Fighting an Invisible Enemy
Race Against Time
07 June 2021
Mr. Jugoprakash Bhattacharjee was born & brought up in Shillong.
He joined Central Govt. Service &
retired as Additional Director General, Ministry of Statistics, Govt.of India.
His articles have been published in many research journals.
He has written this research based article on COVID19 for Ishan Kotha.
Part 1 of the Article in Two Parts have been published today ...
Humanity has co-existed with crisis, threats and challenges of multiple kinds from its infancy. It had to confront scarcity of food, physical attacks on him by other species, battles and wars with competitors of his own kind for resources and survival, and not the least with diseases of strange and deadly nature.
The story of a tiny devil – a silent small enemy that can launch a devastating destruction
The fight with the diseases is particularly complex and vicious in many instances. When there is an injury due to accidents, calamities, or physical fighting, etc., you know the causes. But in many cases, cause is not physically attributable to any event - the challenger here is not physically present or imposing on you but working silently and invisible to the naked eye. You can only see the manifestations in the form of symptoms and if not treated will lead to malfunctioning of the body or death. By the time the manifestations are visible, enemy has either won the battle or made sufficient advances to be a very strong position. This makes the battle very unfavourable to the mankind and it is bound to suffer huge losses.
Bacteria, fungi, protozoa, helminths and viruses are the kind of invisible microbe enemies that can sometimes unleash ravages of lethal kind in a short time. We live in peaceful co-existence with many microbes – not only we, many animals host one or more kinds of microbes. Virus always attaches itself to a living cell. It has to be a host to a living body to survive and reproduce. When a virus is transferred from one living body to another living body to whom the virus is a foreign invader, the battle rages and continues till the immune system destroys the infectious virus or the virus kills the living body.
Every human being carries a number of viruses in its body (estimated to be 380 trillion viruses). This set of viruses is called a human virome. Viruses in the human body may infect both human cells and other microbes such as bacteria. Some viruses cause disease, while others may be asymptomatic. Our immune system keeps them in check. Human virome changes constantly as viruses evolve constantly. In fact, every human being possibly has a different virome depending on its exposure to viruses, its immune system and its store of genetic materials. The human body is a rich environment for microbes, replete with proteins, fats and carbohydrates. Many viruses have figured out how to peacefully thrive in it without making us sick till the human immune system is weakened by other events and not in full strength.
To understand how a virus works, it is necessary to think on such a small scale that the human eye could never see the movements of a virus. Billions of viruses can fit on the head of a pin. They come in very different shapes: as rods, rounds, with crowns or cylindrical tails. However, it is not possible to see this with a simple microscope. To see a virus, it is necessary to use a scanning electron microscope, which uses electrons instead of light to produce an image.
Viruses are simply packets of nucleic acid, either DNA or RNA, surrounded by a protein shell known as capsids and sometimes fatty materials. Outside a living cell, a virus is a dormant particle, lacking the raw materials for reproduction. These organisms enter the body and adhere to the cell surface. Depending on the type of virus, it seeks for cells in different parts of the body: liver, respiratory system or blood. Once it has attached itself to the healthy cell, it enters it. Only when it enters a host cell does it go into action, hijacking the cell’s metabolic machinery to produce copies of itself that may burst out of infected cells or simply bud off a cell membrane. This lack of self-sufficiency means that viruses cannot be cultured in artificial media for scientific research or vaccine development; they can be grown only in living cells, fertilized eggs, tissue cultures, or bacteria.
There are many types of viruses. Some can just cause a common flu, while others can be more harmful such as HIV, Ebola or Coronavirus. And, there are viruses that enter the human body, but the immune system manages to fight them, so the person does not get sick.
They enter the body through the mouth, eyes, nose, genitals or through wounds, bites or any open wounds. Moreover, they are transmitted through different routes. Some viruses are spread by direct contact with infected skin, mucous membranes or body fluids. There is also the possibility of indirect contact, when a person touches an object (door, handle, table), which has the virus on it, when an infected person sneezes, coughs or talks or when the mucous membrane comes into contact with another person. In some other cases, the virus is transmitted through common vehicle such as contaminated food, water or blood. Finally, there are vectors: rats, snakes, mosquitoes etc., which transmit the virus to humans.
