The News Editorial Analysis 14th Jan 2022

Rural cases up after urban surge

Country records 2,59,291 COVID-19cases on ThursdayLike every wave in the past, cases fuelled by the Omicron variant of COVID-19 have initially spread only in urban areas. However, many rural and semi-rural places recorded a sharp spike in infections in the past week.At the start of this year, 50% of the cases were from urban centres such as Mumbai, Delhi, Chennai and Kolkata. However, the share reduced to 35% by Wednesday.In contrast, the share of cases from rural areas increased from 6% at the start of the year to 12% by Wednesday. In the same period, the share of cases in semi-rural areas increased from 15% to 25%.In the first five days of the year, rural and semi-rural areas recorded only 58,000 cases collectively. In the latest five days, the areas recorded 2.12 lakh infections, a 266% increase. In the same period, cases in urban and semi-urban areas increased from about 1,80,000 to 6,00,000 cases, a 233% increase, slightly lower than rural counterparts.India recorded 2,59,291 new cases on Thursday, the highest single-day rise in the ongoing wave. Also, 18.86 lakh tests were conducted on Wednesday, the results of which are made available on Thursday. This is the highest number of tests in a single day in the ongoing wave.

12.5 lakh active cases

The figures are based on the State bulletins released until 10 p.m. on Thursday. Jharkhand and Tripura had, however, not yet released data for the day.

The cumulative cases in India have reached 3.65 crore and the cumulative death count has reached 4,85,376. The active cases stand at 12.5 lakh.As of Thursday, India has fully vaccinated 63.6% of its eligible population (15+) and partially vaccinated 88.6%.

An epidemiologically sound testing strategy

India’s latest COVID-19 advisory shifts the pandemic response from ‘treatment oriented’ to one focused on public healthOn January 10, 2022, the Indian Council of Medical Research released an ‘Advisory on Purposive Testing Strategy for COVID-19 in India’. The advisory (Version VII; https://bit.ly/31UtJ7F) provides details on ‘Who may be’ and ‘People who need not to be’ tested. It proposes that ‘asymptomatic individuals in community setting’ and ‘contacts of confirmed cases of COVID-19, unless identified as high risk’, amongst others, need not be tested. The latest COVID-19 testing strategy replaces the previous advisory (Version VI), released on September 4, 2020 (https://bit.ly/3GsAexi) and inter alia, had the provision of COVID-19 testing on demand for ‘all individuals who wish to get themselves tested’. Clearly, there are a few paradigm shifts in the testing strategy.

Understandably, the revised strategy has now created a flutter and divided epidemiologists and clinicians, pandemic ‘experts’ and television channel commentators, in two halves — of those strongly supporting or vehemently opposing it. So, is the new advisory on COVID-19 testing a right approach? Let us deep dive.

Strategies in sync with stages

When the novel coronavirus pandemic began, the virus was new to any setting and every country including India followed a ‘containment strategy’ to stop the virus spread and prevent community transmission. This required aggressive testing to detect every infection and ‘trace and test’ every possible contact of confirmed cases. ‘Test, test and test’ — as it was colloquially referred to — was an approach recommended and followed by all countries across the world. India, following this approach, ramped up COVID-19 testing capacity and two years on, India has set up nearly 3,100 laboratories conducting COVID-19 testing with daily capacity of nearly two million RT-PCR tests. Over the last many months, additional testing approaches and kits such as rapid antigen test (RAT) and home kits for antigen test have been approved.

The aggressive testing approach seems to have worked — to a large extent and till recently. Yet, no country can claim that it has detected every COVID-19 infection. A few high income countries are estimated to have identified one in every two or three infections. In India, based on the fourth round of the COVID-19 national sero survey between June 2021 and July 2021, only one in every 30 infections has been detected. Clearly, an aggressive testing strategy was useful but not enough.

The emergence of Omicron (B.1.1.529) as a variant of concern now has changed the situation drastically. So there is Omicron, with a three- to four-fold higher transmissibility (when compared to the Delta variant) and also a large majority of new infections being asymptomatic. Along with very high new infections in a short period of time, the testing capacity in nearly all countries has been stretched. Countries are revising testing strategies, mostly with the focus on ramping up testing with the use of RATs and home testing kits. The approaches for other public health tools such as contact tracing, isolation and quarantine are also being reviewed and revised.

