Omicron wave in India

Recently, i have been busy on other projects. But i felt going back to writing a little more on Pandemic. Yes, the bad news is that Pandemic is not over and there may be (will be) a new wave of Omicron variant of Covid-19 in India. The figures of detected Omicron cases (few dozen) are meaningless numbers and real numbers are much higher and we already have community transmission of Omicron.  I will get right to some core points.

Certain positives

Much better vaccination rate compared to the time of Delta wave

 

The vaccination rates and vaccine production in India in last several months has been good. I know, its not up to the mark in many ways - vaccinations per million, vaccination for children, diverse pool of vaccines still not available (mRNA) etc etc. But we now have fully vaccinated nearly 55% of adult population (would be over 60% by end of December), which frankly i didn't expect us to achieve back in May. Covidshield/Astrazeneca production capacity is around 250-275 Million per months right now (will get to Covaxin in a minute). So we have significant protection against severe disease and deaths - symptomatic infection after vaccination or reinfection is still a problem but its not as severe as we saw in Delta wave when we practically had no vaccinations.

Omicron wave not as severe as Delta wave (hopefully)

 

The early indicators suggest that Omicron wave will be less severe than Delta in terms of mortality and severe diseases. The data as of now is encouraging from South Africa. While cases are rising rapidly, the hospitalizations and specially the mortality do not show the same level of increase. The number of admitted patients also have less severe illness, lesser patients are admitted in ICUs, ventilated and oxygenated compared to Beta and Delta wave in South Africa. South Africa has low vaccination rate and despite that is able to cope with Omicron wave because of its less severity. 

So early indicators suggest that we will have lesser cases of severe disease. This is due to many factors. There are some interesting early studies that gives insight on why Omicron spreads faster but may have lesser severity. In India, most of the population has already been infected and has some level of immunity (how much?). Then we have already vaccinated significant part of adult population and older people (though many still remain unvaccinated). And a lot of old age & immunocompromised population has already died in past waves (think in terms of real statistics, not govt data). So much of our surviving population is better prepared to weather a next wave (kind of a morbid observation). But we have to see how things shape up in near future in other countries.

Areas of Concern

What will Omicron wave look like?

 

We have some idea on what Omicron wave will look like, but what actually it will be? - we don't know. Since there is a high risk of rapid rate of transmission, we have to see how this risk materializes in India and how our healthcare system can handle it. While Omicron may not be as deadly as Delta, it spreads fast and can overwhelm hospitals if we have too many people getting infected at the same time. We know the problems of India's healthcare system which is massively deficient compared to developed nations. We don't expect to see the Oxygen shortage crisis as we saw in Delta wave, but think about rural India which doesn't have any healthcare system at all. If there is huge spike of Covid cases and even if very low number of infected people needs medical care and Oxygen, what will happen?

 

Vaccines

 

The problems with our vaccination are quite obvious. We still don't have access to "Rich man's vaccines" - the mRNA vaccines that most developed countries are using like in Europe & North America (read 1 & 2). mRNA vaccines are known to have the best protection against Omicron (with a booster shot). Our pool of vaccines is limited to Astrazeneca (Covishield), Covaxin and Covovax (which is interestingly not yet licensed in India while approved by WHO). Much of our population is vaccinated by Covishield while nationalistic Covaxin lags behind.

While we expect that two doses of Astrazeneca will protect against severe disease & death against Omicron infection, we still don't know to what extent. What is AZ efficacy against Omicron against severe disease and death? Studies are ongoing. On Covaxin, our Yes men scientists (more on them in a minute) have made baseless assertions about its superiority against western vaccines. Two doses of Covaxin may offer negligible protection against Omicron if it follows the results of early studies on Sinovac which is also inactivated virus vaccine. The Covaxin efficacy against severe disease and death (by Omicron) is not known and we should start studies on this urgently.

The problem will be the partially vaccinated people which will have very little protection, the people who missed out on second dose and people who have not been vaccinated at all. Then there will also be a problem of Demographic vaccine disparity. As much as 41% of our population is below 18 years of age. So 60% of vaccination of adult population looks good but now think in terms of total population. We know the impact of Covid in younger people is low but its still an area of concern and unvaccinated people will become carriers of virus. And we have problem with our pools of vaccines. AZ has a risk of blood clots and several developed countries have not recommended it for younger population & children.

 

Another problem with India is lack of booster shots policy even as we are on cusp of 3rd wave. The Vaccination of healthcare workers started in Jan-Feb earlier this year and many of the workers are more than 6 months past their second shot. We should've formulated and executed the booster shot policy at least for healthcare workers in Oct-Nov. Ideally we needed booster shots policy for elderly and immunocompromised as well but unfortunately, we may not have sufficient quantity of vaccines (we don't have scarcity of vaccines). But booster shots for Doctors, nurses and frontline healthcare workers is not a problem as it requires only a few doses. I don't know why Govt has not done it and delayed the decision as we enter into 3rd wave.