It is important to clarify that when a virus infects a human, it does not always end up in a disease. The infection occurs when the virus begins to multiply. And, the disease occurs when many body cells are damaged by the infection, which is also when the symptoms and illness appear.
In a nutshell, if the immune system manages to fight off the virus that entered the cells and replicated, the person will not get sick. Nevertheless, the body will respond in different ways to fight these foreign bodies. When the immune system fails to control the virus, a process called pathogenesis begins. The virus crosses obstacles such as distance, the immune system or mucous membranes to reach different organs. Once it begins to replicate, the healthy cells will be destroyed, the person will get sick and his/her organs will start malfunctioning. Depending on how severe the symptoms are, the person will have to rest or seek medical help.
How to fight the virus?
The immune system is the body’s first line of defense. It is a combination of cells and molecules that secures the living body from diseases. It detects and responds to a wide variety of microbes, distinguishing them from the organism's own healthy cells.
In response to infection, our immune system springs into action. White blood cells, antibodies, special cells and other mechanisms go to work to rid the body of the foreign invader. Indeed, many of the symptoms that make a person suffer during an infection—fever, malaise, headache, rash—result from the activities of the immune system trying to eliminate the infection from the body. Pathogenic microbes challenge the immune system in many ways. Viruses make us sick by killing cells or disrupting cell function. Our bodies often respond with fever (heat inactivates many viruses), the secretion of a chemical called interferon (which blocks viruses from reproducing), or by marshalling the immune system’s antibodies and other cells like cytotoxic T cells to target the invader. Many viruses make us sick the same way, but they also have other strategies at their disposal. Sometimes they multiply so rapidly that they crowd out host tissues and disrupt normal function. Sometimes they kill cells and tissues outright. Sometimes they make toxins that can paralyze, destroy cells’ metabolic machinery, or precipitate a massive immune reaction that is itself toxic.
If immune system is not able to fight the virus because it has already infected several organs, a treatment can be used to relieve the symptoms (inflammation of the organs that produces cough, headache, etc.), until the immune system is able to defend the body. Likewise, drugs, such as antivirals, may be used as they get inside the cells and are integrated into the genomes of the virus to stop it from replicating. This means that antivirals damage the virus DNA/RNA chains in order to prevent them from working. Therefore, these drugs are used to fight viruses such as herpes or hepatitis C. On the other hand, viruses can be prevented with vaccines. Nowadays, this is the most efficient approach used. The vaccine produces a specific immunity against a disease because it trains antibodies and cells to recognize the infectious agent.
In conclusion, viruses are microorganisms that can only live if they find a host. Once they find it, if they manage to overcome all natural and scientific barriers that the body produces, they can infect the person. Plus, if they manage to overcome the immune system, the person will get sick. Although it is impossible to prevent any virus from infecting humans, through the experience of generations and the help of science, the human body should be able to defend itself from foreign agents.
When does a virus infection becomes epidemic, endemic or a pandemic?
A term epidemic is coined for a situation when an infectious disease spreads with rapidity to a large number of people in an area within a short period of time. However, administration declares a particular disease as epidemic only when it exceeds a baseline rate of incidence, the baseline rate may be different for different diseases.
An infectious disease is said to be endemic when the prevalence of the disease remains at a baseline level in a geographic area for a considerable period. For an infection that relies on person-to-person transmission, to be endemic, each person who becomes infected with the disease must pass it on to one other person on average. In this situation we say that basic reproduction number ‘R0’ (pronounced as R-nought) of the epidemic is 1. If that persists, the infection neither dies out nor does the number of infected people increase exponentially but the infection is said to be in an endemic steady state. An infection that starts as an epidemic will eventually either die out (with the possibility of it resurging in a theoretically predictable cyclical manner) or reach the endemic steady state, depending on a number of factors, including the virulence of the disease and its mode of transmission. The number R0 is very useful for mathematical modelling of epidemic diseases.
When the epidemic of an infectious disease spreads worldwide across a number of continents, infecting a huge number of people, it is called a pandemic. A widespread endemic disease with a stable number of infected people is not a pandemic. Recurrences of seasonal influenza are generally not considered as pandemic as they occur simultaneously in large regions of the globe with a steady rate of incidence rather than being spread worldwide with an increasing rate of incidence. For a pandemic disease, the value of R0 will be more than 1 and growth of number of sick persons will be exponential.
