Should Have Planned for Uneven, Chaotic Spread of COVID-19, Rather than Smooth Wave: Satyajit Rath

The COVID-19 situation in India continues to be worsen with daily fresh cases surging beyond 2 lakh and daily deaths crossing 1,000. The healthcare system in the worst affected states have become overburdened, and are running out of space and oxygen.

Was this massive surge that India is currently going through expected? What did India miss in its preparation to tackle 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.

While caseloads went down drastically in December 2020 and sero-surveys showed that in cities like Delhi, Mumbai, Pune, etc., more than 50% resident had been infected. Did these falsely imply that a second wave is not to be expected?

What we should have been expecting ought to 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 of 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 countrywide 'simmering' state, with very local high-number outbreaks emerging (and subsiding) in different places at different times, and sometimes occurring simultaneously enough to give the appearance of a 'wave' that 'came' and 'went'.

This awareness of immense variability was also missing in the wishful interpretations put on the so-called sero-surveys. NONE of them actually reported any evidence that 'more than 50% of residents were reported to have been exposed to the virus'. What they actually showed was an enormous variation from local community to local community in the proportions of residents exposed to the virus.

In Pune, for example, the evidence was that, even in high-caseload prabhag-level small neighbourhoods, these proportions varied between 30% and 70%, and more. That, even within a given prabhag, hutment colony and apartment complex communities—separated only by a (very people-porous) boundary wall—showed huge differences in these proportions.

These data should have been seen as indicating that there was enormous local variation in the extent of the spread of the infection, to the point that the pitiful scale of evidence-gathering was completely incapable of providing a meaningful picture. Instead, we wishfully 'averaged 10% and 100% into 50%', and became complacent.

The Department of Science and Technology (DST) also came out with a so-called super model which said that India's COVID-19 cases will go down. Wasn't this a misleading prediction? Do you think that this misled health authorities?

As I said above, instead of seeing that our scale of evidence-gathering was pitifully inadequate to understand the variations involved, we 'modelled' (or even 'super-modelled') these data and came out, unsurprisingly, with predictions that have not been borne out, to say the least. 

Altogether, India looked at the bits and pieces of emerging evidence through rose-tinted glasses, and took to heart the comforting illusion that the epidemic was not going to affect India as much as it had 'devastated' the West. This fed into the idea that, in comparative terms, India did not need to invest very deeply and/or for very long for the pandemic, and that India's economy was going to recover rapidly by itself, with an even steeper 'V' than 'the West'.

This notion was also useful to a state withdrawing from its social responsibilities, including the one to provide adequate health care to its people, and moving towards its xenophobic-chauvinist nationalist ideologies of the glories and the superiorities of a resurgent ancient India, and to the prevalent capitalist articles of faith that 'the market' can, does and will respond 'optimally' to all situations including the pandemic. 

To what extent are the people responsible for not following proper COVID-19 safety protocols like mask wearing and physical distancing, etc.?

Well, since the infection spreads via air, from 'breath to breath', obviously, it is plausible to say that it spreads quickly if people live at close quarters despite being aware of these consequences. So, are we 'responsible' as individuals and communities? Of course, we are.

That said, it is worth asking the question – would we have behaved like this if our leadership had not fed us a steady diet of the illusions I point out above? Would we have behaved like this if, instead, enabling and supportive structures of governance had been developed to help distancing become the norm, if livelihoods had been well supported, if greatly expanded credible health care that was here to stay had been rapidly developed?

An analogical example is, building a highway through a village, and then throwing up our hands in horror at the high numbers of people dying while trying to cross it, saying that they are responsible since they should not have been stupid enough to be crossing a highway.

When the mutant variants emerged, India should have been quick in finding out the prevalence of the strains, which it lacked then and even now. Could this be a primary factor in giving rise to the second massive wave?

This brings up the woefully inadequate scale of our evidence-gathering that I point out above. We simply do not know enough to be able to answer any questions about 'variant' virus strains with any real credibility. Even now, the scale of the effort to monitor variant virus strains is still stuttering along at far, far below what is needed. As a result, while variants quite likely are indeed playing roles (different variants in different places, quite likely) in today's situations, it is impossible to say much more with any certainty.

During the latent period of almost three months when the daily cases went down along with mortality, India should have visualised the possibility of a second wave and should have prepared better, like increasing capacities of hospitals, makeshift hospitals, producing extra oxygen, mobilising extra health workers etc. But, these remain miles away from reality even now. How missing these has contributed to the sheer catastrophic situation that we are facing today?

Given the awful fact that people are widely reported to be dying without appropriate care, there is no question that we lack the scale of tertiary medical resources we need and should have mobilised. Currently, in many ways, we are digging a well while dying of thirst, as the saying goes. However, a question worth thinking about is, should we have thought of such a mobilisation as a short-term 'girding-up-our-loins' response to an acute, short-term crisis as we are all, communities and governments, thinking (and as the question itself ends up suggesting!)? Should we not have seen the epidemic as a salutary reminder that we needed long-term and durable changes to and improvements in our public health care systems?