The COVID-19 situation in India continues to worsen with daily fresh cases exceeding 2 lakh and daily deaths exceeding 1000. The health systems of the worst-affected states are overburdened and lacking space and oxygen.

Was this massive surge currently going through India expected? What did India miss in preparing to face this rather complicated situation? NewsClick spoke with immunologist Satyajit Rath, who is an adjunct faculty at IISER, Pune, about the COVID-19 situation in the country.

As the number of cases dropped significantly in December 2020 and serological surveys showed that in cities like Delhi, Mumbai, Pune, etc., more than 50% of residents had been infected. Did this incorrectly imply that a second wave was not to be expected?

What we should have expected should have been more nuanced than the idea of ​​a “wave” that “comes” and “goes”. The idea of ​​a “wave” is uniform, but the spread of an epidemic in communities, especially an airborne respiratory infection, is anything but “uniform”. What we should have expected and planned for was a chaotic and uneven spread of the infection, leading to a state of “ thrill ” nationwide, with very local, high-number epidemics emerging. (and diminishing) in different places at different times, and sometimes occurring. simultaneously enough to give the appearance of a “wave” which “came” and “went”.

This awareness of immense variability was also lacking in pious interpretations of so-called serological surveys. NONE of them actually reported any evidence that “more than 50% of residents have been exposed to the virus.” What they actually showed was huge variation from one local community to another in the proportions of residents exposed to the virus.

In Pune, for example, the evidence was that even in the case of a high number of cases prabhag– in small neighborhoods, these proportions varied between 30% and 70%, and more. This, even within a given prabhag, hut colony and apartment communities – separated only by a perimeter wall (very porous for people) – showed huge differences in these proportions.

These data should have been taken as indicating that there was enormous local variation in the extent of the spread of infection, to the point that the pitiful scale of evidence gathering was completely unable to provide a meaningful picture. Instead, we wished “on average 10% and 100% in 50%” and we got complacent.

The Department of Science and Technology (DST) also came out with a so-called super model who said India’s COVID19 cases will fall. Wasn’t that a misleading prediction? Do you think this misled the health authorities?

As I said above, instead of seeing that our scale of evidence gathering was woefully insufficient to understand the variations involved, we “ modeled ” (or even “ super-modeled ”) this data. and came out, unsurprisingly, predictions that weren’t. been confirmed, to say the least.

Overall, India looked at the emerging evidence through rose-tinted glasses and took to heart the heartwarming illusion that the outbreak was not going to affect India as much as it had ‘ devastated ” the West. This fueled the idea that in comparative terms India did not need to invest very deeply and / or very long for the pandemic, and that the Indian economy would quickly recover on its own, with an even steeper “ V ” than “. the west ‘.

This notion was also useful for a state withdrawing from its social responsibilities, including that of providing adequate health care to its people, and orienting itself towards its xenophobic-chauvinist nationalist ideologies of the glories and superiorities of an ancient India. resurgent, and the prevalent capitalist articles of faith that “the market” can, respond and will respond “optimally” to all situations, including the pandemic.

To what extent are people responsible for not following proper COVID-19 safety protocols such as wearing masks and physical distancing etc.?

Well, since the infection spreads through the air, from “breath to breath”, it is obviously plausible to say that it spreads quickly if people live nearby being aware of these consequences. So, are we “responsible” as individuals and communities? Of course we are.

That said, it’s worth asking the question – would we have done this if our leaders hadn’t fed us a steady diet of the illusions I highlight above? Would we have done so if, instead, enabling and supportive governance structures had been developed to help distancing become the norm, if livelihoods had been well supported, if credible and widely expanded healthcare? who were there to stay had been quickly developed?

An analog example is building a highway through a village and then throwing hands in horror at the large number of people who die trying to cross it, saying they are responsible because they shouldn’t have been. stupid enough to cross a highway.

When the mutant variants appeared, India should have been quick to find out the prevalence of the strains, which it lacked then and even now. Could this be one of the main factors behind the massive second wave?

This brings us to the sadly inadequate scale of our evidence gathering that I highlight above. We just don’t know enough to be able to answer questions about “variant” virus strains with any real credibility. Even now, the scale of the effort to monitor variant virus strains still stutters, far below what is needed. As a result, while variants most likely play roles (different variants in different places, most likely) in current situations, much more cannot be said for sure.

During the latent period of almost three months where daily cases declined with mortality, India should have visualized the possibility of a second wave and should have been better prepared, such as increased capacity of hospitals, hospitals makeshift, extra oxygen production, extra health mobilization. workers, etc. But, these still remain miles from reality. How has missing them contributed to the catastrophic situation we face today?

Given the horrific fact that people are dying without proper care, there is no doubt that we do not have the scale of tertiary medical resources that we need and should have mobilized. Currently, in many ways, we dig a well dying of thirst, as the saying goes. However, a question to think about is: would we have thought of such a mobilization as a short-term “ girdled-our-loins ” response to an acute and short-term crisis, as we are? all, communities and governments, thinking (and as the question itself ends up suggesting!)? Shouldn’t we have seen the epidemic as a salutary reminder that we need long-term, sustainable changes and improvements in our public health systems?