An epidemic can turn into a pandemic when exacerbating factors prevail. These may be highly infectious nature of the virus, transportations with high frequency between different geographical regions, events facilitating large congregations, congested accommodations, lack of hygiene and most importantly, lack of acceptance of the dangerous situation and consequent proactive negative actions by the political leaders, managers of the health system and public.
When will a pandemic reduce in its intensity, lose its steam and will it subside completely? - Cannot be predicted. It will again depend on several factors – both natural and man-made. Among the natural factors, the type of virus and its mutation potential are most important. A virus that jumps species – from birds, animals, reptiles - is most potential candidate for a pandemic. Each virus mutates a number of times – some more frequently than others. More the infections, more the possibility of mutations but most virulent mutations which result in fatality will not naturally survive for long as it also dies with its host. So mild mutations which are not fatal will survive for a time period. This time period will depend on the mitigating actions adopted by the society. In certain cases, the pandemic will fizzle out after some time while in other cases, the infections will continue at a low but constant rate over many regions of the world. This is the situation when the pandemic turns into endemic. We continue to be affected but the health system can take care of it because the load is not higher than capacity.
Mankind is witness to a number of pandemics of diseases such as smallpox and tuberculosis. The most fatal pandemics in recorded history are the Black Death (also known as The Second Plague pandemic), which killed an estimated 75–200 million people (in seven years time span) in the 14th century and the 1918 influenza pandemic (Spanish flu) which killed 17 – 100 million people (in two years time span). Other pandemics which resulted in large number of deaths are HIV (still continuing from 1981) :35 million deaths as in 2018; Plague pandemic (1855 to 1860): 12-15 million deaths. There have been numerous epidemics and pandemics which have claimed lives in excess of 1 million in the recorded history period. Plague pandemic has been a regular curse for human population for longest time and also maximum number of times. Current pandemics include COVID-19 (SARS-CoV-2) and HIV/AIDS. The casualty for COVID-19 is officially reported as 3.3 million but estimated to be around 7.2 million as in May 2021. The Influenza pandemic of 1918 (Spanish Flue) has quite a bit of similarity with the current COVID-19 Pandemic.
Spanish Flue and beginning of encounter between virus and modern epidemiological science
A deadly disease, caused by the H1N1 Influenza A virus, started in 1918 and within a very short span of time swept the world. This is usually described as Spanish Flu or 1918 Influenza pandemic. Although it is coined the term Spanish Flu, it neither originated in Spain nor had anything special Spanish. The geographic origin of the virus is not known. The World War I (WW1) was raging on at the time. Spain was neutral in the War and there was no censorship on Press reporting in Spain in contrast to other nations which were involved in the War. Thus, there were actual reporting of details of the disease, casualties caused by it and the grave illness of King Alfonso III of Spain. These widely spread coverages made an impression that it was only Spain which is facing the crisis and retained the term in conversations.
It was the year 1918. The WW1 was at the final stages after America has joined the war in favour of Allied forces. Huge army of American soldiers was moving to different countries by land and navy. Crowded trains and ships were carrying loads of army men from one corner of the world to another corner. On March 4, an army cook at Camp Funston in Kansas, United States, reported the symptoms of the flu. Within days, more than 500 soldiers of the Camp were infected. Although it is believed that the virus originated and started transmitting earlier to this incident, it was the first detected case of the pandemic and alarming scale of infection rate was noticed first in this Camp. It quickly spread to other army camps in US and then to camps in Europe. In March 1918, Germany started releasing Russian prisoners of war, who carried the disease to their countrymen. It reached North Africa, India, and Japan in May, and soon after had likely gone around the world as there had been recorded cases in Southeast Asia in April. In June an outbreak was reported in China. After reaching Australia in July, the wave started to recede. It was the first wave. The mortality rates in the first wave were not too high and no quarantines were reported. However, the first wave caused a significant disruption in the military operations of World War I, with three-quarters of French troops, half the British forces, and over 900,000 German soldiers fell sick apart from high rate of infections in the US army.
