipiravir, has rocketed to make Rs. 352 crore in April 2021 alone overtaking all other top-selling drugs. Such sales were expected by the drug companies during the ‘third wave’, but it didn’t happen.
The ‘mildness’ of Omicron was not due to its ‘intrinsic mildness’ (it is more transmissible than, and as virulent and lethal as the Delta) but the ‘apparent mildness’ is due to the immunity gained by people through vaccination and or natural infection, according to the very recent studies – by Daniel et al, preprint in medRxiv, May 2022. The symptoms of Omicron varied from those of the other variants leading to some confusion in diagnosing. In one case, the symptom of ‘total loss of appetite and absolute aversion to food’ made the attending doctor to think of a psychiatric problem. A psychiatrist was promptly on the scene ! More data may be seen in my articles titled “Ominous Omicron of COVID”, “Omicron – A Paper Tiger” and “Post-Omicron Peregrination” published in The Antiseptic journal of January 2022, February 2022 and April 2022 respectively. 16,17,19
Fourth Indian Covid wave predicted
Right now, in April-May 2022, people have become very complacent and reckless again (just as in January 2021 before the onslaught by the ‘second wave’) in spite of warnings of emergence of a ‘fourth wave’ -- a controversial modelling study by scientists at the Indian Institute of Technology (IIT), India’s top technology school, has predicted a ‘fourth wave’ beginning in June and peaking in August 2022. The complacency and hubris arose out of three factors – one is the feeling that most of the people in the country might have gained huge ‘herd immunity’ through widespread natural infection during the three Covid waves; the second one is of the assumed large-scale immunity obtained through the very wide Covid vaccination coverage; the third one is of the fact that people are sick and tired of listening to and following the same preventive advisories over a long period of two years. Simple fatigue. While Indian authorities are cautioning, people seem not to care a hoot.19,39
Business as usual
So, people are back in the malls, restaurants and tourist spots with a vengeance, as if to make up for the time they lost to the pandemic. ‘Come what may’ is the attitude. But, bitten by the ‘second wave’, the Government of India (GOI) is very vigilant, but hesitant to impose severe restrictions (lest it may incur the wrath of the public), notwithstanding the appearance of some ‘clusters’ of cases here and there in the country during April-May 2022. People can’t be deprived of livelihood for long, and for many ‘making money’ is a hobby or an addiction.
As Scott Alexander said, “Making money is a hobby that will complement any other hobbies you have beautifully ! ” Indian billionaires grew their wealth by a third by this hobby during the pandemic, while the poor workers couldn’t find a decent job, ironically though ! An ‘Oxfam brief’ showed that 573 people became new billionaires (one every 30 hours) and 263 million more people crashed into poverty (a million every 33 hours), during the pandemic -- mostly due to workers working harder, for less pay and in worse conditions. The brief’s title is “Profiting from Pain”. The pandemic had created 40 new pharma billionaires, and brought a profit of $1,000 every second to the Covid vaccine-making companies.
Indian lifestyle and the Covid
Covid in India is linked to the Indian scenario of population localisation, lifestyle, tradition, culture, customs, habits, beliefs, immunity, outlook, mindset, and attitude. Most of the Indian population resides in rural areas where chances of contracting the infection are low, as can be seen from the huge surges of cases in the crowded and polluted Indian cities and towns. Indian rural people who form the majority have a healthier lifestyle – manual work, traditional diet, less junk food, less fast food, less ‘modernity’, less gatherings, less partying, better ventilation, less travel, less exposure to needless and hazardous drugs, etc. Volumes can be written about the bad of modernity and urban lifestyle and their influence on the Covid malady. This reminds me of an article titled “America’s junk food diet makes us even more vulnerable to coronavirus” written by Dr. Nichole Sapher, MD, at New York’s Memorial Sloan Kettering Cancer Center -- https://nypost.com/2020/04/18/americas-junk-food-diet-makes-us-more-vulnerable-to-coronavirus/ . 41
In this context, let’s compare India with a huge population of 1.4 billion with the US of a small population of 0.3 billion. So far, there have been, officially, 375 Covid deaths per million of population in India, whereas there have been 2,984 in the US. Obviously, the Covid impact is low in India (calculated per million of the population) whose strength to combat the disease is nothing when compared to that of the US. What is it due to ? May be due to: 22
(1) The ‘racial herd immunity’ acquired through a series of a multitude of infections, mutations and polymorphisms that occurred over millennia and passed on through Indian generations of ‘cellular receptors’. (2) The more ‘broad spectrum immunity’ of Indians gained from various infections, as some viral protein features are shared with other microbes and parasites through multiple mechanisms of ‘cellular ingress and proliferation’. (3) The low level of general hygiene (sans western type of over-sanitisation) coupled with high degree of pollution in India which might have led to a sort of high ‘general herd immunity' by virtue of a variety of ‘subclinical infections’. (4) The low levels of allergy in Indians, resulting in low 'cytokine storms', compared to the Western societies which have a higher incidence of diseases related to allergy. (5) Almost all Indians (and almost none in the US) had BCG vaccination which might have conferred antiviral immunity, 'trained immunity'. (6) The Indians, especially the rural folk who form the majority, having a healthier lifestyle – manual work, traditional diet, less junk food, less fast food, less ‘modernity’, less gatherings, less partying, less smoking, less alcohol, better ventilation, less travel, less exposure to needless and hazardous drugs, etc. In contrast, America's enormous junk food, less healthy lifestyle and more ‘comorbidities’, indirectly and directly, made Americans more vulnerable. (7) The ‘weak virus’ reaching India a bit late (perhaps due to less international travel to India) after gaining multiple conservative mutations abroad. (8) The younger population being higher in India (65% aged less than 35 years) which has higher immunity, less prone to allergies and less affected by comorbidities. (9) The stringent preventive measures like ‘social vaccine’ (masks, distancing and hygiene) and ‘lockdowns’. (10) The hot weather in India which is not favourable to the virus.
