📰 Prevalence of U.K. variant rises in Delhi
Proportion has risen from 28% in March to 50% last week in genome sequencing.
•The proportion of the U.K. variant (B.1.1.7) in genome samples sequenced from COVID cases in Delhi has risen from 28% in the second week of March to the 50% in the last week, Dr. Sujeet Singh, Director, National Centre for Disease Control (NCDC) said in a webinar on Friday.
•The U.K. variant has a mutation N501Y that is reported to increase the transmission of the virus leading to more numbers and a knock-on consequence of increasing disease severity and mortality.
•Speaking at the webinar organised by the Department of Biotechnology, Dr. Singh said there was also a rise in the Indian variant (B.1.617), that has two mutations associated with increased efficacy and decreasing the potency of vaccines.
•However while the relative proportion of known variants of concern, or VoC, (the U.K., South Africa, Brazil variants) is around 11%, investigations were still on to determine to what extent they were responsible for the severity of disease. New Delhi is undergoing an unprecedented surge in it fourth wave with a rise in instances of people manifesting breathlessness and a demand for oxygen cylinders and beds that has led to health systems being overwhelmed.
•Of 438 sequences of the VOCs analysed in Delhi, 415 exhibited the U.K. strain and 23 the South Africa strain. Delhi was among the States, along with Punjab, Chhattisgarh and Gujarat where instances of the U.K. strain in the wider community far outnumbered those detected among international travellers and their contacts.
•For instance, in Delhi, there were 324 instances of the U.K. strain in the “community” as opposed to 91 among travellers and their contacts (T&C). In Gujarat, it was 18 in T&C and 42 in the community and in Chhattisgarh there was only 1 case in the T&C as opposed to 14 in the community. Such numbers weren’t yet present for the Brazilian and South African strains. Several of these states are showing unprecedented spikes.
•The comparative data was presented by Dr. Singh.
•So far about 15,000 genomes had been sequenced, which is about 1% of India's coronavirus caseload.
•Dr. Anurag Agrawal, Director, CSIR-Institute of Genomics and Integrative Biology (IGIB), said the concern with the Indian variants was that they possessed two mutations — E484K and L245R — that together would increase the likelihood of a wider range of antibodies being unable to counter the virus.
•“However immunity also includes a cellular level response that can generate cross reactivity and so we can still expect, a good antibody response which is why all vaccines, despite the variant, will be fairly protective (against disease),” he said.
•Dr. Priya Abraham, Director, ICMR-National Institute of Virology said the virus would continue to mutate and the best defence would be to continue following ‘COVID appropriate behaviour' and vaccinate at the earliest. She said that 90% of the RT-PCR tests being deployed were accurate. However, there were challenges in testing with several trained staff too testing positive and affecting the quality of testing and analysis, she added.
•Virologist Shahid Jameel, and head of the advisory group to INSACOG, who was moderating the webinar, said there was “preliminary” information that both Covaxin and Covishield appeared to be effective against the Indian variant. He was referring to a report by the CSIR-Centre for Cellular and Molecular Biology, Hyderabad.
•“Science is a process that calls for evidence based policy making and not policy based evidence making. Three 'T's are needed: Truth, Transparency and Trust. Truth leads to transparency leads to trust,” he said.
📰 Centre to give 5 kg foodgrains free to poor
PM calls upon States to take a unified approach in dealing with resource scarcities.
•The Union government announced that 5 kg of food grains would be provided to 80 crore beneficiaries under the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) for the months of May and June as many States were undergoing curfews and the high rates of coronavirus infections had led to a slowdown in economic activity.
•The announcement came on the day Prime Minister Narendra Modi held a meeting with Chief Ministers, especially of States with high COVID-19 case burden. The outlay for the free grain programme has been pegged at ₹26,000 crore.
•Mr. Modi assured States that all resources, including the Indian Railways and the Indian Air Force (IAF), were being deployed to reach oxygen to different corners of the country. The PM asked States to be strict with curbing the hoarding and black marketing of essential drugs and injections as COVID-19 cases soared in India. He also said that the Central government would be providing vaccines against COVID-19 acquired by it to the States for free, as in the past.