Second half of August saw the beginning of the second wave of the disease. It reached many countries of North and South America, African countries through troop movements. The pattern of spread was coastal areas first (through naval movements) to inlands and interiors (through rivers, railways) affecting the inhabitants over widespread geographic areas and different communities. From Europe, the second wave swept through Russia and then spread throughout Asia following the Russian Civil War and the Trans-Siberian railway, reaching Iran and then later to India in September, as well as China and Japan in October. The ending celebrations of the World War 1 (the Armistice of 11 November 1918) also caused outbreaks in some places. The second wave was over by December. The second wave of the pandemic was much more vicious than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. But the second wave casualties included the young population in large numbers. October 1918 was the month with the highest fatality rate of the whole pandemic. The 1918 flu pandemic in India was especially deadly, with an estimated 17–18 million deaths in the last quarter of 1918 alone.
Third wave of the Spanish Flu was noticed from January 1919. Starting with a hit in Australia, following the lifting of a maritime quarantine, it spread quickly through Europe and the United States, where it lingered through the Spring and until June 1919. It primarily affected Spain, Serbia, Mexico and Great Britain, resulting in hundreds of thousands of deaths. It was less severe than the second wave but still much more deadly than the initial first wave. A fourth wave also swept through countries of Europe, Americas and Asia during January to April 2020.
Influenza outbreaks usually kill the very young and the very old in large proportions leaving out the younger age group with less mortality, but the Spanish flu pandemic targeted the younger population more and higher mortality rate was observed for the young adults. The total death toll of the disease is stated to be 50 million (about 3% of the global population) but the estimates vary from 17 – 100 million but it was about one-third of the world population that were affected.
The majority of the infected experienced only the typical flu symptoms of sore throat, headache, and fever, especially during the first wave. However, during the second wave, the disease was much more serious, often complicated by bacterial pneumonia, a common secondary infection associated with influenza, which was the cause of death in a majority of cases.
The basic reproduction number of the virus was between 2 and 3. The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation. The war may also have reduced people's resistance to the virus. Some speculate the soldiers' immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their susceptibility. A large factor in the worldwide occurrence of the flu was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travellers to spread the disease. Another was lies and denial by governments, leaving the population ill-prepared to handle the outbreaks.
State of technological development was also a hindrance to control the disease. The microscope available at that time was equipped only to detect bacteria and could not detect the virus which was much smaller and too small to be seen under that microscope. The scanning electron microscope capable of observing viruses was developed only in 1930s. As a result diagnosis in most cases were misplaced.
Public health authorities existed at that time but knowledge of influenza as a deadly infectious disease was not there in 1918. Nevertheless, maritime quarantines were declared on islands such as Iceland, Australia, and American Samoa, saving many lives. Social distancing measures were introduced, for example closing schools, theatres, and places of worship, limiting public transportation, and banning mass gatherings. Wearing face masks became common in some places, such as Japan, though there were debates over their efficacy. The actual enforcement of various restrictions varied. Vaccines were also developed, but as these were based on bacteria and not the actual virus (since virus was not identified), they could only help with secondary infections. A later study found that measures such as banning mass gatherings and requiring the wearing of face masks could cut the death rate up to 50 percent, but this was dependent on their being imposed early in the outbreak and not being lifted prematurely.
However, more recent study suggests that the virus itself, though more lethal than other strains, was not fundamentally different from those that caused epidemics in other years. Much of the high death rate can be attributed to crowding in military camps and urban environments, as well as poor nutrition and sanitation, which suffered during wartime. It’s now thought that many of the deaths were due to the development of bacterial pneumonias in lungs weakened by influenza.
But whatever be the casualties of the flu, it was the starting point of scientific communities’, especially the epidemiologists’, war against the invisible tiny devil. In the following years, scanning electron microscope was invented facilitating study of virus, the study of human genes gathered momentum and many brilliant scientists and many biologists made invaluable contributions to the study of microbes and discovery of cell structures of human bodies.
How much India suffered through Spanish flu pandemic
Some 17–18 million people is believed to have died in India which was about 5% of the population of India at that time. Another estimate gives at least 12 million dead. It was also referred as Bombay Influenza or Bombay fever. The death toll was the highest among all nations.
The pandemic struck India at Bombay in June 1918 with one of the possible routes being the ships carrying troops returning from the World War 1 in Europe. The outbreak then spread across the country from west and south to east and north, reaching the whole of the country by August. It hit different parts of the country in three waves with the second wave being the highest in mortality rate. The death rate peaked in the last week of September 1918 in Bombay, in the middle of October in Madras, and in the middle of November in Calcutta.
