Monkey see – Monkey Do ?

This is not a well-thought-out piece but a sort of rambling rant of thoughts in my mind for a year.  My previous writing on Covid is here and Ayurveda.

I have no medical/biology/medicine background nor am I am a scientist nor do I claim to understand statistics. Read this as some thoughts of a layman.

It’s been a year since India went hard into the lockdown. And after trying N things for over a year, we are back on the verge of lockdown in Maharashtra. (at least the CM keeps threatening a lockdown). Unlike initial predictions of respite from Covid in warm weather, it appears both Covid spikes in India have occurred in the considerably warmer weather while mysteriously getting low during the winter months. While I am yet to find a convincing argument that explains several strands associated with mechanisms of spread of Covid19, some aspects of the challenge, namely public reaction needs to be assessed as we get into the second year of the pandemic.

A question to ask here is – how different would the global reaction to covid19 have been without the world witnessing the Chinese state response in the first place? Did it act like a guess in an optimization algorithm – which eventually decides the outcome in some cases no matter it’s value? The European nations first chose to ignore and when they acted they acted in echoes of China. While totalitarian states like China or the gulf countries have been able to reign in the pandemic, no significantly sized country has. What would have been the Italian reaction had they First Guess been other than China? This is not to condone any herd immunity strategies – but at least in a country like India, the cost-benefit analysis needs to be done.

Additionally, should we ask if how much did lockdown work? Dr. Watve, a scientist based in Pune has some good blogs on the topic. While I am not convinced by Dr. Watve’s reasoning yet, its opposite doesn’t appear convincing too.

What else (if anything) could we have done differently? especially in India.  Critics of government often talk about the lack of testing as an issue in India. Personally, I feel once we get a critical mass of vectors, testing and tracing becomes merely a placebo exercise. Aping the WHO models on test, trace on Indian scale (at least with the resources we have).

Another thing that continues to bother me is the Fomite transmission theory. Going through the literature, I couldn’t find convincing research to believe it in the first place, let alone taking it to the insane level it was taken to – especially in India. Newspapers and milk delivery was turned off for months. Home deliveries of groceries were turned off initially. Shops were open only for small durations of the day. All these measures together meant that whatever essential services were available were often extremely crowded with people.  How much did these bizarre policies initially aid the transmission of covid?

I still remember vividly the most spectacularly stupid team meeting I have been part of. This meeting took place around 10-15 March 2020 to let the employees know that the company was doing everything they can to stop covid around the company premises (which was mostly a rain of sanitizers). In this meeting, the management called around 30-40 people in a closed room and talked without masks (that was early 2020, and even the scientists and WHO were maskophobic back then). Anthony Fauci who today, parades in “Rand Paul’s words” in two masks after getting two shots of vaccine, was saying a year back that masks are unnecessary (or even counterproductive). It’s perfectly acceptable for humans to make errors and correct those in the course of action – that’s something we should all try to do. But an analysis of what led us to make those mistakes in the first place ought to be done. Or was it just another example of the Sun revolves around the earth?

Local authorities (including society chairmen etc) have been on a different level of insane. After seeing city authorities sanitizing roads, pavements, trees, and even migrant laborers, whenever a patient is found in a building, the staircases, floors, and grounds continue to be sanitized. I am not even a novice on Bacterial evolution, but on my rudimentary understanding- this use of sanitizers scares the shit out of me. It is not that I am totally sure that fomites don’t spread covid, but the focus on fomites has also meant the possible aerosol spread was not focussed on. What’s worse, in my opinion – the focus on fomites and sanitization has lulled large swathes of people into the sense of false security. People wash their hands, sanitize groceries, but when talking to people often take down masks. Almost 95% of the cases I have heard have of contracting covid from a distant family member indoors or at some function. Yet people continue to focus on sanitization while attending public gatherings and religious ceremonies. At one point in my society, deliveries had to be collected at the society gate while members celebrated Diwali, New years, and Republic day inside without masks in large numbers. To this day, servants and handymen are treated with suspicions while friends and family (some of whom may have more exposure) arent. We have a separate lift for non-members – while members don’t mind traveling in lifts with unmasked members.

