Comments on the Lancet Editorial.

Comments on the Lancet Editorial. Vol 397 May 8, 2021

To
The Editors,

The Lancet.
Respected Editors,
Greetings from India.
First we take this editorial seriously, and accept its postulates.

1. That India declared its victory too early with health minister Harshvardhan calling it an end game, disregarding warning.

2. Assuming herd immunity with 21% seropositivity, encouraging complacency, and inadequate preparation.

3. Mistakes of allowing super-spreader like religious festivals and political rallies.

4. Inadequate and slow vaccination and opening it up for 18 years – a botched vaccination
strategy.

5. Ill-preparedness of Indian States for oxygen, beds, etc.

6. Federal government has a role in explaining the necessity of masking, social distancing,
voluntary quarantine, halting mass gatherings and testing.

7. Modi’s actions in attempting to stifle criticism and open discussion.

8. Proposal of a new federal lockdown

9. Public health response that has science at his heart.

Before we look at accusations which seem to be as accurate as hindsight can be, let us look at some figures and facts.
The table below contextualises Covid-related data to population and economy( as collected on 9th May2021) : –

Country

Population In million

Covid cases No

No of Covid Deaths

Deaths per Million(18)

Populatio

n Density Person per sq. km

Gross National Income per capita In US $ per year

USA

331(1)

3,34,54,581 (2)

5,95,588(2)

1790

34(3)

65850(4)

Europe

740(5)

45,411,000(6)

11,72,000(6)

1871(UK) 1625(France) 2032(Italy) 1015(German y)

34(7)

47853(8)

Brazil

212.60 (9)

1,51,50,628(10)

4,21,484(10)

1971

25(11)

14890(8)

Argentina

45.54(12)

31,36,158(13)

67,042(13)

1472

16(14)

22120(8)

TOTAL

1329.1400

16,41,95,734–

22,56,114—

< 34–

12.35% of population infected (7.36 times more than India)

(Death 10 times more than India)

India

1380.00(15)

2,22,96,414(16)

2,42,398(16)

174

455(17)

6920(8)

Now let us analyse these figures: Facts:

India’s population is greater than the population of USA + Europe + Brazil + Argentina combined.

Most of these countries have better infrastructure, far superior healthcare, very deep economic pockets, have printed untold amounts of money, spent enormous amounts of money and yet they have 7.3 times more infection and 10 times more deaths.

India’s population density is 13 times more than all these countries. In simple terms for every 1000 people in these countries India has 13380 people to be managed in a given area. This puts India at a distinct disadvantage, compared to sparsely populated countries where social distancing can be much more easily maintained.

If we understand that India alone is more than 30 countries put together that includes USA +
Germany + France + UK + Brazil +…, then the Indian Prime minister and the government is
doing the job equivalent to 30 Heads of state (and their governments) put together!

And let us say that Team India under the leadership of PM Modi along with cooperation and collaboration of the Chief Ministers of various states have been doing a relentless
job and fighting this Covid war.
Reviewing the Lancet comments from a more complete perspective:

Was Mr Harshvardhan’s optimism too premature? In hindsight, yes. But all preparations made then, based on the data then available from the first wave, probably appeared to be adequate, as even during the height of the pandemic we managed ourselves. In fact, from many healthcare facilities and hospitals, including the places that I work, we were all asking the governments to release the beds for regular medical work. The optimism was in the air. That tsunami of the second wave, much larger, hit us, with unprecedented speed and force, rising quickly and spreading like an uncontrollable wildfire, took us by surprise.

So, in the first instance, did people of India, fed up of prolonged lock down lasting for months, wanting to get back into normal life, needing to start earning their livelihood, their industries, their businesses, for their mental stability and emotional release went about normally, going to markets, malls, offices, shops, factories, taking public transports and forgetting or unable to comply with social distancing, with or without mask? The Answer is Yes. And this happened despite both federal and state governments repeatedly, almost daily reminding people to wear masks, keep social distance, avoid crowding, reminding people that their safety was their responsibility, urging them to take precautions as covid was still going on. Our social media, mainstream media, billboards, caller tunes, Arogya Setu and other Apps were full of these reminders with governments taking even punitive actions against those who did not wear masks.Your call to do so now, laying blame on the government, probably therefore is based on lack of knowledge or lack of ground reality and ignorance of human behaviour.

