Covid-19: India should stop mass gatherings and consider postponing elections, say doctorsBMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1102 (Published 28 April 2021) Cite this as: BMJ 2021;373:n1102
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Forgotten lessons from 2020’s Covid-19
The voice of group of doctors is a serious concern for the country’s political machinery to act swiftly and efficiently to control and manage the spread of Covid-19 surge in 2021 and also beyond. India got credibility and appreciation in managing Covid-19 in 2020 and partnering with global scientific communities in developing vaccines on fast track. The biology and social science of Covid-19 disease is still not very clear to medical and scientific communities. There were predictions in 2020 that there could be second or even third waves of Covid-19 in 2021 or even thereafter (1, 2, 3). From the experience from Covid-19 in 2020, every country could have taken many excellent precautionary and preventive measures to protect and support the whole front line workers who are day and night fighting the Covid-19 to save lives of the people. The lessons and chapters learnt from Covid-19 of 2020 could have helped every country especially developing country like India to prepare and augment to improve and upgrade medical health care systems. The successful development of vaccines, the decline of the Covid-19 curve and the “Covid-19 fatigue” in people might have brought some laxity and lack of alertness and strictness to adhere to the Covid-19 protocols by the authorities, policy makers and public in India. Political set up, administrative systems, social issues and people’s behavioral attitudes may have equally contributed to the current prevalence and surge of Covid-19 in India. Some swift and urgent measures shall be implemented by the central government, state government and policy makers to control and curtail Covid-19 surge in the country.
a) Mass gathering: As voiced by the doctors, policy makers and administrative authorities shall implement strict measures to prevent such crowding and gathering of people especially in election and social events including processions and festivals. Uncontrolled political campaign and rallies for election should have been prohibited. Election should have been postponed to save lives of the people. All social gathering should be strictly reduced. It is also pertinent to mention that the strong observations made by couple of the Hon. High courts of the country on the uncontrolled procedures of election process held in many states while the pandemic has been still lingering around in the country (4). In addition, the social distancing has also been narrowed down without any distance by the people.
b) Education. Schools and colleges should wait some more months for reopening to begin physical classes and examinations till the teachers, students and other staff members get vaccinated.
c) Vaccination drive. The drive did not have enough acceleration and fueling. Although vaccination drive began in India on 16 Jan 2021, the speed and drive did not catch the momentum. India has already developed, and also developing about 2-4 vaccines as compared to many developed countries. But unfortunately, the percentage of people who got vaccinated in India is not all satisfactory as compared to that in USA and other countries. Public has been waiting and ready to get vaccinated for the last 3-4 months. Much precious time is lost. In many places the CoWin app, made for people to register for vaccine, either is not accessible or not available for people in rural areas and remote places in India. Alternative apps and measures should be set up to monitor and implement vaccine drive more efficiently at speed to cover larger population in short period of time. After launching third phase of vaccine drive in India, people are devoid of getting vaccine or waiting for vaccine for many days, even those who had their first dose. In the world India has the largest vaccine manufacturing facility and other giant pharmaceutical companies. But unavailability of vaccine for needy people at this crucial time is a serious concern. Many people were ready to pay for vaccine developed by any country at whatever cost- but vaccines are not made available for them. There was also news that people who took first dose can take second dose after six weeks instead of the proposed 28 days. Hence, many people waited. Their waiting didn’t help them as people started returning from the hospitals and centers due to the unavailability of vaccine. The announcement of third vaccine drive for people above 18 years all the more brings overcrowding of people at vaccine centers. People above 60 years, above 45 years and above 18 years started rushing to vaccine centers. Such centers are constrained with very limited number of available vaccine vials. There is tremendous confusion in public about the current vaccination procedures. The emergency use of vaccine should be a real medical emergency. It is urgency and need of the hour. In India about 2-3% people might have received second dose and 9-10% got first dose of vaccine as on 29th April. At the same time in U.S. 30% people received second dose and 44% received first dose, in Israel about 56% people got second dose and 60% people got first dose; in U.K. 21% received first dose and 51% people second dose; in Italy 9% people got second dose and 23% got first dose; in Japan 0.8 % people received second dose and 1.8% people received first dose (5).
