India can’t fight Covid with such planning

Given the reproduction rate, or the average of new infections caused by a single infected person, of Covid-19 in India is 1.48 right now, a number not seen in the country for a year, it is unlikely the current rates of 2+ lakh new cases a day are going to subside anytime soon. Keep in mind that even in the last peak in September, when the cases were near one lakh a day, the reproduction rate was under one (see graphic).

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And while there is little doubt the general level of carelessness – after a year of Covid-19 – and the massive election rallies and community celebrations of festivals like Kumbh have played a big role in the second surge, an even greater roles has probably been played by the new strains like the double mutant and the South African and UK ones that are very infective. While the government continues to obfuscate on their role, a news report in The Indian Express quoted data from the National Institute of Virology (NIV) in Pune which showed that 61% of the Maharashtra samples that were genome-sequenced from January to March had the double mutation (https://bit.ly/2Qpc5CO).

While genome sequencing is critical to knowing whether the virus is mutating, and then looking for vaccination and other solutions for this including treatment protocols, a Down To Earth investigation (https://bit.ly/3dl3hqs) found that India is sequencing less than one percent of the samples that it is supposed to, primarily due to lack of funds and associated infrastructure. While the 10 research labs that are supposed to do this can process around 30,000 samples a month, if India averages two lakh cases a day, it needs to sequence 10,000 per day based on the 5% sample size that the Indian genome protocol has laid down.

While top union ministers can choose to berate Opposition-led states while ignoring the BJP-ruled ones that are faring as badly, if even something so critical is not being done, it is any surprise that infections are growing as rapidly as they are, causing the country’s health infrastructure to collapse and for states like Maharashtra to impose stringent lockdowns? Keep in mind that, since the current lot of vaccines don’t work as well against the new strains like the double mutation, even if India were to vaccinate everyone in Maharashtra, it may not help; amazingly, the government has still not come out with the results its assessment of the efficacy of existing vaccines on the new strains.

There is little doubt that even countries like the US that have a per capita income over 30 times that of India have struggled as much; the US has had 31 million cases versus India’s 14 million and has had 5.6 lakh deaths versus India’s 1.7 lakh. The US has a case fatality rate of 1.8 versus India’s 1.2 and, at its peak in March, death rates in the US were as high 10.9%. So, while it is difficult to argue that is the Modi government’s hubris that got us to where we are, especially given how broken and under-invested India’s healthcare infrastructure remains, there is little doubt some big mistakes have been made. Unless these are corrected, the damage will be even worse than it is right now, especially since it is not clear this is the last Covid wave, either in India or overseas.

• Even if you go by the limited number of 60 crore persons that the government wanted to vaccinate, this required 120 crore doses; since Serum doesn’t have anywhere near this capacity, especially since half needs to be exported as per its AstraZeneca contract, the government made a big mistake by not contracting for supplies with more vaccine-makers like the US and the UK did.
• Had the government not controlled prices the way it had, it would have given both suppliers as well as hospitals/dispensaries an incentive to boost vaccinations; India settling at around 3 million daily shots means it will take 400 days to vaccinate even 60 crore people. By then tens of millions will be rendered jobless and lakhs of MSMEs will have shut down.

  Given how 40% of daily infections come from 10 districts, it is amazing that the government is not relooking its strategy of vaccinating the 45+ and, instead, doing total vaccination of those in these districts first. That, of course, works only if the government is able to restore the faith of vaccine-makers, critical if they are to do more research to find solutions for new strains as they emerge. Beefing up genome sequencing is a critical part of this.

• Freeing up pricing will also boost private sector participation. Since private inoculation is not paid for by the government, this also frees up money to help fund vaccine-capacity. If 30% of vaccines are being delivered through the private sector, as they are, this will free up Rs 9,000 crore of the government’s Rs 30,000 crore vaccination budget; contrast this with the Rs 3,000 crore Serum Institute wanted to boost output.
• While the shortage of oxygen and remdesivir, etc will keep occurring when infection levels rise beyond a point, the Centre has be a lot more pro-active, especially when it comes to footing the bill. For months now, it has been obvious from the health ministry’s reports that states are not testing enough; Bihar’s daily testing fell from 150,000 in the first week of September to a mere 52,000 in February. In addition, the share of the unreliable RAT tests is too high in many states. Instead of just pointing this out regularly, the Centre needs to pay for higher testing and of the correct type.
• And since it is clear only the armed forces have the capacity to quickly roll out field hospitals to deal with the repeated crises, the Centre needs to take leadership role. It is difficult to see how this can take place in the politically surcharged atmosphere where both the Centre and the states are at each other’s throats, and the Centre’s role in this is not inconsiderable either.