Because not only ordinary common man wants to get on with his life but also the people with privileges and powers would like to get back their lives. None other than the Pope himself expressed his delight, “I am happy to restart this face-to-face meeting again”, after the lockdown was lifted.[19]
One can accept your criticism of religious gatherings or election rallies becoming a superspreader. Therefore let us consider the farmer’s agitation which started in mid-November 2020 at the time of 45000 cases per day and went on for more than 4 months (and is still not officially called off), with thousands of farmers and many rallies in and around NCR – Delhi and Punjab. While religious gathering and election rallies found mention in Lancet editorial, this was conspicuously absent. Just curious, Why?

Just wonder, were the religious festivals and political rallies cleverly cherry picked to make a political point or were they based on scientific medical data ? Does The Lancet have scientific data that farmers’ rallies and sit-ins had no impact on NCR Delhi and other parts of India, but only the religious festivals caused a phenomenal second wave in Delhi and rest of India? It would be enlightening to know from The Lancet why one gathering would be a super spreader and another held for much longer wouldn’t be? Such discovery by The Lancet may give a clue to the world as to what kind of gatherings would not spread infections!! Of course, your insight into many such gatherings all across the world, where only a particular political rally or religious festivals were superspreaders and others weren’t would be an eye opener too.

4. It is better not to talk about vaccination and preach India. Team India has been working on it, and as you have inter-State bickering and complaints in Europe about unavailability or non-delivery of vaccines, so do we have in India. It is because the challenge itself is unprecedented and overwhelming. When after much hard work and as much as possible due diligence, the two vaccines produced indigenously were released under EUA, there was a blitzkrieg of negative publicity that was unleashed in mainstream media and social media raising doubts and fears about a certain vaccine amongst people in India, despite central government’s assurances (through caller tunes at the beginning of a mobile call), that resulted in serious issue of vaccine hesitancy, with people avoiding rather than taking vaccines, with millions of doses going waste. So probably for decision makers it was like walking on eggshells, should a serious or large scale untowards event take place, the government would have been at the receiving end. At such times, with cases declining, vaccine hesitancy at its height, with data of vaccine effectiveness vs side effects still coming in, for ex:some European countries selectively banned the use of one of the vaccines in certain age group, India still went ahead and even helped quite a few nations sharing the precious vaccines on humanitarian grounds. So your criticism of India on the vaccine front was unwarranted and unjust. And the decision for opening up vaccination for 18-45 years, which forms a major part of the work force and an aspiring student population, was to protect the younger population, nation’s intellectual assets, and working class, which form the backbone of Indian society and economic health.

5. Meanwhile, every Head of Nation, around the world, is not only looking at Covid alone, but also economic revival, jobs, industrial, financial and every aspect of human existence to be restarted as soon as possible, or nations will be staring at destruction of industries, job loss, debts, poverty, hunger, depressions, suicides, disruptions, social unrest, political instabilities and anarchy, which will be far more devastating than the number of covid deaths. Mr Modi and the Chief ministers of various States do understand this, and are trying to hold this nation afloat together against this dire challenge. And in India one can’t wait for herd immunity or vaccination of 138 crore Indians which may take about 11⁄2 -3 years before restarting the nation’s engine of growth!! It is a fine balancing act, like walking on a razor’s edge.

So your proposal for a new federal lockdown of the nation would be an economic suicide for the nation, that India can ill afford. And, till now we the Indians, despite our failings here and there, despite a challenge even to our national sovereignty from our hostile neighbours, with our defence forces guarding our boundaries, we the people of India have done relatively well and better than many that you might have overlooked. That Covid can spread quickly in dense populations and in great numbers is beyond human control, unless every single individual is isolated in a cocoon, which is practically impossible or the world would have solved this pandemic long ago. And India can not escape this vulnerability. The second wave of tsunami has proved that.

6. Indian SARS-COV2 Consortium on Genomics (INSACOG) was established by the Central government in December 2020 and is already doing genomic studies of circulating Covid Viruses and their epidemiological trends, and that may satisfy your suggestion.

