India’s Toughest COVID-19 Test Still Lies Ahead

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India’s Toughest COVID-19 Test Still Lies Ahead

Winter smog, religious festivals and election campaigns pose a crucial test of India’s pandemic management.

India’s Toughest COVID-19 Test Still Lies Ahead

An election officer checks the temperature of a voter during the first phase of state elections at Paliganj, in the eastern Indian state of Bihar, on October 28, 2020.

Credit: AP Photo/Aftab Alam Siddiqui

The panel of scientists who conducted a study commissioned by the Department of Science and Technology (DST) recently stated that India, with the second-highest number of COVID-19 cases in the world, may have passed its peak of infections. At this rate, the panel predicted, there would be a significant decline in the number of cases by February. Similar to other government-commissioned studies in India, the study strikes a positive note for a country rushing for a return to normalcy after being battered by the economic and educational downturn caused by the pandemic. However, with the season of toxic air, festivities and election rallies looming, the projection presents a misleading picture.

September 2020 was the cruelest month in India, recording 2,621,418 infections, 41.53 percent of the total COVID-19 cases reported at the time. September alone accounted for 33,390 deaths from the pandemic, 33.84 percent of India’s total to that point. In October, several mainstream media outlets reported the study’s preliminary findings based on interviews with the seven-member panel, which consisted of mathematicians and epidemiologists. Most of the headlines and blurbs that appeared on social media feeds and search engine suggestions failed to tell the whole story, and what should have been a caution to follow safety protocols and guidelines ended up being seen as a go-ahead for citizens who had been spending months cooped up, devoid of any real social life. India currently has more than 600,000 active COVID-19 cases, out of a total of over 8 million infections recorded since January.

“Your last journey cannot be to the crematorium,” said a 58-year-old professor of media arts. She resumed her in-person doctoral study meetings in one of New Delhi’s premier universities last week, after months of academic disruption wrought by the pandemic. “India has probably crossed the peak and there is a steady decline in the number of cases now,” added another professor. Everybody in the conference room wore masks and maintained physical distance throughout the two-and-a-half hour meeting. However, on the streets, it appears that the pandemic is long over.

Blind Optimism

In May, the DST initiated a COVID-19 Indian National Supermodel, a forecast of the future transmission of infection supposed to support decision making, health system readiness and other mitigation measures. The study aimed to “aggregate successful evidence-based mathematical and statistical forecasting models and include the best predictive analytics for robust forecasting of infectious disease spread.”

The study was meant to be used by policymakers in India and around the world, the DST stated in a statement on its website, to overcome difficulties in predicting the rate of spread of infection and how it would burden the health care sector. However, the study projections assumed that the existing safety guidelines on wearing masks, public gatherings and physical distancing were being followed and that the virus would not mutate in the future. In one of the papers published in the Indian Journal of Medical Research (IJMR) as part of the study, the authors clarify that they relied on covidindia.org, a crowd-sourced database, for data and admitted one of the limitations of their research was the non-availability of accurate data.

Interestingly, a poll published in August on the same website found that 51 percent of the more than 1,600 respondents felt that India’s citizens were not being cautious about the COVID-19 threat. In another poll conducted the same month, 55 percent of 1,500 respondents felt the COVID-19 situation in India would become much worse by the end of September. Of 3,000 respondents polled in another survey, 50 percent expressed grave concerns about the increasing caseload and felt that lockdowns were necessary now more than ever. In a poll conducted in October, 36 percent of 1,250 respondents thought that the official figures might not be correct, and the total number of cases was on the decline, while 25 percent felt the official numbers were wrong, and that cases were still increasing.

The paper published in IJMR mainly justifies the lockdowns imposed by the government since March, and estimates what the caseload would have been had the lockdowns been delayed or not imposed in the first place. Even though one of the paper’s authors is the deputy chief of Integrated Defense Staff (medical), at the Indian Ministry of Defense, the paper states there is neither a conflict of interest nor any financial support and sponsorship for the study.

Critiquing the model and the paper, Gautam I. Menon, a professor of physics and biology at Ashoka University, Sonepat, and at the Institute of Mathematical Sciences, Chennai, writes in The Hindu, “basing public health policies on models that are flawed is dangerous, since the lives of people are at stake and false optimism carries risks with it. Science should not serve political ends.”

In April of this year, V.K. Paul, member of NITI Aayog, a policy think tank of the government of India, and member and head of a key government empowered committee on medical management, presented a study forecasting that new COVID-19 cases would stop by May. The projection failed when India steadily climbed to second position in the world for COVID-19 cases. The study had drawn sharp criticism from independent experts.

Even before the “supermodel” study was made public in October, the finance ministry, in its economic review for September, used the 14-day data from September 17 to 30 to contend that India may have passed the peak of COVID-19. It predicted economic growth in India, which witnessed its first GDP contraction in more than 40 years in the first quarter of 2020-21.

The finance ministry’s promise of growth and blindly optimistic studies complementing that narrative are linked to the crucial state elections now underway.

