The Second Wave of COVID-19: A Case of Late Diagnosis, Missed Priorities, And A Chance For Atonement.

Author: Himanshu Ranjan

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According to worldometers, on April 27, 2021, India witnessed a whopping 3, 62, 902 new cases of COVID-19, but even more worrying 3, 285 new deaths due to COVID-19. The growth in the death rate that’s always remained negative since Indian independence has reversed its trend and has become positive from 2019 onward. 

YearDeath Rate PopulationActual Average Deaths/ DayAverage Deaths/Day (No Pandemic Scenario)
2018 7.2371.3526 billion26889.926889.9
2019 7.2731.3664 billion27226.927073.4
20207.3091.3800 billion27634.027324.0
20217.344 1.3955 billion28078.227611.7

                                     Death Rate Source: Macrotrends.net

The difference leads to a total of 2, 24, 225 deaths which is close to 2,01,165 deaths due to COVID-19 thus far in India. The assumption is that the government sources and the macrotrends’ death rate are trustworthy and updated. It is also noteworthy that between the years 2006-2014 the death rate was declining annually at about 1.4 %, but between the years 2014-2018, the death rate declined annually at just about half the rate, i.e., at about 0.7%. The factors that led to a reversal in trend apart from COVID-19 are – poor mental health, suicides, hunger, economic stress, and care diverted from usual patients to COVID-19 patients. 

If on a daily basis 22,950 deaths (85 % of 27,000) are handled by Hindu crematoriums, it seems unlikely that they can’t handle an additional 11.11 % increase (2,550 more deaths, 85 % of 3, 000). But there are reports that new crematoriums are being built, reports of people being cremated near footpaths, in the parks, and mass cremations being done. All of this points to one bitter truth that the official reporting of COVID-19 deaths is lesser than the actual figures. What’s the actual figure then is difficult to estimate – some reports estimate it to be between 5-10 times. On a PAN India basis, looking at the population density, local rituals, under reportage, and lack of knowledge about COVID-19 symptoms such as silent hypoxia, there seems a strong case that the actual death figures are definitely not below three times than the official figures. It also seems highly unlikely that the government is ignorant of it. In a country of the size of India’s population, the annual mortality rate would just move from 7 to 8 with an additional 3800 deaths per day. It means that even if an additional 1.38 million Indians die in a year, an average Indian who witnesses 7 deaths in 1000 people would now try to make sense of 8 deaths in 1000 people. 

Generally, the purpose of a virus is to thrive and not kill the host. Hence, the mutations make it more infectious but less deadly over a period of time. However, that’s not always true. The second wave led by a double mutant virus is highly infectious with additional symptoms and equally deadlier. An event India seemed unprepared for. A sort of black swan event for ordinary people but not for experts. 

9 March17 March31 March9 April20 April 27 April 
16, 84635, 838 72, 182144, 8292, 94, 2903, 62, 902

Daily New Cases: Source: Worldometers

It seems highly unlikely that the cases doubled for the first 8 days, then took 14 days to double, then again 9 days to double, then again 11 days to double. There seems to be an under-reportage of the cases especially between the crucial period of 17 March – 31 March. A period when all people above 60 years of age, and people between the age of 45 years and 60 years but with comorbidities were only eligible for vaccination. A period when our daily vaccination rate was not enough given the size of India’s population. A period when we were exporting vaccines to foreign nations on a grant as well as a commercial basis. A period during which election rallies were held and our leaders didn’t promote COVID-19 appropriate behaviour by either wearing masks themselves or by even requesting people in their rallies to wear masks. A period when Kumbh Mela had not yet begun and could have been cancelled. 