7. Sadly, in a medical journal, I have to write this. There are political and other forces inside and outside India that would want Mr. Modi dethroned, for their own personal agendas. But it is for the people of India to decide who they want as their prime minister. And your comment on Mr. Modi stifling the media is bit off the mark, as many in India are aware that there are large number of dedicated anti-Modi mainstream media, social media, organisations, think tanks and individuals who have been writing, talking and expressing themselves freely even obsessively against Mr. Modi, for more than two decades now. And it is not possible to stifle all of them by anyone, let alone Mr. Modi.
Also, your readers may understand that in India’s federal structure health is a state subject, and Mr. Modi, the prime minister, could achieve little without the consent and collaboration of the chief ministers, health ministers and chief secretaries of states, who are responsible for implementation. Therefore it is team India, not Mr. Modi alone, which is fighting this relentless battle.

8. Let us realise that this pandemic is not just any infection, but a war, a war unleashed against humanity, by angry Mother Nature in the form of a tiny virus. Till now all strategies have failed to completely resolve the challenges from this tiny smart (mutating and adapting) virus. What appears a good strategy in foresight often appears poor in hindsight. And today’s hindsight on which we may take our decisions may again be proved to be poor foresight in future. What guarantee do we have that a mutant may not outwit our present day Wuhan strain specific vaccine strategy in future? Maybe you will have an editorial, “Mutants strike back!”
Let us assess Science frankly. Has science given a foolproof answer as to cure, complete elimination of virus without any side effects and zero morbidity or mortality ? No! Has science created a preventive vaccine that is 100% effective and 100% safe? The answer is no! Has science accurately predicted who would and who wouldn’t get infected? the answer is no! Has science resolved this pandemic ? No! Has science provided a blueprint of solutions for the challenges arising out of pandemic which deeply affect human society in ways other than health? The answer is no! No doubt science has helped, and significantly too in various fields, but it is still searching for the answers.
Today, an over inflated human ego, based on achievements of science and technology, that has made human beings more arrogant, selfish, greedy, insensitive, careless and destructive, stands decimated in front of a tiny virus.

By the way, despite the information on overwhelmed healthcare in European countries and the number of deaths, neither Indian Medical journals nor Indian media criticised or chastised European Heads of states, but empathised with them for the difficult situation they were in.

So, thank you for the editorial and your scathing criticism. One presumes that a premier medical journal like The Lancet’s editorial is not written with a political agenda or a colonial or racist intention to look down upon India in the name of Modi bashing, because the noble editors, one hopes, wouldn’t allow such a hallowed page to be cunningly misused for such a thing. I am sure the humble editors wouldn’t be pompously criticising people, but forthwith give, with their stirling wisdom, the foolproof blueprint of solution, that has somehow escaped the best think-tanks around the world, and teach all countries how to defeat this raging Covid pandemic that has not only affected the physical and mental health of billions, but has also harmed economies, industries, jobs, and the social and emotional life of all. Please do provide a perfect blueprint of action for the world, that has not only science at its heart but also the economics,

the jobs, the industries, the social and emotional well being, and multitudes of all the complex issues at its heart, so as to solve all these challenges simultaneously and and save the world.

Now that data of equivalent population and the information about covid in some First World countries is staring at you, you will surely give some credit to Mr. Modi and his team of Chief Ministers for managing the Covid pandemic slightly better, with comparatively much lesser economic resources and a much greater and denser population.

Who knows, with your enlightenment, The Lancet may come out with many more editorials, so as not to appear racist, colonially patronising or politically motivated, more severely censuring the Heads of the States of these countries who tried to do their best in this raging pandemic storm that has engulfed the entire world.

Jai Hind!

Dr Kalpesh Gajiwala, Mumbai, India. (13.05.2021)

References as on 9th May 2021.

1. us population 2021 – Bing

2. United States COVID: 33,454,581 Cases and 595,588 Deaths – Worldometer
(worldometers.info)

3. U.S. Population Density 1950-2021 | MacroTrends

4. U.S. GNI Per Capita 1962-2021 | MacroTrends

5. Population of Europe (2021) – Worldometer (worldometers.info)

6. Europe: the latest coronavirus counts, charts and maps (reuters.com)

7. Population of Europe (2021) – Worldometer (worldometers.info)

8. GNI per capita, PPP (current international $) – European Union | Data (worldbank.org)

9. Population by Country (2021) – Worldometer (worldometers.info)