•The meeting with Chief Ministers, followed by Mr. Modi’s meeting with oxygen manufacturers, the fourth such review of oxygen availability in the last week, assumes significance with daily new cases going past the 3.5 lakh mark on Friday.
•According to a statement released after the meeting with Chief Ministers, Mr. Modi had called for a unified approach in dealing with resource scarcities, which he said were being addressed. He stated that it was through such an approach during the first wave that India could tackle the first outbreak of COVID-19.
•The PM said that the IAF was flying in empty tankers for oxygen to reduce turnaround time on supplies. The Railways had been roped in to run ‘Oxygen Express’ trains. He urged States fighting for scarce oxygen to set up coordination teams to allow the movement of tankers across State borders.
•Tier 2 and Tier 3 cities, which are now facing swiftly rising COVID-19 cases, were highlighted as an area of concern. Mr. Modi also expressed grief at the accidents that had taken place in hospitals, adding that hospital staff had to be more aware of safety protocols.
CMs interject
•When Delhi Chief Minister Arvind Kejriwal live streamed his interjection in the meeting, Mr. Modi admonished him for violating the protocol of closed-door meetings. Mr. Kejriwal’s office later released a statement expressing regret, saying the live streaming was done under the impression that it was allowed as it had been done in previous meetings.
•West Bengal Chief Minister Mamata Banerjee, going head-to-head with the BJP in the Assembly polls in her State, absented herself from the meeting for the second successive time.
•Chhattisgarh Chief Minister Bhupesh Baghel made a strong demand that vaccines should be provided at the same rates for both the Centre and the States.
•Serum Institute of India has announced that it would be providing the Covishield vaccine, which it currently sells to the Centre at ₹150-200 per dose, at ₹400 per dose to State governments and ₹600 per dose to private entities.
•“Please provide an action plan for vaccine availability to the States for running vaccination drive for those above 18 years of age from May 1,” Mr. Baghel at the meeting.
Virafin reduces oxygen demand in moderate COVID infection
•The Drug Controller General of India (DCGI) on Friday granted emergency use approval for pharma major Zydus Cadila’s antiviral drug ‘Virafin’, to treat moderate COVID-19 disease in adults, company press release said.
•“A single dose subcutaneous regimen of the antiviral Virafin [a pegylated interferon alpha-2b (PegIFN)] will make the treatment more convenient for the patients. When administered early on during COVID, Virafin will help patients recover faster and avoid much of the complications. Virafin will be available on the prescription of a medical specialist for use in hospital/institutional setup,” the release added.
•The drug’s safety profile is already well known as it is used in treating people with chronic hepatitis B and C. The drug has been repurposed for treating moderate COVID-19 disease.
•According to Dr. Sharvil Patel, Managing Director, Cadila Healthcare Limited, the therapy “significantly reduces viral load when given early on and can help in better disease management”.
•In a multi-centre trial in 20-25 centres across India, the company found the drug reduced the need for supplemental oxygen. This clearly “indicates that the antiviral was able to control respiratory distress and failure which has been one of the major challenges in treating COVID-19”, the company said.
•In the phase-3 trials, the drug was able to achieve “better clinical improvement in the patients suffering from COVID-19”. A “higher proportion (91.15%) of patients administered the drug were RT-PCR negative by day seven as it ensures faster viral clearance”. According to an April 5 company press release, the drug reduced the duration for supplemental oxygen to 56 hours from 84 hours in moderate COVID-19 patients.
•The results of the phase-2 trial using the drug published in the International Journal of Infectious Diseases found that of the 20 participants who received the drug and standard of care, 19 (95%) achieved clinical improvement on day 15 compared to 13 of the 20 (68.42%) participants who were in the control arm and received only standard of care. The trial found that 80% and 95% of participants who received the therapy plus standard of care were RT-PCR negative on day seven and 14, respectively, compared to 63% and 68% in the control arm.
•The significant improvement in clinical status on day 15 is likely due to faster viral reduction compared to the control arm. Participants with moderate disease showed a difference as early as day seven, which became significant by day 14, the authors say in the paper.
•Mild adverse events were reported in 11 participants in the phase-2 trial compared with eight in the control arm.
