Read on Twitter
Seeing a lot of explanations that attribute the horrific surge in India to one thing or another (variants, aerosols, vaccines, etc), all of which betray a facile understanding of how a crisis like this occurs. https://time.com/5964796/india-covid-19-failure/
"It's because of more transmissible variants!"
This might contribute, but as Dr. @ashishkjha points out, 40% of the population lives in multi-generational households. This is conducive to the spread of any variant, especially to older, higher risk people.
This might contribute, but as Dr. @ashishkjha points out, 40% of the population lives in multi-generational households. This is conducive to the spread of any variant, especially to older, higher risk people.
And for their contribution to the overall cases, more transmissible variants are a problem in the surge of severe cases that are overwhelming the inadequately funded health care system. The variants may cause more infection, but more people are dying b/c they can't access care.
"It's because WHO didn't send India the memo that this virus is AIRBORNE!"
Except when @WHO released their scientific brief discussing aerosol transmission in July 2020, the Union Health Ministry stated they were following this closely. https://www.thehindu.com/news/national/coronavirus-india-watching-who-alert-on-airborne-spread-of-virus/article32033339.ece?homepage=true
Except when @WHO released their scientific brief discussing aerosol transmission in July 2020, the Union Health Ministry stated they were following this closely. https://www.thehindu.com/news/national/coronavirus-india-watching-who-alert-on-airborne-spread-of-virus/article32033339.ece?homepage=true
While the ICMR continued to attribute spread primarily to droplets at the time, they acknowledged the importance of masks and distancing and also said they were closely following the topic. https://www.financialexpress.com/lifestyle/health/is-covid-19-airborne-what-icmr-advised-and-said-on-indian-coronavirus-vaccine-today/2024072/
And other scientists in India, like @RakeshMishraLab, director of @ccmb_csir, discussed aerosol transmission and the need for well-ventilated spaces: https://www.hindustantimes.com/india-news/is-covid-19-airborne-indian-experts-react-to-latest-finding-say-there-is-no-need-to-panic/story-Liu4eXfo1D6p6sVt61qV3L.html
And this wasn't news to Dr. Mishra, whose institute released guidance in March 2020 encouraging, among other precautions, interventions for aerosol transmission including masks, distancing, staying home, and ventilation. https://twitter.com/ccmb_csir/status/1239807737812283394?s=20
Since that time, Dr. Mishra conducted a study that shows, indeed, a respiratory virus like SARS-CoV-2 does indeed spread through inhalation. Which, again, WHO has acknowledged since last July. https://www.news-medical.net/news/20210108/Airborne-transmission-of-SARS-CoV-2-is-possible-in-enclosed-environments-a-study-finds.aspx
So the real problem with aerosol transmission isn't that WHO didn't bother to tell India about it. It's that you can't realistically say "get N95s & air purifiers & CO2 monitors to India NOW" when frontline HCWs are lacking basic PPE and supplies & there's inadequate testing.
And on top of that, the government implemented policies that put people at grave risk, including by encouraging large gatherings.
And btw, though this is a primarily outdoor event, close contact among large crowds with many infected people is a recipe for disaster. With enough people crowded for a sufficient duration of time, both aerosol & direct contact transmission will occur. https://www.bbc.com/news/world-asia-india-56770460
But the greater failure is in the government's inaction and bad policy decisions that put people at risk, per Dr. Sumit Chanda. We've seen this time and again here in the US and elsewhere around the world.
Both Drs. Chanda and Jha were scathing about the government's failure to act on warning signs that became the appalling tragedy we are witnessing today.
"It's because there aren't enough people vaccinated!"
Sure, that doesn't help, but also that's the result of government complacency and pursuing unrealistic policy goals motivated by politics rather than public health.
Sure, that doesn't help, but also that's the result of government complacency and pursuing unrealistic policy goals motivated by politics rather than public health.
Vaccines are still crucial for long-term suppression of the pandemic and for preventing a 3rd wave. But realistically, vaccines aren't going to be enough to contain the epidemic occurring right now without reliable data about regional hotspots to surge limited vaccine supplies.
And getting that data is a real problem when the government is spending more time trying to suppress criticism than prioritizing responses, including basic data collection that will allow for more effective public health interventions.
And this has been further complicated by a narrative that India had reached herd immunity in 2020, thus justifying government complacency, premature reopening, and policies that endangered people.
This was bolstered by "experts" who took it upon themselves to make definitive proclamations about this (sometimes as part of delivering a decidedly anti-vaccine message, ahem, Jay Bhattacharya).
The government pointed to a paper from September 2020 by their commissioned "supermodel" committee that likely grossly overestimated seroprevalence and suggested the herd immunity threshold had been reached.
https://www.ijmr.org.in/article.asp?issn=0971-5916;year=2021;volume=153;issue=1;spage=175;epage=181;aulast=Agrawal
https://www.ijmr.org.in/article.asp?issn=0971-5916;year=2021;volume=153;issue=1;spage=175;epage=181;aulast=Agrawal
At the time, @winterapples wrote an in-depth piece for Science, dissecting the model's flaws and including the perspectives of many Indian scientists, who strongly disagreed with that conclusion. https://science.sciencemag.org/content/370/6516/513
The present situation demonstrates clearly that this model's estimates were extraordinarily incorrect, and one more example of what I've taken to calling "catastrophic optimism." Optimism is important, but not at the expense of necessary precautions. https://www.theguardian.com/world/2021/apr/29/we-are-not-special-how-triumphalism-led-india-to-covid-19-disaster?CMP=Share_AndroidApp_Other
So what's the point of all this? Well, I've been more and more pissed off by hot takes attributing this tragedy to individual factors that are either beyond our control (variants) or the fault of specific people (WHO didn't say it was airborne) or misinformation (herd immunity).
The reality is more complex. It's many factors: failed leadership, misplaced priorities, lack of access to health care, PPE, & vaccines, lack of epi data to guide evidence-based policy, demographics, epidemiology, misinformation.
I'm no expert in complex systems analysis, but you don't have to be to understand that "double mutants" or what WHO has tweeted are grossly oversimplified and do not adequately explain a national public health disaster (nor should they be used to advance personal agendas).
Reducing this emergency to a quip about variants or transmission not only fails to educate the public about the complexity of the crisis, but does a tremendous disservice to the people who have lost their lives.