Testing with purpose

Any diagnostic testing — especially in outbreaks, epidemics or pandemics — has two broad objectives: of individual and public health benefits and tracking the extent of infection. At the individual level, early COVID-19 testing can help in a suitable modification in clinical management. However, with a decoupling of ‘infection’ from ‘moderate to severe COVID-19’ and a better understanding of disease epidemiology, it is known that for most asymptomatic or even mild symptomatic individuals (i.e., fully vaccinated, young adults, or those without comorbidities), a confirmatory COVID-19 testing would not alter the treatment. Therefore, testing asymptomatic or majority of mild symptomatic would burden the laboratory capacity with almost no individual benefit in treatment.

Second, the testing of asymptomatic cases would have the public health benefit of reducing transmission (if every infection can be detected at the earliest). However, with Omicron, it is neither feasible for any system nor required as transmission is already widespread and a majority cases are asymptomatic. As the COVID-19 testing capacity has been overwhelmed in even high resource health-care systems, countries are resorting to expanding RATs. However, with the low sensitivity of RAT kits, in a hypothetical scenario of even every infected individual undergoing a COVID-19 test, nearly half of them will be missed. Clearly, at this stage of pandemic, the individual and public health benefits of testing contacts and asymptomatic individuals are very limited, if not zero.Promoting the use of self-purchased RATs has an equity dimension as well. This is in addition to it not being a very effective public health tool. A ramping up of RATs may be useful in a setting where every member of society has equal access by free of cost availability to such kits. However, in India, as per the Government announcement, 800 million Indians are eligible and dependent on free ration during the pandemic; they cannot be expected to purchase testing kits and are not likely to use them. Therefore, promoting RAT kits is unlikely to be a solution in India as well as in many other low and middle income countries.In public health challenges such as the ongoing COVID-19 pandemic, every health intervention should be deployed to offer the maximum benefits to most citizens. The available laboratory capacity and the testing kits need to be used efficiently, optimally and intelligently. Testing asymptomatic people has a very limited marginal benefit and can overburden an already stretched testing system — which could essentially mean a delay in the COVID-19 test report for those with a high risk of getting moderate to severe disease.Finally, the argument that testing should be ramped up to get better COVID-19 data is on weak footing. We need to remember that any data collection is a byproduct of public health interventions and not the primary objective. If we can use data being generated currently, even that would be enough to answer most policy questions and guide interventions. Then, in the end, in every country across the world, the final numbers of the pandemic will always be determined by the estimates.

A right epidemiological move

The public health tools need to be suitably modified and calibrated at every stage of the pandemic. Two years into the pandemic, there is limited relevance of continuing with the same old strategies for contact tracing, testing and isolation.

India’s pandemic response has received criticism for being guided by clinical experts and being medical care-oriented with excessive attention on hospital beds and intensive care unit facilities and with a focus on care of the sick. The recent advisory on COVID-19 testing is a hint towards a shift toward the public health approach. There appears to be more attention on a pandemic response guided by local epidemiology and the principles of public health. In addition to testing strategy, in the recent weeks, COVID-19 home isolation guidelines and hospital discharge policies have also been revised.COVID-19 testing has to be used as a public health tool to benefit the most and not as a medical care tool. When the benefit of testing has become limited, as is the case in the current stage, targeted COVID-19 testing — to protect the vulnerable — is the right approach. Public health strategies have to be designed based on local context and cannot and should not be merely ‘copied’ from other settings. There are a few additional things that call for attention. There is a need for developing detailed COVID-19 hospital admission criteria and ensuring a better adherence to COVID-19 treatment guidelines, to prevent unnecessary admission and avoid unproven therapies that are not recommended. To respond to the current surge, there is a need to bring epidemiology and public health approaches to the forefront and ignore the ‘opinion’ of ‘mushrooming experts’ vocal and visible on television and ‘omnipresent’ on social media.India’s latest advisory on COVID-19 testing is bold, pragmatic and epidemiologically sound. More importantly, it shifts the balance of India’s pandemic response from a ‘treatment oriented’ to a public health focused approach. It is another opportunity to bring science, data, debate, dialogue, evidence, epidemiology and public health in shaping India’s response to the COVID-19 pandemic. The revised COVID-19 testing approach, arguably, is a pandemic strategy in which the rest of the world is likely to follow India.Dr. Chandrakant Lahariya is a physician-epidemiologist and public policy and health systems specialist. He is the lead co-author of the book, ‘Till We Win: India’s Fight Against The COVID-19 Pandemic’

