From Tali-Thali to the Vaccine: The pandemic through the year

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About a year ago we responded to the call for a ‘self-imposed Janta Curfew’ observed on 22 March 2020 as the first attempt to contain the spread of coronavirus which had shown its presence in the country on 30 Jan 2020. This response was closely followed by the ‘Tali and Thali’ and lighting of ‘diyas’. The spread, however, continued unabated. On 24 March, 2020 the government announced a nationwide lockdown for 21 days when the number of confirmed cases affected by COVID-19 were close to 500.    The nation came to a standstill. What was so sacrosanct about the figure 21 remained a  mystery. The increase was tremendous consider that about 9 weeks ago there was just about one case in the country. A  number of regulations were enforced in the COVID-19 affected regions. The lockdown seeming slowed down the doubling period of the confirmed cases. From every six days by the first week of April 2020, it slowed down to every eight days by the third week of the same month. Despite this, the experts advised the extension of lockdown beyond 21 days which were due to end on 14 April, 2020.  After three weeks of lockdown, India recorded a decline in daily new cases. Among the 16 worst hit countries that were under lockdown for at least three weeks  at that time, India was positioned seventh after most European countries including Germany, France, Italy and UK.  Within the country, Kerala made the biggest gain with only 6.8 average daily rate of growth in cases as compared to Tamil Nadu with 23.1 %. Three more states, Delhi, Andhra Pradesh and Jammu and Kashmir too reported more that 20% daily increase in cases. The lockdown was extended until 3 May, with a conditional relaxations after 20 April for the regions where the spread had been contained or was minimal. As the spread continued, the lockdown was further extended until 17 May 2020. The districts were divided into three categories based on the spread of the coronavirus. By this time the NDMA Act was invoked and the lockdown was extended till 31 May 2020.

However, the government stated that the lockdown restrictions will be gradually lifted from then onwards, while the ongoing lockdown would be further extended till 30 June for only the containment zones. Services would be resumed in a phased manner starting from 8 June. It was termed as “Unlock 1.0”. The Unlock 2.0, happened during 1 to 31 July, with more ease in restrictions. The Unlocks 3.0- 10.0 assumedly occurred during  each subsequent month, till the last as recently as March, 2021.

While the state machinery continued to claim accolades for a ‘well designed combat plan’ for the coronavirus, the reality was slightly different. The extended lockdown wss designed to be more stringent. Any deviation from the guidelines called for severe penalties including an exorbitant 2000/- for not wearing a mask. Such fines, apparently have earned the state governments, huge money. There was concern whether testing (of COVID -19 positivity) done, was of an adequate sample; of populations likely to be affected more; and the efficacy of different kinds of tests. Amidst such ambiguity and punitive severity the probable cases went under the carpet, further contributing to the surreptitious spread.  Zoning of the districts and states under red, orange and green categories, based on severity of situation, was certainly a good administrative measure but such severity in punitive action affected reporting. Occurrence of new cases may not got reported as the integrated approach proposes punishment instead of care provisioning without reprimanding. The cut-off time of 20 April, 2020 for relaxing the lockdown if the ‘hotspots’ stopped showing upward trends in confirmed cases and deaths; and no new hotspots evolved, was flawed. Considering simple human psyche of desire to be praised, it cannot be ruled out that the cases were underreported and information suppressed. On 20 April, 2020, the number of confirmed cases reported was 17890 of which 1500 (8.5 %) recover and 587 (3.3%) lost their lives. The share of deaths rose from 0.3% on 14 April. As promised, relaxation was extended to conditional plying of private vehicles; 33-50% of employees could be called to workplace; essential services such as electricians plumbers and mechanics; all emergency services were opened with adherence to safety guidelines.

It is noteworthy that since 20 April, the increase in confirmed cases has been 1.3 times, deaths have increased 1.2 times and recoveries have increase by 3.2 times. The improved health infrastructure to combat COVID-19, perhaps attributed to this increase in recovery rate. But sadly, the overwhelming obsession with COVID-19, erased any conversation in any mode- personal, media, and blurred the information on casualties  happening due to other illnesses, maternal and child health related and accidents. There was confusion and panic; stigmatization and apprehension towards the pandemic and those affected by it which loomed large in the public psyche. Beating of the health personnel serving in COVID wards in Delhi hospitals, notice to vacate the rental premises served to the Air India pilots in Kerala, apprehension to cough or sneeze in public places even with the mask on,  corroborate this. As of 22 March 8 am, the number of confirmed cases stand at 1164608, with 95.75% recovery amounting to 11151468 recovered cases. There are 334646 (2.87%) active cases and 159967 (1.37%) deaths.

