 Hello and welcome to NewsClick. Today we have with us Dr. Satyit Rat and our usual Monday discussions on what's happening on the COVID-19 front. At the moment, the picture is very grim. From what the numbers are, they tell a dismal story on two counts. One is the rise is not getting controlled. We have a continuous rise of cases. And the fact that we have reached 275,000 cases is only one issue. The issue is this rise is not showing any signs of slowing down. So when it will peak, we do not know. And predicting the peak is as much as predicting the future. So I don't think our earlier record of any of the models has been good on this. So we have to see when leveling starts. So that is one count on which the things look grim. The second is, and this is something we have discussed earlier as well, the crisis of the health system happens if the numbers go up simultaneously and across a large front. If that happens, then the public health system or the hospital system starts to collapse. And that is when the fatalities really rise. So it's a crisis of the health system that produces the fatalities. And we are seeing now across the board lack of hospital beds, lack of ICU, lack of oxygen, even the basic oxygen that we require to support the patients is not available because supplies are not there. And the numbers of people who need oxygen today have grown enormously. Satyajit, do you think that we missed our chance when we had the opportunity, numbers had gone down, that we missed our chance at the time to really prepare for the next wave, which all reasonable epidemic predictions were making, that we are going to get a second wave. And if and when we do, we need to be prepared for it. Do you think that we really missed our bus at that point of time, strengthening the hospital system, making all the supplies, the supply chain, all of this? Absolutely, yes. We didn't do what we should have done at the time that we should have done it. There's just no two ways of avoiding, there's just no two ways of saying that. So the reality is that epidemics don't function in uniform fashion. And yet, despite this historical evidence, we insisted on believing our own silly nationalist propaganda that we were somehow uniquely protected in relative terms from this pandemic. And as a result, our hubris as a government led to this current state of unpreparedness. And consider the number of ways in which we are unprepared. We are unprepared because we have built no long-term commitments to expanded healthcare facilities, particularly of critically ill people. We are unprepared because even something as fundamental as oxygen is in short supply. We've been talking for the past year, all sorts of things about new drugs and access to new drugs and what is the utility of new drugs and what are the nuances of their use and so on and so forth. And we are sort of oxygen added on top of that is the fact that while our national numbers are steadily rising at a constant acceleration, that is not driven by a few localized outbreaks that is driven by a nationwide all-states rate of increase, which means that our medical facilities, the length and breadth of the country in remote areas, in small towns, in villages are being stretched. And under those circumstances, our deficits and the fact that we have not planned a durable response to the pandemic have become glaringly obvious. And there is this other complete attempt that governments do when they're in trouble, apart from the blame game of which of course is going on, blaming the states, blaming various other sections, blaming the people of course. But one thing that is striking is the fact that you start manipulating numbers, number of deaths. Now, if you take the crematorium figures and we had it last time as well, even in Delhi, we had pointed out the number of crematorium deaths saying that this is COVID patient, which is to be cremated or very much higher than what the government's disclosures are. And at that point of time, the Delhi government had to correct its numbers. We see the same game being played in Gujarat. Of course, it was played earlier also in Gujarat. We say Gujarat, we say we see it in other states. The numbers of COVID deaths are much higher than the one the government figures seem to say. But the point is it's not going to change the reality of people dying. And as you said, it's basically dying. One of the key reasons is really oxygen short supply and not having ventilators, which is of course, last resort, but not having oxygen support and not having ICUs and not having hospitals. Because apparently now, people are now lining up in the hospitals and there are no COVID beds available across not only in cities like Delhi, which has a much larger hospital capacity than others. But even in most other states, this is the same situation. So obviously, it's taken for granted that the health authorities, and don't forget, we still are under the Disaster Management Act, where under law, all the COVID-19 epidemic measures are centralized by the central government. So it is a completely centralized structure that we are talking about, unless the central government is willing to let go, which at the moment doesn't seem to be happening. So in any case, if you have to provide oxygen supplies and so on, then of course, it is a central government, central government, which has to respond, because it's a nationwide problem of getting oxygen and moving oxygen to the places where they're required. But again, no plans from before. So what is the disaster management supposed to be if you don't plan for these things? That's a simple enough question. But without getting into only this issue, the other issue, that what are the measures that now need to be taken? Let me sort of come back to this later. The other issue is that even now, the signal that the central government is sending is that, well, it's happening, but you guys have to take measures and so on. But we have phase-wise elections in Bengal still on. We have the Prime Minister on the election trail. We have Amit Shah, the Home Minister on the election trail, public meetings. We have the Kumbh going on. These are essentially signals by which you seem to indicate, we may say these things are very serious, but we don't really believe it to be so. I do not understand that what signal this sends to the people. If you say you can do elections, public meetings, school, every one of these things, at the same time, say people should be under lockdown, people should not go out, people should wear masks and so on. But the example you are setting is quite different. Absolutely. And that I think is a critical point to keep in mind. The critical point is not so much just how many cases and how many super spreader events there were during