After early success, India’s daily COVID infections have surpassed the US and Brazil. Why?


Rajib Dasgupta, Jawaharlal Nehru University India is in the grip of a massive second wave of COVID-19 infections, surpassing even the United States and Brazil in terms of new daily infections. The current spike came after a brief lull: daily new cases had fallen from 97,000 new cases per day in September 2020 to around 10,000 per day in January 2021. However, from the end of February, daily new cases began to rise sharply again, passing 100,000 a day, and now crossing the 200,000 mark.

Night curfews and weekend lockdowns have been reinstated in some states, such as Maharasthra (including the financial capital Mumbai). Health services and crematoriums are being overwhelmed, COVID test kits are in short supply, and wait times for results are increasing.




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How has the pandemic been spreading?

Residents in slum areas and those without their own household toilet have been worst affected, implying poor sanitation and close living have contributed to the spread.

One word that has dominated discussions about why cases have increased again is laaparavaahee (in Hindi), or “negligence”. The negligence is made out to be the fault of individuals not wearing masks and social distancing, but that is only part of the story.

Negligence can be seen in the near-complete lack of regulation and its implementation wherever regulations did exist across workplaces and other public spaces. Religious, social and political congregations contributed directly through super-spreader events, but this still doesn’t explain the huge rise in cases.

The second wave in India also coincides with the spread of the UK variant. A recent report found 81% of the latest 401 samples sent by the state of Punjab for genome sequencing were found to be the UK variant.

Studies have found this variant might be more capable of evading our immune systems, meaning there’s a greater chance previously infected people could be reinfected and immunised people could be infected.

A new double mutation is also circulating in India, and this too could be contributing to the rise in cases.




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Low fatality rate?

In the first phase of the pandemic, India was lauded for its low COVID death rate (case fatality rate) of about 1.5%. However, The Lancet cautioned about the “dangers of false optimism” in its September 26 editorial on the Indian situation.

In a pandemic situation, the public health approach is usually to attribute a death with complex causes as being caused by the disease in question. In April 2020, the World Health Organization clarified how COVID deaths should be counted:

A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma)

It is unclear the extent to which the health authorities across the states of India were complying with this.

Many states have set up expert committees to re-examine and verify COVID-19 deaths after coming under criticism that reported death rates were not accurate. Many states made corrections in mortality figures, and the full extent of undercounting is being actively researched.

District-level mortality data, both in the first wave as well as in the current wave, confirm that the global case fatality rate of 3.4% was breached in several districts such as Maharashtra, Punjab and Gujarat. Case fatality rates in some of the worst-affected districts were above 5%, similar to the 5% mortality level in the US.

What are the challenges this time?

A majority of the cases and deaths (81%) are being reported from ten (of 28) states, including Punjab and Maharashtra. Five states (Maharashtra, Chhattisgarh, Karnataka, Uttar Pradesh and Kerala) account for more than 70% of active cases. But the infection seems to have moved out of bigger cities to smaller towns and suburbs with less health infrastructure.

Last year, the government’s pandemic control strategy included government staff from all departments (including non-health departments) contributing to COVID control activities, but these workers have now been moved back to their departments. This is likely to have an effect on testing, tracing and treating COVID cases. And health-care workers now have a vaccine rollout to contend with, as well as caring for the sick.




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What now?

In early March the government declared we were in the endgame of the pandemic in India. But their optimism was clearly premature.

Despite an impressive 100 million-plus immunisations, barely 1% of the country’s population is currently protected with two doses of the vaccine. The India Task Force is worried that monthly vaccine supplies at the current capacity of 70 million to 80 million doses per month would “fall short by half” for the target of 150 million doses per month.

Strict, widespread lockdowns we have seen elsewhere in the world are not appropriate for all parts of India given their effect on the working poor. Until wider vaccination coverage is achieved, local containment measures will have to be strengthened. This includes strict perimeter control to ensure there is no movement of people in or out of zones with local outbreaks, intensive house-to-house surveillance to ensure compliance with stay-at-home orders where they are in place, contact tracing, and widespread testing.

It should go without saying large congregations such as political rallies and religious festivals should not be taking place, and yet they have been.

Strong leadership and decentralised strategies with a focus on local restrictions is what we need until we can get more vaccines into people’s arms.The Conversation

Rajib Dasgupta, Chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the risk if Australia opens its international borders? An epidemiologist explains


Tony Blakely, The University of MelbourneCoinciding with the Trans-Tasman travel bubble starting today, over the past week there have been murmurings Australia could soon relax its borders further, through mechanisms such as home quarantine or letting in vaccinated people.

But what are the risks?

Here I propose three things we must consider:

  • the prevalence of the virus in the country from where travellers are coming, including the strain of virus
  • measures taken for the people travelling, including home quarantine and whether travellers are vaccinated
  • the percentage of our population who are immune.

Importantly, all these factors matter. It’s not simply a case of needing to ensure all travellers are vaccinated.

The level of infection in the country of origin matters enormously

At around Christmas time, roughly 2% of the UK population was infected. That percentage is now considerably less, but it’s still likely around 1,000 times higher or more than the risk in China and other East Asian countries. The risk is near zero for New Zealand, Taiwan and many Pacific countries.

