Pandemic response in India: Shortcomings
- Variants: A combination of a large asymptomatic population and the presence of more infectious variants (B1.617) of the virus during the second wave, which is much steeper than the first wave.
- For instance, the UK strain detected in a significant proportion during genome surveillance in Delhi and Punjab, has shown a 50% higher transmission, according to the US Centers for Disease Control and Prevention (CDC).
- The L452R mutation found in the variant B1.671, first detected in India, too has been associated with increased infectivity.
- Containment zone: Second, in the current wave, the marking of containment zone has been less strict. In cities, the government has asked civil authorities to adopt micro-containment: with perhaps just a floor or a house defined as a containment zone.
- Healthcare infrastructure shortage: Shortage of beds, oxygen, remdesivir became steeper with patients dying due to crumbling healthcare infrastructure. Black marketing, hoarding and profiteering became bane to the poor.
- Protocol Fatigue: When cases started declining, people just broke out of the protocol of wearing a face mask, washing hands regularly and maintaining social-physical distance.
- Gatherings began becoming large particularly January 2021 onwards.
- Rules were relaxed. Penalties were not enforced. The pattern was seen across the country allowing the novel coronavirus to create a second and possibly stronger wave.
- Mixed Signal from Government: The queues outside polling booths and gatherings at the election rallies of all the parties defied Covid-19 protocol. This sent a confusing message to the public and also the grassroots-level functionaries of the government. It weakened the vigil against the pandemic.
- Urban Mobility: India has recorded over 1.2 crore cases of Covid-19 yet the pandemic is still mostly concentrated around cities, especially the bigger cities. These cities have greater mobility giving more opportunities for the virus to spread from one person to another when the guard is lowered.
Short term and long term measures needed
- There are only two ways of getting immunity from the virus, one is getting infected, and the other is via a vaccine therefore it is important to fast track the vaccine programme across the country, but testing is equally important.
- The number of tests must go up again and contact tracing, ideally 20 persons for every case, should be taken up intently.
- Decentralise the response to district level. Knowledge of existing and evolving local conditions matters, for the design and the delivery of an effective response. Local data gathering and analysis provide real time intelligence for rapid response.
- Local community networks are important channels for information dissemination and for partnering the administration in implementation.
- We need consultative policymaking at the national level, inter-departmental planning at the State level and data-driven decentralised decision making for situation adaptive implementation at the district level.
- The district collector must coordinate health-care services across all facilities in the district and be empowered to commandeer hospitals, hotels and transport facilities as needed.
- Prevent super spreader events and mandate masks. Testing numbers are again being projected as the best measure of an efficient and effective response. This is incorrect.
- While tests are indeed an important component of the strategy, we cannot test asymptomatically infected persons and mildly symptomatic persons who do not report themselves.
- These constitute a very large number at any time, as we know from antibody surveys.
- We cannot randomly and repeatedly test large proportions of the population to detect virus presence in such potentially infective persons.
- Masks, if worn well and regularly in public and even in indoor gatherings, will greatly reduce risk of transmission from any infected person, known or unknown.
- Even the more infectious variants will be blocked by effective masks, even where physical distancing is not possible.
Nonetheless, as India aims to inoculate more and more people it is imperative to ramp up vaccine production. It is important for the government, therefore, to come up with rational activity curbs, keep them stable and incentivise people, including through financial rewards. These initiatives can lower the perception of lost opportunities and compensate workers in the affected sectors such as the travel, food and hospitality industries. This road map can be reviewed when vaccines become widely available and cases decline, although a return to a carefree past is a long way off. Political communication on the state of the pandemic lacked a clear sense of purpose during festivals and poll campaigns. Now, the COVID-19 strategy can avert costly partial or full lockdowns only with public cooperation, and that calls for building credibility and trust.