the Kumbh Mela. That's not the point. The point is not whether the election rallies turn into massive outbreaks or not. The point is much more what is the message that goes out when you enthusiastically embrace these events in the middle of an ongoing pandemic. And that score, nobody but the union government is squarely responsible. You know, when we had 500 or five cases, we had Mr. Modi, Prime Minister, leading from the front, talking about Mahabharata's 18 days war and this would be over in three weeks, four weeks. Of course, it went on much longer, the lockdown. But now he seems to be only talking about victory over Manta Badaji, while the nation at the moment is laid low by COVID-19. This raises also the question, if the leader of the country's focus is not the pandemic, then what should be the focus of the government? And that I think is also part of the problem. Now, we had the example, for instance, of other Punevala again raising the issue, we need intermediate supplies, what, you know, various things that we need for the production of the vaccine, which are not coming from the United States. We had raised this issue earlier also in NewsClick. We have written about it. The government doesn't seem to be moving on that either. So you have this, of course, vaccine may not be the immediate priority, but it will become the next one. So what is it that we are doing when the leadership, the two most important leaders are not visible in trying to get everybody together, the states together in fighting this? So this, I think, as you said, is also a matter of what is the message that the people get out of this. Coming back to the issue of how do we control the epidemic now? Because a lot of people are talking about vaccines, but the vaccines will take, you know, six, eight to vaccinate people will take longer number of weeks. So at the moment, when you have a peak of this kind, when you have a spread of this kind, vaccination is not the short-term solution. That's what it appears. So what is the immediate short-term solution? And after that, I'll come back to the genomic nature of is there an Indian variant issue, but then I'll do it later. So first, what is the, how do you look at what are the steps to be taken in order to control the epidemic? On this matter, there is very little to disagree with with the technocracies of the union government or of the state governments. They're all agreed, and I think reasonably so, that there needs to be a massive immediate ramping up of tertiary healthcare facilities, COVID hospitals, basically, and that by one modality or another, oxygen supplies need to be acquired and distributed. You know, we all tend to focus on how many megatons of oxygen are needed and how many are available. But I think in that there is the danger of forgetting that in as large a country with as distributed an epidemic as is currently going on as India's COVID is getting oxygen to the right place in time across the country is as critical as having the oxygen to supply in the first place. So I think that those are going to remain the critical issues. And I'm really, really distressed that complete red herrings, such as remdesivir for treating seriously ill people, for which it has not been recommended by any authority ranging from state medical associations in India to the World Health Organization. And yet, we have people desperately looking for remdesivir because again, the signal has gone out from the union government that remdesivir is a medicine of importance for this crisis stage of the epidemic, which has to be managed. And as a result, people are being given this implicit message that remdesivir is an important medicine for your loved ones who are seriously ill and battling for their lives in hospital. And that is leading in turn to black marketeering and over and above black marketeering to utterly petty party-politicking. And I find this astonishing, I could even at a pinch imagine party-politicking over oxygen supplies, because at least that's a critical resource that's needed. But in this stage of the crisis, to be undertaking party-petty politics and power games over a drug that should not be used in the severely ill, because it makes no great difference. This to make us imagine party offices and so on as you saw in this graph. You know, Satjit, this is also interesting. The central government has said it should be only used by serious patients in the hospitals. Now that itself is a signal which makes no sense, because as you have said, from the beginning, even remdesivir makers have said that it doesn't seem to show any significant difference for seriously in patients or mortality. So why is the government of India disagreeing with the makers of remdesivir itself? I'm not even going to understand. But as you have said, it seems to be the red herring. We can't give you oxygen, but we'll try and give you remdesivir. So I don't know whether that's the message, what is the message not clear. But you know, coming back to the issue, that what you've said, this is the medical way we have to do it. But stopping the pandemic, apart from waiting for it to burn out as it will, but the huge cost. Also things like, for instance, lockdowns have started. Now, there is also curfews, which I don't really understand, but okay. But also the fact that some kind of, for instance, diabetes being closed, various public places being closed, all of that is at the moment, something that we need to be done. And of course, it will cause a huge hit on the economy and as well on the migrant workers, as you can see, they're moving in large numbers right now from the cities. Let me make a point about what needs to be done in the public health sphere that that's over and above what we've talked about. And that is speaking of our own unpreparedness and our own missing the bus in preparing. Let me give you an example. That is an N95 mask. Let us ask ourselves, how many of us are using N95 masks? And how many of us are simply tying dupattas or handkerchiefs around our faces? Shouldn't in the past year, we have acknowledged that we need not just masking, but quantitatively efficient masking. And over the year, ramped up N95 mask production facilities in the country, so that N95 capacity masks are widely available. We have not done this. We are simply, you know, the Hindi phrase is naam ke vaste. The Marathi phrase is even more evocative because it acknowledges gender nastiness. Purely for the sake of the Sindoor, we are using, are you wearing a mask? Are you not wearing a mask without even thinking about the efficiency of the masking? And when the epidemic and when the infection is as widespread as it is today, the efficiency of the masks being used becomes as critical a parameter as whether masking is at all done