Grim Reaper Stalks The Land

The end of election season couldn’t possibly have brought more relief—the Covid graph breached the 4 lakh cases a day mark the same day and tragic stories were still streaming in. They came from remote towns—in Karnataka’s Chamarajnagar district, a hospital ran out of oxygen supply in the middle of the night on May 2, leading to the death of 24 patients—and from big cities, where people waited in queues to refill oxygen cylinders or made frantic attempts to get essential medicines for patients. And in between these heart-rending scenes, the menace of overcharging, hoarding and blackmarketing.

Where are we in the battle now? The grim forecasts haven’t changed much—a model by the Seattle-based Institute for Health Metrics and Evaluation projects 6.3 lakh deaths from April 26 to August 1, with the count of daily deaths peaking around May 20. There has been a growing call for a nationwide lockdown to break the chain of transmission—currently, many cities have local versions of lockdowns.

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As the epicurves suggest, the scenario varies from state to state. Take Maharashtra, where signs of the second wave appeared in mid-February—the clue to this was the effective reproduction number, or R, rising above 1 on February 12. An R value greater than 1 points to increasing transmission. “After staying that way for several weeks, the R number dipped below 1 in the last week of April,” says Prof Sitabhra Sinha of the Institute of Mathematical Sciences in Chennai. So also in the case of Chhattisgarh.

“If it is a genuine change, it means the growth is slowing. And interestingly enough, the two states also happen to be the ones that showed extremely high growth rates early on. But it’s still too early to make that correlation,” says Sinha. Firstly, the R values of Maha­rashtra and Chhattisgarh aren’t substantially below 1—currently, they are hovering around 0.9. “There’s no guarantee that next week, it is not going to climb above 1 again,” he adds. Besides, Punjab, which too saw a surge in Febru­ary, is not yet showing a declining R value—hence a counterexample, in that sense. “Some of the states that currently have the highest R number—Rajasthan, Uttarakhand, Gujarat, West Bengal and Karnataka—have not shown any change in the week ending April 30,” says Sinha.

Anecdotally, some of that apparent slowing in Maharashtra is visible, even though the state still has the highest number of active cases in India. “The present week, following a fortnight-long lockdown, is showing some sign of relief,” says Mumbai-based internist Dr Samrat D. Shah. “In OPDs, we are seeing at least a drop by 25-30 per cent of new Covid cases and hospital beds are now available on short notices. Even critical medicines are available more easily. Hopefully, the following weeks will continue to get better and the burden on the healthcare system should come down considerably.” Concurs Dr Vispi Jokhi, CEO at Masina Hospital. “The Covid situation in Mumbai city and at our hospital is certainly improving, and the pressure on the number of beds is decreasing,” says Dr Jokhi, who reckons the lockdown in Mumbai has helped control the wave of new infections. However, he warns that the vaccination rollout, if not decentralised quickly, can negate the benefits of the lockdown as citizens rush to the limited number of centres for vaccination. “We need to be vigilant and keep stringently following the guidelines on treatment to enable rational use of resources and beds,” he adds.

In Delhi, the situation is still grim. “All the hospitals in Delhi-NCR were choked a week back and things are still bleak,” says Dr Mrinal Sircar, director and head of pulmonology at Fortis Hospital, Noida. “From what I am gauging, people are still looking for beds and patients coming to us are sicker. I do not foresee any immediate change in the next two to three weeks.”

The challenges are many, including the fact that more young adults are falling sick now than earlier, doctors reckon. “The virus is showing different clinical pictures in all possible age groups now, varying from early lung involvement, continuous unrelenting fever for days on end, breakthrough fevers and longer time to recover from lung inflammation,” says Dr Shah. Dr Jokhi points out that the need and consumption of oxygen is significantly higher compared to the first wave. Speaking at a Union health ministry briefing this week, All India Institute of Medical Science director Prof Randeep Guleria drew attention to some common panic reactions, especially the ‘misuse’ of CT scans. “There is no benefit from doing a CT scan, especially if you have a mild infection, are in home quarantine, and if your oxygen saturation is fine,” he said.

According to the Union health ministry, the data of daily recoveries vis-à-vis daily new cases has improved over the past fortnight—from 1.5 lakh recoveries versus 2.59 lakh new cases on April 20, it rose to 3 lakh daily recoveries against 3.6 lakh daily new cases by May 3. Meanwhile, how does the vaccination graph look amid a vaccine supply shortage? The pace has certainly tapered off over the past month (April 3-May 3) from a peak of 45 lakh doses administered on April 5 to a little less than 17 lakh on May 3. Though registrations have been opened up for the 18-45 age group, supply shortages have forced some states to delay vaccinations for this group as they prioritise older adults.

For the first time since the vaccination drive started, the number of second doses administered overtook first doses on May 3—out of the total vaccinations on that day, as many as 8.62 lakh people received a second dose, while 8.35 lakh got their first shot. The likely reason for this, as former WHO official Rajesh Bhatia notes, is that senior citizens were anxious to get their second shots before younger adults started to stream in, amid a shortage of vaccines. “There would be a larger number of people chasing smaller quantities of vaccines, so they are trying to go quickly and get their second dose,” says Bhatia. “When more vaccines come into the centres, then people will have more confidence.”

Yet, these numbers were still lower than the high points during the month—on April 23 and 26, over 12 lakh second doses had been given. Cumulatively, over 15 crore doses had been administered during the vaccination drive as of May 3, out of which nearly 3 crore were second doses. Adar Poonawalla, CEO of Serum Institute of India, said in a statement this week that his firm has so far supplied more than 15 crore doses of Covishield out of a total order from the government for over 26 crore doses—the remaining tranche of 11 crore doses would be supplied in the next few months, he said. This tranche, along with an order for 5 crore doses for Bharat Biotech’s Covaxin, would cover the period from May to July, according to the health ministry.