However, things will change. At the moment the United States seems to be maintaining high infection rates while also rapidly vaccinating the population. This is probably because of more transmissible variants, and society loosening up, offsetting gains from more people being immune. But at some point, perhaps around mid-year, the infection rate in the US should plummet as the percentage of people immune increases to somewhere around 60-80%. All this is to say we can expect infection rates in countries to vary a lot in the next six to 12 months.




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Let’s work through an example of the United Kingdom. Assume the UK has another surge of infections such that 0.5% of British people are infected and unaware of it, and could jump on a plane to Australia. Let’s assume we decide to let 10,000 Brits come to Australia each month. So 0.5% of 10,000 would mean roughly 50 infected people arriving per month.

Mitigating the risk of travellers

Of course, we would do more to reduce the risk. We could test people before they get on the plane and when they arrive. Let’s assume that weeds out another 50%, as the other half may be still incubating and not yet testing positive. That’s 25 COVID-positive British people arriving per month.

Next, let’s assume we require all travellers to be vaccinated. That will reduce their risk of unwittingly carrying the virus (through either symptomatic or asymptomatic infection) by between 66% for the UK variant and 81% for “normal” virus for the AstraZeneca vaccine. Data are still sketchy on any infection for Pfizer, but it’s likely 90% or more, given 95% protection against symptomatic disease in Pfizer’s clinical trial. If we assume 80%, we are now down to five infected Brits arriving here per month.

Importantly, the vaccine also reduces both the duration of the disease and its infectiousness, for vaccinated people unlucky enough to get infected. We don’t know by how much as the real-world evidence is still accruing, although animal data on peak viral load and duration of likely infective viral load supports this contention.

If we assume (conservatively in my view) that there is a 50% reduction in duration and 50% reduction in peak infectivity for hapless vaccinated people who still get infected, that is 25% of the risk of passing it on (that is, 50% of 50%).

Therefore, if an unvaccinated person, infected with the UK variant, was going to infect an average of 3.5 people in the absence of any social measures such as mask-wearing, the infected-after-vaccination person would only infect 0.875 other people – a 75% reduction in the reproductive rate. So our remaining five infected Brits are less infectious.

Intensity of quarantine measures for arrivals

Let’s consider the option of home quarantine. We don’t know how effective this will be, because of potential compliance issues.

But the risk of home quarantine breaches can be reduced by technology like ankle bracelets, GPS tracking on travellers’ phones to ensure they stay home, and only allowing home quarantine if any other members of the household are also vaccinated, to give an extra layer of protection.

Let’s assume home quarantine with these extra measures stops 80% of infected people getting out and about in Australia while infectious.

So we are now down to one infected British person who has slipped through per month. But given they are also vaccinated, they’re less likely to pass on the infection. And this risk can be reduced further still by ensuring they’re wearing a mask – although if they “breached” home quarantine rules they may not be likely to wear a mask.

It’s important to remember even “proper” quarantine isn’t foolproof. About one in 250 infected people last year in hotel quarantine caused a leakage.

Is Australia a tinderbox?

Yes. Perhaps only 5% of us are immune. Even if, via the above measures, we get just one infected person a month in Australia – the situation could blow up. Keep in mind the above example assumes we’re only allowing travellers from one country too. More countries means more travellers means more risk – although as above, the risk varies based on the infection rate in the origin country.

You can play with various scenarios in our COVID-19 Pandemic Trade-offs tool, launched two weeks ago. What you’ll find is that until most adults in Australia are vaccinated, any loosening up of how we respond to the virus incursion is unwise. If contact tracing cannot mop up the inevitable incursions, we’ll still need to use social restrictions, including lockdowns, until the vaccination rollout is complete.

But we can probably think about inching forward to some increased risk once all over-50s are vaccinated (phase 2A), with some modest relaxation of the border. Yet we can never totally escape the risk of outbreaks.

So what can we do now with borders?

First, continue with the Trans-Tasman bubble.




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Second, remove or greatly reduce quarantine for vaccinated travellers from many East Asian countries, which present a low risk to Australia. As an example, the average number of known active infectious people in China at any point in time recently is about 250. Let’s assume this equates to about 100 unknown infections at any point in time (that is, people who are not yet symptomatic or detected). For a population of 1.4 billion, that’s a 0.000007% risk of any person in China being infected.

This suggests that for 10,000 vaccinated arrivals from China per month with modified quarantine, the expected number of infected people unwittingly getting out into the Australian population per month is 0.000014. Or, put another way, our above UK example presents 70,000 times the risk of an arrival from China. Given such low risk, it’s hard to justify why university students from China cannot start in time for semester two this year if they’re vaccinated and going into some form of modified quarantine.

Third, we need a national framework to assess the risk. Focusing on one measure alone isn’t wise — you have to look at the whole system. Such a framework can be developed now, at the same time as setting our risk thresholds so policy-makers, airlines and other industries can start planning.The Conversation

Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

To abandon vaccination targets is to abandon the mantle of leadership


Peter Gahan, The University of Melbourne and Jesse E. Olsen, The University of MelbourneThe Australian government has abandoned its ambitious targets to have the adult population vaccinated by the end of October. It has, in fact, abandoned having any target.

