Dear Lancet, people expect scientific solution on Covid-19, not a racist, colonially patronising and politically motivated editorial against PM Modi

Renowned medical journal The Lancet has started to publish a lot of propaganda articles against the Modi government in India. They have been attacking the govt alleging mismanagement of the Covid-19 pandemic. However, most of their criticism of the Indian govt is not based on any fact, they are mostly based on familiar rhetoric that Indian left-liberals keep peddling.

Earlier this month, the journal had published an editorial, where it had placed the entire burden for the crisis at the feet of the Prime Minister while giving every other political party a free pass. The article was riddled with a series of inaccuracies in terms of data, claiming that India will see a million death from Covid-19 by August.

While the Lancet claims that India has failed to contain the Covid-19 infection in the country, it fails to recognise that number wise, India’s position is still better compared to several developed nations. What the journal fails to mention is the population of India, which is the second largest in the world.

The table below shows Covid-related data to population and economy (as collected on 9th May 2021) : –

This shows that compared to a total of 33 countries with a combined population similar to India’s population, India has done much better in terms of managing the pandemic. While those countries have reported almost 10 crores of Covid-19 cases, India has reported 2.84 crore cases. Similarly, while 23.58 lakh people have died of Covid-19 in those countries, the fatality figure for India is 3.38 lakh. The fatality rate at deaths per million in India is also significantly lower. This is despite the fact that India’s population density is much more compared to the other countries, which is a major factor in a highly contagious disease like Covid-19.

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 on healthcare and yet they have 3.5 times more infection and 7 times more deaths. India’s population density is 4.5 times the average population density of all these countries. In simple terms, for every 1000 people in these countries, India has 4,500 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 33 countries put together that includes USA + entire EU with 27 counties + UK + Russia + Brazil + Mexico, then the Indian Prime minister and the government is doing the job equivalent to 37 Heads of state (and their governments) put together. Therefore, we can say that Team India under the leadership of PM Modi along with the cooperation and collaboration of the Chief Ministers of various states have been doing a relentless job and fighting this Covid war.

But the Lancet failed to consider these important factors and declared that India has failed in the war against the pandemic.

While the article is overall misleading, some points it makes are correct. Some of them are:

1. That India declared its victory too early with union health minister Harsh Vardhan 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 events 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.

But some of them have context, and it needs to view them from a more complete perspective.

Dr Harsh Vardhan’s optimism

In hindsight, we can say that Dr Harsh Vardhan’s optimism in the first week of March was premature. But all preparations made then, based on the data then available from the first wave, probably appeared to be adequate. This is because, even during the height of the pandemic last year, we managed the pandemic well. In fact, many healthcare facilities and hospitals were 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 an 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 lockdown 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. The Lancet’s call to do so now, laying blame on the government, probably therefore is based on lack of knowledge or lack of awareness 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.

Selective blaming of super-spreader events

One can accept the criticism of religious gatherings or election rallies becoming a super‑spreader. 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 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 the Lancet editorial, this was conspicuously absent. Just curious, Why?

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 Covid-19 cases in NCR Delhi and other parts of India, but only the religious festivals caused a phenomenal second wave in 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, their insight into many such gatherings all across the world, where only a particular political rally or religious festivals were super‑spreaders and others aren’t would be an eye opener too.

Vaccination

It is better not to talk about vaccination and preach India. Team India has been working on it, and as there are 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, 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 untoward 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 example, 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, The Lancet’s criticism of India on the vaccine front is unwarranted and unjust.

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. Moreover, it was done after major opposition parties like Congress and non-NDA ruled states like Maharashtra and Delhi had started demanding that vaccination should be opened for all.

Economic revival equally important

Every Head of Nation, around the world, is not only looking at Covid-19 alone, but also an economic revival, jobs, industrial, financial and every aspect of human existence to be restarted as soon as possible, or nations will be staring at the 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. PM Modi and the Chief ministers of various States do understand this and are trying to hold this nation afloat together against this dire challenge.

In India one can’t wait for herd immunity or vaccination of 138 crore Indians which may take about 1½ -3 years before restarting the nation’s engine of growth. It is a fine balancing act, like walking on a razor’s edge.

Therefore, the Lancet’s proposal for a new federal lockdown of the nation would be 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’t escape this vulnerability. The second wave of tsunami has proved that.

Genome sequencing

The Lancet suggests that Genome sequencing needs to be expanded to better track, understand, and control emerging and more transmissible SARS-CoV-2 variants. They should have known 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.

The Consortium is expected to help in expanding whole genome sequencing of SARS-CoV-2 virus across the nation, aiding the country’s understanding of how the virus spreads and evolves. Any changes to the genetic code, or mutations, can be observed in the samples. The ten regional genome sequencing laboratories spread across the country cater to the nearest states, which send 5% of the positive samples to these labs for genome sequencing. The viral genome sequencing data generated by the eight regional genome sequencing laboratories are analysed by the respective centres and sent to the National Centre for Disease Control (NCDC), Delhi for collation and integration.

The overall aim of the Indian SARS-CoV-2 Genomics Consortium is to monitor the genomic variations in the SARS-CoV-2 on a regular basis through a multi-laboratory network. This vital research consortium will also assist in developing potential vaccines in the future.

False accusation of stifling criticism

Sadly, the fact is that there are political and other forces inside and outside India that would want PM 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 the journal’s comment on the PM stifling the media is totally incorrect, as many in India are aware that there is a large number of dedicated anti-Modi mainstream media, social media, organisations, think tanks and individuals. The organisations and individuals have been writing, talking and expressing themselves freely even obsessively against Modi, for more than two decades now. And it is not possible to stifle all of them by anyone, let alone Narendra Modi.

Also, the readers of Lancet may understand that in India’s federal structure health is a state subject, and 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 Modi alone, which is fighting this relentless battle.

A war unleashed against humanity

Let us realise that this pandemic is not just any infection, but a war, a war unleashed against humanity, 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 they 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, we thank lancet for the editorial and their 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.

We are sure that the humble editors wouldn’t be pompously criticising people, but forthwith give, with their wisdom, the foolproof blueprint of a solution, that has somehow escaped the best think-tanks around the world, and teach all countries how to defeat this raging Covid-19 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 lives of all.

We request the Lancet to 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 wellbeing, and multitudes of all the complex issues at its heart, so as to solve all these challenges simultaneously and save the world.

Now that data of equivalent population and the information about Covid in some First World countries are staring at us, The Lancet will surely give some credit to PM 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 their 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.

Author: Kalpesh Gajiwala, honorary Consultant Plastic and aesthetic surgeon with more than 30 years of experience at many hospitals in Mumbai.