 Welcome to our weekly COVID update with Dr. Satyajit Rath. Thank you Dr. Satyajit for joining us today. And to start our show, you want to first look at the situation in India, where we see that we're again seeing a surge in the number of cases. It's been called the second wave or perhaps it's not really the second wave. We have had many waves now. So what do you think about this? What is the reason behind this? Why is there a spike in cases again? The virus does not recognize political geography. This should be self-evident, but is quite frequently forgotten. So it's worth underlining. As a result, what we are really looking at when we speak of a national surge is simply an increase in aggregate numbers. That's not necessarily saying that cases in every town or every state or every neighborhood are increasing all at the same time. It's essentially a convergence of a large number of small local outbreaks where transmission numbers are increasing. The pandemic is still going on. Every time national numbers decline, not simply in India but across the world, communities and societies and even more so governments who really should know better begin to pretend that they have won a victory and that the virus is vanquished. None of this is true. The pandemic is still going on. The virus needs to be present in some infected people from whom transmission will happen efficiently in order for a local outbreak to occur. These local outbreaks at some level are statistically random events. So they're helped by all sorts of things as we will come to in a minute. But essentially this is simply a convergence of many small outbreaks. So a reasonable question to ask is, are we seeing a lot of small outbreaks? And the answer to that is yes. We are seeing these small outbreaks and we will see that in metropolitan cities such as Pune where I'm sitting, case numbers are increasing. Once again they are increasing in urban, hyper crowded, working class communities and neighborhoods only this time in communities where case numbers were not that high six months ago. When we had our first national peak as we insist on calling it. So it's really a matter of the virus beginning to pop up in communities where it hasn't so far been over the past year. And as a result beginning to spread. The second thing is that we are beginning to see cases happening in not in so-called Chuggi Chowdhury neighborhoods, but also in so-called apartment complex neighborhoods. In other words shifting from hyper crowded working class neighborhoods into somewhat more lower middle to middle class neighborhoods. And because distances between people are inevitably a little bit more in middle class neighborhoods the speed of transmission still remains relatively low even when case numbers are increasing. So there is a pattern under all the statistical uncertainty of the pandemic. What this search really does say is that the whole notion of a country achieving herd immunity and with natural infection and thereby overcoming the epidemic and the disease or at least the epidemic nature of the disease is really a pipeline. Of course an important way to overcome from this pandemic is through our vaccinations. But even there we are seeing that in India again healthcare workers, frontline workers are skeptical of getting vaccinated from our indigenously developed vaccine coaxing. So and at the same time we have our health minister, Harshvardhan promoting another cure so-called cure, Patanjali's Coronial, which is again without any evidence backing it. So you know what sort of message does this convey and also what do you feel about this skepticism towards coaxing? It's not entirely skepticism. So I think that we need to keep in mind three factors that have contributed to the massive shortfall of vaccination uptake amongst healthcare workers. Clearly there has been a massive shortfall of vaccination uptake. But all the reasons are not necessarily connected to vaccine skepticism. So a major reason is that the way that vaccination has been structured for them, as I for example have been told in the city by French colleagues and acquaintances, is that when your name comes up in the list for vaccination on a particular day, you get that information with very little time. So for many physicians, for many nurses, it has simply not been possible to turn up on that day at that time, especially given that you inevitably have to wait and so on and so forth. So clearly that has been one factor. A second factor has been the repeated examples of the Covina app glitches, which again are not to do with any vaccine skepticism, but instead to do with the practicalities and logistics of the vaccination campaign. There is one component of vaccine skepticism that we have heard repeatedly articulated that says, I'm not going to take the vaccine right now. I'll wait for six months and let other people take vaccine and depending on how it all looks, I will decide six months later whether to take vaccine or not. And I find it very hard to think of a less community oriented viewpoint than this. More, let me be blunt, a more capitalist viewpoint than this. But there are two other issues that contribute to vaccine skepticism. The first is, of course, that the upper classes, metropolitan upper classes in India have imbibed some of the anti-vaxxer, anti-science perspectives that have gained some traction in Europe and North America against vaccines as with vaccines as bad, vaccines as evil, vaccines as toxic and so on and so forth. But apart from that, there are two components that have fed the narrative of vaccine skepticism or fed the idea of vaccine skepticism. One is that all said and done, the ICMR-Bharat biotech vaccine, I guess we have to call it, Covaxin, as you point out, has been given approval without even today, over a month and a half, I think, after approval has been given, any preliminary evidence of protective efficacy? Exactly. That