We all sometimes find ourselves in tough positions and just want to call it a day. But this decision is not what we should expect from the nation’s leaders when so much is at stake. It also goes against decades of research and evidence on the importance of goal-setting.

In January Prime Minister Scott Morrison said the plan was to have four million Australians vaccinated by the end of March, and the entire adult population by the end of October. At the start of April, however, the actual number was less than 842,000. (As of April 15 the number was just over 1.4 million doses.)

Then, on April 11, in a video posted to his Facebook page at 11:35pm, Morrison announced there would be no more targets. “We are just getting on with it,” he said.

But without any target, what is the “it” we should be “getting on with”?


Australia's vaccination score card as of April 4 2021.
Australia’s vaccination score card as of April 4 2021. Don’t expect to see any more of these.
Australian Government/Department of Health, CC BY-SA

Imagine if at your next work meeting the boss echoed the prime minister’s words that “one of the things about COVID is it writes its own rules” and said something like:

This quarter, rather than set targets that can get knocked about by every to and fro, we are just getting on with it.

Will these words inspire your team to succeed?

According to leadership research, good management necessarily entails influencing others to achieve goals or objectives. This is a point made even in introductory undergraduate management textbooks.

To abandon goals or targets is, by definition, to abandon the mantle of leadership.




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When goals work

Study after study has demonstrated why setting ambitious targets is important for virtually any activity — from turning a couch potato into a marathon runner, to putting an astronaut on the Moon, to building a driverless car.

Of course, just setting an ambitious goal is not enough. Done poorly, they can be discouraging and undermine performance, and even lead people to behave unethically. To work, people and organisations need to have the capabilities and resources to address unexpected twists and turns, as well as strategy to manage risks and overcome any barriers that crop up.

But so long as goals are set with these things in mind, they help achieve results, driving creativity, innovation and performance.

We already see evidence of this in COVID vaccinations overseas.

The US government’s Operation Warp Speed, the private-public partnership to develop and distribute multiple vaccines in record time, started with this goal:

to deliver tens of millions of doses of a SARS-CoV-2 vaccine — with demonstrated safety and efficacy, and approved or authorised by the US Food and Drug administration for use in the US population by the end of 2020, and to have as many as 300 million doses deployed by mid-2021.

The goal was both ambitious and specific, defining the “it” that everyone should “get on with”. It formed the basis for planning that has started paying dividends after a year of death and economic destruction.

Goal setting and effective leadership

The federal government’s decision to abandon goals goes against research the Commonwealth itself commissioned just a few years ago.

In 2015, the federal Department of Employment and Workplace Relations funded the University of Melbourne’s Centre for Workplace Leadership to survey more than 3,500 Australian workplaces about how the quality of management and leadership affects productivity and innovation.

The Study of Australian Leadership, which surveyed both private and public sector organisations, found very basic management practices to be among the most important drivers of organisational performance and innovation. These basic practices include setting clear and ambitious targets, communicating them, and regularly monitoring progress.

Scott Morrison communicates via a Facebook video on April 11 that the Australian government has abandoned vaccination uptake targets.
Scott Morrison communicates via a Facebook video on April 11 that the Australian government has abandoned vaccination uptake targets.
Facebook

Leading rapid implementation

Given the evidence, any government with claims to having competent leadership should be setting and communicating a clear and ambitious goal for its vaccination roll-out.

Successful roll-outs in other countries show this should be done in consultation with local and regional governments, health professionals and key players in the public and private sectors (who must also be involved in the design and implementation of strategies and processes).

Given the federal government’s own limited capacities at the local level (public hospitals, for example, are run by the state and territory governments), its engagement with other stakeholders must be meaningful — not just lip service. It must also resist the urge to control everything.

Let there be goals

When faced with complex problems, getting agreement on ambitious goals can be extremely powerful. Nor does it need to take forever, as is often claimed. Australia’s response to the pandemic in 2020 largely shows this.

There will be challenges with meeting targets. Vaccine supplies are limited. There will be hiccups. But abandoning any sense of ambition is not the answer.

Because COVID “writes its own rules”, as Morrison has rightly pointed out, the federal government should pursue multiple alternative paths to achieving its goals. In other words, it should not put all it eggs in one basket, as it did with its plan to rely on local GPs to deliver vaccines, rather than use “vaccination hubs” as other nations have done.




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Abandoning vaccination targets now undermines all that has been sacrificed to be in the relatively good position the nation is now in. The economic and social costs, as well as the potential further loss of life, will mount unless the Morrison government reconsiders its misguided decision.

It must put aside concerns about the political fallout of missing targets. We cannot “get on with it” without leadership that defines the “it” to be gotten on with.The Conversation

Peter Gahan, Professor of Management, Faculty of Business and Economics, The University of Melbourne and Jesse E. Olsen, Senior Lecturer, Dept of Management & Marketing, Faculty of Business & Economics, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A ‘deep clean’ has been ordered for a Brisbane hospital ward. What does that actually involve


Brett Mitchell, University of Newcastle and Philip Russo, Monash UniversityThe Australian public’s infection control literacy continues to expand. We know what PPE is, what “flattening the curve” means, and we are growing increasingly familiar with the term “deep clean”. But what does a deep clean involve, and when is it necessary?