Space for dreams

Under a new leadership, ISRO will need to continue innovationThis year, the harvest festival brings a change at the helm for the Indian Space Research Organisation (ISRO), with S. Somanath who heads the Vikram Sarabhai Space Centre (VSSC) at Thiruvananthapuram taking over as its chairperson. He succeeds K. Sivan, who also came to head ISRO after having led the efforts at VSSC. Mr. Somanath is the third consecutive chairperson of ISRO to have a master’s degree in engineering from the Indian Institute of Science. The organisation thus sees a continuation of the recent trend of being led by engineers. It is to be seen if Mr. Somanath’s specific expertise in leading innovations in rocket engines, the cryogenic engine, for instance, will shape future developments at ISRO. If earlier the Mars Orbiter Mission, which broke the records for expense by costing just ₹7 per kilometre, and Chandrayaan 2, had kept anticipation high, the new chairperson will oversee the unfurling of the human space flight programme — Gaganyaan. Another long-awaited mission is Aditya-L1. This has morphed and grown into what will be India’s grandest investment in space dedicated to science, specifically, solar physics. The aim to take a space observatory to the Lagrangian point one (L-1) to study the Sun offers yet another frontier for ISRO to breach.

Mr. Somanath will also lead a transition in the stance of ISRO towards privatisation. Until a few years ago, ISRO had remained largely preoccupied with deriving socio-economic benefits from space technology and applications that were used by the Government of India and some international collaborations. Of course, these ventures had a strong industry participation, but privatisation reforms have been pursued hard recently. The first announcement came in 2019, with the NewSpace India Limited (NSIL) being floated in March, and the commercial arm of ISRO was more firmly established. Apart from building and launching satellites, the company will provide launch services, build customised launch vehicles, provide services of Earth observation and communication through satellites and also transfer technology to Indian industry. As a sequel to the establishment of NSIL came the announcement of the creation of the Indian National Space Promotion and Authorization Center, in June 2020 — a channel through which non-governmental private enterprises can carry out space activities. The country’s imagination to get up to speed with other competing nations would be put to the test under the new leadership. ISRO and its sister organisations have much to offer in the form of spin-offs and technology transfer. Underlying these questions is the anticipation which stems from the very nature of space science; it not only contributes to immense learning and perspective but also unfolds the very horizon, enhancing universal feelings of oneness.

Liberal economics creates illiberal societies

A new form of ‘Gandhian’ democratic socialism powered by cooperative economic enterprises is requiredA surging tide of nationalism and authoritarianism has imperilled democracy globally, and within presumptively democratic nations — the United States, India, the United Kingdom, and the European Union — too.Economies are not doing well. The benefits of growth are being sucked up to the 1% on the top; ‘trickle down’ to those below has diminished. With every global crisis — the financial crisis of 2007-08 and the ongoing COVID-19 crisis — the rich get richer while millions at the bottom fall off the ladder. Inequalities of wealth have increased around the world and India is becoming one of the world’s most unequal countries.

Political, economic symptoms

Like the COVID-19 virus, whose origins scientists are struggling to understand, another disease has been crippling the well-being of nations for 30 years. Political symptoms of the disease are the weakening of democracy and secularism. Its economic symptoms are inequities within economies and an unsustainability of economic growth. The socio-political and economic pathologies are inter-related. Economic despair is feeding the rise of authoritarianism, nationalism, and identity politics. Liberals who continue to advocate for more liberal economics must understand how their ideas have caused the rise of anti-liberal societies and governments which they lament. They can no longer have their cake and eat it too.

Opening national borders to free trade became an ideology in economics in the last 30 years. Taxes of incomes and wealth at the top were also reduced. The ideological justification was that the animal spirits of ‘wealth creators’ must not be dampened. Otherwise, the pie will not grow and there will not be enough to share. With higher taxes until the 1970s, the U.S. and many countries in Europe had built up their public health and education infrastructure and strengthened social security systems. The rich are now being taxed much less than they were. The pie has grown larger but the richest few have been eating, and hoarding, most of it themselves.

On ‘privatisation’

Governments are hamstrung without resources to provide public goods. ‘Privatisation’ of everything became another ideological imperative in economics by the turn of the century. Selling off public enterprises raises resources for funds-starved governments. Another justification is efficiency in delivery of services, setting aside ethical questions of equity. When ‘public’ is converted to ‘private’, rich people can buy what they need. In fact, they can buy more with their higher incomes even if the services become more expensive — better health care as well as better education for their children at the world’s best schools. The children of wealthier people with better education have greater access to opportunities in the future also. The gaps between the haves and the have-nots become larger.

