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.

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’s the new coronavirus variant in India and how should it change their COVID response?


Prafulla Shriyan, Indian Institute of Public Health, Gandhinagar and Giridhara R Babu, Indian Institute of Public Health, GandhinagarAfter genome sequencing of over 10,000 COVID-19 cases in India, researchers have discovered a new variant with two new mutations which may be better at evading the immune system.

In 15-20% of samples from the Indian state of Maharashtra (the state accounting for 62% of cases in the country) a new, double mutation in key areas of the virus has been detected. These are now known as the E484Q and L452R mutations.

What makes the variant different?

Both these mutations are concerning because they are located in a key portion of the virus – the spike protein – that it uses to penetrate human cells. Spike proteins attach via a “receptor binding domain”, meaning the virus can attach to receptors in our cells.

These new mutations include changes to the spike protein that make it a “better fit” for human cells. This means the virus can gain entry more easily and multiply faster. Given what we have seen with other similar mutations, it might also make it harder for our immune system to recognise the virus due to its slightly different shape. This means our immune system may not be able to recognise the virus as something it has to produce antibodies against.

The emergence of these new variants has only been possible because of the continued viral replication in areas with high circulation.

Though the Indian government has said the data on the variants circulating in India (including this new Indian variant and others including the UK strain) are not sufficient to link them to the rapid increase in the number of cases in the country, we think it’s the most likely explanation. The country had managed to bring down the rate in February, but a sudden increase in the number of reported cases is now being reported.




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Implications

The implications of these developments are greatly concerning – not just for India, but for the rest of the world. Mutations can result in 20% more in-hospital deaths, as we witnessed during the second wave in South Africa. This is because some mutant variants have the ability to spread faster, resulting in sudden surges and, therefore, an overburdened health system.

But there’s hope. Places around the world with higher vaccination coverage such as the UK and Israel are witnessing a steady decrease in cases.

Most of the currently approved vaccines around the world have been found to evoke an immune response to some extent against multiple variants. But no trials have yet been undertaken on the effectiveness of vaccines against these new Indian mutations.

To make it difficult for the mutant strains to develop vaccine resistance, we have to ensure wider and faster vaccine coverage across the world.

What has to happen now?

Apart from vaccine manufacturers’ efforts to update the composition of vaccines to better deal with new strains, it is important to contain transmission across the world. Countries can use the World Health Organisation’s SARS-CoV-2 Risk Monitoring and Evaluation Framework to help identify, monitor and assess variants of concern, swiftly.




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To establish a direct link between a variant and a steep rise in cases in a short time, it is important to use genomic sequencing to link clusters together. But unless contact tracing is done meticulously, it isn’t easy to do so.

It is also important to understand the mechanisms involved in the infectiousness and virulence of the newer variants. For this, lab models are needed to mimic spread and virulence mechanisms efficiently.

To combat the consequences of mutations in India, its pandemic response will have to incorporate several measures. Genomic surveillance will have to be proactive and coincide with the epidemiological investigation of the cluster of cases for early identification and swift action.

As some variants can escape naturally induced immunity, vaccine manufacturers in India will need to develop better vaccines to cover these new variants. Ongoing surveillance and containment measures need to be strengthened to prevent the emergence of new variants by minimising viral replication.

And finally, swift and rapid vaccine coverage is not only necessary but essential for ensuring any modest levels of success in tackling this pandemic.




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The Conversation


Prafulla Shriyan, Research Fellow, Public Health Foundation of India, Indian Institute of Public Health, Gandhinagar., Indian Institute of Public Health, Gandhinagar and Giridhara R Babu, Professor, Head-Lifecourse Epidemiology, Indian Institute of Public Health, Indian Institute of Public Health, Gandhinagar

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

Quad group makes vaccine deal as a wary China watches on



AAP/AP/Ryohei Moriya

Tony Walker, La Trobe University

American officials and those representing other parties to a Quadrilateral Security Dialogue (“Quad”) may try to pretend that a summit of Quad leaders was not driven primarily by concerns about a China threat.

Briefing reporters after the meeting and the announcement of a vaccine deal to help low-income countries fight the COVID pandemic, US National Security Adviser Jake Sullivan sought to play down the issue when he said the Quad was not fundamentally about China:

The Quad is not a military alliance; it’s not a new NATO, despite some of the propaganda that’s out there.

But the fact is there would be no Quad, and no inaugural summit of the leaders of the US, Japan, India and Australia if it were not for deepening alarm among the US and its allies about how China’s rise might affect peace and stability in the Indo-Pacific.

The leaders’ joint statement leaves no doubt a China preoccupation is driving the elevation of this body to national leader status. In doing so, it invests it with much greater significance. The statement reads:

We strive for a region that is free, open, inclusive, healthy, anchored by democratic values and unconstrained by coercion.

If this is not “fundamentally about China”, it’s not clear what it is about.