•According to the release, type I interferons are the body’s first line of defence against many viral infections. In old people, the ability to produce interferon alpha in response to viral infections gets reduced, which might be the reason for higher mortality. The drug when administered early during the disease can replace this deficiency and help in the recovery process.
📰 ‘RBI intent is key to curb further rupee weakness’
‘Bearish bets at highest since last April’
•The rupee’s near-term fortunes may directly be influenced by the Reserve Bank of India’s intent on preventing any further depreciation in the currency as the surge in COVID-19 cases hits jobs and growth, economists and traders said.
•The rupee has already lost 2.6% against the dollar so far this month, putting it on the cusp of marking its worst month since the pandemic hit the country early last year.
•“INR [Indian rupee] is likely to trade with a depreciating bias on the back of a stronger dollar, relatively weaker [emerging market or EM] currencies, muted EM inflows and rising COVID-19 cases in India,” said Sameer Narang, chief economist at Bank of Baroda.
•A fortnightly Reuters poll showed bearish bets on the rupee climbed to their highest since last April, as the surge in infections has halted what had been seen as a promising growth story in the region.
‘Forecast is for 74.50-76’
•The rupee closed at 75.01 to the dollar, and traders said they expect it to stay in the 74.50 to 76.00 range against the greenback in the near-term.
•India reported 3,32,730 new daily cases on Friday, the highest single-day tally anywhere globally. Rising cases have been one of the main factors behind the recent fall in the rupee, but the RBI’s decision to commit to large bond purchases has added to downside momentum.
•The RBI has committed to buying ₹1 trillion worth bonds in the April-June period in its effort to temper the rise in bond yields to help the government borrow its budgeted ₹12.06 trillion from the market at low interest rates. It said it would do more going forward, and this would be alongside its regular open market bond purchases and special open market operations — the simultaneous sale and purchase of government securities over different tenors — the equivalent of the U.S. Operation Twist.
•“We also believe the RBI’s policy priority of keeping a lid on G-sec (government bond) yields is more pressing than arresting INR depreciation,” economists at ANZ wrote. The road ahead for the rupee is likely to be complicated by rising inflation and faltering economic fundamentals.
•The RBI has stressed it intervenes to smooth volatility in the forex market. It aggressively bought dollars last year as investors flocked to India but economists are unsure if the intervention on the downside will be as strong.
•A weaker rupee helps exports and the RBI may prefer it, said economists. Negative real interest rates, potential GDP and earnings downgrades and rising inflation have also become headwinds.“The INR could continue to weaken in the absence of a strong anchor from the” RBI, as per ANZ.
📰 Infernal infernos: On hospital fires amid the pandemic
As hospital fires are on the rise alongside a pandemic, Maharashtra must act on safety
•Maharashtra has been facing the merciless onslaught of COVID-19 cases, but its public health response has also had to combat a second, connected scourge of hospital fires. In recent days, the State has been adding, on average, over 60,000 cases and losing a few hundred lives daily in the second wave of the pandemic, straining its infrastructure and institutions. It is also frequently hit by deadly fires, of the kind witnessed on Friday in the ICU of a small hospital in Mumbai’s suburb of Virar, where at least 15 patients severely ill with the coronavirus died. With about seven lakh active cases now, many of the patients in the State require oxygen support and hospitals are stretched to the limit. Many are small institutions, while a number of facilities are simply not built for purpose, such as the hospital located in a mall in Mumbai’s Bhandup area where several lives were lost in a blaze last month. Now that many COVID-19 hospital fires have been reported during the first peak of the pandemic last year and later, in Maharashtra, Gujarat and Andhra Pradesh in particular, State authorities should be able to document their learnings and put out a checklist to save patients. They should clarify whether fire safety guidelines for hospitals issued by the Centre in September last year, prioritising a strict compliance strategy, third party accreditation on safety, and adoption of a fire response plan were acted upon. This is particularly important in Maharashtra’s context, given that devastating fires have been recurring, and Chief Minister Uddhav Thackeray should lose no time in ordering a comprehensive audit.
