One year into the pandemic, we are still ill-prepared as far as health infrastructure is concerned.
The next wave of COVID-19 infections has crashed on the Indian shores like lightning. Even as we were beginning to make some sense of the pandemic, the virus has made a comeback and is raging with renewed fury across the country. With more than two lakh cases in a day, the second wave of the pandemic appears to be more contagious than last year. The crumbling of our health infrastructure is near complete with stories of death and despair coming from every nook and corner of the country.
The last wave of infection in India had left a total of 1.5 lakh people dead. Millions were economically devastated mainly because of the strict lockdown which was imposed in March 2020. As the virus rages again, whispers of a lockdown have begun to do the rounds. In fact, Maharashtra has imposed a two-week long curfew and Delhi has placed restrictions on people’s movement during weekends. It is, therefore, imperative to evaluate what we have learnt or rather not learnt from our experiences of this pandemic.
Most interestingly, India has been an outlier when it comes to the total number of COVID-19 cases and COVID-related deaths in the South East Asia region. A quick glance at data from 14 South Asian countries reveals that India has done worst in terms of total number of cases and deaths. This is despite a persistent government narrative that the country has done extremely well in dealing with the pandemic. Our flaw lies in comparing the pandemic data from India with that of the West. Compared to the West, particularly when compared to the United States and Italy, we appear to have done good. But a comparison to a similar cohort of population, South East Asia, shows us in poor light. We have done worse than most of our neighbours, including Pakistan and Bangladesh. Astonishingly small, but densely populated countries like Cambodia and Vietnam, have done extremely well when compared to us. Their total number of cases, and most interestingly their fatality, has been particularly less. In fact, China, has also done fairly well with only 90,329 cases and 4,636 deaths. Small countries like Malaysia and Singapore have had a very high number of cases per million population, but their total number of cases and deaths are so low that the effect of the cases per million population appears to be insignificant when compared to India.
What is the reason for such a high number of cases in India even when the region has done quite well? Why has India behaved like a western country when it comes to the COIVD-19 pandemic? In fact, the second wave of infection is also more fierce and infectious in India when compared to the rest of South East Asia. This is an interesting phenomena as it will have answers for future references. Probably, there are multiple reasons for this bizarre epidemiological catastrophe which has besieged us.
In an earlier article (‘No apocalypse now’, IE, March 13, 2020), I had predicted that the COVID-19 pandemic in India will not cause havoc as it had in countries like Italy, Spain and the US. That prediction was based on a historical evaluation of similar pandemics. The prediction did come true except that we did fairly poorly when compared to the rest of South East Asia and more so after a lockdown was imposed. Interestingly, the Oxford COVID-19 Government Response Tracker (OxCGRT) systematically collects information on several different common policy responses that governments have taken to respond to the pandemic on 20 indicators such as school closures and travel restrictions. It then gives a COVID-19 stringency index. In a nutshell, this tool tells us how strict the lockdown was in different countries with a score of 0 being least strict and 100 being strictest. At the peak of lockdown, in May 2020, the stringency index for India was 81.94. On the same date, the index was 56.94 for China, 75 for Thailand, 69.4 for Malaysia and 57.4 for Cambodia. Countries like Pakistan implemented a loose lockdown with hardly any strictness. In the region, besides India, a strict lockdown was also seen in the Philippines (stringency index of 96.3). Extrapolating this data to the total number of cases and fatality, we can clearly see that India and the Philippines had the most number of cases per million population.
This observation is interesting as we are heading on the path of yet another lockdown as a solution to the second wave of the pandemic. How a lockdown increases the potency, virulence or case fatality of the COVID-19 virus is an unanswered question. We are not even sure if this extrapolation is correct. It needs further evaluation as more and more data becomes available.
Having said that, one thing is very clear: Containment (not lockdown) and testing should continue to form the basis of managing the current wave of the pandemic. It is an irony that even one year after the emergence of the COVID-19 virus, we are still ill-prepared in terms of the health infrastructure. That patients are dying due to a lack of oxygen cylinders, due to a shortage of the antiviral drug Remdesivir or a lack of hospital beds is a grim reminder of the total disinterest of policymakers in health infrastructure.
We can pat ourselves on the back and compare our COVID-19 data with the West, but, unfortunately, our response to the pandemic has been one of a nation reeling under the weight of its own contradictions, full of megalomaniac narratives and poor public health infrastructure. It’s high time we wake up to the realities of India and brace ourselves to face this virus in a more cautious but pragmatic way.
This column first appeared in the print edition on April 17, 2021 under the title ‘How not to take on the virus’. The writer is professor of orthopaedics, AIIMS, New Delhi. Views are personal.
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