has led to very many people saying, you know, who all sorts of approvals are given without making the necessary nuanced distinction between the Oxford AstraZeneca serum Institute vaccine, the Covishield vaccine, which has been given approval for emergency use without, with these kinds of preliminary data and numbers for protection. And Covaxin, for which we were told a month and a half back that within the fortnight, there would be data. Now we've been told yesterday that within a fortnight, there would be data. So, again, I think that the data will show protective efficacy. And we've discussed on these updates, on these updates, why I think so. But on the other hand, the way that the government of India, in its anxiety for its own version of vaccine nationalism, has handled the approval process, has fed inadvertently into an additive of vaccine skepticism. Added to this is another component that the government of India has inadvertently fed into. And this time it is fed by this government's enormous love for slogans. And one of the slogans that has been promoted, that has caused confusion, is the government slogan, or more correctly, the prime ministerial slogan of, and what is apparently meant by the way is vaccine. In other words, it's a perfectly praiseworthy idea to try to convey that you should take the vaccine, but you should still keep physical distancing. But for pity's sake, the way means medicine and medicine is something you take when you're sick. Repeatedly, amongst healthcare workers, especially in the supporting nursing assistant level and category of workers, I have heard anecdotal stories saying, oh, the prime minister has said, So when you get sick, you'll take the vaccine. And this really attempting to create a slogan-based publicity-based bragging point has again inadvertently contributed to vaccine skepticism. So these are the components, I think, of the present situation of vaccine skepticism. The other question you ask, which is related to the recent presence and support from not one, but two union ministers, not simply the minister for health and science and technology, Dr. Harshvardhan, but also Mr. Nitin Karkarigu, who was present and who was greatly supportive of this medication called Koronil, which first came to light for six months or so ago, and then went through a very large number of contortions before acquiring some sort of an approval, the basis of which is quite unclear, from the Ayush department of the regulatory authority. Again, to have approval given without evidence of efficacy damages both the integrity of the process, as well as feeding both an anti-science narrative as well as feeding a science skepticism narrative in the vaccine context. So none of this is helping. And moving on to the United States, which is another interesting example of all of these factors playing together. We see that on February 22nd, the country crossed 500,000 deaths. It still has the highest number of cases by a large margin, I think 28 million cases over 28 million cases, which is over a quarter of all infections. And India is, you know, the second highest, which is far behind at 11 million cases. We see these extremely high numbers. And we also see that the US is also the country which has administered the highest number of vaccine doses. I think around 60, over 60 million doses or so. So what explains this sort of contradiction? Well, there isn't really a contradiction. We should all keep in mind that a vaccine is not a magic bullet. It doesn't instantly cover you like one of these Avengers movies in an impenetrable, virus impenetrable shield the moment the needle enters your eye. It takes at least a fortnight for good, substantial, high quality antibodies to be generated in response to a vaccine. And in fact, at least for some people, it takes the second dose, which is taken four months later in order for those antibodies to be generated. That's not true of everybody, but it is true of some fraction of the vaccinated population. And if you look at the, if on the worldometer site, you look at today's graph of the daily case numbers for the United States. You will see that over the past fortnight or more, I think ever since the end of January or late January, case numbers in the United States have been steadily declining. So unlike for India, where over the past 10 days or so on the same website, case numbers have begun to show a modest increase. So these are patterns that are driven where we identify cases, but the cause causation of the cases is back in time. So it's perfectly plausible for American authorities, health authorities, as indeed they have argued to claim that vaccination to a certain extent is working because case numbers are declining. Now, is that necessarily the case? Again, as we repeatedly pointed out on this program, we should be, we should learn a little bit of humility in the face of the sheer unpredictable nature of any kind. Something that sounds reasonable and rational and kind of sort of evidence based for us to adopt. If we do that and case numbers decline, we shouldn't be in a hurry to say that that has necessarily worked. There are coincidences in these kinds of situations. So we will wait and see. But to all appearances, American case numbers are steadily declining. There are other places in the world where case numbers are increasing. The pandemic is still under its course. Is vaccination going to bring speeds of transmission down, reduce the numbers of outbreaks? Absolutely. Is that going to happen even in a place like India where the rate of vaccination and the uptake of vaccination is much, leaves much to be desired? Yes, it will. But vaccination is not some sort of a magic bullet that's going to terminate the pandemic. So thank you, Dr. Satyajit, for joining us today in this discussion. Again, we'll come back to you next week to continue these updates. Thank you for watching NewsTik.