📰 As new IT rules come into force on May 26, Facebook says it aims to comply
The CII and the US-India Business Council have written to the government for up to a one-year compliance window, particularly in the view of COVID-19.
•Social media giant Facebook on Tuesday said it aimed to comply with the provisions of India’s new IT rules of intermediaries, which come into effect on Wednesday. The U.S.-headquartered firm added that it continued to discuss the issues related to the new guidelines with the government.
•Replying to a query on its readiness to comply with the new guideline, a Facebook spokesperson said, “We aim to comply with the provisions of the IT rules and continue to discuss a few of the issues which need more engagement with the government. Pursuant to the IT Rules, we are working to implement operational processes and improve efficiencies. Facebook remains committed to people’s ability to freely and safely express themselves on our platform.”
•The three-month deadline for social media platforms such as Facebook, Twitter and YouTube to comply with new stricter rules for intermediaries ends on Tuesday even as at least five industry bodies, including the Confederation of Indian Industry (CII )and the US-India Business Council (USIBC), have written to the government for up to a one-year compliance window, particularly in the view of the pandemic.
•The Centre on February 25 notified the ‘The Information Technology (Guidelines for Intermediaries and Digital Media Ethics Code) Rules, 2021’, which make it mandatory for platforms such as WhatsApp, Signal and Telegram to aid in identifying “originator” of “unlawful” messages, while also requiring social media networks to take down such messages within a specific time frame, set up grievance redressal mechanism as well as assist government agencies in investigation. The ‘significant social media intermediary’ were given three months for compliance.
‘Safe harbour’
•The industry has also raised concerns over potential unavailability of ‘safe harbour’ protection given to intermediaries under Section 79 of the IT Act, under the new rules. They have requested a re-think over a clause in the new rules which can lead to imposition of criminal liability upon the employees for non-compliance by intermediaries, asking for it to be dropped in the interest of ease of doing business.
•Over the past two months, five industry bodies have written to the Ministry of Electronics and IT seeking an extension of six months to a year for compliance. While the CII, the Federation of Indian Chambers of Commerce & Industry (FICCI) and USIBC have asked for a minimum of one-year compliance window, Asia Internet Coalition (AIC) has recommended an extension of 6 to 8 months and U.S.-India Strategic Partnership Forum (USISPF) has sought an extension of six months.
•In its letter, AIC, whose members include leading tech firms such as Google, Apple, Facebook and Twitter, has said that in the current climate, where India is dealing with the second-wave of COVID-19, intermediaries will find it extremely onerous to organise the capabilities and resources required to configure their operations with the fresh obligations imposed on them. These obligations include new frameworks governing the requests for information from the government, grievance handling of users, new avenues for blocking of content and the short set of timelines to respond to all these.
•“As Intermediaries we will undertake a comprehensive mapping of the laws against our services and identify the modification and compliance requirements under these Rules. This will require legal, operational and technical changes which could include recruitment of significant numbers of fresh and uniquely qualified personnel to handle the responsibilities, the latter being particularly challenging given the various restrictions and human impact caused by the new wave of COVID-19,” AIC said.
•Echoing similar views, USISPF said its members were facing difficulty in complying with the timelines stipulated for the transition to the newly notified rules which would require extensive capacity building, new operational models, product redesign, and personnel on boarding. “... the current timelines seem impossible to meet given the magnitude of the health crisis that is facing the country,” it said.
Criminal liability
•On imposition of criminal liability, the USIBC pointed out that the Rules stipulated that non-compliance by an intermediary would extend the possibility of imposing personal criminal liability on employees of intermediaries (such as the chief compliance officer of a significant social media intermediary). “This possibility of imposition of criminal liability of the employees of an intermediary is at odds with modern corporate criminal liability jurisprudence, which is leaning towards replacing criminal liability with monetary penalties, in the interests of ease of doing business and better enforcement of laws,” it said in the letter.
•The CII, in its letter, noted that, “The IT Rules, 2021 impose certain obligations that are novel, for instance, with respect to expansion of the power to block content and the grounds on which such content can be blocked”.
•It added that the rules also prescribed brief timelines to comply with orders and requests from the government and users for takedown, respond to information requests etc., which may not be sufficient given the volume of requests and the scope of the actions to be carried out by entities. “It is our submission that the scope of such requests should be limited to a few Central government agencies only,” the CII recommended.
‘Caution needed’
•Kazim Rizvi, founder of policy think-tank The Dialogue, told The Hindu that given that the digital ecosystem was replete with fake news, child sexual abuse material and radicalisation among other social vices, it was indeed crucial to regulate this space. “The IT Rules of 2021 is a much-awaited step in this direction, but we must be cautious that we do not end-up over-regulating this space which could chill not just free speech and business freedom but also have a deleterious impact on user privacy and national security,” he said.
