Variant-Intensive Wave Wreaks Havoc on India’s Health System: Perhaps the Biggest Challenge in Modern Indian History

Variant-Intensive Wave Wreaks Havoc on India’s Health System Perhaps the Biggest Challenge in Modern Indian History

Mass cremations, terrified family members, and souls released before their time become ever more common as each day of this second wave of the pandemic surge intensifies. While so many assumed the waning numbers just weeks ago was a harbinger of normal days to come, most prepared for an ever dropping decline, not a steep rise of cases. Political season was in full swing, and everywhere has been a seeming shift back toward normalcy—from full political campaigns with no social distancing and masks to big weddings—all leading to super spreader events. India still has hundreds of millions living in abject poverty, with massive slums in cities such as Mumbai, Delhi, Calcutta and other big cities. In many poor communities, there is little space and large families live in close quarters—and next to no healthcare infrastructures is readily available. A complete tragedy. In the meantime, major oxygen supply shortages surfaced yet again and now India is on the brink as black markets for oxygen emerge and emergency measures shift all production to medical use. But is there time? In the fronts of many hospitals are families, with their elderly parents, many who are having difficulty breathing, in dire need of oxygen. Children are in tears as they try to calm their potentially dying parents or grandparents. It’s a devastating sight that turns the stomach in despair. While politicians showed no real rational leadership—there of course have been exceptions—the locks and stage-gated Indian society, where no commerce, trade or process flows freely, is forced now to open up and let help flow through, but it could be too little too late. It would appear that in some quadrants, health services have all but collapsed. The Indian government had an opportunity to prepare for a second wave after the first but it failed to act. Even after watching America, the biggest GDP and richest society in the world nearly drop to its knees as well as the more recent case of Brazil, its political and leadership class didn’t come through. In defense, it appeared that a youthful, relatively healthy population would spare the world’s second largest nation but that hope has turned into a nightmare in what has become the worst human catastrophe of the pandemic. But really a theme in many nations, especially fragmented democracies—that is, places with regional state or local autonomous rule that doesn’t roll up and standardize to a more rational emergency response plan—what ensures is conflict over the standard rules, norms and mores of pandemic response and the associated despair and death. The United States, India, and Brazil are the top three epicenters of the pandemic. But the U.S., a rich and streamlined country compared to the world that is India, seems to pale in comparison as far as the desperation and misery index. Nations didn’t collaborate but rather a form of nationalism emerged that pitted countries against each other in a race to see who could vaccinate their people first. The poor always lose in a coin-operated market structure. The second COVID-19 wave in India now sets world records for the number of cases per day with over 330,000 estimated new cases yesterday. In the meantime, only about 1% of the 1.4 billion population, the world’s second largest, have been vaccinated. As over 700 variants swirl throughout the society, including dangerous double mutants, this may be the biggest test for India in its modern history, and TrialSite suggests the world’s nations rapidly figure out how to come together, collaborate, and coordinate in ways not seen since World War 2.

TrialSite has commissioned a project to study the use of ivermectin, favipiravir and other treatments to determine whether the dosages need to be increased based on the circulating powerful variants. The All India Institute of Medical Sciences (AIIMS) recently released Interim Clinic Guidance for Management of COVID-19 based on the massive surge in cases covering patients with mild, moderate and severe cases here.

AIIMS Guidelines

The guidelines are segmented into mild, moderate and severe disease. For mild, action “must” include home isolation, physical distancing, hydration, vitamins and other care as well as maintaining close contact with the treating physician. Ideally, the patient can probe for temperature and oxygen levels.

If conditions worsen (e.g. difficulty breathing), the patient must seek immediate medical attention. Patients are offered the suggestion to take what are classified as therapies based on low evidence, certainly including Ivermectin (avoid in pregnant and lactating women), Hydroxychloroquine and/or inhaled budesonide. Again, the specific dosages and instructions for all stages can be read here.

Vaccination Status

Four (4) vaccines are authorized here, including 1) Oxford/AstraZeneca AZD1222; 2) Gamaleya Sputnik; 3) Serum Institute of India (Covishield); and 4) Bharat Biotech Covaxin. India has another 10 vaccines in clinical trials. Presently about 1% of the nation’s population is fully vaccinated (e.g. two doses). As TrialSite reported, India, the largest vaccine maker, has exported much supply but put a temporary ban on all exports till the situation gets under control here.

Under the Gun

Prime Minister Narendra Modi truly fell asleep at the wheel of leadership. While America, the world’s largest economy, has been severely hit by this pandemic, the behavior in India became lackadaisical as political campaigns and super spreader events seemed perfectly acceptable.

Now in a big-time reactionary scramble, the Prime Minister has opened up vaccines for all adults but supplies are perilously short. While the country is trying to ramp up its vaccine production, imports from Russia, for example, are on delay as reports are from Dr. Reddy’s, the Sputnik distribution, that vaccination supplies are lagging behind by at least a month. So even as the government opens up more eligibility, this doesn’t mean the supplies or the wherewithal to administer will be here anytime soon.

Chaos, haphazard planning, or the lack of any planning—combined with a severely class stratified society ensures that the poorest of the poor will have the least options for any help in hospitals, as reports of full capacity are now ubiquitous. With mounting concerns of not just a health system collapse but broader disorder, the country’s leadership is working to cut down on the various locks and staged gates permeating Indian society.  Much international help is needed, and now.

Responses

  1. Hear me!
    Ivermectin does work for patients with low oxygen saturation (<90%). Adding ivermectin inhalations 4 ml of 0.5% ivermectin aqueous solution (repetition interval 48 hours, up to 4 inhalations ) to standard therapy for 26 patients allowed 23 patients to avoid resuscitation over the past 6 week. The ivermectin solution was poured into the humidifier of the oxygen generator (forms foam).

  2. use of Ivermectin needs to be done in combination with daily zinc which underpins effectiveness of immune system. Also for hydroxychloroquine. Both of these have less effectiveness on their own. Both act as ionisphores for zinc and carry it into the cell so that it can inhibit RNA replication of the virus. In addition Ivermectin has been shown in both in vitro and in vivo studies to block ACE receptors on cells which the spike protein of COVID19 uses to as its gateway to enter cells. Thus Ivermectin in combination with zinc has been shown to have maximum benefit for both prophylactic use and treatment. Zinc tablets should be freely available in India as they are in almost every other country. If diets are poor so will zinc levels in individuals, thus compromising their immune systems. In addition Vitamin D is also indicated to support proper immune response. Why is there no mention of these as part of a treatment strategy in India???