Electoral Opportunism Vs. Public Safety

“The NDA government in Bihar has set an example in the fight against novel coronavirus. It is our promise that when a vaccine for COVID is available after clearance from ICMR, every Bihar resident will be given free vaccination.” So the Bharatiya Janata Party (BJP) pledged in its Bihar election manifesto. The Bihar Assembly elections will proceed in phases until November 7. After Bihar, the ruling BJP in Madhya Pradesh, too, promised free COVID-19 vaccines for the state in its assembly elections manifesto for the 28 state constituencies that will vote on November 3.

Political parties kickstarting their election rallies in Bihar led to the fear that crowded campaign rallies would send the state’s number of COVID-19 cases skyrocketing. All safety protocols were thrown to the wind, and people jostled to look at their political leaders who welcomed them to the rallies and took no efforts to educate their followers. Instead, footage of such crowds was used for further publicity. While the Bihar state government claimed it was conducting an average of 150,000 tests a day, most of these were rapid antigen tests, which have an accuracy rate as low as 30 percent.

Bihar, Uttar Pradesh, Rajasthan and Madhya Pradesh are also the states with the highest number of inter-state migrants, who bore the maximum brunt of the sudden lockdowns in March. Prime Minister Narendra Modi’s 21-day lockdown announcement left millions of migrant workers suddenly out of jobs, and gave rise to an exodus similar in scale to the India-Pakistan partition of 1947. With all public transportation stopped, migrants walked hundreds of kilometers with their families, carrying bundles of clothes and often going without food for days. In April, a World Bank report stated that the lockdown had impacted the livelihood of nearly 40 million internal migrants.

Professor Amitabh Kundu of the New Delhi-based Research and Information System for Developing Countries, estimated that Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh accounted for 25 percent, 14 percent, 6 percent, and 5 percent, respectively, of the total 65 million inter-state migrants in India. Approximately 33 percent of these migrants are workers. The pandemic lockdowns risked the loss of livelihood of around 12 to 18 million people, of which 4-6 million are from Uttar Pradesh, 1.8-2.8 million from Bihar, 700,000 to 1 million from Rajasthan and 600,000-900,000 from Madhya Pradesh. While there is no official data on inter-state migration, Kundu’s estimates are based on the 2011 Census, NSSO surveys and economic surveys.

The exact number of migrants who returned to Bihar is not known, but the Election Commission added a little less than a million to the voting rolls in the six months ahead of the Assembly polls that started on October 28. Among them, 300,000 were estimated to be migrant laborers who were forced to return home after the COVID-19 lockdown. Bihar has failed miserably to resettle these migrants, and the ruling party faces an angry, unemployed electorate this election. Those voters are now being promised free COVID-19 vaccines while government-sponsored studies keep stressing the efficacy of the lockdown.

The state governments have already failed to manage campaign crowds and ensure people follow pandemic safety protocols during the major festivals of Durga Puja and Navratris in October. Before the Calcutta High Court order to control the crowd at the Puja venues, people had already thronged for a month at markets shopping for the festivities. The pujas, a major Hindu celebration in West Bengal, had also become an opportunity for Chief Minister Mamata Banerjee to compete with the BJP in wooing Hindu voters in a state that is readying itself for elections in May 2021. Criticized by the BJP for her “anti-Hindu” stand, Banerjee doubled the financial assistance to Puja committees from 25,000 to 50,000 Indian rupees and permitted 37,000 pujas across the state, 9,000 more than last year.

With crowd management gone awry, India now enters the most critical phase – the smoggy winter – which the government studies that forecast dwindling cases by February 2021 did not factor in for their research.

Toxic Air, Deadlier Virus  

According to IQAir AirVisual’s 2019 World Air Quality Report, 21 of the world’s 30 worst cities for air pollution were in India, including six cities in the top 10. The Central Pollution Control Board (CPCB) found that Delhi’s air quality in the first two weeks of October 2020 was worse than the same period in 2018 and 2019. This poses a more significant challenge this year, since an increase in pollution level leads to inflammation in the lungs, potentially making people more vulnerable to COVID-19. While Indian scientists are yet to establish a causal link between a spike in pollution levels and coronavirus cases, global health experts feel that the winter is likely to bring another COVID-19 wave.

A nationwide study released in September by Harvard University’s T.H. Chan School of Public Health  found that people with COVID-19 who live in U.S. regions with high levels of air pollution are more likely to die from the disease than people who live in less polluted areas. The study, which is yet to be peer-reviewed, is the first to explore the correlation between long-term exposure to fine particulate air pollution (PM2.5) and the risk of death from COVID-19 in the country. Another April study by the University of Cambridge found an association between living in areas of the United Kingdom with low air quality and the severity of COVID-19 infections. A study by researchers in Italy showed that pollution particles can carry traces of the SARS-CoV-2 RNA and could exacerbate transmission of the virus in areas with low air quality.

Far from passing its COVID-19 peak, India is inching toward one of the worst phases of the pandemic. The smog’s return in the winter, a festival season with no crowd management and upcoming political campaigns marked by large election rallies all pose a litmus test for India. The coming months will determine if the country finally moves toward normalcy, or sees another spike that pushes it past the U.S. as the nation with the most cases of COVID-19.

Soma Basu is an investigative journalist and a research scholar based in New Delhi, India.