The outbreak most severely affected younger people in the age group of 20–40, with women suffering disproportionately. The spread of the disease was exacerbated by a failed monsoon and the resultant famine-like conditions that had left people underfed and weak, and forced them to move into densely populated cities. As a result of the severity of the outbreak, the year 1919 saw a reduction of births by around 30 percent. The population growth of India during the decade from 1911–1921 was 1.2%, the lowest among all decades under the British Raj. Rivers Ganga and Narmada were swollen with dead bodies. The sanitary commissioner's report for 1918 also noted that all rivers across India were clogged up with bodies, because of a shortage of firewood for cremation. Public Health Management system in the country almost collapsed in face of the sudden increase in demands for medical emergencies. The consequent toll of death and misery, and economic fallout brought about by the pandemic and the World War 1 together was unmatched with any other social chaos of contemporary period.
To put this in perspective, more people died from the influenza pandemic in India than the global death count attributed to battle casualties in World War I. More Indians died in the influenza pandemic in a few months than the global death toll of the last plague pandemic. This influenza pandemic ranks as the most catastrophic pandemic in modern history of India and as India’s worst recorded demographic disaster till date.
COVID-19 – Unveiling the devil in new incarnation
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus named SARS-CoV-2. Coronaviruses (CoVs) are a large family of viruses, infecting both humans and animals including bats, camels, cattle, etc. Several of these viruses cause respiratory diseases in humans, from the common cold to more rare and serious diseases such as the Severe Acute Respiratory Syndrome (SARS) and the Middle East respiratory syndrome (MERS), both of which have high mortality rates and were detected for the first time in 2003 and 2012, respectively.
Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease and cancer are more likely to develop serious illness. The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it’s important that we practice respiratory etiquette (for example, by coughing into a flexed elbow).
The genomes of most organisms are based on DNA. Some viruses such as those that cause the flu and HIV, however, have RNA-based genomes instead. In general, viral RNA genomes are much more mutation-prone than those based on DNA. SARS-CoV-2 is an RNA based virus.
Mutation rates in RNA viruses are important because these viruses cause a terrible toll in terms of human death and disease. The high mutation rate means that they can rapidly evolve resistance to new drugs. Average mutation rates in RNA viruses are estimated to be about 100 times higher than those for DNA viruses. Any given population of these viruses is very genetically diverse. This makes it very difficult for scientists to develop vaccines for the flu, for example. Because the influenza virus genome is diverse, scientists must often combine vaccines for several viral strains. And, because the flu virus genome changes constantly, vaccines that are effective during one flu season might be ineffective the next.
The picture of global pandemic as of now (15th May) is that 161,513,458 cases (India – 24,372,907) have been reported and 3,352,109 (India – 266,207) deaths. Daily number of cases is 677,387 ( India – 326,098) and deaths is 12,936 ( India – 3,890) on 15th May.
As of 11 May 2021, a total of 1,264,164,553 vaccine doses have been administered.
The first human cases of COVID-19 were identified in Wuhan, the capital of the province of Hubei in China in December 2019. The most recent country or territory to report its first confirmed case was the Federated States of Micronesia on 8 January 2021. However, it is not confirmed that the virus originated from Wuhan. It is believed that perhaps the virus was circulating for few months before it was first case of identity as a new virus in Wuhan.
On 31 December 2019, WHO was informed of cases of pneumonia of unknown cause in Wuhan City, China. A novel coronavirus was identified as the cause by Chinese authorities on 7 January 2020 and was temporarily named “2019-nCoV”.
It spread like a wildfire within China. In a quick response, WUHAN and Province of HUBEI was brought under total lockdown by the Govt. Lockdown was extended to many other adjoining and risk prone areas. But before the outside world could come to grip with the fast developments, it spread to other parts of the world with very high rapidity. By the time political decision to stop international flights were taken, the war has been lost. Health networks in Europe, arguably one of the bests in the world, was in shambles in a few days unable to bear the extraordinary load of medical emergencies and hospitalizations.
Timelines of spread of COVID-19 in first three months of 2020
Dec 31, 2019 – WHO is informed of cases of pneumonia of unknown cause in Wuhan City, China.
