In a scathing opinion piece on how India has handled the Covid-19 pandemic, the Lancet has given a thumbs down to information dissemination in the country. Lancet says India giving a positive spin to the Covid-19 situation , not relying on science despite a strong response at the outset of the pandemic is not a good situation to be in.
The British journal has underscored that the country has the world’s fastest growing outbreak of Covid-19 in absolute numbers according to World Health Organization (WHO). India has reported more than 5.6 million infections, which only started to increase after restrictions began to be lifted in June.
The journal does say that the country has responded well in many regards, especially for such a large and diverse nation. India imposed a nation-wide lockdown in March, which was praised by the WHO. During the lockdown period, tertiary care provision was increased, including access to specialist equipment such as ventilators. Testing numbers also increased quickly, with India being among the first to roll out innovations like pooled testing.
India has also been at the forefront of efforts to develop and manufacture a vaccine, both through domestic vaccine candidates and manufacturers such as the Serum Institute of India preparing production capacity for internationally developed vaccine candidates.
But many difficulties remain. The parallel crisis of falling incomes and growing hunger have not been addressed.
Migrant workers walked long distances home. India’s GDP was already falling before Covid-19, but the contraction of almost 25% year-on-year in the April-June quarter could make India one of the worst-affected countries economically, the Lancet says.
With the outbreak spreading from its initial foothold in cities to smaller urban areas and villages, pre-existing disparities in healthcare provision have become increasingly relevant. Rural health infrastructure in India can be sparse, and some smaller private hospitals have reported equipment shortages, especially of oxygen.
More than anything else, the journal says, there is an “atmosphere of fatalism mingled with false optimism that undermines effective use of non-pharmaceutical interventions such as masks and physical distancing”. “The epidemic in India is far from over, with a potentially huge burden of mortality and morbidity to come unless public health measures are used and adhered to. Without clear and honest communication of the risks of COVID-19 to the population, stemming the epidemic will be impossible,” it said.
The Lancet says that Prime Minister Narendra Modi’s reported communication with owners and editors of media organisations saying negativity must be avoided kept the press and several scientific organizations under pressure. The Indian Council of Medical Research (ICMR) has also been singled by experts for straying from scientific evidence. Referring to the ICMR’s deadline of August 15, 2020, for a vaccine, the Lancet says, the letter from Professor Balram Bhargava, the DG of ICMR, appeared to be at worst “politically motivated, at best overly optimistic”.
“Transparency of the data on Covid-19 cases and deaths, especially those underpinning the case fatality rate, has also been questioned, as detailed in a recent World Report. The Indian Government reports a case fatality rate of 1.8%, much lower than the reported rate in other countries, but it is difficult to know if the numbers are comparable,” the journal said.
“Hope is important, and recognising successes is vital, especially during a pandemic. But presenting the current situation in India with a too positive spin not only clouds reality but also hampers vital public health initiatives. Perpetuating unrealistic claims or failing to honestly report negative news creates uncertainty among the public and healthcare professionals, discouraging people from taking preventive action or taking public health messages seriously. India has the expertise in medicine, public health, research… To capitalise on these attributes, the country’s leaders must respect scientific evidence, expert commentary, and academic freedom, and not provide false optimism,” it added.
The Lancet has also questioned the fact that the ICMR has supported treatment with hydroxychloroquine despite insufficient evidence. It is important to mention that The Lancet was forced to change its editorial policy after publishing a study in May which concluded that Covid-19 patients who received the drug hydroxychloroquine were dying at higher rates. Figures on the number of deaths and patients in hospital cited by the authors did not match up with official government and health department data. The Lancet had to withdraw this study eventually.
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