However, another question posed by this pandemic is, what should be the role of the state? and what should be its Aim?

  • Is the Aim to try and prevent every covid infection – at cost of the economy and livelihood?
  • Is the aim to avoid the overcrowding of medical facilities so as to avoid collateral damage?
  • Is the aim to keep pushing potential cases in the future – so as to reduce potential cases by vaccination?

When it comes to livelihoods, we need to separate two strands – the effect on the economy due to natural fear in people & and lockdown invoked economic downturn.

The mathematics of economic catastrophe is clear enough to follow – while the mechanism of spread seems to allude even the best of the minds. Every time someone comes up with reasons for why Covid stopped spreading rapidly around the end of 2020 in India and began afresh in 2021. The lockdown had ended in October and *new normal* activities had opened by November, but it appears this increased activity didn’t immediately accelerate the pandemic. Intuitively I would guess it takes time to gain a critical mass and a similar time for it to reduce. The momentum of the critical mass of vectors ought to carry on the spread (due to unavoidable contacts) in spite of overall contacts being low. Maybe once the first fuel was exhausted, it took time to gain a similar mass of vectors before it could truly explode. Add to this the new variants and reinfections (especially those who were asymptomatic the first time), then maybe the second wave starts making sense. Or maybe I am just pulling theories out of my ass which has no value – Either way I don’t mind as no one seems to have any deep insight into this.

All well-meaning people have been trying to shield the elderly for over a year. I have myself spent hours convincing older people to stay secure. But at what point does this become unbearable for a 75-year-old? Would it be wrong for an older person to be to think that they might not survive the pandemic (dying naturally amidst it) to live the end of the pandemic? Can they decide to take the risk of living a few months dangerously ahead of being condemned to a year in lockdown. (This equation has changed now with vaccines but the question still carries some weight I reckon)

Maybe this time next year we would have more answers than we have at this point. And hopefully, we would devise better strategies in countering such events in the future than acting like imitating monkeys in an experiment.

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18 Replies to “Monkey see – Monkey Do ?”

  1. While totalitarian states like China or the gulf countries have been able to reign in the pandemic, no significantly sized country has.

    Depends on what scale you are talking about. Compared to China, there’s only India and maybe the US.

    On the other hand, if you are thinking about population density, various non-totalitarian countries in East Asia managed to suppress the pandemic in non-totalitarian ways, to the extent that normal life never really got disrupted there: Taiwan, South Korea, Japan, Vietnam, are examples. (Not sure if Vietnam is semi-totalitarian, but they didn’t do what the Chinese did in Wuhan.)

    Going toward Australia and NZ, they also did not see big outbreaks but they did seem to use totalitarian methods: the Aussies were locking down entire cities that saw like 3 COVID cases.

    About why India didn’t see more COVID cases in the winter while there’s been a spike during the recent scorching weather (memo to those who live outside India: most of the country gets blisteringly hot by March unlike in more temperate climes), I have a mundane explanation and a crackpot one.
    – Mundane: once the vaccination started, basically everyone started taking it more easy, regardless of whether they themselves got vaccinated.
    – Crackpot: if your family is as desi as mine, you know that people here associate the cooler season with sickness and unhealth, i.e., the “cold” is supposed to have an intimate connection with the common cold and its variants. In the winter, people expect to get colds, flus, etc., and they generally don’t bother to go to the doctor but rather ride it out with dollops of Crocin and Vicks. Most of the country hasn’t heard of flu shots either. So it’s likely that a lot of people who got COVID in the winter just never bothered to get it diagnosed. But people don’t expect to get colds in the March heat. Hence most doctor visits, more tests, and more COVID diagnoses.