Jan 7, 2020 – China reports first known death (a 61-year-old man) in Wuhan from an illness caused by the new coronavirus
Jan 13 – WHO reports a case in Thailand, the first case outside China
Jan 16 – Japan reports first case of Coronavirus in the country
Jan 20 – South Korea reports its first case of the new coronavirus infection
Jan 21 – USA reports its first case – infection of a 30-year-old man
Jan 22 – Death toll in China mounts to 17 with more than 550 infections. Many airports start check on flights from Wuhan.
Jan 23 – Wuhan put under Lockdown. WHO says there is no evidence of human to human transmission outside China
Jan 24 – France confirms first case.
Jan 25 – Canada confirms the first case – a man travelling from China tests positive. Australia and Malaysia also confirm their first cases.
Jan 27 – Germany confirms first case
Jan 30 – WHO declares the outbreak a global health emergency as more than 9000 cases are reported from spread over 18 countries beyond China. First case of Italy was reported when two Chinese tourists were tested positive.
Jan 31 – First case reported in Spain when a German tourist was tested positive.
Feb 2 – First death outside China (in Philippines) from coronavirus reported.
Feb 4 – a ship, Diamond Princess, quarantined off the coast of Japan with about 3700 people including passengers and crew on board.
Feb 11 – WHO announces that disease caused by the new coronavirus will be known by the official name COVID-19. It stands for the coronavirus disease that was discovered in 2019.
Feb 14 – Egypt announces first case – the first also in the continent of Africa.
Feb 19 – Iran reports first case.
Feb 21 – Lockdown started in Italy.
Feb 24 – Italy becomes the worst hit country in Europe as cases spike.
Feb 29 – First COVID-19 death in USA
March 6 – Number of global cases hit 100,000. Iran becomes one of the worst hit countries.
March 9 – All of Italy is brought under lockdown.
March 11 – WHO reports spread of infection in 114 countries of the globe. WHO declares it as a Pandemic.
March 16 – Canada closes its borders to non-Canadians except USA. Egypt suspends all flights. New York city closes theatres, bars and cinemas. France imposes stringent restrictions on movement of people. Germany closes its borders with France. USA researchers try the first dose of experimental vaccine for coronavirus.
March 18 – Canada and USA temporarily close border to each other. UK shuts down schools
March 19 – China reports no new coronavirus case for the first time after the outbreak of the disease. UK faces a shortage of medical equipment to control the disease. Australia and New Zealand close the borders.
Thus, within March 2020, almost all countries of the world were bearing the load of a virus pandemic shaking the public Health infrastructure of the countries, developed or underdeveloped, engulfing all continents.
Vaccine development efforts started in Jan 2020 with collaboration between governments of countries and multinational pharmaceutical companies. By January 2021, many countries, including India, commenced the vaccination of their population. Vaccines have never been invented in such a short time in history earlier.
COVID-19 in India
India is currently at the second position after USA in in terms of cumulative number of cases of infections and third in cumulative number of deaths after USA and Brazil. The first case of COVID-19 in India was reported on 30 January 2020.
The first cases of COVID-19 in India were reported in the towns of Thrissur, Alappuzha and Kasargod, all in the state of Kerala, among three Indian medical students who had returned from Wuhan. On 12 March, a 76-year-old man, with a travel history to Saudi Arabia, became the first COVID-19 fatality of India.
After one day of Janta Curfew, lockdowns were announced from 25 March all over the country. Five cities accounted for around half of all reported cases in the country by mid-May 2020: Mumbai, Delhi, Ahmedabad, Chennai and Thane. Lockdown had its effect on containing the infections. Lockdown restrictions were relaxed in phased manner and movements of people were restored gradually. Infection rates started to drop in September, along with the number of new and active cases. Daily cases peaked mid-September with over 90,000 cases reported per-day, dropping to below 15,000 in January 2021.
The Department of Science and Technology (DST) has initiated a COVID -19 Indian National Supermodel to help monitor the future transmission of infection, thus aiding decisions involving health system readiness and other mitigation measures. The Committee for Indian Supermodel on COVID-19 stated in October 2020 that the pandemic had peaked in India, and could come under control by February 2021. That month, a new SARS-CoV-2 variant, Lineage B.1.617, was detected in the country.