Return of history

With not enough in the present, and receding hopes of better conditions in the future, people lose faith in their governments. History shows that whenever hopelessness spreads in societies, they are fertile grounds for messianic saviours who whip up pride in citizens’ identities to distract them from their woes. History has not ended, even though Francis Fukuyama said it had when the Soviet Union collapsed. With it, he suggested, the idea of totalitarian governments as saviours of the people had been debunked; and the idea of public ownership of property, which the communists had taken to an extreme by abolishing all private property, had failed.

History has returned. Authoritarian governments are now being democratically elected by people seeking a way out of the morass. The U.S., the leader of the Cold War against the Soviets, built the “Washington Consensus” around a starkly “unsocialist”, capitalist ideology which swept across erstwhile socialist countries of Europe and India too. Socialism seems to be back in U.S. politics now with Bernie Sanders, Elizabeth Warren, and young Democrats.Liberal economists, promoting free markets, free trade, and privatisation, are worried by nationalism and authoritarian governments. They rail against “populist” policies of governments that subsidise the poor and adopt industrial strategies for self-reliance and jobs for their citizens. Liberals must re-examine their ideas of economics, to understand their own culpability in creating authoritarian and identitarian politics.

The property problem

Thomas Piketty’s Capital and Ideology traces the ideology of “property” rights and its encounters with evolving ideas of “human” rights over the last three centuries. In proprietarian societies, it is just that he who owns more must have a greater say in the governance of the enterprise. In truly democratic societies, human rights must prevail, and every person, billionaire or pauper, must have an equal right to determine the rules of the game.Democratic and capitalist principles were becoming reconciled with “socialist” ideas in Europe and the U.S. after the World Wars, and in developing countries such as India after the collapse of colonialism. The socialist era ended with the collapse of communism and the resurgence of neoliberal economics around the world afterwards.While communism had lifted living standards, and the health and education of masses of poorer people faster than capitalism could, communism’s solution to the “property” question — that there should be no private property — was a failure. It deprived people of personal liberties. Capitalism’s solution to the property problem — replacing all publicly owned enterprises with privately owned ones (and reducing taxes on wealth and high incomes) has not worked either. It has denied many of their basic human needs of health, education and social security, and equal opportunities for their children.The private property solution has also harmed the natural environment. The belief that private owners will husband natural resources sustainably for all has proven false. When natural resources, and knowledge converted into “intellectual property”, become the property of business corporations, they will use them for the purpose for which a business corporation is created — which is to increase the wealth of its owners. The ecological commons are harmed, and social equity suffers.Communism and proprietarian capitalism carried too far have both failed. Climate change and political rumblings around the world are both warnings that capitalism needs reform. Economic policies must be based on new ideas. Thought leaders and policymakers in India must lead the world out of the rut of ideas in which it seems to be trapped. Principles of human rights must not be overpowered by property rights. A new form of “Gandhian” democratic socialism, powered by cooperative economic enterprises, is required in the 21st century, to create wealth at the bottom, not only at the top, and save humanity and the planet.Arun Maira, Former Member, Planning Commission, is the author of ‘A Billion Fireflies: Critical Conversations to Shape a New Post-pandemic World’

A pig heart transplant in Assam in 1997

On January 7, doctors at the University of Maryland Medical School in the U.S. made news when they transplanted a genetically modified pig heart into a 57-year-old man.

Few remember now that Dhaniram Baruah, a cardio-thoracic surgeon based in Sonapur near Guwahati, transplanted the organs of a pig into a human body in 1997. However,Dr. Baruah’s xenotransplantation procedure ended badly.Xenotransplantation is the process of grafting or transplanting organs or tissues between members of different species.“It is not easy for a human body to accept the organs of a pig. Time will tell whether the human body will accept the organ of a genetically-altered pig,” the 72-year-old doctor, who lost his voice after undergoing throat surgery some time ago, said via S.A. Achrekar, a senior scientist at his research institute in Sonapur.At an international conference in 1995, Dr. Baruah had said pigs are close to humans in various aspects. He had at the time developed an “electric motor-driven artificial biological heart made of ox pericardium that was implanted in a pig”.Dr. Baruah said he had carried out 102 animal experiments on xenotransplantation. He transplanted a pig’s heart, lung and kidneys to Purno Saikia, a 32-year-old end-stage organ failure patient, on January 1, 1997. Jonathan Ho, a Hong Kong-based doctor, had assisted him in the transplantation at his research centre.But Sakia died a week later, triggering an uproar. The two doctors were arrested on January 10 under the Transplantation of Human Organs Act, 1994, booked for culpable homicide and imprisoned for 40 days. Subsequently, the Assam government formed an inquiry committee that found pig heart implants to be unethical and unlawful.

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The News Editorial Analysis 13th Jan 2022