This week, media reported that a ward at Brisbane’s Princess Alexandra Hospital was to undergo further “deep cleaning” after testing found a “COVID-19 related virus” in the ward. This was to be combined with further engineering reviews, although the ward’s isolation rooms were deemed to be functioning as expected.

What role does environmental cleaning play?

SARS-CoV-2, the virus that causes COVID-19, can survive on surfaces. This means if a surface is contaminated by someone with COVID-19, it is theoretically possible for other people to become infected if they touch those surfaces and then touch their nose, mouth, or eyes.

It is not clear how many cases of COVID-19 are acquired through surface transmission, although the risk from this transmission route is thought to be lower than other routes, such as droplets, aerosols and direct contact.

The other good news is that SARS-CoV-2 is easily broken down and can degrade quickly upon contact with particular cleaning agents and under certain environmental conditions.




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Nonetheless, because SARS-CoV-2 can survive on surfaces and there is a theoretical risk, it is important that measures to reduce subsequent transmission include cleaning. This is on top of other, potentially more important measures such as increasing appropriate ventilation, waiting as long as possible before entering the space (at least several hours), and using personal protective equipment (PPE).

So, what is a deep clean?

There is no nationally agreed definition of what constitutes a “deep clean”. The term seems to have originated during disease outbreaks in hospitals in the 1990s and 2000s.

Cleaning is a complex and skilled process involving many facets. Evidence has shown that improving routine cleaning in hospitals can reduce infection risk, and that this is cost-effective. But what is the difference between a routine cleaning and deep cleaning?

Hospital worker mops floor
There’s no agreed definition of a deep clean, but it goes a long way beyond mopping the floor.
Masanori Inagaki/AP

In the absence of detailed guidelines, institutions and companies have developed their own approach to deep cleaning. In Victoria, there is some limited guidance of what a deep clean involves.

Broadly speaking, a deep clean should pay particular attention to cleaning objects or surfaces that may not be cleaned as part of a routine clean. These could include walls, ventilation ducts, curtains, and harder-to-reach surfaces that are touched less frequently. In contrast, routine cleaning focuses on surfaces that are frequently touched.

Deep cleaning typically involves the use of a disinfectant, as well as a detergent. Typically detergents are used to remove organic matter. Disinfectant can kill bacteria and viruses (depending on the type of disinfectant). Products or surfaces that are more difficult to clean, such as carpets, soft furnishings or certain equipment, may also be included in a more thorough clean, noting that care has to be taken not to damage such items in the process.

Training and auditing are also crucial for effective cleaning. Cleaners need to be properly trained, including in the correct use of PPE to ensure they are protected.

Regular auditing of cleaning can be done in various ways, including direct observation or by using fluorescent markers. Fluorescent markers are invisible to the naked eye, but are removed when a surface is cleaned. They can be applied before cleaning a surface and checked again after, to determine whether it has been effectively cleaned.

What about ‘fogging’?

Media footage often shows workers “fogging” rooms and facilities as part of a deep clean. This involves spraying the area with very fine droplets of disinfectant, and it certainly makes for compelling television.

But several Australian organisations have recommended against fogging, including the Victorian Department of Health and Human Services, New South Wales’ Clinical Excellence Commission and Safe Work Australia.

The US Environmental Protection Agency does not recommend fogging or fumigation, unless the product label specifically includes disinfection directions. Australia’s Therapeutical Goods Administration has also noted that testing of disinfectants may not apply to techniques such as fogging.

Where to from here?

Like all things COVID-19, our understanding of the role of surface transmission and the benefits of deep cleaning continues to evolve. Any unusual transmission events or “mystery” cases, particularly in a health-care setting, need to be thoroughly investigated.

Technologies such as genomic testing, which provide detailed information about specific chains of transmission between people, could provide rich data to help us understand the role of the environment and inform future strategies.

Importantly, any findings from investigating these unusual events need to be made publicly available so the wider community can better understand how to combat the spread of COVID-19.




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The Conversation


Brett Mitchell, Professor of Nursing, University of Newcastle and Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Doctors do not face a greater legal risk if they give AstraZeneca to younger Australians — here’s why


Simon Santi/AAP

Cameron Stewart, University of SydneyLast week, the federal government changed its recommendation for COVID-19 vaccines. The Pfizer vaccine is now the “preferred” jab for adults under 50.

Amid the political fallout and worries about what it means for Australia’s COVID recovery, doctors have expressed concern about their liability. Some said they would even stop giving the AstraZeneca jab until they were more certain of their position.




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Are they at greater legal risk if they give AstraZeneca to younger Australians? The government insists they are not. This is correct — here’s why.

Proving fault

In Australia, medical liability is, for the most part, fault-based. This means patients who are injured by medicines, medical devices and medical interventions must prove the doctors who used them were to blame for any injury they suffered before any compensation will be paid.

Australian liability laws are state-based, but generally speaking, fault can only be proven when the doctor has acted outside of the professional standard of care in a way that is not supported widely in Australia by professional peers.