CountryDate Supplied
Bangladesh12 lakh doses on 26 March
Nepal1 lakh doses on 28 March
Bhutan 4 lakh doses on 21 March
Maldives 1 lakh doses on 29 March 
Mauritius 2 lakh doses on 18 March
Saudi Arabia 15 lakh doses on 28 March
Nigeria1 lakh doses on 25 March (Note 39.24 lakh doses supplied to Nigeria on 1 March when Nigeria was seeing a decline in cases with only 360 new cases) 
Laos 1.32 lakh doses on 17 March when the country was experiencing 0 cases 
Namibia 0.3 lakh doses on 18 March 
Paraguay 2 lakh doses on 26 March
Fiji 1 lakh doses on 26 March when the nation had 0 new cases
UN Peacekeepers 2 lakh doses on 27 March 
Zimbabwe 0.35 lakh doses on 28 March when the nation had 4 new cases
Yemen 3.6 lakh doses on 29 March 

                                         Source: Ministry of External Affairs 

Life-saving vaccines were supplied to nations either grant or commercial between the crucial period of 17 March-31 March when COVID-19 cases had already doubled within 8 days as on 17 March. Vaccines were supplied to some nations with 0 new cases and nations that were seeing a declining trend. Meanwhile, India would later allow Kumbh Mela, and its leaders did not follow COVID-19 appropriate behaviour during the election rallies with Election Commission of India a silent spectator as the covid cases kept their exponential increase. 

One conclusion is clear – no expert group either observed this doubling of cases within 8 days or their warnings were ignored either due to elections, religious biases, or short-sightedness. Also, there is a possibility of deliberate under-reporting of cases between 17 March and 31 March 2021. 

Our national leaders prioritized state elections as if it was a national election. The damage done was stopped too late – by as late as mid-April. 

The confidence with which cases were allowed to increase meant that the central and state governments had worked massively to ramp up vaccine production, oxygen plants, ventilators, and hospital beds. But by the time reality dawned – most of the hospitals were already at their peak capacity by the third week of April. People are dying and have died due to oxygen shortage, shortage of essential medicines, unavailability of hospital beds, black marketing became rampant, and there was complete chaos. Requests of plasma, remdisivir, oxygen cylinders, beds, ICU beds, ventilators started to make rounds on social media, WhatsApp groups, and the government machinery failed. Common people started to help each other or asked for leads that meant prioritizing one over the other. Even the elite class began to feel vulnerable. If such was the scenario what gave the leaders so much confidence in the first place? 

Moving ahead from criticism to solutions. Professor Manindra Agrawal of IIT Kanpur has presented his SUTRA model that predicts mid-May projection. If the government focuses single-mindedly and understands the gravity of the situation- then in the coming months one million lives can be saved as one needs to be also prepared for any unexpected outcomes. It will also act as an atonement for the mistakes done by the government. 

Prioritize Saving of Valuable Lives: 

1. Make a website/app on which real-time availability of life-saving equipment and medicines are updated. Ask talented people to volunteer and collate all district, state, and national data at a single source so as to avoid panic and confusion. Hire hundreds of volunteers for this purpose. Data of all districts need to be available there – government or private. Such websites are already doing rounds. They need to be updated in real-time regarding the availability of beds, ventilated beds, oxygenated beds, medicines, blood plasma. Certify and reward the volunteers. 

2. On the website, many have reached zero availability due to higher cases – there is a dire need to ramp up their availability. On a war footing, with the help of industry leaders, set up oxygen generating plants, oxygen concentrators that can be manufactured within the next 21 days period. Steel plants can provide oxygen as well as innovative techniques can be used to boost production. One just needs to enrich air that is plentily available. 

Meanwhile, identify the top ten most suitable nations who can provide these and import from them. Be ahead of the expected demand rather than falling short of it. The same is true regarding ventilators, ICU beds, essential medicines. Cryogenic containers and oxygen cylinders need to be also taken care of.

3. Solve the logistics issue by assigning designated nodal centers. Using rail infrastructure is good, but simultaneously also utilize the air and road networks as feasible. Strategize so as to reduce time. Consult the experts for this. Mobilize all available resources including the army. 

4. For moderate cases – schools, and hotels can also act as temporary hospitals. Identify such centers. Utilize and train medical manpower to handle these patients with timely supervision by experts. Collate a list of this medical manpower. 

5. Use the contingency funds, PM cares funds, raise funds, divert funds, tax billionaires, add cess, take loans whatever be the channel – estimate how much funds can do and raise it. Let funding shortage be not an issue. 