    (I’ve commented in the past that I believe the “numbers” we keep seeing are more a sociological than a serological phenomenon. But of course, I could be completely wrong.)

    1. Numinious,

      wrt summer temps and ppl living indoors i tend to agree. that could be a reason.
      However on the other two points, i dont agree –
      People didnt let it go in january – they let it go in Novemver itself – Diwali was celebrated very enthusiastically – When i compare Ganesh Festival – which saw a huge spike in a fortnight to Diwali – the difference is clear.
      About the reporting problem due to Desi attitude – No the difference is so stark – Mind you from all experience – Covid symptoms even the mild ones are drastically different from other illnesses. The fatigue is terrible even for people with no fever and cough- the Tasteless ness and smell loss are very remarkable too. So i dont see that being true.

      The cases are tangible enough – when you just look around – friends, family, neighbourhood, celebrities. ITs pretty clear we had a major drop in Winter to see a major spike. Testing positivity rate was down to 4% in Decc – its back at 10-15%.

      About eastern countries – I would wager lot of cross immunity in those countries along with other reasons stated. As for Aus/NZ they re too small and too sparse than even European standards. With good infra they can handle the pandemic as they have done.

      The interesting question of comparison for me is MAHARASHTRA Vs UP/Bihar/Bengal. MH is accounting for 60% of cases. Its not just the cities – even rural areas are badly affected. Whereas the Gangetic plain is not while Punjab is,

      Pakistan seemed to have gotten over the first wave quickly – even theyre back at tall second wave. Just lot of confusion

  2. Do people here have any theories on why we are unable to ramp up vaccination?

    It’s deeply frustrating to see.

    1. extremely frustrating. just good old Indian Governments i guess – center and state.
      BTW UK has been far ahead of the world in vaccination. Great work by the folks over there. Much tougher than Israel or Gulf nations. Theyre vastly ahead of europe and even better than east asia and USA/Canada

      1. UK has certainly done a good job. By the time the Indian team reaches England in August, we might have crowds in the stadium.

        From what I have heard, US has picked up pace as well. One of my friend’s mom from Delhi visited her brother’s family and got vaccinated inside a week. Even one of my friends got vaccinated today.

        We are stuck at the 2-3 million mark in India. And I’m hearing of lot of people getting Covid even after their first shots. Couple of them in my society. Also of cases where the antibody counts have gone down very quickly.

        My somewhat suspicious take is that the AstraZeneca vaccine is much less effective than Pfizer vaccine. The government knows this. So they don’t want to go overboard on it. But that then begs the question, why not let Pfizer in for private buyers?

        1. i know loads who have got covid after first shot of AZ. cant comment of efficacies ofcourse. Pfizer/Moderna seem to have done a better job Test efficacies wise. I hope in coming week government approves all vaccines in the table – Pfizer,Moderna, sputnik and JnJ and get private players in. Those who want can pay extra for vaccines. everything will help reducing the surge

          1. My understanding is that the Pfizer and Moderna vaccines are no-gos in India because of their stringent cold storage requirements, which we don’t possess, at least in sufficient quantities. Is that right?

            On the efficacy of the AZ vaccine, are the people getting infected after their first shots largely asymptomatic or in dire straits? You seem to be in ground-zero of the recent spike. In my circles in Bangalore and JH state, I’ve only heard of a couple of people getting infected (and recovered). There seems to be something especially distressing about this disease in MH.

        2. My somewhat suspicious take is that the AstraZeneca vaccine is much less effective than Pfizer vaccine. The government knows this.

          If this is the same vaccine the UK govt has been using, wouldn’t they have arrived at a similar conclusion?

          And if the Indian govt was indeed thinking this, why would they increase the wait time for the second dose from 4 to 8 weeks?