What is the standard of care?

The standard of care for diagnosis and treatment is effectively set by the medical profession. In cases — such as COVID vaccines — where the treatment is new and knowledge about the treatment is emerging, the standard of care is also developing.

Importantly, doctors are judged by measuring their behaviour against the standard of care at the time the treatment was given. This means that if, in 2020 a doctor administers a COVID vaccine in a way that was supported by their peers at that time, they will not be found to have breached the standard of care if, years later, other side effects become known.

Prime Minister Scott Morrison inspecting AstraZeneca production.
Last week the Morrison government changed its advice around the AstraZeneca vaccine.
David Caird/AAP

We should also be careful not to automatically equate the government’s advice concerning the AstraZeneca vaccine with what the standard of care should be at the individual level.

The government’s advice is concerned with the big picture and with risks across a population. Doctors have the task of treating individuals. So, the government’s advice should be considered by doctors when working out which vaccines to offer to patients, but there may well be situations where the AstraZeneca is the best option for individual adult patients under 50.

Giving advice and accepting risks

Doctors also have a duty to inform individual patients about material risks of the treatments they provide. Every intervention comes with a set of risks but only the material ones need to be disclosed.

Material risks include those the profession would usually notify patients of (objective material risks), as well as risks the individual patient may have a particular concern about (subjective material risks).

The classic example of this is the 1993 case of Rogers v Whitaker where a woman who was blind in one eye was considering cosmetic surgery on that eye. She was concerned about any risk (no matter how remote) of going blind in her “good eye”. Later, she became blind from a complication of her treatment, which was known but very rare. The doctor’s failure to inform her was considered a breach of the duty to inform — even though it was not a risk normally disclosed — because the risk was subjectively material to her.

Again, the doctor will always be judged by what the profession knew at the time regarding these risks. If a patient is told about the material risks of the treatment and decides to go ahead with the treatment, the doctor has satisfied their legal duty to advise and cannot be held liable for subsequent injuries.

What now for GPs and AstraZeneca?

As long as doctors consider the government advice, keep up with professional news about best practice and communicate material risks to patients, they face no greater liability for providing COVID vaccines than they do for any other treatment.

The reality is the risks of people being injured by vaccines, and of doctors being sued for vaccine-related injury, is incredibly low.

At the weekend, the Australian Medical Association also said if a patient makes an informed decision to receive the AstraZeneca vaccine, GPs are protected under professional indemnity insurance.

Of course, the reality of low risk may not match the fear practitioners experience. So, are there things we can do to reduce the anxiety practitioners feel regarding liability?




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One obvious measure is to move to no-fault systems of compensation. Many countries including the United States and New Zealand have no-fault compensation schemes for vaccine-related injury. Putting such a scheme in place may very well help doctors get over the fear of being sued. It might also give patients confidence knowing that in an extremely rare case of injury, they will be covered.

This could be done either with a one-off scheme or by expanding the National Injury Insurance Scheme, which covers personal injuries from motor vehicle accidents.

Without such schemes, Australian patients will only have access to compensation for vaccine-related injury if they can prove it was caused by a failure to act according to medical standards of care or a failure to properly inform the patient of material risks.The Conversation

Cameron Stewart, Professor at Sydney Law School, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As India’s COVID crisis worsens, leaders play the blame game while the poor suffer once again


Sujeet Kumar, Jawaharlal Nehru University India is witnessing a sharp spike in COVID-19 cases after months of declining numbers had given the country hope it had made it through the worst of the pandemic relatively unscathed.

On March 1, India recorded just 12,286 new cases, but since early April this figure has skyrocketed to over 100,000 every day. Earlier this week, it hit a record of 168,912 cases in a day — the highest in the world.

As the health crisis escalates, the poor are once again fearing a return to lockdown and economic hardship. Migrants have started fleeing from cities to their home villages in order to avoid the pain and trauma they went through a year ago when Prime Minister Narendra Modi enacted a nationwide lockdown. Many cities, including Mumbai and Delhi, have already announced nightly curfews.




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For now, the Indian government has just asked the states to focus on “stringent containment and public health measures”, including testing, tracing and inoculations. Modi has also appealed to people to get vaccinated during a four-day “Tika Utsav” (special vaccination drive), which began on Sunday.

However, the situation remains grim. Even though India is one of the world’s biggest coronavirus vaccine manufacturers, some states are experiencing vaccine shortages. At the same time, experts fear a lack of social distancing and new variants of the virus are causing infections to potentially spiral out of control.

How the poor suffered during last year’s lockdown

When COVID-19 first appeared in India last year, the Modi government was quick to bring the country together.

In a speech to the nation last March, he announced a 21-day nationwide lockdown of 1.3 billion people with only four hours’ notice. All means of transportation were suspended. The rich and affluent started hoarding food and medicines, while the poor worried about their livelihoods.

A mass migration ensued as hundreds of millions of migrant workers headed from the major cities back to their home villages on foot. This was the most visible face of the humanitarian crisis. Others, however, suffered out of the public eye, such as the street vendors, waste pickers, domestic maids and shopkeepers in slums, who were all forced to stop working.