not. Again, did the government consider this? Did they think about this? Did their task force advise them about this? Do we have any N95 mask manufacturing upscaling? No. So, I'm sorry, I brought up as simple as that. And a signed issue, but I think that it's both important substantively and symbolically of where we stand today. And something that we could have done quite easily. That's the other part. It did not need a major technological revolution in the country to produce N95 masks. So, therefore, at most, you would need to break the patents that exist in some of these components, which is an important issue in N95 masks, as you know. There are a number, I think, something like 400 patents on the various things that go into the N95 mask. Now, one issue that does or is causing a lot of concern is the talk about the Indian variant. The Indian variant, it seems to be has proved more transmissible. It is affecting also younger people, not more younger people seem to be getting seriously ill, which is of some concern. And there seems to be a report that it also could be having a new escape, which means some of the vaccines may not be as effective. And as you know from the reports, AstraZeneca against the South African variant didn't do very effective. While the Sinovac vaccine in Brazil did provide, even after all the criticism that it has been raised against it, more than 50% protection against the Brazilian variety. And that also for mild symptoms for the more serious cases, the numbers are even much higher. So, do you think there is a possibility that the Indian variant is proving more dangerous at the moment in terms of transmissibility? There are two sides to the virus variant issue, Praveen. One is, we need to keep in mind that everything that you have said about the variants is what is being said in public discourse. And every one of those statements is an overstatement of the evidence. None of this, which is out there in public discourse as an article of faith, is actually well proven and robustly supported by evidence. And we can go over each one of those. Number of samples are very few. Not simply that. For example, the so-called immune escape notion. The immune escape notion is based firstly on escape from a few monoclonal antibodies. But how many of us are going to be taking monoclonal antibodies anyway? On the other hand, the recovery, the ability of whole blood serum has not been as massively affected by the virus variation as monoclonal antibody recognition has been. So to say that there is an immune escape is in some ways an overstatement. Let me add to that the AstraZeneca South African data for the Covishield equivalent vaccine are from a limited trial where the trial was not properly reporting what the effect was on hospitalizations, on ICU admissions and deaths. But an extremely similar vaccine, namely the Johnson and Johnson vaccine, which was tested for this, showed excellent protection even though at the antibody level there was not much difference between the two vaccines. So what I'm trying to point out is that the evidence is far shakier with many more caveants. This doesn't mean that we should not be worrying about variants. It does mean that we shouldn't be panicking about variants. And I think that that's important to underline as a distinction. The second component of the variants is what you refer to as the numbers difficulty. If we want to be able to assess the impact of virus variants in any current or past outbreak, we need large numbers of variants to be sequenced and identified. And in order to do that, we need an extraordinarily well-organized, systematic sampling and sequencing effort over time. Even today, India does not have an adequate size of such an effort. Under those circumstances, all assessments of the role and impact of variants in our current outbreak that anybody is making are based on extremely small and shaky numbers. Within that, let me make a final point. What we are beginning to suspect, what the field is, what the people involved are beginning to suspect is, unsurprisingly, that India's surge is not one homogeneous surge. So for example, the so-called Indian variant, which like the UK variant, which in the UK is called the Kent variant, the Indian variant in India is presumably called the Maharashtra variant. And in Maharashtra is called the Akola-Yavatmal variant and so on and so forth. We always like to blame somebody other than ourselves. But the B-16-17 variant, which is what we should really be calling it, it's found in huge numbers, but in the Maharashtra cases. In the Punjab surge, there is no B-16-17. There is no B-1-1-7. So we're not the same across the country and therefore for us to keep averaging the country and either trying to understand it or to plan for it is a basic category here. That's an interesting point you're making that if you take for instance what's happening in India as a microcosm of what's happening elsewhere in the world, what we are seeing is somewhat converging evolution of the virus itself because after all, the most vaccines, body, everything effectively is focusing on the spike protein. Therefore, that is where the most active changes would take place and completely separate evolutionary changes could lead to somewhat similar results and that's what we seem to be seeing. In fact, there are papers now which have really pointed this out, completely separate lineages showing somewhat similar behavior. So I think that's an interesting scientific issue we need to perhaps discuss on another day. The point that we have right now is that we need to strengthen the public health system, oxygen supplies. Basically, it's not fighting the virus at the moment but making the patients be able to survive the infections because this surge is going to take some time to come down and what we're seeing at the moment is that whatever little time we have and whatever resources we have, we need to use it to fight right now what the patients are facing, expand the emergency infrastructure to be able to cater to the large number of cases we are likely to see now in other states as well and that's the immediate issue of course along with masks and other steps that the governments are taking for essentially trying to reduce the transmission. Vaccination for some time later because this is not going to be handled in vaccines. So people who are talking about increasing the rate of vaccination, this is not the focus at the moment that we should be having. Our focus really is to handle the immediate urgent hospital crisis we are having. Thank you very much Satyajit for being with us explaining to us about where and how we need to handle this particular phase of our very difficult situation. Do keep watching, use, click and do visit our website.