People shop at a crowded market in the old quarters of Delhi, January 4, 2022. Photo: Reuters/Adnan Abidi
The omicron variant of the novel coronavirus has driven an exponential rise in the number of cases in the country. It is certain that the next few weeks are going to be challenging and will put our medical readiness and health resources to the test.
Our healthcare personnel are already overworked, and our systems and economy are still reeling from the effects of previous waves. India is also yet to start administering booster doses and its paediatric vaccination drive has just begun.
If we are to avoid a repeat of the devastation of the past two waves, but especially the second, we shouldn’t make the following mistakes.
1. Conducting state assembly elections in as-usual fashion
Five Indian states – Uttar Pradesh, Uttarakhand, Manipur, Goa, and Punjab – will hold state assembly elections from next month. Last year, just before the second COVID-19 outbreak took off, India had had elections in five states. Political rallies attended by thousands led to a big increase in case numbers. So it makes little sense to conduct polls and campaigns sitting in the shadow of a potential third wave.
There is enough evidence to show that election states last year reported a rapid rise in case loads following the campaigns and demonstrations. The current state of affairs in the country is concerning. Recently, over one lakh people attended a rally organised by a national political party in Uttar Pradesh. This isn’t negligence; it’s being oblivious.
2. Lack of care for non-COVID patients
Most healthcare resources were devoted to COVID-19 care during the first two waves, and most hospitals were turned into COVID-only facilities. Thus, people in need of non-COVID care were left in the lurch. People who were undergoing or were about to begin critical treatment like chemotherapy or dialysis were unable to access care anywhere.
There is also a backlog of patients awaiting treatment that was delayed or restricted during the previous waves. Delhi has already reserved 40% of beds in private hospitals for COVID-19 patients, instead of increasing the total number of beds. We should be better equipped to manage both COVID and non-COVID patients if we’re planning ahead.
3. Misinformation and false narratives
Aside from the flood of misinformation, there have also been copious amounts of fake news. In particular, people are becoming more complacent because of the false narrative that an omicron-fuelled third wave will be non-lethal.
The omicron variant spreads more easily than the delta, so if we are careless, we risk passing the virus along to vulnerable people who could still develop debilitating symptoms. In addition, the longer the virus circulates in a population, the more opportunities it will have to mutate, potentially into a deadlier variant.
But the false news will continue to flow, distracting people from the gravity of the issue and allowing the virus to thrive. Effective communication from the concerned authorities will help avert this.
4. Unpurposeful capsize pricing
The Indian government has had to cap the prices of essential goods such as masks, hand sanitisers and PCR test kits.
Although the move was well-intended, it was devoid of the economic reasoning of demand and supply. The demand for these products was high but the supply wasn’t being met. New businesses were unable to enter at the low price-point that the government had fixed. Even diagnostic labs had complained that low costs of testing rendered their business unviable.
This resulted in hoarding and black marketing, and the segment of the population that really needed these products couldn’t get its hands on them. The quality of supplies – especially triple layered masks – was affected as well.
5. Ineffective supply-chain management
The country has previously experienced a severe shortage of vital goods due to poorly managed supply chains and non-scalable procurement processes. Product quality was also compromised on occasion. The first two waves had also spotlighted shortcomings on this front and a need to transform our processes.
6. Flagging pace of vaccination
India missed its target to fully vaccinate all eligible adults in the country against COVID-19 by December 31, 2021; thus far, we have covered 65%. Data from the UK suggests 90% of hospitalised people are unvaccinated, iterating the importance of being vaccinated, especially in the face of more transmissible variants of the virus. Together with India’s poorer healthcare infrastructure, the number of daily new cases in the third wave could reportedly reach as high as 2 million.
7. Non-availability of mRNA vaccines
The Pfizer and Moderna mRNA vaccines are not available in India even though the drug regulator has approved their use. This is due to a problem with an indemnity clause in the vaccine sale agreement: these US companies want the government to assume liability when their vaccines’ recipients have severe adverse reactions, instead of being liable themselves. The government is reluctant to grant this privilege because it has denied the same request when it was made by vaccine manufacturers based in India.
The government could consider a temporary indemnity clause or alternative mechanisms, considering mRNA vaccines have emerged as good booster doses.
8. Late preparation of healthcare infrastructure
During the second wave, medical oxygen, hospital beds, medicines, ventilators and medical personnel to manage patients were all on short supply. The Indian government claimed that the sudden increase in healthcare demand was unexpected – but reports published by then had clearly indicated a paucity of oxygen and other resources during a subsequent wave.
It has been more than two years into the pandemic; if we are still not prepared for unexpected events, we shouldn’t claim that we have responded effectively – much less in a way the rest of the world could learn from.
9. Testing, tracking, treatment leniency
Testing and tracking are still the best ways to stop the spread of the novel coronavirus. An increased emphasis on masking up, social distancing and isolation can help. Officials have neglected these efforts before, or have paid attention to them in short and fleeting bursts. We also need to increase the pace and scale of genome-sequencing of patient samples, including by boosting the capacity of the corresponding institutes. The fraction of samples sequenced should be increased from 0.5% to 5%.
10. Imposing unnecessary restrictions
The government imposed many irrational measures during the last two waves and is turning to them again during this one – such as night curfews. They are not effective if social gatherings have already been restricted, and represent a waste of our time and resources. At best, they help put on a show that the government is doing something. Similarly, closing well-ventilated open spaces such as parks won’t help cut transmission and could rob people of a place to safely relieve themselves of mental stress.
Mahek Nankani is an assistant programme manager and Dr Harshit Kukreja is a research analyst, both at The Takshashila Institution. They tweet at @maheknankani and @harshitk43 respectively.