Migrant laborers wait for buses during last year's lockdown.
Migrant laborers wait for buses to transport them to their hometowns following last year’s lockdown.
AP

As part of a study last year, I helped conduct a series of six rounds of telephone surveys in 20 diverse slums in the city of Patna, the capital of the northeastern Bihar state from July to November.

Nearly all slum residents we spoke with — except the rare few with protected formal sector jobs — were cut off suddenly from their sources of income after the lockdown was announced. And more than 80% of slum households in Patna lost their entire primary source of income.




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Economic recovery since the lockdown has also been slow. By mid-November, one-third of respondents had still not fully recovered their pre-pandemic incomes. Many had been hired back at their old jobs on a part-time basis or at a fraction of their former pay. Many jobs simply disappeared.

The poor survived by cutting back on their food, borrowing money and helping each other.

Given these struggles, there is now a sense of anxiety in these slum communities and a mistrust of the government, especially Modi. Says Ajay, 35, a street vendor who lives in the Kankarbagh slum,

The government finds it is easy to lock us down but not to provide financial and livelihood support. PM is busy campaigning for an election where thousands of people come without masks and are violating social distancing norms.

The government’s failed leadership

Undoubtedly, Modi still remains popular among most ordinary people. When he says something, India listens carefully. It worked well last year, and his appeal compelled people to wear masks and maintain social distancing, helping to flatten the curve and limit the loss of lives.

However, making public speeches will not be enough during this second wave. The prime minister needs to be seen adhering to these practices in his own daily life, but this is not happening on the ground.

In the ongoing elections in West Bengal, Assam, Kerala and Tamil Nadu, as well as the election in Bihar last year, Modi and other party leaders have addressed several rallies without paying much attention to COVID restrictions. Modi himself has addressed more than 20 rallies attended by thousands of unmasked people.

When leaders are seen addressing mass gathering without masks and social distancing, the public will not only assume everything is normal, they will lose their fear of COVID.

Modi has also insisted he would not politicise the pandemic, but he has done exactly that. In states like Maharashtra, Punjab and Chhattisgarh, which are facing a spike in cases, Modi’s party is pointing the finger at the state leaders, who come from opposing parties. The states, meanwhile, are blaming Modi’s government for failed leadership.




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Another concern is the Modi government’s decision to allow a major festival, Kumbh Mela, to take place in Uttrakhand state, which is ruled by his party, the BJP. Several million people gathered at the Ganges River for an auspicious bathing day this week, flouting social distancing practices.

Uttrakhand’s chief minister said the “faith of devotees will overcome the fear of COVID-19”, at a time when infections are skyrocketing.

Millions take part in Hindu festival.
Devotees take holy dips in the Ganges during the Hindu festival, Kumbh Mela.
DIVYAKANT SOLANKI/EPA

Who will help the poor?

As the numbers of COVID-19 cases are rising every day, the fear of a return to lockdown is ever-present, haunting the poor. Many have yet to recover from their previous debts, and COVID-19 is now threatening their livelihoods again.

Last year, several not-for-profit, grassroots organisations came forward to help the migrants and urban poor dwellers, but this is going to be more challenging this year.

Not only have their funds been depleted, but recent changes brought by the government have stopped the flow of foreign aid money to many organisations. Amnesty International announced in September it would halt its operations in India after its bank accounts had been frozen.

One NGO volunteer, Prabhakar, who works with slum dwellers in Patna, told us,

if the government is going to announce the complete lockdown like last year, many people will run out of food, as parent NGOs have stopped sponsoring the small organisations which work with the slum dwellers.

This is the time for Modi to show decisive leadership in not only controlling the surge of the virus, but also providing financial assistance to millions of urban poor and helping them reach their home villages with their dignity intact. This is what is needed to instill trust in the prime minister again.


Binod Kumar, a senior project officer in the Entrepreneurship Development Institute of India, contributed to this article.The Conversation

Sujeet Kumar, Senior Research Fellow, Centre for the Study of Law and Governance, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is Novavax, Australia’s third COVID vaccine option? And when will we get it?


Jamie Triccas, University of SydneyAs AstraZeneca is no longer the preferred vaccine for Australian adults under 50, attention is turning to what other COVID-19 vaccine options are in our arsenal.

The federal government has ordered 40 million doses of the Pfizer vaccine, which will become the mainstay of the rollout, while AstraZeneca will continue to be administered for people over 50 in the current phase 1B.

The federal government also this week ruled out using Johnson & Johnson’s one-shot vaccine.

But Australia does have a deal for a third vaccine, by US biotech company Novavax. The government has ordered 51 million doses of this vaccine, though it’s yet to be approved by Australia’s drug regulator, the Therapeutic Goods Administration (TGA), which is expected to make a decision in the third quarter of the year.

At this stage, Novavax would be made offshore and imported, although Melbourne-based biotech CSL can make the vaccine if requested by the federal government.

How does the Novavax vaccine work?

The Novavax vaccine is given as two doses, similar to the Pfizer and AstraZeneca shots already being used in Australia.