•Mr. Rizvi added that rendering the safe harbour immunity conditional to a “mandate for proactive monitoring and carte blanche takedown and legal assistance requests could lead to unwarranted mass censorship”. Additionally, the extant data retention mandate entailed risking privacy of users in India and abroad in addition to security risks and technical complexities which requires a lot of time for development and testing before integration with the existing ecosystem, he said.
‘Consult stakeholders’
•Likewise, he noted that the originator traceability mandate in end-to-end encrypted platforms could end up weakening the security architecture of the platform. This could render the entire citizenry susceptible to cyberattacks by hostile actors, he said.
•“It is important that stakeholders are consulted, especially technical experts, to discuss the challenges involved in technical mandates like proactive monitoring, traceability and data retention who can assist the State in recommending the way forward,” Mr. Rizvi said, adding that the implementation of the Rules should be delayed for such time till the inputs of the stakeholders were incorporated to ensure a progressive platform regulation regime in India.
‘It was not a comment on professional prowess of those who are left out of contention’
•Chief Justice of India N.V. Ramana’s opinion in the high-level committee to avoid officers with less than six months left to retire for appointment as CBI Director is a simple “statement of law”. It was not a comment on the professional prowess of those who now find themselves outside the zone of consideration.
•Two senior IPS officers, Y.C. Modi and Rakesh Asthana, are out of contention for the post. Mr. Modi retires in May. Mr. Asthana in July.
•The CJI was clear during the meeting chaired by the Prime Minister and attended by Adhir Ranjan Chowdhury, leader of largest Opposition party, on Monday that the committee’s selection of officers should be able to withstand the “scrutiny of law in the future”.
•For this, officers with a “few days left” in service should not be considered. In this context, 10 of the senior most officers of the 1984 batch, scheduled to retire soon, were not considered. The six-month minimum residual tenure rule was introduced by the Supreme Court in a March 13, 2019 order. Though the order in the Prakash Singh case pertained to the appointment of DGPs, it was extended to CBI Director too.
•The order, pronounced by a three-judge Bench led by then Chief Justice Ranjan Gogoi, had clarified that the “recommendation for appointment to the post of Director General of Police by the Union Public Service Commission and preparation of panel should be purely on the basis of merit from officers who have a minimum residual tenure of six months, that is, officers who have at least six months of service prior to retirement”.
•The apex court had indicated the possibility that officers with only a few days of service may be in an insecure state of mind. In the Prakash Singh case, the Supreme Court had stressed the point that appointment of DGPs “should be purely on the basis of merit and to insulate the office from all kinds of influences and pressures”.
•As on date, the CBI has jurisdiction to investigate offences pertaining to 69 Central laws, 18 State Acts and 231 offences in the IPC. The Director is to hold the post for not less than two years as held by the Vineet Narain judgment of 1998. He/she may not be transferred except with the previous consent of the high-level committee. The CJI had also studied a Supreme Court judgment, Union of India versus C. Dinakar, reported in 2004, in the context of the appointment process. In this, the apex court had held that “ordinarily IPS officers of the senior most four batches in service on the date of retirement of CBI Director, irrespective of their empanelment, shall be eligible for consideration for appointment to the post of CBI Director”.
📰 Mucormycosis | ‘Avoid visiting damp and dusty places for a few weeks’
It is generally affecting COVID-19 patients who are prescribed steroids or those who have uncontrolled diabetes: Experts
•It takes around four weeks for the effect of steroids administered to COVID patients to wear off and it is important to keep oneself protected during this time. Patients, specially those in high risk category for mucormycosis, should avoid visiting damp and dusty places for a few weeks post recovery, Arun Sharma, Director, National Institute for Implementation Research on Non-Communicable Diseases ( NIIRNCD) Jodhpur and a Community Medicine expert told The Hindu.
•He said if it is unavoidable, they are strongly advised to wear a three-ply mask, gloves and fully cover legs and arms.
•“It is vital to keep COVID-19 patients’ oxygen mask and canula sterile to prevent mucormycosis. It is necessary to keep a regular check on water used in oxygenation for any possible contamination.”
•Mucormycosis (black fungus infection) is caused by a group of moulds known as mucormycetes, which are present in the air, water and moist surfaces, in damp places. It appears as black spots in the nasal cavity, mouth and throat. A healthy person’s immunity does not allow it cause infection. However, it can cause severe infection in an immunocompromised person. The Central government on Tuesday allocated an additional 19,420 vials of Amphotericin-B to all States/UTs and Central Institutions.
•Dr. Sharma said doctors should guide a COVID-19 patient about how to look for its early signs. “At the hospitals, doctors and nurses should check for the symptoms in patients being treated with steroids or other immunosuppressive agents,” he said.
•On why so many patients are getting affected, Dr. Sharma said mucormycosis is generally affecting COVID-19 patients who are prescribed steroids or those who have uncontrolled diabetes.
•“Though steroids are an effective treatment for some patients who develop severe inflammatory response. But they should always be given under medical supervision. If given too early, too much and for too long, they can make one susceptible to catching secondary bacterial or fungal infections,” he said.