Adherence to the safety norms kept the health personnel away from their families including newborns and infants for months together. Poor living conditions of those in quarantine was reported to be appalling. Closure of essential services including maternal and child health centres affected adversely and is evident in the increased home deliveries during the lockdown. There is no record of other casualties and the repercussions of missed immunization to the expectant mothers and children will show itself later in the time.

‘Staying home’, proposed as most effective in containing the spread, proved to the driver of increased crime against women during the lockdown period as evident from the NCRB (National Crime Report Bureau) and NCW (National Commission for Women) data. Advice to frequently wash hands overlooked the availability of water. Staying indoors affected our immunity provided by exposure to the outdoors. Indoor alternatives along with the unconventional systems of medicine, including home remedies, emerged as supplements to improve immunity. Sales of such substances increased during the pandemic. The only other sales registering upward trends were the internet service providers. Thanks to the ‘work from home’ mandate, which accounted little for the access to the gadgets and the connectivity.

Use of the phrase ‘social distance’ for containing the spread is grossly misplaced. It is actually physical distance from the infection that is needed. The term evolved during the 1918 ‘Spanish Flu’, which infected worldwide about 500 million persons and killed about 20-50 million people as documented in the pandemic history, the Pale Rider by Laura Spinney. Since social stratification is endemic to South Asia, the term appears appropriate for the nations who do not experience and practice it. In our case, it categorically has to be stated as contagion distance- keeping away from the infection, to differentiate from ‘social distance’ which we practice fairly much, given the graded inequalities entrenched in our society.

As testing improved, plasma therapy was experimented as one of the treatment option when it was administered for the first time on Day 21  of the Lockdown. Phobia induced stigmatisation of Tablighi Jamaat as ‘spreaders’ was at its height around the same time. The High Court ruling later quashed the charges. As the pandemic panned itself, there were peaks and troughs which continuously fed into the conundrum of care and containment of the spread. Amidst all this the vaccine trials were underway in many countries including ours. Before the year ended, the solution to the pandemic was reported to have arrived in the form of the vaccines from Bharat Biotech and Serum Institute, for us here in India. The latest in the line of probable vaccines is the intra-nasal vaccine. A dose given through the nose as a nasal spray. It is non-invasive and does not need a health worker to administer. It can be sprayed in the nostril which will touch the mucous in the naval cavity  and hence is likely to act faster, and only one dose will be sufficient.  Bharat Biotech is working on one such vaccine in collaboration with the Washington school of Medicine, USA. We will have to wait and watch for the results. No vaccine is fool proof is not denied by the experts even in case of the COVID vaccines. Like the virus, not much clarity is evident in this regard too.

The pandemic has created more confusion and ambiguity than understanding and clarity both about the virus and protection against it. Covering the nose and mouth when the virus is not known to be airborne, frequent washing of hands when water availability is questionable, disease-distance amidst ‘stay at home’, political rallies and kumbha mela- raise more questions than offer answers. A tiny organism has given the biggest shock to the ‘most developed’ organism. Roughly about 500 cases on this day last year to 47000 cases today- 22 March 2021 is a huge surge, with intermittent crests and troughs The All India Institute of Medical Sciences categorically stated today that the cases in specific pockets are likely to spread. There are also considerations for changing the doses for COVIDSHIELD, placing them between 6-8 weeks. Many states have imposed curfew, mostly during night. Ahmedabad has increased the duration by an hour. In Maharashtra, the functioning of the theatres has been curbed to 50% occupancy.

If we consider that the law of exponential growth set in for India after the number of confirmed cases crossed 50 on 10 March 2020 reporting 58 confirmed cases. It took four days to double, stacking the figures at 103, which doubled in six days on 20 March to 258. Further doubling happened in two days from 258 on 20 March to 466 on 22 March. Doubling period fluctuated from two to eight days.  But given the natural history of disease, the progression of infection does not happen this way. With increase in the number of infected persons the rate of transmission slows down as herd immunity develops and eventually the disease is eradicated. Cities like Delhi and Hyderabad have reported 50-60% population has developed antibodies against coronavirus by the first week of March 2021.  For coronavirus it has been estimated that when about 70% of the population gets the infection, then progression will automatically stop. More than half of Indians seem to have developed the antibodies and the current vaccines have about 81% efficacy. Neither Tali, nor thali or even diyas  have managed to do the job. Thus, what continues relevant even today is dispelling the confusions and lowering the panic, which remain abound even for the vaccines as it was for the virus.

Author’s Affiliation- Professor, Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University New Delhi and Former Director, Indian Institute of Dalit Studies. New Delhi . Research interest include health and discrimination; marginalization of underprivileged and vulnerable populations.



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