Indian migrant workers
There is no ‘one-size-fit-for-all’ formula to prevent, control and manage Covid. Each country has to formulate its own strategy. Under the prevailing circumstances and the limited knowledge about the new virus, at that point of time in the beginning of the pandemic, India did a good job on the whole, but seems to have had blindly copied the Western strategies, especially the ‘lockdowns’. Bill Gates, co-founder of the Bill & Melinda Gates Foundation, said that “India has a lot to feel good about in terms of vaccines, digital systems, and communications … it’s really incredible how quickly measures were put in place by India to respond to the pandemic.”
Somehow, certain consequences of a sudden nationwide lockdown were not foreseen. Industry came to a grinding halt with no timeline for reopening. Sadly, the economy plunged down exponentially beyond any hope of full recovery in near future. Added to this is the pathetic collapse of the livelihood of the huge self-employed manual labour in India. The pitiable plight of the migrant workers which is a huge force in Indian industry could not be thought of in the hurry to contain the virus. Their miserable run, literally on their feet, to their native States, in the absence of any work or mode of transport was pathetic.5
The impact of the run of the migrant work force on public health and more so on industrial economy also could not be fathomed. Apart from the agony they suffered to travel back to their native places, they were stigmatised by their own people as ‘virus carriers’ when they could return to their home villages after undergoing immense hardship. In some villages, they were barred entry into their own villages because of the fear of getting infection from them. And, in fact, they might have spread the infection in remote rural areas where healthcare vigilance is substandard.
Lockdowns in India, good or bad ?
The subject of 'Lockdown' is an epidemiological hot potato. In the initial confusion, India, the world’s second most populous country, opted for a sudden national ‘lockdown’. ‘Lockdown’ is a blunt and dangerous instrument which should be used strictly according to the context of each country and zone for best results. The good and bad of ‘lockdowns’ would continue to be a debatable subject forever. The ‘lockdowns’ played a major role in the economic slowdown of India. The Reserve Bank of India (RBI) report ‘Report on Currency and Finance for 2021-22 : Revive and Reconstruct’ released on April 29, 2022 says that the deep economic injuries inflicted by the Covid pandemic on India will take 13 more years (up to 2035) to heal. The report estimates the output losses during the pandemic years of FY21, FY22 and FY23 at more than 50 lakh crore rupees! One has to ruminate on the wisdom of imposing ‘lockdowns’.
Proponents of the ‘lockdown’ say that the situation would have been lots worse if the ‘lockdown’ was not clamped and that a humongous catastrophe could be averted. The critics say that it not only failed to contain the spread but also caused disastrous economic collapse. An editorial in a world famous medical journal, The Lancet, didn't consider the lockdown as favourable for India (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30938-7/fulltext ). Our own advisors seem to have followed double standards, dillydallying.
Sunetyra Gupta, Professor of Theoretical Epidemiology at Oxford, England explains the downside of lockdowns. She said "The thought of lockdown imposed in India and other countries with similar problems sends chills through me ... I felt it was going to cause immense harm and untold damage. So, I don't think that it was a good solution ... This is just one disease. Let's face it, we don't have the infrastructure in place to prevent the deaths occurring from TB, diarrheal disease and other respiratory infections. We don't have the health infrastructure and that is an international disgrace ..." For more details, go to:
https://timesofindia.indiatimes.com/blogs/the-interviews-blog/we-cannot-look-at-this- epidemic-as-a-single-axis-of-how-many-people-are-going-to-become-infected/ 42 We seem to be uncertain of the merits of our own interventions – lockdowns, quarantines, medicines, ventilators, vaccines and a host of other things (some comments on this aspect are in my article titled “The Science and Nonsense around COVID”, The Antiseptic, November 2021). 3 It seems that no one really knows what’s right in many issues in the Corona arena, and the answers keep changing. It’s a jigsaw puzzle with many pieces missing. Ironically, the young Covid has a stupendous volume of research literature, a lot more than that of any old virus.
Lockdown, a blunt instrument, has become the default strategy and an epidemiological fashion, based on mathematical models of a limited theoretical frame. An indefinite transnational blanket ban of all activities just to tame one disease in a country like India is an example of profound insanity. Further lockdowns may further vitiate a nebulous situation. Nevertheless, lockdown is a very effective preventive medicine for small countries but is too toxic for the huge India where it cannot be implemented as it should be on a national scale. Nonetheless, localised lockdowns (cluster restrictions) are necessary for India. Lockdown is just one of the tools, not a silver bullet.