•Doctors say Amphotericin-B is not a commonly used antifungal drug and with a low safety profile it’s used for very severe, life-threatening fungal infection or for mucormycosis, for which cases were low previously.
•Said Vikramjeet Singh, senior consultant, Department of Internal Medicine, Aakash Healthcare, Delhi: “Now due to COVID infection and some other factors, the incidence of mucormycosis has increased and we have started using Amphotericin-B in these cases. For post-COVID mucormycosis, this is the only drug which can be given.
•“Due to the shortage of the drug, it is the patients of mucormycosis who are suffering. But the situation is improving and we are hopeful that patient survival rate will be good,” he said.
It is generally affecting COVID-19 patients who are prescribed steroids or those who have uncontrolled diabetes: Experts
•It takes around four weeks for the effect of steroids administered to COVID patients to wear off and it is important to keep oneself protected during this time. Patients, specially those in high risk category for mucormycosis, should avoid visiting damp and dusty places for a few weeks post recovery, Arun Sharma, Director, National Institute for Implementation Research on Non-Communicable Diseases ( NIIRNCD) Jodhpur and a Community Medicine expert told The Hindu.
•He said if it is unavoidable, they are strongly advised to wear a three-ply mask, gloves and fully cover legs and arms.
•“It is vital to keep COVID-19 patients’ oxygen mask and canula sterile to prevent mucormycosis. It is necessary to keep a regular check on water used in oxygenation for any possible contamination.”
•Mucormycosis (black fungus infection) is caused by a group of moulds known as mucormycetes, which are present in the air, water and moist surfaces, in damp places. It appears as black spots in the nasal cavity, mouth and throat. A healthy person’s immunity does not allow it cause infection. However, it can cause severe infection in an immunocompromised person. The Central government on Tuesday allocated an additional 19,420 vials of Amphotericin-B to all States/UTs and Central Institutions.
•Dr. Sharma said doctors should guide a COVID-19 patient about how to look for its early signs. “At the hospitals, doctors and nurses should check for the symptoms in patients being treated with steroids or other immunosuppressive agents,” he said.
•On why so many patients are getting affected, Dr. Sharma said mucormycosis is generally affecting COVID-19 patients who are prescribed steroids or those who have uncontrolled diabetes.
•“Though steroids are an effective treatment for some patients who develop severe inflammatory response. But they should always be given under medical supervision. If given too early, too much and for too long, they can make one susceptible to catching secondary bacterial or fungal infections,” he said.
•Doctors say Amphotericin-B is not a commonly used antifungal drug and with a low safety profile it’s used for very severe, life-threatening fungal infection or for mucormycosis, for which cases were low previously.
•Said Vikramjeet Singh, senior consultant, Department of Internal Medicine, Aakash Healthcare, Delhi: “Now due to COVID infection and some other factors, the incidence of mucormycosis has increased and we have started using Amphotericin-B in these cases. For post-COVID mucormycosis, this is the only drug which can be given.
•“Due to the shortage of the drug, it is the patients of mucormycosis who are suffering. But the situation is improving and we are hopeful that patient survival rate will be good,” he said.
📰 EU leaders agree to donate 100 million doses of vaccines
They vow support to COVAX for equitable access to doses
•EU leaders agreed on Tuesday to donate at least 100 million doses of COVID-19 vaccines to poorer nations by the end of the year as supplies steadily rise across Europe.
•Gathered in Brussels for a two-day summit, the 27 leaders backed a text in which they pledge to continue efforts “to increase global vaccine production capacities in order to meet global needs.”
•Leaders also called “for work to be stepped up to ensure global equitable access to COVID-19 vaccines” and reiterated their support for the UN-backed COVAX programme. COVAX aims to ensure equitable access to COVID-19 shots for low-and middle-income countries.
•The programme suffered a major setback last week when its biggest supplier, the Serum Institute of India, announced it would likely not export any more vaccines until the end of the year due to the COVID-19 crisis in the subcontinent.
•Leaders acknowledged that vaccination has finally picked up across their continent following a painfully slow start.
•European Commission President Ursula von der Leyen presented data to the leaders suggesting that 300 million doses will have been delivered in the region by the end of May, with about 46% of the adult population in the bloc of 450 million getting at least a first dose of vaccine.But as vaccination campaigns continue to progress in the Western world, poorer countries are struggling to acquire supplies.
•The leaders also pledged to help countries in need to develop vaccine production locally.
📰 Rules and rulers: On social media curbs
The Govt. must hear out the social media industry, and shed its arbitrary rule-making
•It does seem that most if not all global social media giants will miss complying with the new IT rules of intermediaries, which come into effect today. It would be unfortunate if this non-compliance were to trigger a further worsening of the already poor relationship between some social media players and the Government. The new rules were introduced in February. Among other things, they require the bigger social media platforms, which the rules referred to as significant social media intermediaries, to adhere to a vastly tighter set of rules within three months, which ended on May 25. They require these platforms to appoint chief compliance officers, in order to make sure the rules are followed, nodal officers, to coordinate with law enforcement agencies, and grievance officers. Another rule requires messaging platforms such as WhatsApp to trace problematic messages to its originators, raising uneasy questions about how services that are end-to-end encrypted can adhere to this. There are indeed many problems with the new rules, not the least of which is the manner in which they were introduced without much public consultation. There has also been criticism about bringing in a plethora of new rules that ought to be normally triggered only via legislative action.