It can be stored for up to three months at fridge temperature, which differs from the Pfizer mRNA vaccine which needs to be kept at ultra-low temperatures. In saying that, the TGA said last week the Pfizer vaccine can be stored at normal freezer temperatures for two weeks during transport, and at fridge temperatures for five days — though must still be kept ultra-cold after transport and in the long-term.

A graphic comparing Australia's three vaccine options
Comparing Australia’s three COVID-19 vaccine options.
Jamie Triccas, made with BioRender, CC BY-ND

The vaccine also uses a different technology to the Pfizer and AstraZeneca vaccines. It’s a “protein subunit” vaccine; these are vaccines that introduce a part of the virus to the immune system, but don’t contain any live components of the virus.

The protein part of the vaccine is the coronavirus’ “spike protein”. This is part of the other COVID-19 vaccines in use but in a different form.




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The Novavax vaccine uses a version of the spike protein made in the lab. The spike proteins are assembled into tiny particles called “nanoparticles” which aim to resemble the structure of the coronavirus, however they cannot replicate once injected and the vaccine cannot cause you to get COVID-19.

In order for these subunit vaccines to generate strong protective responses, they need to include molecules that boost your immune system, called “adjuvants”. The goal of these adjuvants is to mimic the way the real virus would activate the immune system, to generate maximum protective immunity.

Novavax includes an adjuvant based on a natural product known as saponin, an extract from the bark of the Chilean soapbark tree.

How effective is the vaccine compared to those already in use in Australia?

The interim data from phase 3 testing, released in March, was very encouraging. When tested in the UK in a clinical trial including more that 15,000 people, the vaccine was 96% effective at preventing COVID-19 disease for those infected with the original strain of the coronavirus.

This compares well to the Pfizer vaccine, with an efficacy of 95%, and recent data from AstraZeneca demonstrating 76% efficacy against COVID-19.

The Novavax vaccine is also safe. In early clinical testing the vaccine caused mainly mild adverse events such as pain and tenderness at the injection site, and no serious adverse reactions were recorded. In the larger trials, adverse events occurred at low levels and were similar between the vaccine and placebo groups.

What about protection against variants?

In the UK trial, the vaccine maintained strong protection against disease in people infected with the B.1.1.7 “UK variant”, demonstrating 86% efficacy.

This is good news because the B.1.1.7 variant is now dominant in many European countries, is more transmissible and deadly than the original SARS-CoV-2 virus, and is responsible for most of the cases that have arisen recently in Australia.




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Less encouraging is protection against the B.1.351 variant first identified in South Africa, which can evade immunity that developed in response to earlier versions of the virus. The efficacy of Novavax’s shot dropped to 55% in protecting against COVID-19 symptoms from this variant. Protection against severe disease however was 100%, indicating the vaccine will still be important in reducing hospitalisation and death due to this variant.

Novavax, along with the other major vaccine companies, are developing booster vaccines to target the B.1.351 variant. Novavax are planning to test a “bivalent” vaccine, which targets two different strains, using the spike protein from both the original Wuhan strain and the B.1.351 variant.




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The Conversation


Jamie Triccas, Professor of Medical Microbiology, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Double trouble: floods and COVID-19 have merged to pose great danger for Timor-Leste


Antonio Dasiparu/EPA

Mark Quigley, The University of Melbourne; Andrew King, The University of Melbourne; Brendan Duffy, The University of Melbourne; Claire Vincent, The University of Melbourne; Ian Rutherfurd, The University of Melbourne; Januka Attanayake, The University of Melbourne, and Lisa Palmer, The University of MelbourneTimor-Leste is reeling after heavy rain caused severe floods and landslides over the Easter weekend, killing at least 42 people. Rates of COVID-19 in Timor-Leste are also on the rise. Together, these hazards threaten to interact with deadly consequences.

Our research has assessed the likelihood of natural hazards coinciding with, and influencing, the COVID-19 pandemic. Unsurprisingly, we found temporary relaxations of COVID-19 restrictions during natural disasters are likely to cause large spikes in infection rates.

In Timor-Leste’s capital Dili, the floods and the pandemic have combined to form a dangerous dynamic. Flood damage prompted authorities to temporarily lift COVID-19 restrictions. Evacuees are gathered in group shelters where social distancing may be challenging. Flooding cut power to some COVID treatment centres and put extra pressure on Timor-Leste’s health system.

The situation offers lessons for other populated, flood-prone cites battling the COVID-19 pandemic. Natural hazards will, of course, persist throughout the pandemic. Better understanding the complex interactions between double disasters will help societies and systems become more resilient.

A boy undergoes a COVID test
A boy undergoes a COVID test in Timor-Leste, where the pandemic response has been complicated by flooding.
Antonio Dasiparu/EPA

Dili: a recipe for disaster

On April 3 and 4, more than 400mm of rain was recorded in Dili. Floodwater and debris washed into populated areas. Recent reports indicate at least 42 people died and 13,554 were displaced. Nearby Indonesian islands were also hit and at least 130 deaths were reported.

Several natural and human factors combine to make Timor Leste vulnerable to flooding.

The country’s mountainous topography (see image below) encourages rainfall and creates steep stream systems that rapidly transfer floodwater into adjacent populated areas. Weak rocks and steep catchments are highly susceptible to landslides.