"The most absurd expectation from a "lockdown" is that it is a totally effective eradicator of the virus. The truth is that it is the costliest medicine with a little effectiveness and a lot of serious side effects." -- T. Rama Prasad
For more comment on ‘lockdowns’ go to my article published in The Antiseptic journal of October 2020 titled “Is the ‘Lockdown Medicine’ too toxic ? ” 5
Lockdown myth
In March 2020, we thought that a nationwide lockdown for a few weeks (taking into consideration the short incubation period of the novel coronavirus) would effectively cut down the transmission of the virus. Also, we thought that a vaccine would put a permanent end to the virus. Two years on, now, we found that they didn’t work as expected. Theoretically excellent ideas and programmes may not get translated into action in field conditions. Ground realities dictate the outcomes. The National Tuberculosis Control Programme of India of decades of implementation is a typical example – even now, one thousand Indians are still dying due to tuberculosis (TB) everyday. Read about it in my article titled “COVID and Tuberculosis” in The Antiseptic journal of December 2021. 15 And, look at the China’s ‘Zero COVID’ strategy of the strictest ‘lockdowns’ in the world. While it did well in the short term in terms of human loss, now the country is facing fresh surges of infection due to variants and is unable to lift the ‘lockdowns’. For how many more years the country can afford to shut away from the rest of the world ?
Covid deaths in India
As the adage has it, “There are three kinds of lies: Lies, Damned Lies and Statistics” (Mark Twain / Benjamin Disraeli) ! A war on the figures of ‘Covid deaths’ in India has been going on among statisticians, epidemiologists and officials. Finally, India and the World Health Organization (WHO) are at loggerheads. The WHO, on May 5, 2022, made public its estimate that India had 4.7 million ‘more (excess) Covid-19 deaths’ by 2021-end, which is 10 times the Indian official figures of half-a-million and almost a third of Covid deaths globally. Shortly thereafter, the Indian government issued a strong rebuttal questioning the validity of the models used by the WHO, its methodology of data collection and its statistical soundness. The Health Ministers of various States of India at the 14th conference of the Central Council of Health and Family Welfare slammed the WHO for its estimate and said that the estimate of 4.7 million deaths was “baseless” and “intended to show the country in a poor light”. ‘Excess deaths’ mean the increase in deaths due to all causes during 2020-2021compared to the presumed number of deaths during the same period if the pandemic was not there. So, the ‘excess’ number may not be due to ‘Covid deaths’ alone; it could be due to ‘excess’ deaths due to other diseases which could not be attended to promptly due to the Covid situation. On the other hand, there might have been lesser deaths too due to some causes like low level of travel accidents, because of travel restrictions of the ‘lockdowns’. It’s difficult to put down the numbers on paper by anybody except Mr. Statistics, the king of liars !
Pakistan also rejected the WHO’s estimate of 2,60,000 – eight times its official figure of 30,369 ‘Covid deaths’. Whether it is for ‘Covid deaths’ or ‘Covid wave predictions’, mathematical modelling is often a precarious and imprecise exercise, dependent on multiple factors, assumptions, presumption and extrapolations which may be data-deficient and unrepresentative of ground realities. Fallacious statistics are, sometimes, mechanically rolled out in India which entertains us -- According to an official reply to an RTI (‘Right To Information’) query, a 732-year-old Pushpa Sahu became the beneficiary of a cycle under a State welfare scheme for women (Chhattisgarh, India) in 2013. As per the Chhattisgarh Labour Department, 6,231 beneficiaries of the sewing machine scheme and 1,368 beneficiaries of the cycle scheme were aged above 100 years, including the 532 – year-old Usha Jamgade ( http://www.thehindu.com/todays-paper/732yearold-gets-cycle-under-welfare-scheme/article6278743.ece ).43 Incredible India !
So far, there have been, officially, only 375 Covid deaths per million of population in India, whereas there have been 2,984 in the US. Amusingly, health officials and governments across India took credit for the low fatality rate. No doubt, they played an important role, but obviously, the low fatality rate can’t be mainly due to the India’s (rickety) medical care infrastructure, (weak) healthcare system or the (perfunctory) observance of preventive measures like ‘lockdowns’ / masks / distancing / hygiene, etc. It’s beyond that – it may be the ‘Indian immunity’.
Indian immunity
“You are an Indian and you had BCG vaccination. And you had grown up amidst filth and germs which gave you immunity. So, you may not die of COVID-19.” – T. Rama Prasad
This quote sums up the ‘Indian immunity’ – conferred by (1) ‘Racial immunity’, (2) ‘BCG immunity’ and ‘LTBI immunity’ which are detailed below.