•With no end in sight to serious hospital fires, there may be a case for judicial oversight and systematic inquiries into such mishaps. COVID-19 has turned into a conflagration, and the Supreme Court has taken suo motu cognisance of many aspects of pandemic management, such as availability of oxygen and essential drugs, method and manner of vaccination, and declaration of lockdowns. Nearly 10 High Courts have taken up pressing matters pertaining to COVID-19. It would be logical to add fire safety to such scrutiny, to make accidents rare. Evidently, State bureaucracies can achieve a lot more on their own, if they diligently implement existing regulations. There is a professional knowledge base available with important features. It calls for ICUs to be equipped with an exhaust system to prevent smoke accumulation in a fire, ventilation cut-outs to stop a blaze from spreading, periodic maintenance of safety equipment and, very importantly, an evacuation plan for the sickest patients, who may be attached to life-saving equipment. It is undoubtedly complicated to retrofit poorly designed hospitals for high safety standards, especially when it has to be executed on the go, and every bed is precious in the pandemic. But as each successive blaze proves, business as usual may extract a heavy price. Patients should be able to go to a hospital without the fear of fires threatening their lives there.
📰 Arise and rejuvenate the third layer of governance
Political acts depriving people of their rights must stop and there needs to be a movement to strengthen Panchayati raj
•What is progress? When has a government achieved its goals? What is the true indication that a government is not just planning, but also putting into action those plans? The half-hearted execution of a plan by a government that the people chose is not a sign of achievement. The government must ensure that even the last man sitting in the remote corner of the last row should have access to the benefits of the plan. This is why it is crucial that strong local bodies are formed to enable genuine feasibility and execution. The Cholas were the pioneers in the formation of local bodies as part of a well-organised hierarchy to oversee the implementation of progressive plans.
The journey of Panchayati raj
•“The voice of the people is the voice of god; The voice of the Panchayat is the voice of the people,” is the quote attributed to Mohandas Karamchand Gandhi. Panchayati raj ensures that the voices of the people are heard loud and clear. But, drawing up a path for a brilliant organisational structure like the Panchayat raj, and then travelling along the path is not a simple task.
•Realising that seamless administration is impossible without power sharing, the British, in 1884, passed the Madras Local Boards Act. With this, the British formed unions in both small towns and big cities and began to appoint members to ensure better administration. To a certain extent, this brought about positive changes in basic parameters such as health and hygiene.
•With the advent of gram panchayat laws in 1920, people over 25 years of age were bestowed with the right to vote and choose their panchayat members.
•Even though Gandhiji was constantly laying emphasis on the importance of autonomously ruled villages, the idea received constitutional recognition only in 1992.
•It was only after the 73rd Amendment in the 1990s, that the Panchayati raj law came into force. This was the law that brought about massive turning points such as the initiation of grama sabha, a three-tier Panchayati raj methodology of governance, reservation for the downtrodden and women, consistency in economic development, local body elections once in five years, the formation of the State Election Commission, Finance Commission, and the power to draft the rules and responsibilities of the Panchayat.
•The regions which were better equipped with basic facilities and which were more developed than the villages were brought under one coordinated body, namely, the municipality. The district capitals were further slotted into a combined parameter, namely, the corporation. Administration was transferred to the people, from the politicians and other officials.
•The lofty dream of Gandhiji to make each village of the independent India a republic organisation, and to reiterate that the autonomous administration of villages should be made the foundation of the entire country’s administration was heard and he lay stress on the active participation of the people in governance.
Ideal platform
•For seemingly trivial and easily resolvable issues, the villages did not have to seek the assistance of the State or the Central governments. Grama sabhas could and can be the platform to resolve such issues. According to the rules framed by the Tamil Nadu government, it is mandatory that grama sabhas meet at least four times in a calendar year. Besides, grama sabhas can be convened as and when the necessity arises. Every grama sabha meeting ensures the equal right to highlight the issues that disrupt life. In addition to this, the elected members of the Panchayat are obliged to read out the financial statements and balance sheet to ensure transparency.
The reality
•The decisions taken during a grama sabha meeting and the proposed solutions with a feasible deadline are potent and powerful. Unfortunately, the reality today is that grama sabhas have become more like auction houses. In Tamil Nadu, for instance, the present government did not even make an attempt to seek the opinions and the consensus of the people on significant issues such as an eight-lane highway project and even a major hydrocarbon project. Even though the government announced that people’s opinions would be considered, it went ahead and conducted meetings, which were marked by poor attendance and poor representation from the people. Even then, the government went ahead with the approval of projects which are impediments to normal life.
