The daily spikes in Covid-19 cases have left many wondering where India went wrong. Did people stop following Covid-appropriate behavior, or did the government make a mistake by not planning for a second wave, which had been observed in the West and was likely to hit India next? Eminent doctors Dr Nita Radhakrishnan, HoD, Pediatric Hematology-Oncology, SSPHPGTI, Noida, Dr Shuchin Bajaj, founder and director of Ujala Cygnus hospitals, Dr Avinash Bhondve, former president, IMA Maharashtra, and Dr Prachi Jain, ENT specialist, Alchemist Hospital, speak to The Sunday Guardian about their views on what is causing the deadly second wave of Covid-19 in India.
Q: What exactly went wrong that has left India so vulnerable to a second wave of Covid-19 with multiple mutations?
Dr Shuchin Bajaj: Till around February, we were all congratulating ourselves and patting our backs for being the only one among the top five affected countries that had not seen a second wave. We were attributing it to our natural immunity and other factors. The WHO, in fact, wrote a paper saying it was due to the mass behaviour of Indians and the government enforcing monetary penalties for not wearing masks. But it was not the correct way to think. We work in the hinterland, in rural areas and semi-rural areas and we saw that nobody was wearing masks there, whether at election rallies or celebrations or at the farmers’ movement. So I think it is the virus’ behaviour, as has been seen repeatedly in various countries, where it goes away and comes back viciously as a second wave. This is exactly what happened a century ago with the Spanish flu as well. The second wave was much deadlier and wider in scope. Unfortunately, although we knew about this behaviour, that this was happening in Western countries and we were about three or four months behind them, we did not take it seriously enough. We did not realise that it would affect us as well. We went about merrily, attending weddings and parties, and now it has come back with a vengeance. It is like a tsunami now, it is no longer a wave. The numbers are shooting up rapidly and we are seeing so many mutant variants of concern that I think there are a few tough months ahead of us.
Q: What do we blame for India’s latest Covid crisis?
Dr Avinash Bhondve: As Dr Bajaj rightly said, in the month of December and January, all the people, including the Government of India, thought that this corona wave has come down and is almost gone. But we had been expecting a second wave in November and December. Fortunately, the numbers came down that time. However, in the great return, it was found that there was a new strain and there were a lot of patients who were affected rather rapidly—30 times faster than the previous virus. They did immediate genome sequencing and found out that there is a new mutant. We asked the government to take great precautions. Flights from Great Britain were stopped but genome sequencing of all those who came, which had been advised, was not done in full capacity. A few hundred were examined but there was more than that. At the same time, we got strains from Brazil and South Africa and even after that very few samples were tested. Then it was declared that a new strain was found in Amravati. Towards the end of January, the numbers were coming down but it never touched the baseline, so it was clear that the second wave was bound to come in a few days and it happened in February when the numbers started rising again. It was absurdly speedy and the government should have informed all the people that this is the speed at which the numbers are increasing. The government is saying that it happened because of people not following Covid-appropriate behaviour but they did not do that even in the months of September October or January or even today. So that was not the main reason, also since the numbers were increasing more in Maharashtra and Kerala. It was quite clear that there was some Covid strain or mutant which had been ignored. The early preventive measures which had been advised came out on 25 March, when the previous year’s highest point was crossed and it was announced that there are at least two mutants. By the double mutant, it was said that 18% to 20% people in Maharashtra were affected then, but today, as per the latest report, around 61% are affected. So, for all these things precautions should have been taken in February, especially contact tracing, which was advised but not done. Many who were asymptomatic or mildly symptomatic were not diagnosed so they spread the infection as carriers. They were people travelling for business, in local trains and buses, and all this became the main reason for the spread of the new mutants.
Secondly, when the vaccinations began in January, it was so slow that at some places there was only one centre open or only open for four days a week. So many people, even doctors and health workers, avoided taking it because of their work. The government never came out with an open statement saying the vaccines are safe. It was never announced officially. It was also expected that new vaccines would come, which would be better. These were things which the government never planned. Even planning ahead for hospital beds. In Maharashtra, all those Covid centres or jumbo Covid centres where 500 to 1000 people used to be accommodated were closed. The doctors were sent back as they had been taken on a contract basis. There was no planning or expectations about future events. Then, when the numbers started increasing, they never accepted it as the second wave, and were then taken aback with its speed.
Right now, the healthcare system in Maharashtra has totally collapsed. There is absolutely no place, even for simple isolation beds. Oxygen beds and ventilators and the ICU are really out of the question. Even Remdesivir is not available. Around 5% of the infected people may require Remdesivir. So if there are 50,000 patients per day, you require that amount. But it was not planned which is why Remdesivir is falling short now. It is the same for oxygen. Even worse is the state at crematoriums where people are waiting for hours to perform the last rites of their relatives. It is happening for not listening to experts or those who have been studying pandemics.
Q: How are children getting affected by Covid-19? Especially children who already have diseases like cancer and have low immunity levels.
Dr Nita Radhakrishnan: Globally, there has been big concern from the beginning about how this infection is going to affect immune-compromised patients. In many situations, it was found that cancer patients were more susceptible and died of the infection more. Then later on, we saw that the overall mortality was much higher in adult cancer patients than in children. For children with cancer, mortality is definitely higher than among the normal population, but it is not very high either. There are a couple of reasons. One, cancer patients are kept isolated anyway. Their families know the importance of hand hygiene and protection and not going out to crowded places. These things have been there even before the pandemic started. So, in a way, these children were protected. But I agree with the previous speakers on the statement that we have been very lax as a community. The government issuing a challan for not wearing a mask will never be a solution. It has to come from all of us. We have to decide as a group that we will wear masks till our immunity is at a level which is good enough to tackle the infection. Till the time that doesn’t happen, these children, including cancer patients, are going to be highly susceptible to the disease.
Q: How is Sputnik V different from Covishield? What is its composition?
Dr Prachi Jain: All these vaccines are basically aimed at different components of the virus. Some vaccines use mRNA, some use the whole protein, some use the spike protein. In the case of Sputnik V, which is roughly 91.6% efficient, it is a little different from Covishield. In this, different components have been used but the efficacy has been around 90%.