RamananLaxminarayan , Director and Senior Fellow at the Center for Disease Dynamics, Economics and Policy, was among the experts who underscored the importance of testing and predicted the scale of devastation of the first wave of COVID-19 as early as in March 2020. The lockdown, he had stated in many interviews last year, had only slowed down the virus, not eliminated it. He feels that while the second wave was not avoidable, the scale was entirely preventable. Laxminarayan, who is an Affiliate Professor at the University of Washington, a Senior Research Scholar and Lecturer at Princeton University and a Consultant with the World Health Organisation, has co-authored an epidemiological study of the transmission pathways and mortality of COVID-19 in Tamil Nadu and Andhra Pradesh. Among other things, the study suggested that primary data were of crucial importance to guide control measures; and that surveillance and contact tracing were critical components. In an interview to
Frontline , Laxminarayan, who has been involved in helping people get oxygen through a forum called OxygenforIndia.org, said that preparedness was totally lacking in many parts of the country and added that people dying because of lack of oxygen was unpardonable. Excerpts:

Multiple waves have been noted in other countries, and second waves have been severe in other countries as well, but none as overwhelming as what we are seeing in India. What we are witnessing is the scale of devastation that I had anticipated in interviews last March when calling for an early lockdown. That lockdown helped temper disease transmission, but this year, with no restrictions on activity, the virus has shown what it is capable of when it is allowed to transmit freely.

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My own assessment in February was that the low caseload was partly a result of immunity pockets in some urban areas but also that if everyone returned to normal activity, there could be a significant uptick in cases. There are others who believed that COVID was essentially over in India, and that has not been the case. The second wave was not avoidable but the scale, and lack of preparation, was avertable. We were told that there was enough equipment, COVID beds on trains and supply of drugs for any eventuality. Now we see that the preparedness was not just lacking, it seems to have been wholly absent in many parts of the country. Some things, including Intensive Care Units and critical care physician capacity, are hard to establish in a short time. But most people today are dying due to lack of oxygen, an issue that could have been solved for a trivial sum of money. That is simply unpardonable.

The higher mortality in this wave is first and foremost going to be because of people who died needlessly due to lack of oxygen. Other explanatory factors may be present but will likely play a smaller role.

It is really hard to tell and it will depend entirely on our own behavioural response. If mass gatherings continue and we give the virus additional opportunities to spread, this could go on for a while.

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In that study, we observed a median time to death of five to six days. That time seems to have dropped even more during this current wave and there does seem to be a combination of differential impact of a variant and people coming into hospital later, likely because of the difficulty in finding beds.

Vaccination is our only way out of the pandemic. At the current rate of vaccination, getting to a reasonable level of coverage that will be protective is going to take more than two years. However, India has the capacity to expand manufacturing. A five-fold increase in supply could see us exiting this pandemic in 2021 but that takes political will and good execution.

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I don’t think this virus is done with us. It is possible that places that seem to have performed better today may end up worse depending on the way transmission unfolds. We have to see what the impact of variants will be and it is not inconceivable that one of these could cause havoc in places that seem to have avoided the brunt of the pandemic thus far.

India’s size, population density and slow rate of vaccination all put it at risk for being a giant Petri dish for generating new variants, since viruses do mutate. Some of these variants could pose a risk both within and outside the country. The current level of sequencing is wholly inadequate and one of the immediate responses should be to vastly increase that capacity. This is in the interest of not just India, but the whole world.