Perhaps, because of better ‘India-specific’ ‘racial immunity’ / ‘native immunity’ and ‘cross resistance’ passed on through generations of cellular immunity factors and ‘memory T cells’, the Covid ‘Case Fatality Rate (CFR)’ has not been high in India, despite the creaky, rickety and shambolic health care systems in many parts of India. The immunity against Covid has two arms – One, humoral immunity manifested by the production of antibodies (these are the ones that are easily and usually estimated to identify the immunity gained by infection or vaccination; they usually wane by around six months; they prevent infection); Two, cellular immunity through ‘memory T cells’ (which give a longer protection, even years and decades; they don’t prevent infection, but prevent progression of infection to serious levels; difficult to identify by ordinary tests). The phylogeny of genomes also makes it evident that a unique mutation in the spike surface glycoprotein (A930V - 2435 C>T) is present in the Indian sequence, as observed in a study. Any variation in the immunity or response to treatment may be due to this 'India-specific' difference. COVID-19 genomes, host-virus interaction and pathogenesis may vary from country to country (https://doi.org/10.1101/2020.03.21.001586). Many people all over the world are exposed to four different coronaviruses that cause 'common cold'. The ‘common cold’ infections produce what are called 'Memory T cells' or 'Memory CD4 T cells' or 'Memory Helper T cells' or 'pre-existing cross-reactive memory T cells'. These ‘memory T cells’ may confer some immunity against SARS-CoV-2 also.46 This is called 'Pre-existing immunity' in individuals who were never exposed to SARS-CoV-2. It may be possible that Indians have more of these cells which reduce the severity and death rate of COVID-19. In one study (La Jolla Institute for Immunology, California) it was found that 28% of healthy blood donors were found to have the ‘pre-existing cross-reactive memory T cells’ against spike or membrane proteins of SARS-CoV-2. The pre-existing ‘cross-reactive memory T cells’ might be from previous exposures to ‘common cold’ coronaviruses. This is an unanticipated degree of 'population-level immunity' against COVID-19 which may be more in the Indian population (https://www.thehindu.com/sci-tech/science/unexposed-people-may-have-covid-19-specific-memory-t-cells/article32052605.ece). 47
Almost all Indians were given BCG vaccination (from 1948 onwards) soon after birth to prevent some forms of TB. They seem to be lucky to have some immunity against coronavirus also, unexpectedly. BCG vaccination significantly increases the secretion of ‘pro-inflammatory cytokines’, specifically IL-1B which has been shown to play a vital role in 'antiviral immunity' / 'trained immunity'. And, BCG vaccination has been reported to offer broad spectrum protection against respiratory infections. Thus, the BCG protection might influence the morbidity and mortality due to COVID-19 by protecting people from co-occurring infections and sepsis which ultimately kill (https://doi.org/co.1101/2020.03.24.20042973). In a study (University of Texas, Houston) covering 178 countries, it is found that death rates due to coronavirus are lower by a factor of 10 in countries that had a strong BCG vaccination regimen. It is found that morbidity and mortality due to COVID-19 are high in countries where BCG vaccination is not in practice universally (Spain, Italy, France, USA, etc.). The COVID-19 didn't affect much the countries where BCG vaccination is given soon after birth universally since a very long time (India, Japan, etc.). Death rates are low even when infection rates are moderate in Malaysia, Ireland, the Czech Republic, the Slovak Republic, Hungary, Costa Rica, India and many other nations which have strong BCG programmes. On July 13, 2020, a BCG study trial was initiated to evaluate the effect of BCG in preventing or modifying COVID-19 at the National Institute for Research in Tuberculosis (NIRT) at Chetpet, Chennai under the auspices of the Indian Council of Medical Research (ICMR). Five more centres are chosen for this study in Gujarat, Rajasthan, Madhya Pradesh, Maharashtra and Delhi.
Latent Tuberculosis infection (LTBI) – a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB disease - may also act like BCG vaccination. In India, TB germs are present widely in the air that is breathed in. They don't cause disease in most of the people but may increase the immunity, advantageously for them. This may be one of the reasons for the low mortality in India due to COVID-19. It should be studied to validate this reasoning. For more information, look into my article titled “COVID and Tuberculosis” which was published in The Antiseptic issue of December 2021.
India-specific mutations
The low fatality rate in India may also be due to India-specific mutations. The coronavirus keeps on changing through mutations. The SARS-CoV-2 that is present in India is not the same as the one that caused the first case in China or in other countries. There are at least five identified ‘time-stamped’ ‘lineages’ evolved from the ancestral virus. The D614G lineages became dominant in India sometime back -- 20A in northern and Eastern zones; 20B in southern and western zones, of India. The D614G mutant viruses were ‘super-rapid spreaders’, but not very lethal. In India, the first coronavirus was of the ‘L strain’ originated in Wuhan, which eventually mutated into the ‘S and G strains’ and spread all over the country. Due to closing of borders between Indian States during the lockdown period, different types of mutations might have evolved in different States.
Indian attitudes, beliefs and aberrations
Bill Gates said: “We have one country, Japan, where mask compliance was unbelievably high because it’s sort of viewed as politeness to other people and they have saved a lot of lives with masks.” Here in India, many wear a mask only when police impose a fine for not wearing a mask. It’s the same even in the case of helmets which are for self-protection. The negative fallout of this attitude is that people didn’t approach government medical facilities out of fear of quarantine and police action. They stayed at home and roamed about spreading the viral infection. They cared neither for their health nor for others. In some remote areas, people climbed up trees to evade vaccination when vaccination teams approached ! The initial ‘vaccine hesitancy’ gradually transformed into ‘vaccine demand’.
Many Indians have immense faith in ‘native remedies’ and also in the sanctions of divine figures. Deities and temples for the coronavirus came up. At Kadakkal (Kollam, Kerala State), an idol of ‘Goddess COVID-19’ christened ‘Corona Devi’ was installed in June 2020. There has already been a deity for smallpox in Kerala State. And some have faith in the efficacy of a variety of things -- sacred ‘Gangajalam’ (water of Ganges river), ‘Gomoothram’ (urine of cows), milk of asses, various indigenous formulations, various vitamins and minerals, preparations of various systems of medicine to build up immunity against Covid, yoga, meditation, spiritual support, psychological conditioning, etc. Some of them may be beneficial, but we don’t precisely know about their usefulness in the Covid context. Some bought various gadgets to get rid of the virus from vegetables, newspapers, currency notes and rooms. India has always been an eclectic potpourri of social influences and beliefs. Apart from traditional superstitions and medieval practices, some had floated their own notions, but not as amusing as that of the Brazilian President Bolsonaro who warned his people that Covid vaccination may turn people into crocodiles or may change their gender ! 24 Read my article on these ‘Covid crocodiles’ ! -- https://drtramaprasad.blogspot.com/2017/04/covid-crocodiles.html 24 .