6. Guidelines – Use of oximeters, ayurvedic treatments, self-proning, steam inhalation, budesonide, immunity boosters (Vitamin C +Zinc), steroids as well as limited use of plasma and remdisivir – their side effects, etc. need to be circulated widely. Doctors and Tele Counsellors need to be available 24×7 on a designated covid helpline with sufficient manpower to handle the demand.  

7. A healthcare team to look after other emergency cases apart from COVID-19. 

8. Keep the data transparent at all costs. Let people know the genuine data and ensure no compromise with that. 

9. Anyone hoarding/black marketing/ extracting superprofits need to be penalized. 

Flatten the Curve By: 

  1. Daily vaccinations seem to be a constant at 3 million doses daily. Set increasing targets and scale to 6 million doses a day by ramping up production and distribution. Set a deadline by which 70 % of the population or 90 crore Indians can be vaccinated. 
  2. The mantra of Test, Trace, and Home Quarantine needs to be followed.
  3. Run ads on newspapers, TV channels, radios, social media regarding the importance of masks. They are the single most important thing to curb the spread.
  4. Set a positivity rate/mortality rate range for a district within which it would be wise to apply lockdown at the district level. Issue guidelines.
  5. Unless urgent/necessary, work from home needs to be promoted. 
  6. Give nutrition support to vulnerable people. Activate and mobilize ASHA workers. Free food schemes.
  7. Fine heavily those who are not wearing any mask. 
  8. Use sanitizers/soap to wash hands.
  9. Activate NGOs, Youth Organizations, Influential Leaders, Political Parties, Organizations for spreading awareness.
  10. Set a local center where people who cannot afford an oximeter can get their oxygen levels tested. 
  11. Promote the practice of Yoga and Pranayam for better oxygen, immunity, and mental health. 
  12. Promote mental health and well-being. Hire volunteers for counselling sessions. Stop any suicides.
  13. Mobilize Disaster Management Teams. 

Raise the Morale of COVID warriors: 

  1. Offer protection to doctors and health workers in these challenging times. Offer insurance, respect, and boost the morale of the medical manpower as well as those taking risks to go outside. Make sure the doctors are not attacked by mindless people. 
  2. The Prime Minister should address the nation to take precautionary measures. Prevention is better than cure. 
  3. Build a world-class medical college in the memory of those who lost their lives fighting this disease. 

Take Lessons: 

  1. Take/Hold accountability and rectify mistakes. An Expert Group should have warned when cases got doubled within 8 days by 17 March.
  2. Health Infrastructure from the primary to the tertiary level needs to be boosted. Adequate training of medical manpower is required. For the same, if the budget doesn’t permit – print money, build medical infrastructure, and give money in the hands of the people. It will boost demand. 
  3. Health and Education are important sectors to raise HDI. An educated population can take responsibility to follow COVID appropriate behaviour while a healthy and educated population raises the productivity of the nation. If the budget percentage allocated to these sectors is increased – there will be positive externalities that will give multifold returns.
  4. Charity begins at home. 
  5. The coming month is challenging. No nationwide lockdown ensured economic activity as well as prevented useless disruptions. That economic gain needs to reflect in the form of adequate expenditure to prevent this catastrophe.
  6. Think about what needs to be centralized and what needs to be decentralized. 
  7. Prioritize national issues over state elections 
  8. Strengthen the constitutional institutions. 
  9. Government can create independent autonomous and productive units by introducing incentives and organizational changes. If IITs, NITs, IIMs, AIIMS,  ISRO, DRDO, ONGC, CIL, SAIL, and other PSUs can be successful. There is no need for privatizing everything. The need is to introduce timely reforms within the organizations before they become liabilities. PSUs/Railways are doing an excellent job in handling crises. 

The year is 2021 – past the year of VISION 2020 of Dr. A.P.J. Abdul Kalam. As a citizen of India, it’s my right to ask the Prime Minister, the Election Commission of India, the Supreme Court, and all those in responsible positions of authority – DO LIVES OF INDIANS MATTER TO YOU?

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