By February 2021, daily cases had fallen to 9,000 per-day. However, by early-April 2021, a major second wave of infections took hold in the country; on 9 April, India surpassed 1 million active cases and by 12 April, India overtook Brazil as having the second-most COVID-19 cases worldwide, behind only the United States. The second wave was much larger than the first, with shortages of vaccines, hospital beds, oxygen cylinders and other medicines in parts of the country. By late April, India led the world in new and active cases. On 30 April 2021, it became the first country to report over 400,000 new cases in a 24-hour period. Experts believe that India's figures are vastly underreported due to poor infrastructure, low testing rates, and people dying at home.
India began its vaccination programme on 16 January 2021, and by April was administering 3–4 million doses a day. India has authorised the British Oxford–AstraZeneca vaccine (Covishield), the Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V vaccine for emergency use. As of 15 May 2021, around 40,298,750 people have been fully vaccinated with a total of 181,201,743 doses administered.
Multiple factors have been proposed to have potentially contributed to the sudden spike in cases, including highly-infectious variants of concern such as Lineage B.1.617, a lack of preparations as temporary hospitals were often dismantled after cases started to decline, and new facilities were not built and health and safety precautions being poorly-implemented or enforced during weddings, festivals (such as Holi on 29 March, and the Haridwar Kumbh Mela in April), sporting events (such as IPL), state and local elections in several states, and rallies in public places. An economic slowdown put pressure on the government to lift restrictions, and there had been a feeling of exceptionalism based on the hope that India's young population and childhood immunisation scheme would blunt the impact of the virus. Models may have underestimated projected cases and deaths due to the under-reporting of cases in the country.
The Haridwar Kumbh Mela was linked to a huge increase in the active cases in Uttar Pradesh. The Politicians and activists have been criticised for holding rallies during the pandemic. Due to high demand, the vaccination programme began to be hit with supply issues; exports of the Oxford–AstraZeneca vaccine were suspended in order to meet domestic demand, there have been shortages of the raw materials required to manufacture vaccines domestically, while hesitancy and a lack of knowledge among poorer, rural communities has also impacted the programme.
By mid-May, India passed *** million active cases and was reporting an average of over 400,000 new cases and over 4,000 deaths per-day. Some analysts feared this was an undercount and estimated that the actual death toll of the pandemic in India may be two to five times higher than the official totals. The ominous factor is that infection in rural areas contributing almost equally to that in urban areas. An article in the Lancet estimated that India might face up to one million (ten lakh) deaths by 1 August 2021.
The second wave placed a major strain on the healthcare system, including an ongoing shortage of liquid medical oxygen due to unanticipated demand, delays in transport, and a lack of cryogenic tankers.
It is fast deteriorating to the level of pandemic situation encountered century back during Spanish Flu. The history is repeating itself with crematoriums not able to accommodate dead bodies, bodies floating in Ganges, bodies sunk under sands, hospital beds scarce, oxygen cylinders not available, inhuman acts perpetrated by greedy and unscrupulous persons, black marketing taking advantage of the situation, and so on.
The Blind spots of India’s response to the second wave of COVID-19
Indian Leaders were overconfident. It was foolhardy on their part to believe in unscientific propositions such as we have more immunity against the virus, our child vaccinations programmes are better than others so that we fared reasonably well in the first wave.
The actions of the leaders and policymakers that are blind spots for the analysts are:
The second wave was already arriving in some countries at the beginning of 2021. The second wave of Covid-19 has come to India a few months after the second wave in other countries, which had a similar situation somewhere in the mid- to late 2020. There was no reason to believe it would be any different in India. What made the them shrug away these signals.
All models based on scientific reasoning were saying not to relax the containment strategies. Even the National Supermodel Committee was also saying that all projections depend on maintaining the containment measures. It is true that Govt was under pressure to lift the lockdowns to enable economy to revive and common man to return to livelihood jobs. But it has to be intermittent strict containment and relaxation under adequate surveillance. What made them look other way when people were throwing these measures to winds.
Religious festivals like Gangasagar Mela, Holi and Kumbh Mela were held knowing well that COVID restrictions cannot be enforced in such huge gatherings. Committee on Supermodel has specifically said that religious gatherings would increase infections. They made a mention of festival in Kerala after which the infections went up in a big way. What made them ignore such warnings.