Out of fear, ignorance or vested interests, people were ‘disinfected’ of the Covid virus in India ! Amusingly, “disinfectant tunnels” were used to forcibly ‘disinfect’ people on some Indian roads from the virus – an absurd and hazardous practice ! The Supreme Court also found fault with the authorities in this matter. In some places, disinfectants were sprayed on people which is unscientific, barbarous and very hazardous. Most disinfectants, by nature, are potentially harmful and even toxic to humans and animals. 7
In India, certain things like this happen without the knowledge or approval by the concerned authorities, a recent (April 30, 2022) example of which is that of the MBBS students who took the ‘Maharshi Charak Shapath oath’ instead of the conventional ‘Hippocratic oath’ at a government medical college function purportedly without the knowledge or approval by the Dean of the college. Consequently there was a huge furore and the Dean was ‘removed’ from his post ! The office bearers of the ‘Students Council’ of the college clarified that the decision to take the new oath was theirs and that they didn’t bring the matter to the notice of the Dean. Nationalism sometimes throws realism out of focus. Anyway, who would follow what Hippocrates or Charak says ! Obscene amounts are charged for admissions into medical colleges. Reports of studies say that around 55 million Indians are driven into poverty every year due to medical expenses, and that about 44% of patients were advised unnecessary surgery in India. 27 Forget Hippocrates. Stop being hypocrites.
Predictions of the ‘waves’ in India
The academic atmosphere has been rife with speculations about Covid waves in India. In spite of many modelling outcomes, no study group predicted correctly or warned of the severity of the ‘second wave’ in India, even by the ‘supermodel’ called SUTRA. On July 18, 2021, Samiran Panda, an epidemiologist, predicted that the ‘third wave’ could hit India as early as end of August 2021, but it didn’t happen. On the basis of the ‘Sutra’ mathematical model of the Indian Institute of Technology, Kanpur, it was predicted that the ‘third wave (Omicron wave)’ would manifest in India in January 2022, may ‘peak’ in February 2022 with 1.8 lakh daily cases, and would end in April 2022.35 It was also predicted that after April 2022 the Covid would become an ordinary endemic. In addition, it was predicted that 1 in 10 will need hospitalisation and that two lakh beds may be needed by the middle of March 2022.35The professor behind the ‘Sutra’ model, Mahindra Agrawal warned that election rallies can prove to be super-spreaders of the virus.35
Mathematical projections, about the ‘third wave’, like: "In a very short period of time, 80 lakh cases may be reported in India with 1% mortality which would mean 80,000 deaths" rattled everyone. And, based on the scenario in the UK, some scientists predicted a huge 14 lakhs of cases a day in India. Some experts felt that a sudden huge surge of infections during the ‘third wave’, though of a low fatality rate, may overwhelm hospitals with a sudden demand for intensive care. This is the reason why governments had built up facilities to deal with a probable ‘tsunami’. But nothing of that sort happened. In fact, the ‘third wave’ was of a short duration of about three months with a peak at the end of January 2022 with very much lesser virulence than the ‘second wave’. A ‘fourth wave’ beginning in June and peaking in August 2022 has been predicted by the researchers at the pioneer institute, Indian Institute of Technology (IIT), Kanpur. More than anything else, it is the unexpected emergence of variants that had upset many of the epidemiological predictions. It was the ‘Delta’ during the ‘second wave’, and the ‘Omicron’ in the ‘third wave’.
Covid vaccination in India
India has the distinction of being a major vaccine manufacturing country for a long time, and the already available ‘cold chain’ of the well-established national Universal Immunisation Programme (UIP) has been a propitious stroke of luck. Even then, during the first year of the pandemic (2020), Covid vaccination for India was a distant dream. It was thought that Indians may get vaccinated from 2022 or so. But it was a pleasant surprise that the government of India launched the vaccination programme as early as January 16, 2021with 3,006 vaccination centres to start with, and the vaccination drive had matured with commendable coverage: creditably giving 1.8 billion doses, covering over 95% of the population with at least one dose and 86% with two doses, by April 2022 through an admirable regimental CoWIN digital portal. Of course, there were hiccups and glitches. For details go to my article titled “Vagaries of India’s Covid Vaccination Policy” published in the August 2021 issue of The Antiseptic journal. 10
India initially approved the Oxford AstraZeneca vaccine (manufactured under license by Serum Institute of India under the trade name ‘Covishield’) and ‘Covaxin’ (a vaccine developed locally in India by Bharat Biotech). They have since been joined by the ‘Sputnik V’ (manufactured by Dr. Reddy’s laboratories, India) and many others. This was followed by graded approvals for ‘booster’ (called ‘precautionary’ in India) doses. The ‘precautionary’ dose was already given to around 20 million people.
On April 26, 2022, a green signal was given for children – Biological E’s Corbevax (5-12 years) and Bharat Biotech’s Covaxin (6-12 years) and Zydus Cadila’s two-dose ZyCov-D (above 12 years). Covaxin was already approved on December 24, 2021 for the age group of 12 to 18. India began inoculating children aged 12-14 on March 16, 2022 and all people aged more than 45 years from April 1, 2021. To read more about vaccination in children and the link with the unscientific and disastrous closure of schools for such a long time, go to my articles titled “Covid, Children and Schools” and “COVID Fear and Paranoia” in The Antiseptic of October 2021 and May 2022 respectively.14, 39 India had achieved the dubious distinction of becoming the country with the second longest Covid-linked school closure in the world -- next only to Uganda.