•The truth is that keeping in mind a single goal, of profit, politicians hold ‘negotiations’ with the officials. Several projects are being implemented for the benefit of private and corporate entities.
•Sadly, in this age, women do not find themselves in major administrative roles in the local bodies, though, on paper, women are shown to be a considerable force.
•The Makkal Needhi Maiam has been laying stress on the importance of grama sabhas and has been extending its support in a very transparent manner to rejuvenate the dying system of Panchayati raj.
The Kerala example
•The neighbouring State of Kerala has been diligently working toward ensuring the proper use of allotted funds, and ensuring the efficiency of administration and eligible member appointments. Thus, it stands tall as being exemplary. If Tamil Nadu wants to stand tall too, it needs to take steps to enable the power of administration to Panchayats, as stated in the Constitution.
•To ensure efficiency, we need to strengthen our grama sabhas, hold area sabhas in cities, form ward committees, hold online Panchayat meetings, ensure decent remuneration to Panchayat chiefs and councillors and also bestow the grama sabha with the power to revoke appointed members and representatives. These steps are what will ensure real growth in the State.
•The State-appointed corporation commissioner faces mammoth challenges when a member of the Opposition party takes charge as a mayor. The constant and meaningless conflicts between the ruling party and the mayor from the Opposition party make it impossible for the corporation commissioner to execute what was agreed upon in a meeting. The officials kowtow to pressures from the ruling party. The same treatment is meted out to municipal councillors and district councillors.
In Tamil Nadu
•The Constitution is clear in stating that local body elections must be conducted once in five years. But the ruling party keeps postponing the holding of local body elections, which is a breach of the Constitution. Strangely, this form of disrespect never materialises when it comes to the Assembly elections!
•Local body elections have been held once in five years for the last 25 years, since 1996. But for the first time, the All India Anna Dravida Munnetra Kazhagam government has travelled on without holding a local body election. This is not only an act of escapism but also a stain on the State’s political history.
•The recent reconstitution of nine districts in the State is an invalid excuse to postpone the holding of local body elections. The government gives a variety of empty and irrelevant excuses to postpone these elections and to cancel grama sabha meetings. The time has come to stop this act — of depriving people of their basic rights.
•The demand for federal rule in the Centre and autonomous rule in the States should resonate along with the need to have autonomous local bodies too. We must collectively ensure that Panchayati raj should be strengthened. This should be the outcome of a peoples’ movement.
•I wish to end by citing Gandhiji’s belief that the voices of people will resolve what violence can never be successful in resolving. Let the peoples’ voices be heard. We should also note that every year, April 24 is celebrated as Panchayat raj day.
📰 India’s COVID crisis — when difficult became worse
Its second wave is a result of poor political choices, bad communications, and neglect of public health principles
•India is in its darkest days of the pandemic, but there may be still darker days to come. With one in three new infections globally occurring in the country, India’s astronomic surge in cases — more than 3 lakh daily — is propelling the global pandemic, and represents a grave threat to the economic and social well-being of the Indian people. The political leaders, who have been too slow and largely failed to take the outbreak seriously, are now coming to realise the gravity of the task at hand. Lockdowns are spreading, but always one step behind the virus. Given the catastrophic state of affairs, effective intervention will require much more rigorous and extensive action.
A data gap
•It is difficult to grasp the true scope of this crisis. New Delhi’s test positivity rate — the rate at which people getting tested for coronavirus receive positive results — recently climbed above 30%. If it takes three tests to find one positive patient, it means that we are likely missing many, many infections. Indeed, one would not be surprised if the true number of infections was now above 10 lakh daily. And we can see it in all those undocumented deaths. While the official statistics suggest 2,000 deaths daily, the true number again is much higher. One crematorium in New Delhi has gone from managing 20 bodies daily to 100; the constant running of the furnaces has caused its steel chimneys to melt.
