A year of living with Coronavirus: Lessons learnt and the challenges that lie ahead

India completed one year of Covid-19 induced lockdown on March 25. As the nation witnessed an exponential surge in Covid-19 cases, crossing the 1-lakh mark (daily surge) on Sunday even with the vaccination drive taking place in full swing, Dr Shahid Jameel, director of Trivedi School of Biosciences at Ashoka University in an Indian Express article reviews the year that went by and attempts to augur what lies ahead.

Often asked about which vaccine to go for and the adverse reactions come, Dr Jameel explains that one should take whichever is available. Even when the past year a remarkable time for science and the value it adds to Society Dr Jameel finds that the understanding of the scientific method depended only on data and evidence.

Quoting Nobel laureate Orhan Pamuk, he re-iterates that even with a century between the past and the present, the initial response has been the same. Like in the past understanding for a new disease was driven by a rumour, the same happens at present but. With new-age communication tools, it spreads faster. Accusations based on religious and nationalist identities fueled through social media impacted how the Covid-19 story took lead in India and other parts.

The blame has always been on the origin country, who carried the diseases and was it could not be contained before reaching a foreign land. Like during the plague of smallpox, the Romans blamed it on Christians, homosexuals, voodoo practices, bioweapons created in CIA lab were held to be responsible for HIV/AIDS virus, in the present times many still believe that Covid-19 was made in a Chinese lab and was not transmitted from bats to humans, recalls Dr Jameel.

Another negative response to pandemic outbreaks, Dr Jameel finds is a distortion of facts and manipulating data by the government to the countries to deny the prevalence of the disease and then no reveal to the common seriousness of the situation to the full extent. Like it took much time for the South African government in the early twenties to acknowledge that HIV was caused by a virus that cost the country thousands of death, the initial denial of the US and Brazilian government about the grievousness of the situation costs the nations severely; both countries are still reeling under millions of cases and unprecedented deaths. Even with a strong healthcare system, Sweden recorded 15 to 20 per cent mortality in April, May almost year because of relying on herd immunity to take charge, opined Dr Jameel.

Outlook of people towards pandemic and how it differed among economic sections

Although a viral disease is caused by an infectious agent it is spread by humans to a pandemic level. The behaviour of humans drives the spread more than medical interventions. Even with overwhelming evidence that masks prevent infections and save a life, people don’t wear them properly or don’t avoid crowded places. Their choice depends on the economic nature of an individual decision. Here cost of illness is lower than the cost of avoiding illness. With people whose primary requisite is to earn a living, it is difficult to convince them to practice ‘social distance’

Even though a pandemic affects all alike, its impact is uneven among various social and economic sections. During the ‘Spanish Flu’ the mortality rate among the British was 0.47 per cent, for British in India it was slightly higher 0.83 per cent, but for Indians, it was 2 per cent. Among Indians, the lower cast showed much higher mortality at 6.1 per cent compared to 1.9 per cent among the upper cast. A similar inequality in impact was seen in South Africa under apartheid between the colonisers and the black population, points out Dr Jameel.

As in the case of Covid-19 poverty and unequal access to healthcare creates a rift. The overall life expectancy in the USA fell by 2,.7 years for the Black population, making the gap between the Blacks and Whites widest in six years. India with its informal workforce and fragile healthcare infrastructure reels with the same problem opined Dr Jameel.

How the pandemic panned in India

India started a lockdown with 525 cases and 11 deaths and ended it after 68 days on May 31 with close to 2 lakh cases and 5, 408 deaths. Even when battling migrant crisis, loss of livelihoods, the country managed to flatten the curve by ramping up its healthcare and ancillary capacity and with the shared experience of physicians, ICU admissions and mortality rates were decreased. According to the Indian Medical Association figures, India lost 734 doctors by early February 2021.

There have been several discussions, criticism on if India could have done better, on losing preparatory time before March 2020, the timing for lockdown and government reliance on administrative data than on scientific evidence etc. By according to Dr Jameel, all are just academic discussions.

India reached its peak in September with 97, 894 cases after which there was a fall. On Sunday it exceeded last year’s highest count and crossed 1 lakh cases. The daily rate of infections has increased to 0.6 per cent but the mortality rate is slow and steady. Ten states are driving 90 per cent of the cases. Serosurvey studies show only 35 to 40 per cent of the population had acquired protective antibodies in big cities which means acquired immunity is un-uniform, especially in rural areas. In Maharashtra 25 per cent of cases are from the Vidharbha region.

With cases falling rapidly in the last five months, the people have developed low compliance with dancing and masks further triggering the surge. Emerging mutants from UK, Brazil, and South Africa are being accounted for the present surge but everything still remains to be seen, said Dr Jameel’s article.

India’s vaccine challenge

About 76 million people have been administered vaccine till now. Only 4.8 per cent and 0.7 per cent of the Indians have received one of both vaccines. At this rate, it would take nine more months to vaccinate 20 per cent of India with both diseases. The challenge lies in increasing vaccine administration with more supply and administration points and convincing people for it. Moreover, the vaccine manufacturers have to keep international commitments intact as well.

With only two vaccines receiving approval in India, data shows Covaxin accounts for less than 1 per cent of administered doses and media reports suggest Covishield is not able to meet the local and export demands. DGCA should consider approving more vaccine candidates like Johnson & Johnson’s single-dose vaccine that showed an efficacy of up to 72 per cent or Russia’s Sputnik V vaccine reported efficacy of 91.6 per cent, said Dr Jameel.

In India with almost 45,000 administration pints, two million vaccinations daily, 74.2 million registrations, the problem lies in capacity and vaccine hesitancy. Vaccine points need to increase in rural areas and vaccine hesitancy related to has to be addressed. One of the recent was reports of blood clots linked with Covishield, where the European Medical Agency found no enough evidence to link both.

Science and future

The scientific community’s response to handling the pandemic was remarkable. Within few months, the virus samples were collected paving way for developing therapies, vaccines. At present, 1 million SARS-Cov-2 genomic sequences are available now. Several vaccines, diagnostic methods were developed; it took 20 months for the SARS vaccine to reach the testing stage.

However, apprehensions like blood clotting after vaccination can impact the scientific process, said Dr Jameel. According to the virologist, the incidence of blood clotting is 0.08 per cent in 1,000 people per month in the US and for the EU countries; it can be worked out at 0.066 per cent incidence rate. Also, the incidence of blood clots n in both vaccine takers and placebo groups are and not statistically different. For Dr Jameel, this is the scientific method and the rest everything is ‘scaremongering.’

The vaccine availability and duration of protections will determine how the pandemic affects us this year or the future. Reports suggest Covid-19 vaccines sufficient to cover all vulnerable groups of the population will only be available by mid-2022 and for everyone by late-2023.

Regarding durations of vaccine-mediated protection, Dr Jameel finds that the neutralizing antibodies prove protection for 3 to 5 months but cell-mediated immune response lasts longer. Moreover, if the infection is caused by other endemic coronaviruses can also offer protection. Nevertheless, emerging variants have added to the complexity, Trails showed that the efficacy of vaccines gets altered against the variants of the virus prompting vaccine manufacturers to develop new vaccines. However, increasing vaccine coverage will lead to evolutionary pressure on the virus to develop mutants that can evade vaccine protection, said Dr Jameel.

Moreover, vaccination will change the virus-cell binding interface, it may also lead to less fit and less virulent viruses. With increased genomic sequencing, the researchers will be able to catch variants that spread faster or are more severe with time. The scenario needs to be monitored closes for years now.

Till then the need of the hour is to better communications and build trust among the public that the vaccines are safe and effective, affirmed Dr Jameel.