‘Desi’ (Indian) vaccine
It’s a matter of great pride that India had developed its own vaccine under the name ‘Covaxin’ which seems to be, at least, as effective and safe as those developed abroad. Some people even came from abroad to have this indigenous vaccine in India in preference to the ‘mRNA’ vaccines available in their home countries. In April 2022, the Chairman of Bharat Biotech which manufactures ‘Covaxin’ said: “We have established Covaxin as a safe and efficacious universal vaccine for adults and children (2-18 years age group).” The company said it had conducted Phase 2/3 studies which had shown robust safety, reactogenicity and immunogenicity. Now, on April 26, 2022, the national drugs regulator of India had approved Covaxin for emergency use in children aged 6-12 years. Unfortunately, due to inherent complexities in manufacturing this vaccine, production couldn’t be stepped up to meet the demand. That’s why most of the Indians so far were vaccinated with ‘Covishield’. For more details, read my article titled “Covishield or Covaxin ?” published in The Antiseptic journal of April 2021.2 Another shot in the arm for the Indian Bharat Biotech company is its role to develop a new ‘adjuvanted subunit’ vaccine designed to provide broad protection against all known SARS-CoV-2 variants of concern, in partnership with the Coalition for Epidemic Preparedness Innovations (CEPI).
Regrettably, there is a flipside to the ‘Covaxin’ which tarnished its image. Authorities had overreached in granting approvals by cutting corners, justifiably for ‘emergency use’, before completion of the clinical trials. Nationalism sometimes throws realism out of focus. The Director-General of the Indian Council of Medical Research (ICMR) urged researchers through a demi-official letter dated July 2, 2020 to launch the Indian ‘Covaxin’ for public use by August 15, 2020 (Independence Day), long before the expected completion of the clinical trials to confirm the efficacy and safety of the vaccine. How to compress 15 months (Bharat Biotech’s estimation) into 45 days ! This had eroded the trust in ‘Indian science’. So, when the ‘Covid vaccine drive’ was initiated in India on January 16, 2021 with Covishield and Covaxin, the ‘Tamil Nadu Government Doctors Association (TNGDA)’ advised its members to opt for Covishield, not for Covaxin.2 And, the government in Chhattisgarh (a State in India) said in January 2021 that it will not allow Covaxin vaccination in its State until the clinical trials prove it to be safe and effective. That had been the acceptability status of the two available vaccines until mid-March 2021. Later, with the reporting of some serious ‘blood clots’ to Oxford AstraZeneca (Covishield), the balance tilted in favour of Covaxin. Curiously, the FDA, in May 2022, almost banned (severely restricted the use) Johnson & Johnson’s vaccine in the US in view of serious ‘blood clots’.
Again, of late, on April 2, 2022, a jolt of fear engulfed people who had over 300 million doses of Covaxin when the World Health Organization (WHO) declared that it had suspended supply of Covaxin, through the United Nations Agencies, to allow the manufacturers to upgrade facilities and address deficiencies found in an inspection. In the same breath, the WHO said that the vaccine is effective and that no safety concerns exist. But, obviously, that doesn’t refurbish the tarnished image. Added to this is the announcement that the US Food and Drug Administration (FDA) had put on hold the phase 2 and 3 clinical trials of Covaxin in the US. That’s the saga of the Indian ‘Covaxin’. Is this all a storm in a tea cup ?
Plant-based Covid vaccine
Interestingly, a new plant-based Covid vaccine (‘Recombinant Plant-based Adjuvanted Covid-19 vaccine - CoVLP+AS03’) of 70% efficacy against symptomatic disease caused by five variants is developed. The vaccine contains ‘coronavirus-like particles’ (CoVLP) produced in plants which are combined with an adjuvant (ASO3). India, with its rich background of ‘Ethnobotany’ and ‘Phytotherapeutics’, should have developed this, but the Canadian biotechnology company Medicago did it. The study is published recently (May 4, 2022) in the New England Journal of Medicine (NEJM) (https://www.nejm.org/doi/full/10.1056/NEJMoa2201300 ).44 The plant-based vaccines may be right for those who are worried about the ‘Trojan horse’ of ‘blood clots’ that some ‘pharmaceutical’ vaccines may leave behind in brains.
Booster dose
Though the Indian government greenlighted a ‘precaution’ (‘booster’) dose (after nine months following the second dose) to people above 60 years with comorbidities and health-care and frontline workers from January 10, 2022 , there had been accounts of younger people without comorbidities taking ‘boosters’ unofficially on their own from private hospitals, violating the government’s policy. The ‘precaution’ dose was already given to around 20 million people. From April 10, 2022, all above the age of 18 were made eligible for the ‘precaution’ dose at private hospitals. Despite easing the regulations, there had been only a lukewarm response from the public. The reasons are many including the finding of an Indian study (a preprint posted on April 28, 2022) that ‘booster’ dose may not alter the severity of COVID-19 though it may prevent infection to some extent.
India and Covid from animals
Evidence of ‘Covid virus’ jumping from animals to humans (zoonosis) is growing. The Centers for Disease Control and Prevention (CDC) of the US confirmed that four people in Michigan in the US were infected with a version of the coronavirus observed mostly in minks during the first year of the Covid pandemic. The WHO said in March 2022 that the introduction of COVID to wildlife could result in the establishment of animal reservoirs of the virus. Some virologists are of the view that the highly-mutated Omicron variant, which caused a deluge of cases globally, including in India, emerged from animals, potentially rodents (which are abundant in India) rather than from immunocompromised humans. Recently (February 2022), a study from Canada reported a ‘white-tailed deer to human’ transmission of SARS-CoV-2.
