COVID-19: Perils of vacuous claims

The Central government’s claim of having controlled the second wave in the shortest possible time is hollow. Studies indicate the challenges to come: a possible third wave, infections among children, deaths from fungal infections, and the emergence of mutating and highly transmissible virus variants.

At the Sawai Man Singh Hospital , Jaipur, Rajasthan, on June 1, a patient recovering from surgery to remove a fungal infection associated with mucormycosis.

Union Home Minister Amit Shah’s widely publicised comment at an event in Gujarat on June 3 that India had “controlled” the second wave of COVID-19 in a “very short time” under Prime Minister Narendra Modi’s leadership once again revealed the government’s insensitiveness towards what lakhs of people in the country have been going through in the past few months. He also made fantastic claims about India’s vaccination drive being the “fastest” in the world. Contrast this with the remarks made three days earlier by Peru’s Prime Minister Violeta Bermudez acknowledging the recommendations of a government-appointed panel and revising the COVID-19 death toll in that country from 69,342 to 1,80,764. With this the Andean nation earned the ironic distinction of having the highest number of deaths per million population in the world, but Violeta Bermudez said it was her government’s duty to make this updated information public. Amit Shah, on the other hand, made assertions that flew in the face of even officially acknowledged facts and widespread reports of undercounting of COVID deaths in India. Indeed, Bihar had to revise its official COVID death toll upwards by 73 per cent after the Patna High Court ordered an audit of the figures.

Amit Shah’s claim that India controlled the second wave “quickly” is vacuous. In the three months leading up to May 6, when the curve began to dip, the number of daily cases had shown a continual upward trend to record a global high. It is a different matter that the Modi government took a long time to even acknowledge the second wave. This understanding was epitomised, among other things, by the now infamous statement by Union Health Minister Harsh Vardhan on March 7, a full month after the onset of the rising trend in daily cases, that we are in the “end game of the pandemic”. In fact, by the second week of June, the number of daily cases reported countrywide was still averaging at 90,000; this was close to the highest levels seen in 2020. Between May 7 and June 10, there were 7.8 million new COVID cases. These figures expose the hollowness of the Health Minister’s claim.

What should also be a cause for concern is a deceleration in the rate of decline in cases. This makes the declining phase slower than the upward one, resulting in more people getting infected in the former phase. The 7.8 million cases reported after May 6 constitute 42 per cent of the total number of cases reported in India during the second wave from February 8 onwards. Notably, between February 8 and May 6, only 10.7 million people had been infected.

Significantly, the second wave is marked by a large number of fatalities. From May 7 to June 10, India recorded nearly 1.29 lakh COVID deaths, which was significantly higher than the number of deaths from February 8 to May 6 (79,000). The seven-day average daily death toll dipped below the 4,000-mark only towards the end of May; a month after the peak, it still remained above 2,500, which is more than double the highest levels seen in 2020.

Undercounting of deaths

Data from across the country reveal a huge undercounting of COVID deaths. In Gujarat, the home State of Modi and Amit Shah, journalists found that the number of death certificates issued in 71 days from March 1 to May 10 was more than double the number issued in the corresponding period last year. Apparently, the death count reported in ‘excess’ of the official toll of 4,218 was 65,000. In Delhi, too, it was revealed that there were 24,000 ‘excess’ deaths in April-May of 2021 than the corresponding period in 2020. Delhi’s official count, however, was over 13,000. Bihar’s revision of COVID deaths shows a significant increase in the number of deaths in percentage terms (73 per cent).

If India were to count all the COVID deaths in the country properly, it would have had the highest number of total cases in the world; right now it is third, behind the United States and Brazil. India’s official number of deaths per million population exceed the levels in most Asian countries. Amit Shah’s claims ring all the more hollow when one takes into account the shortage of hospital beds, oxygen and medicines in the recent past, exposing the Modi government’s lack of preparation.

States’ interventions pay

Significantly, the Central government’s claim of having controlled even the first wave was rather bizarre. Serological surveys by official agencies such as the Indian Council of Medical Research (ICMR) show that 21.5 per cent of the population in India had been exposed to the virus by the beginning of 2021, that is 28 times the number of people who tested positive. In other words, neither had the virus spread been controlled effectively nor had the testing been extensive enough to trace those infected. The second wave is likely to have increased the proportion of the exposed population to over 60 per cent. This widespread exposure indeed might be the reason for the COVID curve turning downwards, but the experience of cities such as Delhi shows that this effect may not be long-lasting.

