Fighting a War Without a War General: Experts on COVID Crisis
“We need an over-haul of our public health systems. Issues like lack of oxygen should never be happening.”
At least 100 Indian scientists have petitioned the government through an open letter on 29 April, to demand more access and transparency to ICMR data to help deal with the current COVID crisis.
As the second wave lashes on and many Indians are still grappling for basic requirements, scientists have urged the ICMR to open up their data for more collaboration.
The Office of the Principal Scientific Adviser to the Government of India, K. VijayRaghavan acknowledged the problems and added, “Our broader research community needs to be much more facilitated by our research agencies.”
Why Is The Govt Not Sharing Data?
“We must share data. We have to give other countries a heads up. Remember how much flack China got for not sharing data openly?”Dr Swapneil Parikh, Internal Medicine Specialist, Mumbai
The petition by top scientists including famed virologist Dr Gagandeep Kang, noted, “The ICMR database is inaccessible to anyone outside of the government and perhaps also to many within the government. Most scientists — including several identified by Department of Science and Technology and NITI Aayog to develop new prediction models for India — do not have access to these data.”
It added that data was needed to gauge and forecast waves, and in turn help with estimating requirements for medical supplies, oxygen, ICU beds and medicines. The letter lamented the closed access of ICMR data, adding, “Many scientists have been trying to get data on comorbidities and blood analysis of hospitalized COVID-19 patients, without success.”
ICMR has collected data on the demographic details such as age, health and location of those who submit samples for COVID tests and this granular information can help scientists understand more about the disease. Dr Kang said, “Lots of people want to know, for instance, what mortality is by location, and whether it differs between rural and urban areas. This speaks to the kind of care people are getting.”
Faster Genome Sequencing
An example cited by the petition was a critique of the Indian SARS-CoV-2 Consortium on Genomics (INSACOG), established for genomic surveillance, for its slow and limited sequencing. “Only 1 per cent of infected individuals are sequenced,” and more data is crucial to understand if a mutated virus is more virulent and transmissible.
“We are in a pandemic and this is a virus that is evolving very, very quickly. I don’t think the sequencing we are doing is enough. It’s not geographically or epidemiologically representative. I hope the efforts undertaken by INSACOG and others are addressing this.”Dr Gagandeep Kang, Virologist
The letter aims for more collaboration to help faster sequencing of the Indian variant. The letter also asks to remove bureaucratic hurdles that prevent INSACOG from faster sequencing. As per a report in ScienceMag, currently, INSACOG researchers face many “bureaucratic hoops to import reagents, plastics, and other key materials,” which all slow down processes in a crucial time.
Public Health Lessons
The letter aims to increase transparency and global public health cooperation, and Dr T. Jacob John, virologist and former professor at the Christian Medical College, Vellore explains that India needs to revamp its idea of public health to truly “learn its lesson from the pandemic.”
While he was not a signatory on the petition, he adds that the issues we are facing are systemic and not just limited to COVID-19.
“The variants came to India in December but we picked them up post the second wave. Why? There is a no guiding force. We are fighting a war without a general and there is no one accountable.”Dr T. Jacob John, virologist and former professor at the Christian Medical College, Vellore
He adds that from vaccine mismanagement to the disaster with deaths due to a lack of oxygen, “not one single thing is going right.”
“Our communication is also lacking - proper masking can prevent up to 90 per cent of infection. The vaccine can protect against disease not infection, so masking is essential. And yet, there is no clear public health communication on these basic guidelines. I can’t say it’s mismanaged as there is no management only,” he laments. “There is no clarity. Is our immunisation program national? There should be equal opportunity and cost to people in Kashmir or Kerala. But there is no leadership. Why is was the cut-off age 45? Again, no clear communication. There are so many myths feeding into hesitancy but there are no programs assuring people that the vaccine is safe and effective to fight the pandemic.”
Even on the issues of sequencing, he adds that “our Indian academies took no leadership.”
“The first wave, it took 1 month to collect 1 million infections. Currently, the doubling time is 10 days - this is 3 times as fast. This also means we could have picked up the variants early.”Dr T. Jacob John, virologist and former professor at the Christian Medical College, Vellore
‘Will We Learn Lessons?’
With no clear leadership and a desperate lack of oxygen and medical supplies, volunteers are attempting to plug the gap.
But how long can this last? When will authorities step up and help manage the crisis on larger scale?
“We could manage in the first wave, but not again and again. This is a chronic problem and needs to be dealt with by increasing health systems capacities.”Dr T. Jacob John, virologist and former professor at the Christian Medical College, Vellore
And this is all doable with adequate and dedicated planning. “For COVID I had suggested an independent task force that only focussed on managing the pandemic.”
Overhauling public health may seem daunting, but the solutions are there as well.
For example on oxygen plans, he says that every medical college - with its five thousand bed capacity - should have an oxygen plant. “See, there needs to be an overhaul in the system and not stop-gap measures just for COVID.”
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