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GUEST EDITORIAL
Year : 2021  |  Volume : 14  |  Issue : 5  |  Page : 479-480  

COVID-19 Situation in India: Fundamental Epidemiological, Operational, and Ethical Questions for the policy-makers


Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission17-Jul-2021
Date of Decision18-Jul-2021
Date of Acceptance18-Jul-2021
Date of Web Publication30-Aug-2021

Correspondence Address:
Sachin Atre
Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_589_21

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How to cite this article:
Atre S, Walunj G. COVID-19 Situation in India: Fundamental Epidemiological, Operational, and Ethical Questions for the policy-makers. Med J DY Patil Vidyapeeth 2021;14:479-80

How to cite this URL:
Atre S, Walunj G. COVID-19 Situation in India: Fundamental Epidemiological, Operational, and Ethical Questions for the policy-makers. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Oct 19];14:479-80. Available from: https://www.mjdrdypv.org/text.asp?2021/14/5/479/324787



COVID-19 pandemic is one of the nightmares in the 21st century for numerous countries which experienced its devastating impact not only on human lives but also on the economy at large. Epidemiologically, India being one of the most densely populated countries with a weak health system structure would be expected to experience more serious impact than any other country. We made an attempt to synthesize some available factual data based on which we raise the fundamental questions around COVID-19 situation and its handling in India.

As per the Government reporting, as of July 10, 2021, a total of 43, 08, 85,470 samples were collected from the individuals (including both symptomatic and asymptomatic) and tested for SARS-CoV-2 causing COVID-19 in India. Of these, 3, 08, 37, 222 (7.1%) were positive. A total of 2, 99, 75, 064 (97%) individuals were discharged (after cure) and 4, 08, 040 (1.3%) deaths had been reported.[1] These data indicate that despite massive screening effort, only a small fraction of samples were found to be positive (which might also include repeated tests). Majority individuals were discharged even before the roll out of mass vaccination drive from March 2021 onward. A careful review of last 1 year's data (though cross-sectional represent testing of approximately 31% population (43 of 139 crores) indicate that epidemiologically, a vast majority of Indians did not even experience COVID-19 despite being exposed to it over a year and especially when no vaccine existed. Moreover, despite acquiring COVID-19, most (97%) were cured. Although the sheer number of deaths in last 1 year appears large (the number of actual COVID-19-related deaths is still debatable), it is not unexpected considering the total population size of the country. It is also comparable with other leading infectious diseases such as tuberculosis (TB). Unlike TB, the costs of COVID-19 treatment (excluding unwarranted hospitalizations that happened in last the 1 year) are actually negligible and most did not require any treatment. These observations based on robust data as reported from the Government website raise some fundamental questions: First, is there really any need for mass vaccination for a condition that is self-limiting? Second, would vaccination for high-risk groups preferrable over mass vaccination? Third, does India really need to divert huge resources for COVID-19 management by sidelining other major infectious disease conditions and development programs, which require far more priority?

Another issue is that India experienced two major waves of COVID-19 during following periods: First, between April and November 2020 and second, from the end of February 2021 to beginning of June 2021. The graphical representation of data showed that these were essentially lockdown periods when there was a rise in the number of cases.[2] On the contrary, surprisingly, during unlocking periods, i.e., from November 2020 to February 2021 and after June 1, 2021, the cases actually declined and hospitalizations reduced considerably. Considering the conventional theory of transmission of virus that leads to COVID-19,[3] one would logically expect an increase in the number of cases during the unlocking period, but the reality is opposite. How does one justify this observation and the need for unwarranted lockdowns which led to several collateral damages to existing systems? Numerous anecdotal case reports suggest that people were hospitalized out of fear to acquire beds and to avail insurance facility and died due to comorbidities and/over medications and were labeled as COVID-19 deaths. Further probing is needed in this matter. Nosocomial transmission in crowded hospital settings also could not be ruled out which might have led to localized epidemics in some settings.

Furthermore, the WHO solidarity trial data along with three other randomized controlled trials including over 7000 patients suggested no important effect of remdesivir on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes. This evidence-based reporting has been available on the WHO website since November 20, 2020.[4] However, rampant use of drug remdesivir (exorbitantly priced through black market) continued in India even during the second wave and continued later. Why was this existing evidence not translated into policy and practice? Finally, The Ministry of Health and Family welfare, Government of India declared that COVID-19 vaccination is voluntary.[5] However, various private and governmental agencies are seen forcing their employees to get vaccinated. Are not such decisions ethically inappropriate and reflect clear violation of human rights?

In our opinion, Indian policy-makers and expert advisory groups need to take cognizance of these epidemiologically relevant questions and plan steps accordingly to prevent further damage to the other health programs, economy, and human life. It is also important to note that viral diseases continue their course in the populations, some deaths are inevitable but they never wiped out populations. This is a clear indication that natural selection operates and controls them. However, unjustified lockdowns have far greater devastating impact on human life than COVID-19 itself. We are of the opinion that normal human life with certain safety measures can help to curb this disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
COVID-19 Live Dash Board. Available from: https://www.mygov.in/covid-19. [Last accessed on 2021 Jul 11].  Back to cited text no. 1
    
2.
3.
Coronavirus Disease (COVID-19): How Is It Transmitted? Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted. [Last accessed on 2021 Jun 20].  Back to cited text no. 3
    
4.
WHO Recommends against the Use of Remdesivir in COVID-19 Patients. Available from: https://www.who.int/news-room/feature-stories/detail/who-recommends-against-the-use-of-remdesivir-in-covid-19-patients. [Last accessed on 2021 Jun 20].  Back to cited text no. 4
    
5.
Ministry of Health and Family Welfare, Government of India, Frequently Asked Questions. Available from: https://www.mohfw.gov.in/covid_vaccination/vaccination/faqs.html#:~:text=Vaccination%20for%20COVID%2D19%20is,%2C%20relatives%20and%20co%2Dworkers. [Last accessed on 2021 Jul 11].  Back to cited text no. 5
    




 

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