Epidemiologist and Head of Lifecourse Epidemiology (Public Health Foundation of India) Giridhara R Babu says it is easier to beat the enemy when it is the weakest; we missed the opportunity by probably celebrating early. However, we are capable and we need to regroup, refocus, and reinforce the proactive measures to take control over the pandemic response. Excerpts...
Q: What are your thoughts on the current status of the Covid pandemic in India? Would you say that the tsunami of infections we are seeing currently was expected epidemiologically?
A: The current scenario is concerning and seems to be going out of control soon. We have not peaked yet, though most metro cities seem to be struggling in catering to the critical care needs of the population. We should not be surprised by the second or multiple waves. For example, we had predicted a second wave in Karnataka in November or February but got the timing wrong. The expected numbers are also higher, and it is at a very fast pace compared to what we had expected based on the first wave. Epidemiologically, you are bound to get outbreaks whenever susceptible pools are built.
Q: What do you think could be driving the current wave of infections?
A: In most infectious diseases, outbreaks occur mostly because vaccination coverage is poor and more uninfected people are pooled together. In the case of Covid, it is also accentuated by potentially contagious variants and conducive environments created by many super spreader events. Along with Covid appropriate behaviour, we need Covid appropriate governance and public health measures to contain the transmission. It is easier to beat the enemy when it is the weakest; we missed the opportunity by probably celebrating early. However, we are capable and we need to regroup, refocus, and reinforce the proactive measures to take control over the pandemic response.
Q: When the pandemic first struck, a strict lockdown was imposed and was later justified as a buying time to prepare healthcare infrastructure to deal with the crisis. One year later, we see an unprecedented situation with thousands of desperate people sending out calls for help with hospital beds, oxygen, and experimental drugs on social media platforms. Where do you think we failed?
A: Pandemics provide these windows for implementing necessary public health actions at heightened priority. However, the systems will have to create proactive mechanisms to learn and adapt. For example, few states have set up oxygenation plants to cater to the needs of Intensive Care Units, built newer ICU facilities in public health sectors at district and subdistrict level, and have implemented innovative measures such as Tele-ICUs to reduce mortality in remote areas. Most metros and states are struggling to cope with the unexpected quantum jump in cases. We should have had a plan for tackling a second wave. Even now, it is not too late. We need to have a national policy to tackle multiple waves, including ramping up vaccination. Also, all the Covid responses should be managed by a well-established governance and review mechanism.
Q: Many metropolitan cities like Delhi, Mumbai, and Pune, which had seen quite a few peaks before, are also seeing even a worse situation? Do you think serosurveys -- showing quite high seropositivity rates in these cities -- painted a misleading picture and lulled people and governments into some sort of complacence?
A: Higher seroprevalence in metros indeed provided a remote and counterintuitive scenario for explaining the current surge in cases. For the same reason, we should have investigated when areas with higher seropositivity showed higher numbers of cases than expected. Concurrent genomic sequencing and studies on the infectiousness of the variants, aligned with strict epidemiological investigations, could have provided inferences. The second wave is a reminder that failure to act early can prove to be devastating as we prepare the country to face multiple waves.
Q: Where do you think the situation might be heading in terms of the epidemiological progression of the pandemic, and what could be the way forward?
A: This will not be the last wave and not the last pandemic either. We need investments in strengthening resilient health systems and human resources. We need to build a futuristic health security system that integrates the One Health approach, strong surveillance platforms, and an autonomous agency to coordinate public health actions. So far, there is no empirical evidence to suggest whether eliminating Covid is feasible in any near term. If disease control is neglected in some parts of the world, every other part is at risk of importing the infections. We need to strictly and meticulously review the Covid situation in the country while expanding vaccine coverage.
Strong public health leadership and resources should be available to build resident systems, including strengthening epidemiological and genomic surveillance for COVID-19 to detect outbreaks. It is unrealistic to expect tangible gains without a strong focus on health system strengthening, especially not strengthening human resources recruitment and capacity building.
While the disease will become endemic, it is essential to resume pursuing Universal Health Coverage to ensure we build strong systems capable of handling any pandemic.
Q: In terms of vaccination, in your view, what should be done to reach a reasonable level of herd immunity?
A: It is important to cover the eligible population as early as possible with vaccination depending on the logistical and operational feasibility. Herd immunity is specific to each variant, as evident from the ongoing surge in cases. Hence, results from genomic sequencing of the ongoing variants should be used as inputs to update the vaccines for the future.