It remains to be seen whether the first Quad summit bolsters the group’s ability to counter a rising and increasingly assertive China, or whether differing priorities among its participants expose its limitations.

The Quad is being marketed as a constellation of liberal democracies against an illiberal China. But there is a world of difference between how each of the participants view and interact with China.




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Not just about China

In assessing the likely effectiveness of the Quad, it is well to keep in mind that nations do not have permanent friends or permanent enemies – just permanent interests.

Canberra would be foolish to invest too much faith in what is, at this early stage, a consultative body that will meet semi-regularly to discuss regional challenges and conduct military exercises.

Prime Minister Scott Morrison would be advised to contain his exuberance in describing the Quad as the arrival of a “new dawn”.

This is not a “new dawn” in Asia, even if we are witnessing a Chinese sun rising.

In a paper – How Biden can make the Quad endure – the Carnegie Endowment for International Peace argues the body needs to avoid a “China Trap” – becoming a narrowly-defined China-obsessed body – and seek to broaden its scope.

In this regard, it is a positive development that Quad leaders have undertaken to supply up to one billion coronavirus vaccines across Asia by the end of 2022. This is a practical demonstration of the Quad’s potential and one aimed at countering China’s soft power.

The Quad must ensure it doesn’t fall into the ‘China trap’, making everything about Beijing’s rising power.
AAP/AP/Andy Wong

A ‘new kind of diplomacy’

History is important to understanding the Quad’s genesis and where it might head. The body owes its start to the establishment in 2004 of an ad hoc grouping formed to deal with the devastating Boxing Day tsunami.

The United States, Japan, India and Australia established what was described then as the “Tsunami Core Group”. This initiative represented a “new type of diplomacy” to face an existential challenge.

In 2007, the first meeting of the Quad was held on the fringes of the ASEAN Regional Forum in Manila. The Quad showed promise as a regional grouping, but the Kevin Rudd government, elected that year, abandoned the Quad dialogue on the grounds it would be perceived as being part of a China containment policy.

This did not align with Labor’s strategic impulse, which was to continue to elevate relations with Beijing.

In 2017, under the Turnbull government, the grouping was revived. It has been described as “Quad 2.0”, to distinguish it from its first iteration.

Since then, participants elevated a dialogue among themselves to defence and foreign minister level. Quad countries have also participated in regular military exercises. However, until last week, when newly-elected President Joe Biden decided that in his first significant foreign policy initiative he would bring together Quad leaders, the body had lacked head-of-government imprimatur, and thus credibility.

That has changed.

Biden’s description of the Quad as a “vital arena for cooperation in the Indo-Pacific” means it has the potential to become an important component of a regional security architecture.

This is provided it does not get bogged down in a defensive anti-China mindset in dealing with regional concerns from China’s power to climate change to health challenges.

Helping to put the Quad summit into perspective is the planned meeting late this week in Anchorage, Alaska between US Foreign Secretary Antony Blinken, Sullivan and their Chinese counterparts. This includes Foreign Minister Wang Yi.

This will be the first high-level meeting between senior American and Chinese officials since the inauguration of the Biden administration on January 20. The Anchorage meeting will be critical to Washington’s efforts to establish a better working relationship with Beijing.

Top of the agenda will be discussion about a prospective summit between Biden and Chinese President Xi Jinping.

This is shaping as one of the more important encounters of the modern era.

Testifying last week before the House Committee on Foreign Affairs, Blinken said the Anchorage meeting would be an opportunity

to lay out in very frank terms the many concerns that we have with Beijing’s actions and behaviour.

The Blinken-Sullivan meeting with Chinese counterparts will be framed by a discussion Biden had last month with Xi in which he told the Chinese leader the US intended to challenge China’s “coercive and unfair economic practices” as well as its record on human rights, and its crackdown on Hong Kong.

According to the White House summary of that discussion, Biden also said he hoped to cooperate with Xi on matters like the coronavirus, nuclear proliferation and climate change.

There was no indication from the summary whether Xi had raised with Biden his election description of the Chinese leader as a “thug”.




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China’s response to the Quad meeting has been predictable, although less florid than might have been anticipated. This no doubt reflects an understanding in Beijing that attitudes in New Delhi, Tokyo, Washington and Canberra are not identical. This is how Beijing’s mouthpiece the Global Times put it in a commentary:

The Quad is not an alliance of like-minded countries as the US claims. The three countries other than the US would probably take a tactic of coordinating with the US in narrative while sticking to their own approaches to China.

Beijing will seek to wedge Quad members where it believes opportunities arise. Its wedge diplomacy will be a test for the group’s solidarity in its efforts to provide a regional counterweight to China.

Consolidation of the Quad’s importance will depend on self-interest of its various participants and circumstances. Beijing’s willingness to acknowledge the legitimate interests of Quad members will determine whether it proves to be a useful addition to a crowded regional architecture, or another irritant in an increasingly fractious relationship between China and the West.The Conversation

Tony Walker, Vice-chancellor’s fellow, La Trobe University

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