    2. I thought India had already administered >70m first jabs. Not too bad compared to the US that had started earlier and is at ~100m. As far as efficacy is concerned, the AZ is at ~75% after both doses, so seeing vaccinated folk catch the virus should be fairly common. More importantly perhaps, is that the efficacy in preventing death is almost 100%. That should be what we are after. And the delta between pfizer/moderna and AZ/JnJ is less significant in that context.
      The word I’m getting from health workers here is that the over 60 cohort did not come out to get it sufficiently. Only 30% coverage . Hence they accelerated the roll-out to the 45-60 yr cohort. I don’t know if administrative capacity is the bottleneck here. I presume a lot of rural ppl haven’t been affected whatsoever. and don’t see the need to get it. In my circle, absolutely everyones parents have gotten it.

  3. Anecdotally, when I went with my dad to get his shot (AZ/Covishield) at a govt hospital in mid-March (in Bangalore), there was no one ahead of us waiting to get a vaccine, though someone was resting after getting a jab. Well after my dad got his shot, another person showed up. And this was on a weekend in a facility that offered free shots (my dad did the booking himself.)

    So it didn’t look like people were particularly keen on getting vaccinated, though I’m not sure if attitudes have shifted since. Even my dad took some convincing, but that probably had more to do with Modi himself getting vaccinated and the buzz going around in the right-wing Whatsapp groups he subscribes to than my personal exhortations.

    1. Yupp. Pune was hit pretty bad first time around. And it’s as bad now ( just docs know what to do from get go). My mom got vaccinated mid March. There was terrible rush. Her appointment got delayed from Friday to Saturday due to unavailability of AZ vaccines.

      Yeah AZ vaccines have good record in reducing severity and ppl I know r getting milder infections after even Dose 1.

      We don’t have capabilities to ship Pfizer Moderna vaccines accorss the countries. But Urban centers definately ought to have the capacity to start those vaccinations.

      JnJ and Sputnik might also do the trick. All seem to work to a certain degree.
      Govn really can charge more from masses who can afford it. 250rs is a paltry amount for large section of country. They can pay more. Anyways thats not gonna happen I fear.

      Why is Pune worse than Mumbai Delhi Bangalore beats me though. It’s much smaller than all these cities

  4. I wonder what happens to the IPL. Also, which foreign players will show up if it does go forward. Remember that the Aussies cancelled their official tour to South Africa when they saw a spike in Jan/Feb. It’d be massively hypocritical of their players to come here and play in the IPL now.

  5. We are peaking at 4 million people vaccinated per day in a week. Some days it is down to 500k. So net, India is currently at 15-20 million vaccinations per week. We should end up vaccinating the entire 45+ cohort somewhere by end of June. That should suppress the death rate to negligible levels.

    I don’t think Covid infections will ever go away. They will be here for decades. Tuberculosis killed 80000 Indians in 2019 – has been killing at such annual rates since the 1940s. It spreads via airborne aerosol mechanism (coughing, spitting, sneezing).

    1. Hope that happens. Maybe we would also vaccinate all 30+ year olds by Next summer. With potential booster shots for the older folks.
      Disease will stay. Pandemic has to end though. People were just getting back on their feet – again have the rug pulled out. Restaurents, travel agencies and all the other folks. Can’t even imagine their fear and pain

  6. Cities like Delhi and Bangalore can manage the Pfizer vaccine cold chain.

    The number of daily vaccine shots has doubled here in Delhi since 1st April unlike the rest of the country where it’s stayed more or less constant. So there’s definitely a demand in the younger cohorts in the city.

    I’d also think that it makes more sense to double down and reach herd immunity in large population centres than target an even spread across the country.

    With that assumption, it’d make a lot of sense to let all the vaccines be available for purchase to anyone 18+ so that offices, schools, restaurants can open up.

  7. What dashboard do you folks use to track the vaccination numbers?

    The numbers given on the Cowin dashboard, on the MOHFW website, and on Covid19India dot org all seem to be different.

    (Although directionally they are similar)

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