Long COVID (PASC) and Persistent COVID
The term ‘Long COVID’ has nothing to do with the ‘long’ in the title of this article: ‘The long and the short of COVID in India’ ! The WHO has developed a clinical case definition of a ‘post-COVID-19’ condition called ‘Long COVID’ by Delphi methodology that includes 12 domains, available for use in all settings – ‘the post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually starting three months after the diagnosis of COVID-19 with symptoms, which lasts for at least 2 months and cannot be explained by an alternative diagnosis’. Common symptoms include fatigue, shortness of breath, cognitive dysfunction. Less frequently, brain fog, dementia, loss of smell and taste, cough, muscle pain, joint pain, chest pain, anxiety, depression, headache, fever, sleeplessness, etc. may also occur. Generally, the symptoms have an impact on normal activities. The symptoms may be of new onset following initial recovery from an acute COVID-19 episode or may persist from the initial illness. Symptoms may also fluctuate or relapse over time.
Some experts have coined a new term for it: ‘post-acute sequelae SARS-CoV-2 infection’ (PASC). Recent research suggests that more than 40% of people who have or had COVID-19 get ‘Long COVID’. A large study in the United Kingdom looked at data on more than 1.2 million partially or fully vaccinated people found that fully vaccinated people -- those who had both doses of COVID-19 vaccines like those made by Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca -- had almost 50% lower odds of having Covid symptoms at least 28 days after infection. Nothing much is known about ‘Long COVID’ until now, much less in India. It is difficult to know the magnitude of this problem in India as many may not come forward to report the ‘non-acute’ symptoms. After recovery from Covid, many are facing increased problem of Tuberculosis, other respiratory diseases, diabetes – new and uncontrolled old cases, tachycardia, etc. Many Covid rehabilitation centres came up across India to cater to ‘Long COVID’ patients.
In some cases, rarely though, Covid infection persists with RT-PCR positivity for a very long time. This “Persistent Covid” is different from “Long COVID”. In ‘Long COVID’, the virus may not be detectable after a short period, but some symptoms would persist for a long time – months or even over a year. In ‘Persistent Covid’, the virus can be detected for over a long period of time – in one case in the Uk, it was as long as 505 days. Many of the patients with ‘Persistent Covid’, have weakened immune systems evolved from organ transplants, HIV infection, cancer or treatment for other illnesses. The ‘Persistent Covid’ promotes development of mutations and variants of the Covid virus. This would be the resultant disaster for the community, and India has to be very alert to this new problem.
While no specific therapy is known to tackle “LONG COVID”, a study revealed that “Enhanced-External-Counter-Pulsation (EECP)” may be a potential treatment option for this ill-understood disease (https://www.acc.org/About-ACC/Press-Releases/2022/02/14/14/25/Enhanced-External-Counterpulsation-Offers-Potential-Treatment-Option-for-Long-COVID-Patients)
COVID-acquired hepatitis (CAH)
Called also as ‘COVID-19-assiciated hepatitis in children (CAH-C)’, this liver problem has been reported in small numbers in many countries recently. The CAH doesn’t fit into the profile of the usual cases of hepatitis, and the WHO said that 348 probable cases of “hepatitis of unknown origin” had been identified across the world, and the prime suspect was an adenovirus in combination with Covid. A recently reported study (https://www.medrxiv.org/content/10.1101/2021.07.23.21260716v7) revealed that 37 of the 475 Indian children who tested positive for Covid had CAH. The information is scary and the CAH is to be carefully studied, especially as it affects children.
Covid orphan children in India
According to a study published in The Lancet of February 24, 2022, around 19 lakh children in India lost a parent between March 2020 and October 2021. But the Indian government’s representatives said that there were only 1.53 lakh children in that category, and that ‘The Lancet Study’ is a “sophisticated trickery intended to create panic among Indian citizens”. These children have an increased risk of poverty, exploitation, sexual violence or abuse, mental illness, etc. The government has to support these unfortunate children through all the Covid response plans and welfare schemes. (https://www.thehindu.com/news/national/lancet-study-on-orphanhood-in-india-due-to-covid-19-sophisticated-trickery-says-government/article65184668.ece ) 45
India’s legal view on Covid vaccination
Based on the current scientific evidence that ‘unvaccinated individuals are no more likely to spread the virus than those vaccinated’, the Supreme Court of India ruled on May 2, 2022 that a person cannot be forced to get vaccinated against Covid-19 and that nobody can impose restrictions of entry into public spaces on unvaccinated individuals, while in the same breath it said that the government can still impose certain “reasonable and proportionate” limitations on individual rights in the interest of public health.
Covid treatment in India
As there has been no ‘specific and proven’ treatment for Covid in the ‘modern medicine’ until now, various modalities of treatment from various systems of medicine had emerged. Even in the ‘modern medicine’, various practitioners and hospitals followed various protocols, despite the authorities spelling out protocols and changing them periodically. It's a see-saw like situation with evidence for and against with shifting advisories which had become common. For instance, the All India Institute of Medical Sciences (AIIMS) and the central Health Ministry, on September 2, 2020, advised not to use favipiravir, pirfenidone, methylene blue, itolizumab, tocilizumab, etc. too enthusiastically as sufficient evidence was lacking to support their use. We have to still learn on the go !