•But non-compliance can only make things worse, especially in a situation in which the relationship between some platforms such as Twitter and the Government seems to have broken down. The latest stand-off between them, over Twitter tagging certain posts by BJP spokespeople as ‘manipulated media’, has even resulted in the Delhi Police visiting the company’s offices. Separately, the Government has been fighting WhatsApp over its new privacy rules. Whatever the back-story, it is important that social media companies fight the new rules in a court of law if they find them to be problematic. The other option, that of engaging with the Government, may not work in these strained times. But stonewalling on the question of compliance can never be justified, even if it is to be assumed that the U.S. Government has their back. Facebook, on its part, has made all the right noises. It has said that it aims to comply with the new rules but also needs to engage with the Government on a few issues. What is important is that the genuine concerns of social media companies are taken on board. Apart from issues about the rules, there have been problems about creating conditions for compliance during the pandemic. As reported by The Hindu, five industry bodies, including the CII, FICCI and the U.S.-India Business Council have sought an extension of 6-12 months for compliance. This is an opportunity for the Government to hear out the industry, and also shed its high-handed way of rule-making.
📰 Calibrated closures: On localised lockdowns
With no short road to universal vaccination, lockdowns should be precise and painless
•Several States have extended the coronavirus lockdowns beyond May 31, while fresh cases appear to show a downward trend, but India’s COVID-19 battle lacks strategic focus. Although a cessation of activity has been imposed, there is not much clarity on the future threat from virus variants, notably B.1.617 that now has three sub-types and the dominant one, B.1.617.2, is estimated to be 50% more transmissible than another variant of concern, B.1.1.7. Neither is there a road map for vaccine availability ahead, with direct imports by States hitting a roadblock and vague assurances of a domestic ramp-up from July substituting for firm commitments. Some States are unwisely taking the foot off the testing pedal, making it that much harder to map the course of transmission. A miasma of confusion has come to pervade COVID-19 policy, where the Centre no longer has an appetite for leadership, even if it means shunning responsibility for universal vaccination, and the only tool available with States is a lockdown. But as Tamil Nadu Chief Minister M.K. Stalin has pointed out, a lockdown does not provide a solution, and comes with its own economic side-effects that hit the working class poor the hardest. The time has come for a pandemic policy reset that reflects scientific insight, encourages safe public behaviour through persuasive communication, monitoring, and, importantly, incorporates medical interventions of scale.
•The medium-term outlook does not point to a steep rise in vaccination by the end of the year to cover most of the population, making it imperative for States to prepare for potential future surges. Although claims have been made of a large volume of three vaccines becoming available between August-December, the road to universal immunisation is going to be long. The process is complicated by the finding in Britain that it takes two doses of Covishield for 60% protection against the dominant virus variant that is also found in India; the second dose, therefore, should be administered after eight weeks, not 12 or 16. What States can do immediately is to arrive at a good lockdown protocol, sparing people frequent shocks. Tamil Nadu’s recent move to intensify the lockdown, and, inexplicably, allow even jewellery and clothing shops to open for a day before that, led to massive crowding triggered by induced demand. Clearly, measures to shut down everyday activity lead to fear and panic, and leave less affluent sections, the disabled, migrant workers and many single individuals unable to cope. The golden mean would be to shut all non-essential shops, encourage remote transactions, open street sales and home deliveries, actively monitor compliance with COVID-19 protocols in public places and vaccinate workers in services, including domestic workers, on priority. Free food distribution must be a central feature of lockdowns.
📰 Vaccination is our only weapon
It is important to hold manufacturers to account on efficacy data
•On May 14, 2021, the Indian government announced that over 2 billion doses of vaccines against SARS-CoV-2 will be produced in India from August to December. The government can be applauded on its intent: vaccinating a billion Indians with two doses each should in theory give India herd immunity. But while the number 2.1 billion doses makes sense, little else does. Vaccines don’t save lives; rapid, mass, repeated vaccinations do.
Vaccinate on a war footing
•In the 2019 general election, in just five weeks, about 610 million Indians voted at one million polling stations that were supervised by 10 million election officials. If the nation can be mobilised every five years for the general election, there is no reason why India cannot vaccinate one billion Indians in five weeks. On a war footing, India needs to vaccinate 75% of the population in five weeks, not five months.
