India and COVID 19: The War is On
“…..If you can trust yourself when all men doubt you,
But make allowance for their doubting too….”
- Rudyard Kipling.
We recollect the words of Rudyard Kipling while writing this report. The last few months have been especially challenging for the republic of India. We are currently going through the second wave of COVID 19 and it has caused much devastation across the country. Though we knew that Coronavirus may return in some way if the COVID protocols are not properly followed and if most of the population is not vaccinated, the disease surprised us in many ways. The first wave was manageable, and India performed better than most of the world. However, the second wave hit the country hard, and we witnessed a change in the pattern of the disease and complication profile. Neurosurgical diaspora could not remain untouched as most of the hospitals were devoted to COVID care. As it happened in many countries during the peak of the pandemic, the available medical infrastructure has been diverted to the care of patients with COVID. As of this writing, neurosurgery in some areas with high disease prevalence remains confined to emergency cases only, while in other areas with lesser disease burden, there has been a fall in elective neurosurgical work.
Vaccination in India started on the 16th of January 2021, with a preference for healthcare and frontline workers. Vaccination for those above the age of 65 years and those below this age but with comorbidities started on March 1st, 2021. From the third week of May, many states have started vaccination for those in the 18 years – 45 years age group. However, until the onset of the second wave, the entire vaccination program was bedeviled by vaccination hesitancy, which was mainly contributed by biased, misleading, and unsubstantiated reports through both conventional and social media. Therefore, until the ferocity of the second wave struck the general population, there was considerable difficulty in vaccinating the susceptible population and this vaccine hesitancy might have also contributed to the more rapid spread of the disease. It was further compounded by the rapidly changing protocols published by various medical organizations such as the use of hydroxychloroquine, plasma therapy, use of antiviral agents, etc.
The second wave is different from the first wave in many respects: the disease is more transmissible, a disproportionately larger number of younger individuals are affected and the surprisingly high incidence of rhinocerebral mucormycosis. India with its wide differences in geography, cultural beliefs as well as differences in healthcare infrastructure in different states, the deficiencies in the healthcare infrastructure became evident in the form of a shortage of hospital beds, oxygen, and medicines. Although there was a time lag in filling the gap, these were subsequently identified and rectified. We also transiently faced an acute shortage of emergency medicines. These shortages have now been addressed by ramping up the production and distribution networks. There are several reasons for the alarming increase in the incidence of the disease during the second wave and subsequent strain on the health care system: allowing social and religious gatherings once the first wave subsided, political rallies held in several states where the elections were conducted, a sense of complacency among the general population that the pandemic had been overcome, belief by some sections of the public in untested alternative medical systems that were touted as preventive/curative measures for the disease which resulted in late referral of patients to the COVID care centers and to some extent the social stigma attached to the disease until recently.
Many medical professionals including many neurosurgeons have lost their lives to COVID. As per Indian Medical Association (IMA), 750 doctors succumbed to COVID during the first wave and as of this writing, 594 doctors lost their lives during the second wave including neuroscientists as of this writing. At the time of writing this article, the case fatality rate in India stands at 1.2%. Looking at our population of 1.39 billion, the absolute number of deaths will always be high. Our incidence must not be compared to smaller nations with a lesser population burden. In India, the COVID-19 mortality per million population is less than that seen in many western countries.
We produced two vaccines indigenously. As of June 8th, 2021, 236 million have been vaccinated in India, second only to USA where 302 million have been vaccinated. To supplement our indigenous production and to accelerate the vaccination drive, we have started importing vaccines from other countries. As of this writing, India has placed orders for importing 440 million doses of vaccine. India is a country of 1.39 billion population which means 1 out of every 6 people in the world lives in India. The density of population in our country is 12.25 times higher than in the USA and Europe. Despite these adverse factors, strong measures are being taken at every level to control and prevent the infection. As per the Indian Council of Medical Research (ICMR) last data update in May 2021, there are 2504 COVID labs which conducted 346 million COVID diagnostic tests. We sincerely appreciate the help extended by many countries to India in these difficult times.
The need of the hour is not to panic and spread the wrong news. It is disheartening to see the predatory journalism by newspaper groups, journal houses, 24 x 7 TV channels to tarnish the reputation of India. COVID-19 mortality in India, when seen as per million of the population is only a fraction of that seen in many western countries. Even today, the deaths per million of the population in India is less than 10% of the developed nations. This irresponsible journalism had an adverse impact and spread panic, chaos, and despair. The disturbing images shown in the conventional and social media appeared to deliberately highlight the misery and not with the view of informing the readers/viewers. This is in total contrast to the low-key and muted murmurs about hundreds of bodies (of those who died due to COVID-19 at the peak of the pandemic last year) that were awaiting burial and lying-in refrigerated trucks outside major cities in an advanced nation.
What has not been highlighted in the media is the tremendous and spontaneous outpouring of help from different sections of the Indian society to fight this pandemic. People from all walks of life including those from the lowest economic strata to CEOs of top companies rallied together in our time of need. Many industries halted their production and used their spare capacity to produce medical grade oxygen, philanthropists donated liberally to hospitals to purchase the necessary equipment including oxygen generators. It was inspiring to see people feeding the poor and downtrodden on their own free will. Even stray cattle that often roam the streets of India were being fed by large-hearted people. Indian industries in a committed effort showed a remarkable record in manufacturing personal protection equipments, production of medical grade oxygen and temporary centers dedicated for COVID care. Unfortunately, the biased media outlets and vested interests did not highlight these humanitarian gestures but chose to focus on the negative news. Both within and outside the country, politics and bigotry were allowed to supersede truth.
It would be enough to say here that when the whole of Europe and USA and many other countries were under the peak of the pandemic India showed empathy with them and did not highlight their misery. We extended help to many countries with the supply of emergency medicines and vaccines while we were still fighting our war. India’s Vaccine Maitri (Friendship) project, undertaken by our government, has provided 66 million doses of COVID-19 vaccines to 95 countries – either free or at a minimal cost. The need of the hour is to use our scientific knowledge and ingenuity to ward off this threat facing humankind. This is possible only if we are free of biases and prejudices and work as one instead of accusing and demeaning one another.
Some experts have predicted that our country will face a third wave during this calendar year. Aggressive vaccination of the vulnerable population, constant surveillance and promoting COVID-appropriate behavior will prevent or minimize the impact of the third wave. We are confident that, if and when the third wave hits, we will be prepared to face the onslaught with courage and fortitude as we have always done.
Together, we WILL beat this pandemic.
Dr. Manjul Tripathi, Member, Neurological Society of India.
Dr. Natarajan Muthukumar, Secretary, Neurological Society of India
Dr. Daljit Singh, Treasurer, Neurological Society of India
Dr. V.P. Singh, President-Elect, Neurological Society of India.
Dr. Lokendra Singh, President, Neurological Society of India.