Its also unfortunate that while central govt is lazy, the state governments have also showed little competence and vision on booster shots policy. State govts can make their own booster shot policies for healthcare workers. Let central govt object to it and haggle it out with them. If several states collectively pressurize center, then we can have booster shots for healthcare workers sooner. Booster shot policy has nothing to do with licensing protocols as the vaccines are already licensed, now its only a matter of giving extra shot. The central govt Cowin portal presently doesn't register a 3rd shot but this is not a problem. The states can create their own temporary system of registering booster shots for healthcare workers and later when Cowin is amended, the state govt data can be incorporated and registered into it. On policy of booster shots, we should focus on AZ / Covishield on which we have positive data of efficacy results. Booster shot on Covaxin needs further studies to establish efficacy.

Yes Men Scientists and their policy misguidance

We know that a policy prescription of India's Covid response is in hands of Yes men scientists. They are people like VK Paul (NITI Aayog member), Manindra Agrawal (member of India's Covid-19 supermodel committee - whatever that is), Balram Bhargawa (ICMR chief) etc. These scientists are morally bankrupt, ethically compromised and possibly even scientifically incompetent. The job of scientists is to give objective and scientific policy guidance and ideas to govt. But job of Yes Men scientists is to lend their professional and "intellectual" credentials in supporting foolhardy, reckless and destructive policies of political govt which has caused great tragedy in this country. Yes Men scientists have lend their PHD degrees to legitimize Govt policies.

 

There are problems in India's Covid response strategy and Yes Men scientists have done nothing to resolve these problems. For example we are still sleepwalking in this pandemic because we don't have a reliable mechanism of data and statistics. If Covid is a war, we have wrapped a blindfold around our eyes and shooting in the dark. Much of the problems with collection of data is due to structurally deficient healthcare infrastructure (Covid dashboards of states like UP, Bihar, Madhya Pradesh etc etc have no basis in reality). But some of the critical data can be organized which govt has so far ignored like a robust system of AEFI recording (at least for the healthcare workers), increasing genomics testing to detect new variants and creating a real time updated dashboards of all the critical data.

 

Bhargava, the ICMR chief, has been making wrongful statements about efficacy of Covaxin and maligning reporters who have raised valid questions about Covaxin, its efficacy and some unethical aspects of its trials (read 1, 2, 3). ICMR under Bhargava has also stalled Booster shot policy. On one occasion, he said that "there is no scientific evidence so far to support the need for a booster vaccine dose against Covid-19" - which flies in face of reality as many countries have already adopted booster shot policy.

Our Yes men scientists have made wrong claims about variety of things. To name a few, VK Paul projected the end of first pandemic wave in last May. VK Paul also promoted Covaxin even before its Phase 3 Trials data was published and before WHO approved it. Manindra Agrawal has legitimized official govt data with his complex mathematical models. According to his model which is remarkably in parallel with official data, there is very little to question about excess cases and deaths. Agrawal has also published some papers about his SUTRA model where he flaunts about his accurate projections. Its ironical given that he wrongfully predicted Delta wave peak at 170K cases per day. Then he later revised his estimates to 390K and claimed to successfully predicting the peak. Perhaps the most outrageous work of Agrawal is his report on UP's handling of pandemic, essentially covering up the gross mismanagement of UP Govt.

There now appears to be some difference of opinion among our Yes Men Scientists. Agrawal two weeks ago projected Omicron wave peak at 100-150K cases. However, VK Paul has a grim view of things as he said that India might have 14 Lakh cases per day in Omicron wave considering the developing situation in Europe. The problem with Agrawal is that he likes to jump the gun and make predictions, revise predictions later, and still flaunt that he successfully projected India's Covid curve. Its like throwing enough darts on dart board and some will eventually land.

Its a sorry state of affairs about our technocrats who are guiding our Covid response policy.

Political leadership which disregards public safety

Our Yes Men scientists have been misguiding our pandemic response policy but we know that there's a broader problem. Its our political class - the sociopathic political elites who don't have any empathy. They deny the Oxygen shortage deaths, the deaths of migrant workers, the deaths of frontline healthcare workers. They have convenient way of denying humanitarian catastrophe of this pandemic by saying - "we don't have data". They don't have data on death of healthcare workers, infected people who died due to Oxygen scarcity, the migrant workers who were made to walk hundreds of miles on national highways and died of exhaustion (read 1, 2, 3). They have even denied the mass graves and mass cremations of Delta wave. Our sociopathic politicians are scientifically ignorant, morally & intellectually corrupted and worse - psychologically unstable.