•Up to May 23, only 10.9% of the population had received one dose and only 3% had been fully vaccinated with two doses. On average 1.5 million Indians have been vaccinated every day since the vaccination programme started on January 16. If in the 150 days between August and December this year, about 2.1 billion doses are produced, India requires not just the production but the administration of at least 14.4 million vaccines per day. But it lacks the infrastructure to administer the produced vaccines at 10 times the current rate. It will fail in this critical task unless it mobilises the armed forces for logistics. Every health worker not working in a hospital and every medical, paramedical, and nursing student will have to be on vaccine administration duty. Unless every Indian is protected either by vaccination or herd immunity, India will remain unprotected.
•Spreading viruses mutate. The only way a host can break the cycle of replication and mutation is if the host’s immune system neutralises the virus. Immunity is acquired in only two ways – either by natural infection or vaccine-derived immunity. The problem with the current rate of vaccination is that in the large population groups which remain unvaccinated or under-vaccinated, the virus is spreading, replicating, and mutating. Unless it resorts to mass, rapid vaccinations, India will be condemned to new variant pandemic cycles that will keep surging and receding with cyclical and devastating consequences on lives and livelihoods.
•Like influenza, SARS-CoV-2 is here to stay. There is a high possibility of another wave of infections, with another strain if not this. Many more will get infected. The aim is to downregulate the virus with rapid, mass and repeated vaccinations from an epidemic to an endemic infection that has seasonal outbreaks with lower number of cases, morbidity and mortality, allowing us to safely open up and keep the economy open.
•Sadly, many decision-makers forget that vaccinating the nation is not a one-off; we will have to repeat this herculean exercise every season with updated and re-engineered booster vaccines to prevent the next pandemic cycle which will be driven by new and emerging variants.
•All vaccines are not equally effective – high efficacy equals high economic benefit. The primary driver of the choice of a vaccine manufacturer is not just the ability to produce large quantities in the time frame required; it is the efficacy of the vaccine following peer reviews, publications and rollout. Equally important is the ability of the manufacturer to quickly re-engineer and produce updated vaccines against the prevalent strains and future ‘variants of concern’.
•Both the Russian Sputnik V and the Chinese Sinopharm vaccines were rolled out widely and ahead of sufficient phase 3 trial data. Mostly low- and middle-income countries have given emergency use licence to both these vaccines and millions have been vaccinated with them. Both vaccines remain under review by the European Medicines Agency. On May 7, the World Health Organization listed Sinopharm for emergency use and is expected to do the same for Sputnik V shortly. However, absence of transparency in clinical trial protocols and of the data and its analysis have cast doubts on approval of these vaccines in developed countries with access to other vaccines.
Surge in the Seychelles
•Policymakers and vaccine manufacturers would be wise to pay close attention to what is happening in the Seychelles with respect to the efficacy of vaccines. Despite being the most vaccinated nation in the world, with more than 60% of its population fully vaccinated, the Seychelles is battling a surge of the virus and has had to reimpose a lockdown. In the fully vaccinated population in the Seychelles, 57% were given Sinopharm (donated by the United Arab Emirates), while 43% were given AstraZeneca (produced by the Serum Institute of India). On a per capita basis of reported cases, the Seychelles outbreak is worse than India’s. All vaccines do not necessarily demonstrate the efficacy that the manufacturers tout. Manufacturers must be held to account not just on their production targets but on efficacy data. Transparency in clinical trials including post-vaccine rollout analysis is mandatory.
•Until all Indians are protected, none of us is protected. The government’s announcement that 2.1 billion doses will be provided in five months, without any mention of a central vaccine agency managed by experts to govern the purchase, procurement and production centrally for all States, will create and promote vaccination asymmetry. It will exacerbate the pre-existing healthcare iniquity and inequity in India. To the rich-poor, rural-urban, digital divides we now appear to be adding a new vaccination divide.
•India has to learn from its colossal mistakes. It must set aside its hubris and exceptionalism. It must on a war footing coalesce behind the only weapon that works — vaccination. The pandemic cycles have left in their wake incalculable but preventable loss of life, human suffering, financial ruin and economic decrepitude. If we fail, generations of Indians to come will ask why we did not come together and do the right thing.
📰 Slowing the pace of India’s mucormycosis threat
The experience of oncologists who rely on steroid-based protocols offers lessons in preventing and managing cases
•The alarming rise in India recently in the incidence of mucormycosis — a rare fungal infection — in patients who have been diagnosed and treated for COVID-19 has come as no surprise to those of us in the medical oncology community. This outcome was our greatest fear as the administration of dexamethasone and other steroids began to become common. As oncologists who rely on steroids in many of our protocols, and having managed several cases of mucormycosis, we are acutely aware that treatment protocols need to differ from patient to patient due to the complexities in clinical presentation and an individual’s tolerance to treatment.
•However, we find ourselves in a different position today because of the magnitude of cases being reported, and the inability of treating physicians to create individualised treatment protocols under this burden. Some States, including Tamil Nadu, have declared mucormycosis as a notifiable disease under the Epidemic Diseases Act. Guidelines and protocols need to be adapted and modified rapidly to arrest this growing epidemic.