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Flowing water interacts with the mountains, causing sediment to accumulate in the shape of a fan or cone. This directs flood waters and sediment into central Dili. Also, rampant deforestation and development has increased soil erosion and stream discharge during heavy rain.

Rapid and largely uncoordinated population growth, particularly in Dili, has concentrated vulnerable populations into flood plains and low-elevation coastal areas highly exposed to flooding.

Other factors increasing the flood risk in Dili include:

  • concrete structures that don’t allow water to sink into the ground
  • multi-pylon concrete bridges that trap flood debris
  • urban drainage channels choked with sediment and urban waste.

More broadly in the region, three climate features combined to create ideal conditions for the recent high rainfall and tropical storms: the West Pacific Monsoon, the Madden Julian Oscillation and a La Niña

The top image shows modelled rainfall from April 1 to 5 across Timor-Leste. Inset images show the total daily rain (top left) and maximum hourly rain over a 24-hour period (bottom right) recorded at Dili. The bottom image shows the topography of northern Timor-Leste, where high-elevation catchments exit into low-elevation populations centres of Dili and Laclo.

The COVID combination

Dili is frequently hit by large floods – most recently in March 2020. But this time, the disaster coincided with an escalation in Timor Leste’s COVID-19 infection rate.

In late March this year, the number of new daily cases in Timor-Leste was rising quickly. On April 10, there were 70 new daily cases, bringing the total confirmed cases to more than 1,000.

Even without these twin disasters, many in Timor-Leste already lacked access to medical services and lived below the poverty line. COVID-19 restrictions exacerbated food shortages and poverty.




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Then the floods hit. They left thousands homeless with severely restricted access to food and clean water. Roads and bridges collapsed. Crops were destroyed and firewood collection – essential for cooking – has been difficult in some areas.

The floods disrupted a COVID-19 lockdown in Dili, and forced people into crammed refuge centres. Flooding of a national medical storage facility damaged supplies. The national laboratory also flooded and a COVID-19 isolation facility was temporarily evacuated.

During floods, the risks of waterborne and vector-borne disease outbreaks increases. Should this occur, Timor-Leste’s fragile health system would be under even greater pressure.

The first batch of COVID-19 vaccines arrived in Timor Leste on April 5 and the vaccination program has managed to operate despite the flood-related challenges.

A road collapsed after floods
Floods in Timor-Leste caused roads to collapse.
Antonio Dasiparu/EPA

A global problem

Many global cities are vulnerable to multiple interacting hazards like those now faced by Timor-Leste. Our analysis suggests 16 of the world’s 20 most populous cities, comprising 5% of the world’s population, have similar geology, population density and/or land use to Dili and could face similar multiple disasters. These cities include Jakarta, Tokyo and Manila.

In emergency situations, the need for disaster response and recovery may justify temporarily lifting COVID-19 restrictions. But pandemic measures must be reinstated as soon as possible. Our modelling, pictured below, suggests when COVID restrictions are lifted in response to a disaster, infection rates ascend rapidly.

Blue line shows confirmed daily COVID-19 infections, which have increased since mid-March. The red and green lines are modelled forecasts for daily infection rates assuming relaxation of COVID-19 restrictions for two weeks (green) and three weeks (red). Testing delays may produce a time-lag between our forecast scenarios and the real-world data.

What can be done?

Potential solutions are more likely to be effective when they involve multiple groups working together. This includes international and local experts, diverse support agencies and affected communities.

Our research identifies ways to improve disaster preparedness and response in a COVID-19 world. They include:

  • developing scenarios and forecasts to deal with the interaction of multiple hazards, including COVID-19
  • using centrally operating disaster coordination platforms to assist and empower local disaster responders
  • evacuation centres that allow for social distancing
  • storing supplies of personal protective gear and medical equipment in areas less exposed to natural hazards
  • mobile teams of humanitarian workers, volunteers and medical staff that can respond to natural disasters in COVID-affected regions.
Dili residents clean up after flooding
Widespread change is needed to protect vulnerable Dili residents from future disasters.
Antonio Dasiparu/EPA

Finally, measures must be taken to reduce the risks posed by future disasters. This must be done in culturally informed ways and includes:

  • improving land and water management
  • land-use planning that considers disaster risk
  • urban clean-up after events such as floods.

Such actions are crucial in developing nations such as Timor-Leste, where urban development can amplify natural hazards with tragic results.

Oktoviano Tilman de Jesus, Demetrio Amaral Carvalho and Josh Trindade contributed invaluable expertise to this work.


This article is part of Conversation series on the nexus between disaster, disadvantage and resilience. Read the rest of the stories here.The Conversation

Mark Quigley, Associate Professor of Earthquake Science, The University of Melbourne; Andrew King, ARC DECRA fellow, The University of Melbourne; Brendan Duffy, Fellow in Structural Geology and Tectonics, The University of Melbourne; Claire Vincent, Lecturer in Atmospheric Science, The University of Melbourne; Ian Rutherfurd, Professor in Geography, The University of Melbourne; Januka Attanayake, Research Fellow, The University of Melbourne, and Lisa Palmer, Associate Professor, School of Geography, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.