In fact, India’s COVID cases declined because of States’ intervention in imposing lockdown and other restrictions, and not because of the Centre’s ‘strategy’. Even as late as April 20, the Prime Minister had appealed to State governments to avoid using lockdowns as a way of containing the second wave. And the State governments received little support from the Centre to deal with the fallouts of such restrictions.

At the same time, the Prime Minister and the Home Minister had lost no opportunity to hog the headlines. However, during the height of the second wave, they remained in the background when bad news dominated the news. The lack of leadership in the midst of such a calamity was widely noted not only by sections of the media but also by the judiciary in its own way.

A sorry aspect of the lack of leadership has been the Central government’s recurrent failure to have proper interaction with the States, and whatever interaction it had was of an adversarial nature. Nowhere has this indifference more visible than in the matter of the vaccination drive. But in this regard too there have been tall claims. On March 7, while declaring the COVID-19 “end-game”, Harsh Vardhan also claimed that India had emerged as the world’s pharmacy and supplied 5.1 crore vaccines to 62 countries. In the subsequent months, whenever State governments talked about the inadequate supply of vaccines, he and his colleagues kept insisting that there was no shortage and accused the States of playing politics. However, the Union government itself later put a restriction on the export of vaccines, hitting several countries. The world has since given up hopes of expecting significant vaccine supplies from India in the near future as its own vaccination programme is floundering.

In fact, Modi thanked U.S. Vice President Kamala Harris for promising India a share of the 25 million doses that the Joe Biden administration plans to share with other countries. As many as 19 million of these are intended as U.S. contributions to COVAX, a worldwide initiative aimed at equitable access to vaccines; India will receive a part of the seven million vaccines earmarked for over 15 countries in South and South-East Asia. India will also get some part of the remaining six million doses “targeted toward regional priorities and partner recipients” and to be distributed among more than a dozen countries. In other words, even with India’s tepid vaccination pace, a gift of doses that will not be enough for even two days is what India is celebrating.

The second monthly update on the worldwide production of COVID-19 vaccinations, which was recently released by the Global Commission for Post Pandemic Policy, reveals the collapse of India’s lofty ambitions to use the pandemic to emerge as an alternative to China on the world stage. The update notes that the worldwide production of COVID vaccines doubled between April and May. China led this surge by increasing its production from 164 million doses in April to 454 million doses in May, which accounted for over half the world’s total production (822 million doses) in that month. In contrast to this, India’s production fell from 76 million doses in April to 62.6 million doses in May. In the same period, the U.S. and the European Union increased their production from 71 to 105 million doses and 69 to 140 million doses, respectively. Of the total production of approved COVID vaccines until the end of May, India’s 279 million doses accounted for just over 13 per cent of the world total. This is a far cry from the 60 per cent share India earlier had in global vaccine production.

Similar was the case of the number of vaccine doses administered in India in April and May. From 89.9 million doses in April, it dropped to 61.1 million in May, according to the data on the Health Ministry website. While vaccination picked up in June, the number of doses administered in the first nine days of the month were much lower than in the first nine days of April. In contrast, China administers over 20 million doses daily even as it exports vaccines to other countries.

With fewer than 5 per cent of the adult population fully vaccinated and barely 20 per cent having received at least one dose, India’s vaccination drive is behind global averages. According to Our World in Data, a research and data website, on June 9, the number of vaccine doses administered in India per hundred population was 17.16 against a world average of 28.93. The lack of planning to widen the country’s vaccine production base will have its effect for months in spite of the Centre backtracking at least partially on its bizarre policy of decentralising vaccine procurement and raising its price.

Policy flip-flops on vaccination

Policy flip-flops such as this are also a matter of concern. The Central government had given up its responsibility of procuring vaccines for the nation and placed the onus on the States, projecting this decision as its commitment to co-operative federalism. But no private manufacturer was willing to commit to provide vaccine doses for the entire population of a State.

From January 16 to April 30, the Central government procured the vaccines and handed them over to the States to inoculate the country’s front-line workers and vulnerable persons. On May 1, it revised this policy and reduced the Centre’s procurement of vaccine to 50 per cent even while extending the vaccination programme to all adults. The States had to procure the remaining 50 per cent on their own. Soon this policy was revised again as States could not do it on their own and the rural-urban skew became more and more evident. This was because vaccination centres were concentrated in cities and urban hubs within districts.