d) Mask away man. People start keeping mask away from the face or stopped wearing mask in the crowded places, shops, malls, apartments etc. The mask became a “chin warmer” or “neck warmer” for many in crowded places rather than protecting them. This leniency to wear proper masks in public too might have contributed to the emergence and spread of virus among people especially at indoors and at crowded places.
e) Medical facilities and supporting systems. From the previous year’s Covid-19 appearance and its first peak has taught us many lessons especially in the capability and lacunae in the medical and health care system. Emergence of Covid-19 may be a wakeup call to revise and rebuild the health care system in the country. As in many countries, in 2020 India lacked many supporting systems in health care including availability of high quality masks, PPE, medicines, gloves, ventilators, oxygen supporting systems, number of health care workers, ICU s/ beds and hospital etc to manage and control with the emergence of Covid-19. People were desperately looking for even masks, gloved and hand sanitizers. Gradually the situation changed. In 2020 many multinational and national companies including automobile companies pitched in and diverted their capabilities to manufactures many essential medical care items like ventilators, masks, PPE, gloves, hand sanitizers and medicines at affordable and easily available. However, in some particular areas, policy makers did not pay serious attention to augment the health care systems especially in the up gradation infrastructural facilities in number of hospitals/primary health centers (PHC) including number beds/ICU etc , the numbers of medical and paramedical staff, in-built supply of medical oxygen, availability of emergency medicines etc. In India some state like Kerala, from the experience of Covid-19 in 2020, administration proactively upgraded oxygen availability in various hospitals (6). Many state and central government should establish such measures in various hospitals especially those are in rural areas in India. Government and private business companies should come forward to set up more hospitals with ICU/bed and oxygen plants. Time has come for both state and central government to make effort to address the shortage of doctors and paramedical staff in the country. It is paramount important for the country to have easily available, accessible and affordable health care systems for common man. We shall be prepared and quipped well to face and manage any such disease and health care calamities in future.
f) Hotels and Restaurants: Strict Covid-19 protocols needs to implemented and practiced when these business units get opened for public till majority of the population get vaccinated.
g) New Drug Discovery: As preventive and protective measures, many global companies developed successful Covid-19 vaccines. India and other developed countries have many top pharmaceutical companies who have shown outstanding capabilities to discover many new drugs and new chemical entities (NCE) against many viral and other diseases. Such companies shall collaborate to make global partnership to develop putative drugs on fast tract to treat and manage Covid-19.
1) Brown G. Scientists make grim prediction about second coronavirus wave Graeme Brown
14 July 2020. https://www.coventrytelegraph.net/news/health/scientists-make-grim-predi...
2) Thakur T, Patel DK , Soni B, Raval M, Chaudhary S. Prediction for the Second Wave of COVID-19 in India. Big Data Analysis. L. Bellatreche et al. (Eds.): pp. 134–150, 2020. https://www.springerprofessional.de/en/prediction-for-the-second-wave-of....
3) Scudellari M. How the pandemic might play out in 2021 and beyond. Nature 584: 22-25 (2020). https://www.nature.com/articles/d41586-020-02278-5
4) Were you on another planet during political rallies?': Madras HC slams ECI for COVID-19 surge. The New Indian Express. https://www.newindianexpress.com/states/tamil-nadu/2021/apr/26/were-you-...
5) Percentage of population in select countries and territories worldwide that had received a COVID-19 vaccination as of April 29, 2021. https://www.statista.com/statistics/1202074/share-of-population-vaccinat...
6) Jacob J, How Kerala ramped up oxygen capacity and supply India Today. April 27, 2021
Competing interests: No competing interests