•Why did the risk of mucormycosis overwhelming us come as no surprise? The estimated burden of mucormycosis in India is 14 per 100,000 in a study published in Current Fungal Infection Reports. This is almost 70 times higher than what is reported in other countries. In a multi-centre study across several tertiary-care hospitals in India, published in Clinical Microbiology and Infection, the rough estimate of proven mucormycosis was around 40 cases on an average over a 21-month period observed at each centre.
Focus on diabetes
•It must be made absolutely clear that mucormycosis is not transmitted from one individual to the other, the way COVID-19 is. The most common cause is uncontrolled diabetes mellitus (raised blood sugars). Other causes include the treatment of some cancers; steroids, chemotherapy or immunotherapy, and solid organ or stem-cell transplantations. The common sites of presentation include rhino-cerebral involvement (i.e., the fungus can damage the nose, paranasal sinuses, the eyes and the brain), and pulmonary involvement (i.e., the fungus can cause pneumonia).
•Raised blood sugars being a cause is of particular concern for multiple reasons. According to a study in The Lancet , the number of people with diabetes increased to 65 million in 2016 in India. The highest prevalence of diabetes was observed in Tamil Nadu, Kerala and Delhi. The crude prevalence of diabetes above 20 years of age has increased to 7.7% in 2016, from 5.5% in 1990. Further, there is an underlying higher genetic susceptibility to diabetes in Indians; some of these cases could get unearthed only after exposure to steroids.
•The treatment of COVID-19 is, unfortunately, only worsening this situation. In a lab study published in Nature Metabolism, SARS-CoV-2 can potentially multiply in pancreatic cells and contribute to increased blood sugar levels in COVID-19 patients. Steroids form a very important aspect of treatment for COVID-19 because they lower death rates by reducing the cytokine storm phase which can develop in some patients. However, steroids when used excessively or prematurely, and without medical supervision can be harmful. Besides causing reduced immunity levels, steroids can also increase blood sugar levels which can cause additional harm if left unchecked. Dexamethasone, methylprednisolone or prednisone are among the steroids used in the treatment of COVID-19.
Treatment approach
•Mucormycosis is associated with very high morbidity and mortality. Its treatment requires a multi-disciplinary team approach that includes microbiology, pathology, radiology, infectious diseases, surgery, pediatrics, hematology, intensive care, dermatology, and pharmacology. A multi-disciplinary approach is simply not feasible on a large scale, especially in areas with limited medical access.
•Surgery for mucormycosis can be debilitating requiring major resections. Additionally, there are limited antifungal drugs available for mucormycosis. The gold standard drug is liposomal amphotericin B, which is priced out of reach for many. Amphotericin B deoxycholate (conventional) is cheaper, but is associated with an unfavourable toxicity profile including kidney problems, abnormalities in electrolyte levels; reduced sodium, potassium, calcium and magnesium levels can lead to other toxicities. Some other expensive treatment options include posaconazole and isavuconazole. All these medicines often have to be administered for prolonged durations, making treatment protocols difficult to sustain on a large scale, given the cost implications and difficulty in drug administration due to its side-effects.
•When a patient is recovering from COVID-19 infection, it is certainly going to be a challenge to perform debilitating surgeries and administer these antifungal drugs for a prolonged duration. In the case of rhino-cerebral mucormycosis especially, surgery is usually required in addition to antifungal drugs. If these surgeries cannot be performed, the outcome is dismal. It is also important to keep in mind that treatment for mucormycosis will require prolonged hospital admissions. Given the health-care constraints we are faced with, this infection should be avoided at all costs.
Monitoring is essential
•What can be done to reduce the number of cases and the intensity of mucormycosis? Steroid use at home for COVID-19 should be only under the supervision of a health-care worker. The control of blood sugars during steroid intake is crucial to avoiding mucormycosis. When patients are medicating themselves at home, monitoring of capillary blood glucose is essential. If high blood sugars are encountered, a tele-consult with a doctor is advisable. Going a step further, health authorities may consider arranging for blood glucose monitoring for patients at home on steroids, and also promoting awareness campaigns on the importance of controlled blood sugar levels.
•Patients on steroids for COVID-19 should report symptoms of mucormycosis at the earliest. Among other symptoms, they should look out for facial swelling on one side, protrusion of the eyeball, new-onset visual disturbances, headache and vomiting, new onset swelling or ulcers with blackish discolouration, and prolonged fever. COVID-19 treatment experts and policy-makers may consider widespread training of health-care personnel including Accredited Social Health Activists (ASHAs) and nursing professionals to raise awareness on mucormycosis while educating people locally.
•The prolonged requirement for hospital admission linked to COVID-19 will also lead to a rise in other hospital-acquired infections necessitating the use of multiple antibiotics. We are staring at the grim reality of managing large numbers of patients with other long-standing side-effects of steroids. Additionally, the concern is the alarming increase in multi-drug resistant bacterial infections for which we are grossly unprepared.