Premature celebration
•How did India find itself in this predicament? Certainly, the country faced many challenges in controlling the coronavirus, including the second largest population in the world, and one spread over an enormous, geographically and socially diverse country comprising both very rural areas and sprawling cities. But India’s leaders have made a very difficult situation worse. Early this year, daily new infections dropped to less than 10,000 — a remarkable achievement, driven in part by successful efforts to enforce social distancing and other public health measures. India began to roll out homegrown vaccines to much fanfare. Bharatiya Janata Party President J.P. Nadda declared that Prime Minister Modi had “saved the country,” comparing India’s performance under Modi favourably to that of the United States.
•But this premature celebration has ushered in a nightmare. The resumption of large, in-person political rallies and other large gatherings are part of the fuel that has caused COVID-19 to explode. The Prime Minister recently declared, “I can see a sea of masses” at a rally in West Bengal, apparently oblivious to the grave risk that such a sea poses to his supporters. The government also took almost no steps to limit the risk posed by the Kumbh Mela festival, ironically claiming that infection precautions would present too great a threat to crowd safety. As a result, the Kumbh Mela has resulted in thousands of positive tests, including several sadhus and former King Gyanendra of Nepal, with many thousands of infections sure to go undetected as pilgrims return to their home communities and expose their families and neighbours.
Control strategies
•The virus has taken advantage of the overconfidence of the government over the past months, making matters worse. Viruses mutate constantly, but it is when they are allowed to spread unchecked through large populations that more infectious and more deadly variants become established and change the dynamics of outbreaks. India is now faced with managing a renewed epidemic driven at least in part by the B1.617 “double mutant” strain of SARS-CoV-2, with similar mutations to more virulent strains found in Brazil and South Africa. At the moment, however, scientists and public health policymakers are drawing on extremely limited data, as far too few cases of infection are being analysed to provide a complete and actionable picture of the spread of variants and their influence on disease dynamics. India must rapidly scale up its genomic surveillance efforts to give scientists and public health researchers the data they need to guide policy decisions.
•How can the astronomical growth of the pandemic in India be brought under control? Short-term targeted lockdowns can help — the kind we are seeing in New Delhi and elsewhere. They will break the chains of transmission and can curb the exponential growth we are seeing across the nation.
•A second strategy is expanding access to vaccines although its benefits are likely to take weeks to be felt. Vaccine rollout without massive outreach and support for the complex, the challenging logistics of administering vaccines, and simply broadening eligibility requirements will do little to slow the virus. The lockdowns we are seeing now will almost surely need to be extended beyond a week and will need to be in place until infection numbers start coming down substantially. It is worth remembering that lockdowns exact a terrible economic and social cost and are a strategy of last resort.
Steps to take
•So what might we do to minimise the time that cities and regions need to be in lockdown? India needs a surge of testing. Right now, given high test positivity rates, it is clear that the nation is not testing enough. Ideally, India would increase its testing rates several times over, with the goal of getting the positivity rate under 5%. The nation has the capacity to do that many more tests but has not made it enough of a priority.
•We also know that universal mask wearing when people are outside their homes can be enormously helpful in curbing the spread of the disease. Given the crowds of Indian cities and towns and the high rates of infections, universal mask wearing, ideally with high quality masks, is critical and must be mandatory.
•And banning all major indoor and outdoor events, including rallies, religious festivals, weddings, and so forth, is essential. If those were to continue, any hope of bringing this outbreak under control would quickly vanish.
•Of course, India’s pandemic will finally come to an end when enough Indians are vaccinated — and targeting vaccines now most quickly and effectively can help control the spread of the virus. Whatever strategy India takes to administer vaccines (focus on elderly to save lives, young people to slow spread, etc.), the key is ensuring the country has enough vaccines. Here, the government needs to work with manufacturers like the Serum Institute, identify what is slowing them down, and use the full clout of the Indian government to drive production higher.
Looking forward
•India is now suffering the worst days of the pandemic, going through a second wave of coronavirus as a result of poor political choices, poor communications, and neglect of public health principles. For months, too many celebrated that India had “beaten the virus” even though none of us could explain how that could be and why. In this crisis, there is much that individuals can do to protect themselves and their families. But political leaders must do much more. The good news is that we know it can be done, and we know how to do it. Focus on public health measures, improve vaccinations, universal masking, and effective coordination across public health efforts. If we do these things, infections can turn, hospitals can stop being overwhelmed, and life can begin to go back to normal.
