Health experts raise concerns over Lancet censure

An oxygen cylinders is being loaded onto a taxi near CSMT on Monday. Pic/Ashish Raje

Health experts have expressed their deep concerns over recent editorials in British medical journal The Lancet lambasting the Indian government and the states on their handling of the second wave of Covid-19.

Lancet said the Centre's assertion that India was in the endgame of the pandemic came despite warnings of more waves and threats of new strains and mutation. It said the state governments scaled back the healthcare arrangements made after the first wave ebbed.

"The Lance editorial of May 7 said India could witness 1 million Covid-19 related deaths between now and August 1. It quoted the Institute for Health Metrics and Evaluation, an independent global health research organization in the US, without giving any details of the mathematical model used for these alarming figures, or the basic assumptions of the Indian figures applied in the model. Instead, the editorial jumped on to say ‘India squandered its early successes in controlling Covid-19'. Until April 2021, the government's Covid-19 taskforce had not met in months," said a surprised Dr Subhash Hira, Professor of Global Health at the University of Washington-Seattle.

Dr Hira, who was in the past a health advisor to the Ministry of Health, said, "Lancet did not spell out the government's major mistakes except pointing out at a few ‘adhoc' health officials who were managing the pandemic without inputs of the national task force. The Lancet too had faced severe criticism in early 2020 for its lop-sided editorial decisions under the pressure of business houses. There is no denying that the coordination between policymakers, technical departments and scientists is in shambles."

Despite an emergency, Dr Hira said, "Mighty mediocres have succeeded to popularize themselves, and continued to deliver mediocre results." He said the government should restructure its response to the crisis by roping in top scientists and pandemic specialists who are readily available in the country. "The success of that effort will depend on implementing a public health response that has science at its heart."

When asked to elaborate, Dr Hira said a back-of-envelope calculation puts India's Covid-19 deaths between 4.3-7 lakh till August 1. "On May 9, the number of accumulated active cases was 35 million. Another 37 million active cases will be added in the next 3 months as seen in the trends. Applying India's current fatality of 0.6 per cent to 1 per cent as per different studies, one gets 4.3-7 lakh deaths. The IHME (Institute for Health Metrics and Evaluation) estimates of 10 lakh deaths in the next 3 months is overestimated."

Dr Hira said the two-pronged strategy, including curbing the transmission rate from Ro=3.1 to <1.0, suggested by the Lancet is not rocket science. "India should keep popularizing the barrier messages and include stronger penal actions for those who intentionally put communities at risk. For example, efficient use of mask, hand sanitization, physical distancing is more of an attitudinal issue, and needs a serious effort at developing healthy behaviours. Otherwise, every city in India has some super-spreader events every other day as some sort of social gathering! How many activists in India have tried to instill these behaviours among their neighbours through personal efforts," asked Dr. Hira"

Another health expert from Delhi said, "If we ramp up oxygen supplies and reach rural areas, it [deaths] can be reduced further."

Dr. Wiqar Shaikh, Professor of Medicine, Grant Medical College and Sir J.J. Group of Hospitals, too, expressed concerns over the Lancet editorial. He said the editorials pointed to the Kumbh mela and polls in five states that led to the gathering of too many people at one place. He said Lancet also highlighted shortage of hospital beds, oxygen and medicines across the country, resulting in people scrambling to help their near and dear ones. The Lancet deplored that India's healthcare workers were exhausted, said Dr. Shaikh.

The expert raised concerns over the projected fatalities of 1 million by August.

Dr Shaikh said Lancet has deplored India's poorly planned vaccination strategy that has resulted in a vaccine shortage. Dr Shaikh reiterated that points about providing responsible leadership and that the Centre must ban rallies, mass gatherings and enhance testing facilities and vaccinations across the country.

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Lancet's estimation of Covid-19 fatalities in India by August