According to the new guidelines, which will come into effect from June 21, the Central government will procure 75 per cent of the vaccines produced. Domestic manufacturers can supply 25 per cent of their production to private hospitals at rates that they would declare and private hospitals can take a maximum of Rs.150 as service charges. In any event, with most vaccines being priced over Rs.700 on an average (Rs.780 for Covishield; Rs.1,410 for Covaxin and Rs.1,145 for Sputnik V), it is apparent that a large number of people in the low-income bracket will find it hard to afford.

State governments are expected to “monitor” the charges. The revised guidelines stated that those who have the “ability to pay are encouraged to use private hospitals’ vaccination centres”. Those with the “ability to pay” have already been doing that and many more among them who were able to register their names on Cowin (the official ‘app’ for the purpose) used the facilities in the government dispensaries as well. In the absence of a free mass vaccination drive, the poor got completely left out in the process in urban and peri-urban centres.

Genomic surveillance

An study of genomic surveillance data from Delhi and surrounding areas looking at the epidemiological and genomic characterisation of a virus variant responsible for the fourth COVID wave in Delhi shows that the threat is far from over. The survey was conducted by the National Centre for Disease Control, the CSIR-Institute of Genomics and Integrative Biology and the Ghaziabad-based Academy of Scientific and Innovative Research with samples collected in two phases, May-September 2020 and February-March 2021.

According to this study, which is yet to be peer-reviewed, the upsurge in April 2021 was driven by the emergence of the more transmissible variant B.1.1.7 (identified as a variant of concern, or VOC) in January and at least one super-spreader event in February 2021, relatable to “known mass gatherings in this period”. This was followed by the seeding of the highly transmissible B.1.617 variant in this period and the sub-lineage B.1.617.2, which “outpaced all other lineages”. The surge in Delhi was explained by the presence of this variant, which is likely to have had immune evasion properties.

The third national sero-survey by the ICMR had shown a seropositivity of 21.4 per cent among adults and 25.3 per cent among children of 10 to 17 years. Delhi, like other mega cities, had reported a high seropositivity of 56 per cent, much higher than the national average. But, intriguingly, the high seropositivity did not protect the population from getting infected by the new variant.

In its third wave in November 2020, Delhi reported almost 9,000 cases daily and a test positivity rate of around 15 per cent. This declined to 1 per cent between December 2020 and March 2021. By the third week of March, the reversal began. By April 30, the positivity rate was 30 per cent and the daily number of cases averaged 30,000.

A subset of the seropositive samples studied in April 2021 showed that the level of anti-spike antibodies was low, indicating the limited levels of protection. Another significant finding was that in the community samples studied between November 2020 and May 2021, the detection of the B.1.1.7 variant was minimal until January 2021. It increased to 20 per cent in February and 40 per cent in March.

The B.1.617 lineage soon overtook the earlier variant from February onwards and accounted for 60 per cent of all cases. The sub-lineage B.1.617.2 accounted for 80 per cent of all cases. In both Punjab and Delhi, B.1.617.2 replaced the B.1.1.7 in April 2021. No VoC was observed in Kerala; the Maharashtra outbreak was related to the B.1.617.1 variant.

The study observed strong phylogenetic connections (common ancestry) between Delhi and Punjab, and Delhi and Maharashtra. But more importantly, it found that the B.1.617.2 variant was responsible for breakthrough infections (reinfection despite vaccination). The structural study of the spike protein mutations showed unique features in the B.1.617.2 variant that enabled higher transmissibility, 50 per cent greater than B.1.1.7.

On the basis of data from both India and the United Kingdom, the study also found that the viral load (virus replication and progress) and vaccination breakthrough rate was high. As many as seven spike mutations were observed in the study of the B.1.617.2 variant. It was capable of creating fast rising outbreaks and vaccination breakthroughs. “We would re-emphasise that prior infections, high seropositivity and partial vaccinations are insufficient impediments to its spread, as seen in Delhi, and a strong public health response will be needed for its containment,” notes the sero-survey study.

The genomic and epidemiological sero-surveys indicate that the challenges are still not over: a possible third wave in India, infections among children, deaths from fungal infections, and mutating and highly transmissible variants, and so on. In such a scenario, for the Central government to claim any success in controlling the pandemic would not only be premature but misleading and disastrous as well.