Election Commission announced polling in five States in the midst of surging number of infections. In West Bengal it was held in eight phases. All political parties were allowed to hold rallies and marches, COVID restrictions being only for record. Administration could not enforce the restrictions. The impact is observed below:
What were the bureaucrats of the Election Commission with constitutional responsibilities expecting? Polling will have dampening effect on COVID-19?
Few grave errors have cost India many lives and an epic load of distress:
The honest reporting of infections cases and deaths were not the priority of the managers of the crisis but it is the heart and soul of the crisis management by the scientific community of epidemiologists, medical researchers and health resources specialists. These people, especially the health personnel, are waging a fierce battle and dour defense surpassing their capacity to save lives and to provide care, relief to the beleaguered population. It is our responsibility to feed them actual figures for making accurate predictions and prepare for the worst rather than an unreal picture. It is understood that there should not be publicity of information which might create panic among public but there is no reason to hold it back from the specialists who could work with the data discreetly. They have been responsible all through.
People in all countries tend to view the restrictions as loss of freedom. It is for the administration to impose the restrictions. But from February to April 2021, the government too did not show its resolve to enforce public health measures. While customary guidance on Covid-appropriate behaviour was issued, it was policymakers and elected leaders who tacitly encouraged crowding in festivals (Holi at end March 2021), election rallies in five states (March-April 2021) and religious congregation (Kumbh Mela in Haridwar; March-April 2021).”
Public health initiatives started and facilities were geared up in the initial months of COVID-19. These were not maintained and the tempo was lost. Even some of the infrastructure and facilities that were created during 2020 were dismantled rather than augmenting the medical facilities. The testing facilities were laxed and momentum was lost.
However, some commendable things were done like inventing two vaccines and starting the vaccination of the population in a phased manner, finding a medicine for the for emergency use, etc.
New crossing between microbes and people pave the way for disease-causing agents to enter our species. One event that has put us at risk is the global human population explosion to nearly 7 billion today. We have cleared forests for agriculture and ubanization, leading to closer contact with plants and animals that may harbour novel (or newly introduced) pathogens. Through massive expansion of roads, human settlements have been created that are filled with opportunities for contact with potential virus agents.
Human travel and commerce have brought other risks. Millions of passengers, each a potential carrier of infection, travel daily by aircraft to international destinations. International commerce, especially in foodstuffs, adds to the global traffic of disease-causing microbes. Because the transit times of people and goods are shorter than the incubation periods of some infections, it is not possible to detect an infectious person boarding at a port before he carries the infection to other countries.
Human behaviour, demographics, war, famine, poverty, living congested lives in urban ghettos are also contributing to or potential contributors to epidemics. Societies such as Japan and South Korea are less affected by mass infections probably because the people there use masks and sneezing or coughing habits are less conducive to transmission through mouth and noses.
It is well accepted that lockdowns, containment measures, social distancing, responsible behaviour from citizens are required to reduce pressures on the public health system. Attaining herd immunity is the goal but the process should not be cruel. Therefore, basic reproduction rate (average number of persons infected by a single person) must be brought under control by containment measures whenever required. And whenever things are under control and public health system regains strength, economic activities shall resume and people will return to livelihood jobs. The decision of switching between containment and resumption of activities are yet to be data driven, model based and may not be left to the whims of bureaucrats and political leaders alone.
Pandemics have been an inseparable part of human history. What we are experiencing now is far less chaotic than what our predecessors had to endure. We are fortunate to have more scientific knowledge, more assistance of technology to counter virus infections. We can identify the genome sequence and therefore can identify the new virus and its mutations with remarkable speed. However, it is of utmost importance to share the facts about virus and its infection potential, death potential truthfully so that virus can be deciphered as quickly as possible, knowledge shared globally and concerted efforts are made in every corner of the globe. It saves life, it helps in shaping up the policy on public health, reduces pressure on public health system. The author John M Barry while recounting the events of Spanish flu in his book The Great Influenza: The Epic Story of the Deadliest Plague in History makes the observations that the strongest weapon against pandemic is the truth. Concealment of facts and figures robs the specialists of weapons against the deadly enemy and robs the rulers of public trust.
Before it is realised that he is there, he destroys man’s defence and is running to the next battlefield for a repeat action. Humanity is indeed in race against time.
Contd. (Another part of the article in Part 2) ...