📰 Still grappling with online classes
State universities require funding if online education is to continue in India
•A year since the outbreak of COVID-19, online education remains a chimera in India. Notwithstanding their preparedness, higher education institutions were directed by the government to shift from classroom education to online education. This was mandated even though the government spent merely 3.2% of its GDP on education in 2020-21. University administrations too released orders overnight in haste. They instructed teachers and students to move to online classes without taking cognisance of changes needed in infrastructure, training, etc.
Differences within institutions
•The financial health of state universities in the country is an open secret. While centrally funded elite institutes such as the IITs, IIMs, NITs and Central universities launched video channels and uploaded e-content on institutional websites and digital platforms, a majority of the state universities still struggle without proper Internet connectivity and bandwidth in their campuses. State universities are only able to provide salaries on time. The move to online learning especially came as a surprise for overburdened teachers given that there are several vacant faculty positions in universities across India. This move also came as a shock for the students, many of whom are distressed by the COVID-19 situation. Many of them also lack the facilities to attend online classes. Teachers and students had a sense of déjà vu as they had a similar experience when the annual scheme of teaching and regular courses was replaced by the semester scheme of teaching and the choice-based credit system earlier.
•A transition from conventional classroom teaching and learning to online education needs to be done in a phased manner. State universities should first equip their infrastructure (both hard and soft) with wholehearted government support. A sledgehammer approach to adapt to a new setting won’t serve anybody’s interests. On the contrary, it may prove to be a counterproductive exercise.
•There are 993 universities, 39,931 colleges, 3.73 crore students and 14.16 lakh teachers in India, according to All India Survey on Higher Education (2018-19). If such a drastic decision was to be taken, there should have been wider consultation between the government and all the academic stakeholders to find a way forward. With Internet penetration still low in India, it is incumbent on the government to allow suitable financial aids to state universities to obtain appropriate IT tools, platforms, devices, provide training, etc. before initiating such an exercise. Else, given the difference in students’ access to digital education, their performances are also bound to differ. This creates an asymmetrical society and leads to anxiety among the students. Most importantly, education is denied to the less privileged student community.
Study material
•Another predicament in online education is the preparation of appropriate study material. Policymakers need to acknowledge that merely uploading scanned lecture notes or power point presentations does not serve any meaningful purpose. There is no imaginative thinking and exploring, no application-based learning for students. For practical field and laboratory-based learning, the whole idea of online education could prove to be a disaster.
•Given that there is talk of more COVID-19 waves, it is imperative for the government to embrace a pragmatic approach by engaging all academic stakeholders and investing generously in online education as suggested by the Fifteenth Finance Commission in its report. Development of massive open online courses (MOOCs), direct-to-home (DTH) content development, digital classrooms and provision of devices (laptop/tablets) for 25 lakh students belonging to the socially and economically weaker sections of society, especially in state universities, would help.
📰 One-state solution, the way forward in Palestine
The whole premise of the two-state solution is wrong, providing Israel the immunity to continue its ethnic cleansing
•For more than 50 years, well-intentioned and more cynical, local and external actors involved in the attempts to bring peace and reconciliation to historical Palestine have religiously adhered to the two-state solution as the only way forward.
•The idea of partitioning Palestine between the settler movement of Zionism, and later the state of Israel and the indigenous population of Palestine is not new. It was first offered by the British in 1937 and rejected by the Palestinians already then. The Zionist movement was hardly 50 years old and was already offered by the new British occupiers of Palestine, a chunk of the Palestinian homeland as a future state. This in the 1930s and 1940s would have been akin to an offer to decolonise India by partitioning it between a British India and local India or to propose the decolonisation of Algeria by dividing it between a French Algeria and a local Algeria. Neither the Indian anti-colonial movement nor the Algerian one would have ever consented to such a post-colonial arrangement; nor did the British and French dare to offer it when they reconciled with the fact that they will have to leave their colonial empires and go back to Europe.
Catastrophic event
•But even when decolonisation was achieved in India in 1947, not only the British but also the so-called civilised world through the United Nations insisted that the Palestinians should give half of their homeland to the settler movement of Zionism. The Palestinians attempted to convince the international community that the problem was not only about dispensing with half of their homeland but that the settler movement of Zionism would not be content with just half of the country and intended to take as much of it as possible and leave in it as few Palestinians as possible. This ominous prediction turned out to be chillingly accurate and true in less than a year after the UN insisted that partition was the only solution for Palestine. Under the guise of UN support, the new Jewish state took over nearly 80% of historical Palestine and ethnically cleansed almost a million Palestinians (more than half of Palestine’s population), and in the way demolished half of Palestine’s villages and most of its towns in nine months in 1948; an event known by the Palestinians as the Nakba, the catastrophe.