My concern is upcoming election season and notably in most populous sate of Uttar Pradesh. The coming elections will be held in states (UP, Punjab, Uttarkhand etc) which have combined population of around 260 million. This is nearly one third population of entire Europe. One of the strategy of political parties in India is organizing huge election rallies to show political strength. These rallies were organized during elections earlier in Delta wave and they became the super spreader events.  The rallies of tens of thousands of people, roadshows and marches where there is no social distancing and mask wearing.  Our politicians will use the poor people in their rallies as sacrificial lambs to achieve political results. Its projected that Omicron wave will peak in February next year, around the same time when election season will be in full swing. The election rallies are already in full swing while we are under a shadow of new pandemic wave.

The impact on India's Education system - Possibly more delays in reopening of schools & colleges

Another unfortunate impact of new pandemic wave will be on India's education system. Schools and colleges shutdown early last year with arrival of Pandemic and this caused huge disruption in our education system. The learning of children of all age groups was affected, the school classes stopped, the university & colleges closed down, the model of examinations and promotions has to be changed, and began the era of digital education which is severely biased towards most of the student population of this country. 

 

India is light years behind western education system which could cope with online learning and new models of education. In India, where we have severe poverty, socioeconomic inequality and poor internet infrastructure, the poor students were just thrown off from their learning process (read 1, 2, 3, 4). As much as 60% of students in India don't have remote learning facility and even private institutions who provides online classes have much lower standards of education in comparison to in-person classroom education. A computer with internet is needed for online education but only 8% of homes have it. For upper middle class and rich people, they could afford private tuition to their children, a great luxury which most Indians can't provide to theirs.

As Covid subsided, India went back to in-person school classes on a limited scale (classes are not mandatory in most states as per Covid guidelines on education). But even this limited resumption of education is now under threat. India's academic session for schools starts from March-April and this may also be jeopardized if we have new Covid wave lurking around at that time. Another problem with resumption of schooling is our lack of vaccines for children. The mRNA vaccines which have been safely used in children in developed nations are out of reach of India.

The pandemic impact on education system is much broader. Many private schools got bankrupt, teachers lost jobs and those who could keep it were heavily underpaid or even worse - went without pay for many months (read 1, 2, 3, 4). There will also be major long term impact of disruption in education system on quality of labor force and this will also transpire negatively into economy down the road.

Impact on Economy and future of uncertainty

There will also be impact on economy due to Omicron wave as we will see more disruptions in economic activity, specially service sector like small businesses, offices, commercial markets, restaurants, social hubs etc. I don't think we will go into full scale lockdowns like first two waves but there may be some limited restrictions. Also economic disruption most severely affects the poor people who have already been beaten badly by this pandemic. 

Developed nations like America have taken the pandemic induced slowdown head on with variety of strong economic relief measures to support their population like extended unemployment insurance, expansion of food aid programs, paychecks to families with young children, debt relief, assistance to small businesses and enterprises. Here in India, there has been very limited direct fiscal program to fight pandemic induced slowdown. Much of the pandemic relief measure was imaginary credit - meaning loans - while people needed fiscal support. The extended food aid program (food festival) is fortunately been extended which was meant to expire last month (actually motivated by upcoming elections).

The economy has still not recovered from economic slowdowns induced by past waves of pandemic. The jobs lost in last two years of pandemic have not been fully recovered and labor force participation rate continues to linger near its lows. Economy has nearly 80-90 Lakh less salaried jobs compared to pre-pandemic period (salaried jobs stood at around 86-88 million and stand today around 77 million). The pandemic induced unemployment and income depreciation has evaporated the of savings in poor and middle class in last two years.

The bigger problem is actually the sentiment of uncertainty created by newer waves of pandemic. Economy has been crawling since last two years and when it feels that it can stand up and start walking again, a new wave of pandemic begins. This was what happened in past delta wave. The problems with economy are magnified by the incompetent governance and bungling by govt. We can only hope that the Omicron wave will be nothing like the previous wave we witnessed and we hopefully won't have to shut down economy again.

Conclusion 

I think that Omicron wave will be less severe than Delta wave in terms of healthcare costs and mortality. I believe that Omicron wave may cause disruption in economy and stall the reopening of our schools and education system. I am concerned about the uncertainty and drag of pandemic on economy - as pandemic stretches to 2022. I am also disappointed with our style of governance and pandemic management which reflects that our policy makers have learned little from tragedies of this pandemic. If Omicron was really as damaging like Delta variant, then our policy makers would have been caught pants down once again. I hope we will pass through Omicron wave with minimal damage and disruption, and hopefully this will be the last wave of this pandemic (better not jinx it).