Many Indian doctors were praised for their exemplary service during the pandemic, but there were some black sheep too. No doubt, there are kind-hearted souls who practise medicine with humanism and sacrifice, but the ‘second wave’ made the ‘once-upon-a-time-noble profession’ seem like an unholy business in India. Black-marketing of everything connected with Covid treatment seemed to have prevailed during the ‘second wave’ period. Desperate patients were exploited. Over-charging seemed to be so rampant that the General Insurance Council moved the Supreme Courtagainst alleged 'profiteering' by private hospitals in India. When objected, in one case, the bill of Rs.14 lakh was brought down to less than 4.5 lakhs ! This is the horrendous facet of the ‘second wave’ in India. Chaos and confusion prevailed everywhere with overwhelming demand for treatment, hospital beds, drugs, medical materials and burial space too. Acute shortage of oxygen took away numerous lives. People died in ambulances outside hospitals while waiting for beds. Heartrending and urgent appeals for help went in vain. Relatives couldn’t do anything but watching their dear ones gasping for air. … . People sold their assets, including their cattle and sheep, in an attempt to save their near and dear. Most of them mourned at graveyards.” 4 All this had shattered the last remaining sangfroid of a human being. And, all the same, numerous doctors and frontline health workers sacrificed their lives for the good of humanity during the pandemic. For details, have a look into my articles titled “Disastrous Second Covid Wave in India” and “The Science and Nonsense around COVID” in The Antiseptic journal of June 2021 and November 2021 respectively. 4, 3
The lessons
COVID-19 is neither the first nor the last of pandemics. During the first two decades of this century, the world went through some other pandemics, viz. SARS in 2002-04, H1N1 and Swine flu in 2009, MERS in 2012 and Zika in 20015-16. Because of the previous experiences, the world had overreacted to COVID-19. During 2020 when the virus was raging and the vaccines were in a nascent stage, the scientific wisdom was that ‘lockdowns’ and vaccination of two thirds of the population would end the pandemic – an idea that has not come to pass. Newer highly transmissible variants and the West’s experience, of infections being rife despite triple-shots, have brought down the hope of blasting the blight. The latest news about this, at the time of writing this (May 2022), is that “a new variant named ‘BA.2.12.1’ is spreading rapidly and will likely in the next few weeks become the dominant form of the virus in the US.” Already, the presence of ‘BA.1 immune escape’ BA.4 and BA.5 Omicron lineages in South Africa (which are riding a wave with 10,000 cases a day in May 2022) has raised a global concern of a new wave across the world. Omicron planted the perils of rushing to proclaim victory over Covid. India may be lulling itself into a sense of complacency and normalcy when many countries are still under-vaccinated and are not out of the woods.
Now, the Indian population is well-vaccinated (which led to recklessness), well-infected (hence have good ‘herd immunity’), well-fatigued (hence intolerant to further restrictions) and seem to be well-protected by ‘native immunity’(the main virtue of Indians). Countries which may not have good ‘native immunity’ and which are overprotected (and hence not well-infected, resulting in low ‘herd immunity’ and high susceptibility) by ‘Zero-COVID’ strategy are faring badly now. After the long pandemic hiatus, for more than a month now, the Indians have been enjoying ‘freedom’ from ‘Covid restrictions’ and ‘serious Covid problems’. Hence the current attitude is foregrounded in the ground reality that Covid cases are low in number despite a complete opening up of normal life. The current ‘acquired immunity’ in Indians may protect them up to around six months after which it may wane. ‘To be, or not to be vaccinated every six to 12 months ? That is the question’ , as in the Shakespeare’s Hamlet. And, India has a younger population (65% aged less than 35 years) with a high burden of diabetes and cardio-respiratory diseases which make them vulnerable for Covid infection.
Now, we have to wait and look out on the horizon for the ‘fourth wave’, beginning in June and peaking in August 2022, as predicted by the researchers at the pioneer institute, Indian Institute of Technology (IIT), Kanpur. Meanwhile we should not freeze into immobility when spikes or waves occur in the coming months, and think about other diseases instead of continuing to give ‘royalty’ status to Covid. We should take the ‘common-sense-driven’ preventive measures like improving ventilation, wearing masks when necessary, getting not exposed to the virus, avoiding unnecessary social activities and travel, etc. If ventilation is excellent everywhere, there wouldn’t be any need for any preventive measure, including vaccination. But, unfortunately, the comfort-seeking modern man is addicted to live in closed air-conditioned ‘boxes’.
And, for the programmers, there seems to be a need for a high level of granularity of data, real-time information and decision-making on the fly. Alongside, they need to prepare a roadmap to ‘live with Covid’. Continuous epidemiological and genomic surveillance is imperative, as new variants packed with both speed of spread and vile virulence may ‘float like a butterfly and sting like a bee’ like ‘The Greatest American Boxer’ Muhammad Ali.
For the long-term protection, one should protect ‘Mother Nature’. Invoking the ‘Parens Patriae’ jurisdiction, Justice S. Srimathy of the Madurai Bench of Madras High Court did an admirable job of declaring ‘Mother Nature’ to be a ‘Living Being’ having the status of a legal entity with all corresponding rights of a living person, in order to protect and conserve ‘Mother Nature’, and directed the Central and State governments to protect her, while imposing a punishment for an act done against ‘Mother Nature’ on a former revenue official in April 2022. We have interfered too much with 'Nature', intruding into the forests and causing 'tropical biosphere devastation' leading to ‘ecological imbalance’ which may be the cause for the emergence of new dangerous (Biosafety Level 4) microbes. “Mother Nature knows how to take revenge. So be careful before hurting Nature.” -- QuotesLifetime.com We have tasted the revenge through COVID, and we must learn the lesson. 26
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