Lessons India needs to learn from Covid-19

Updated on Mar 23, 2022 06:36 PM IST

On the medical oxygen front, the nation is unlikely to witness shortage; on the district hospital front, there is a long way to go; and in terms of science- and evidence-based decision making, some progress has been made

Life and work are almost back to normal in India; providing booster shots to everyone over the age of 18 will ensure it stays that way (PTI) PREMIUM
Life and work are almost back to normal in India; providing booster shots to everyone over the age of 18 will ensure it stays that way (PTI)

Two years ago today, at midnight, India imposed a near-total nationwide lockdown to combat the spread of the Sars-CoV-2 virus that causes Covid-19. On March 24, 2020, India recorded 64 cases and one death, according to the HT dashboard. In the two years since, the numbers have grown — to around 517000 deaths and 43 million cases (till March 23), although it is almost universally acknowledged that both numbers are being unreported, with the only point of argument being the degree.

The lockdown and restrictions on movement and activities that continued till almost the end of 2020 took their toll on the economy in 2020-21: It contracted by 6.6%. It has rebounded smartly since, unaffected by the brutal second wave of the pandemic in April and May 2021, a period which saw, by HT’s dashboard, 37% and 33% respectively of the cases and deaths recorded till March 23 this year. Despite the turmoil caused by Russia’s invasion of Ukraine, the economy looks set to grow by 8.9% (the government’s latest estimate) this year. Next year’s projections are equally robust — though the economy will take a harder hit from the Russian invasion if the issue remains unresolved for a few more months.

Some sectors have done better than the rest — with, in general, large companies doing better than small enterprises — as have some people, and at least in its initial stages, the recovery seemed to be more driven by profits than wages (and looked K-shaped), but some of these disparities predate the pandemic (with a few even being structural).

It is important to acknowledge the eventual success of India’s vaccination programme. Eventual, because it was off to a patchy start on account of supply constraints, but a success nonetheless, because at last count, India had completely vaccinated a little over 80% of its population over the age of 14 years (with two doses of the vaccine), with another 16% of the same population having received one dose, and in line to receive the other. The recently launched vaccine drive for 11-14 year-olds is off to a slow start, but that is likely on account of school examinations, and it is too soon to comment on that data. Few countries have managed to vaccinate almost their entire eligible population, or even cross the 80% level. Vaccine hesitancy is a real problem in the United States, the United Kingdom, even parts of Europe — but a non-issue in India. Given the size of India’s population, the remoteness of some areas in the country, and the lack of awareness of a significant proportion of the population, this is a huge achievement.

By now it is also becoming clear that the Sars-CoV-2 virus (including all its variants) has, like other viruses, a math that is near-universal. That means that populations with similar levels of vaccination are likely to display the same trajectories of infections. They are also likely to demonstrate the same trajectories of fatalities, adjusting for demographic factors (age and prevalence of lifestyle diseases that make Covid-19 fatal). Purely from this construct, and given what we know of India’s health indicators (not the world’s best), there is no doubt that official data on both cases and deaths are undercounts — just as they are in many other countries. But it is also clear that given the extent of exposure to the virus in the country (antibody surveys have consistently turned up huge numbers, and it can be safely assumed that at least a third of the country has been exposed to the virus), and the reach of vaccines, India is well on its way to putting Covid-19 behind it (provided it does everything right from now on). Interestingly, at last count, India had recorded 43 million cases. A third of the Indian population of 1.3 billion works out to 430 million, which means only one in 10 cases is being reported, a number that matches what even early studies on the spread of the virus indicated.

But the objective of this piece is not to look back, but ahead, and see if the lessons of the past two years have been learned. On the medical oxygen front, they have, and the country is unlikely to witness the shortage it experienced in April-May 2021.

On the district hospital front, anecdotal experience would suggest that they haven’t. These hospitals, as Dr Rajinder K Dhamija (now the director of the Institute of Human Behaviour and Allied Sciences) pointed out in an op-ed in Hindustan Times, are the second level in India’s three-tier health system with village or community health centres at the bottom, and premier, speciality hospitals at the top, and while their decay dates back at least two decades, it was only during the pandemic that the implications of this really dawned on policymakers: Plans drawn up in Delhi couldn’t be implemented at the district level, nor could equipment shipped from Delhi be used.

And in terms of science- and evidence-based decision making they partly have. Policymakers have started looking to data and science to better inform their decisions, but there’s more work to be done. For instance, despite scientific evidence overwhelmingly pointing to the benefits of and need for booster shots, India has shown a remarkable reluctance in expanding the eligibility for these (currently only those over the age of 60 years can get one). The second wave of Omicron in many western countries — one possible reason for this, according to scientists, is waning immunity in the population — is a warning for the country.

Life and work are almost back to normal in India; providing booster shots to everyone over the age of 18 years will ensure it stays that way.

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    Sukumar Ranganathan is the Editor-in-Chief of Hindustan Times. He is also a comic-book freak and an amateur birder.

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