Incremental cleansing
•In 1967, Israel occupied the rest of historical Palestine, and in the process expelled another 300,000 Palestinians. Like all settler colonial projects, it had to navigate between a wish to take over indigenous territory while downsizing the number of native people living on it. It was impossible after 1948 to repeat a massive ethnic cleansing, so it was substituted by incremental ethnic cleansing (the last stage in this process was one of the root causes that ignited the cycle of violence last week — the proposed eviction of Palestinians from Shaykh [Sheikh] Jarrah, an East Jerusalem neighbourhood, as part of an overall attempt to Judaise East Jerusalem).
•Incremental ethnic cleansing is not the only way of achieving the old Zionist goal to turning historical Palestine into a Jewish state. Imposing military rule in the West Bank and the Gaza Strip after they were occupied was another means which enclaved the people there without basic human and civil rights. Imposing a version of an Apartheid regime on the Palestinian minority in Israel is another method and the constant refusal to allow the 1948 refugees to return completes the matrix of power that allows Israel to retain the land and disregard a demographic reality by which the Jews are not the majority in historical Palestine.
It is Israel that decides
•The two-state solution, offered for the first time by liberal Zionists and the United States in the 1980s, is seen by some Palestinians as the best way of ending of the occupation of the West Bank and at least the partial fulfilment of the Palestinian right for self-determination and independence. This is why the Palestine Liberation Organization was willing to give it a go in 1993, by signing the Oslo Accords. But the Palestinian position has no impact in the current balance of power. What mattered is how Israel interprets the idea and the fact that there is no one in the world that could challenge its interpretation.
•The Israeli interpretation, until the rise of Benjamin Netanyahu to power in 2009, was that the two-state solution is another means of having the territories, the West Bank and the Gaza Strip, without incorporating most of the people living there. In order to ensure it, Israel partitioned the West Bank (which is 20% of historical Palestine) into a Jewish and an Arab part. This was in the second phase of the Oslo Accords, known as the Oslo II agreement of 1995. The Palestinians were forced to accept it under American and Egyptian pressure. One area, called area C, which consists of 60% of the West Bank) was directly ruled from 1995 until today by Israel. Under Mr. Netanyahu, Israel is in the process of officially annexing this area while at the same time ethnically cleansing the Palestinians living in it. The remaining 40% of the West Bank, areas A and B under Oslo II, were put under the Palestinian Authority, which optimistically calls itself the state of Palestine, but in essence has no power whatsoever, unless the one given to it, and withdrawn from it, by Israel.
A Bantustanisation
•The Gaza Strip was divided too. But the Jewish part was small and could not be defended from the local national movement’s wrath. So, the settlers were taken out in 2005 and Israel hoped that another Bantustan, like the one in areas A and B, would be established there under the Palestinian Authority’s rule and under the same conditions. But the people of Gaza opted to support a new player, Hamas, and its ally, the Islamic Jihad, which resisted this offer. They supported them not only because there was a return to religion in the face of the ongoing predicaments but also because there was big disappointment from the compliance of the PLO with the Oslo arrangements. Israel responded by imposing a callous siege and blockade on the Gaza Strip that, according to the UN, made it unliveable.
•To complete its strategy that included the partition of the West Bank, its Bantustanisation, and the siege of Gaza, Israel passed in 2018 a citizenship law, known as the nationality law, which made sure that the Palestinian citizens who live in Israel proper (which is Israel prior to the 1967 occupation of the West Bank and the Gaza Strip) and who are supposedly equal citizens of the Jewish state, will in essence become the “Africans” of a new Israeli Jewish apartheid state: living in a permanent regime that discriminates against them in all aspects of life on the basis of their nationality.
•The endless negotiation on the two-state solution was based on the formula that once the two states become a reality, Israel will stop these severe violations of the Palestinian civil and human rights, wherever they are. But while the wait continued, more Palestinians were expelled and the Jewish settler community in the West Bank doubled and tripled and took over the fertile land, leaving no space for Palestinian expansion. The presence of more than 600,000 Jewish settlers, with a very high rate of natural growth, means that Israel will never consider moving them out; and without that, even a soft version of a two-state solution is impossible.
Decolonise, build a new state
•The whole premise of the two-state solution is wrong and that is why it did not materialise. It is based on the assumption of parity and of framing the conflict as one fought between two national movements. But this is not a “conflict” as such. This is a settler colonial reality which began in the late 19th century and continues until today. The late scholar, Patrick Wolfe, described settler colonial movements as motivated by a logic he called “the elimination of the native”. Sometimes it led to genocide, as it happened in North America, sometimes it translated to an ongoing ethnic cleansing operation, which is what has unfolded in Palestine. The two-state solution is not going to stop the ethnic cleansing; instead, talking about it provides Israel international immunity to continue it.
•The only alternative is to decolonise historical Palestine. Which means that we should aspire to a state for all its citizens all over the country, based on the dismantlement of colonialist institutions, fair redistribution of the country’s natural resources, compensation of the victims of the ethnic cleansing and allowing their repatriation. All this will be so that settlers and natives should together build a new state that is democratic, part of the Arab world and not against it, and an inspiration for the rest of the region which desperately needs such models to push it forward towards a better future.
