NEW DELHI—While the current second wave of COVID-19 isn’t unique to India, the South Asian nation presents a unique set of problems that are aggravating the surge of the disease, according to a global health care policy expert who has authored a book on the pandemic.
Meanwhile, experts are warning that a third wave of COVID-19 is inevitable in India.
“But it’s the same way which happened in the U.S., which happened in the UK and Europe, France, Italy all over. So this is nothing new. This is to be expected. And I’m not sure this is the last wave.” The second waves already occurred a few months ago in New York and Miami, and “as we speak,” it’s happening in other places of the world like Brazil, he added.
However, the case fatality ratio of deaths per 100,000 of the population of India is lower than that of the United States, Brazil, and Mexico, he said.
“They believed some of the publications which came in international journals that the reason why even the first wave was not that bad in India; they were trying to find excuses or reasons for it, talking about the immunity of Indian people, and the BCG vaccinations and the malaria prophylaxis—all those things,” Chalil said.
Chalil said that after the first wave subsided, it’s likely that some of the administrators would have become relaxed in their preparation.
“But there was no excuse for not stocking up on in PPPs [personal protective equipment], not stocking up on enough oxygen or medications, because this was predicted to happen,” he said. However, the situation is so complex that one particular factor can’t be to blame.
“Because even imagine, like a metropolitan city in the U.S. like New York, where we spend at least $11,000 [over eight lakhs] per person, every year on health care expenses. Yeah, we ran out of ventilators. We didn’t have enough ICU beds available. We were having patients dying in nursing homes left and right. We discharged COVID patients to nursing homes from hospitals,” he said, noting decisions by New York and other states to order nursing homes to admit COVID-positive patients that had been released from hospitals.
Historically, the second wave is more deadly than the first wave, and no one is prepared for it, according to Chalil, who is chairman of the Complex Health Systems Advisory Board, College of Business and Entrepreneurship at Nova Southeastern University in Florida, and a member of the Dr. Kiran C. Patel College of Allopathic Medicine Executive Leadership Council.
“It’s like a world war. So you know, you don’t know how it’s gonna go, whether it’s going to be light or hard,” he said. “But I believe India’s health minister should take responsibility for lack of action.”
3rd Wave ‘Wake-up Call’
While some countries have been hit by a fourth wave, Indian media has been replete this week with stories of what an inevitable third wave could mean for India. Chalil said the issue is less about a new wave hitting India but rather if the currently available vaccines will work against the new mutations that define each new wave.“On top of the second wave, versus the third wave which is coming a few months later, it’s a wake-up call for every country! What if the virus mutates, and our current vaccines—people taking Pfizer and every other vaccine and Sputnik or Chinese vaccine? What if it doesn’t work?” said Chalil, who’s an expert in U.S. health care policy.
Amid speculation about another nationwide lockdown in the country, Chalil said the last year’s experience with lockdowns wasn’t good, and India should instead focus on containing the pandemic hotspots.
“I would recommend what the British did—create hotspots, contain them for a couple of weeks until the current situation subsides because the pandemic’s second wave will go on for the next few weeks, and maybe by end of May, it should be over,” he said.
India’s Drug and Cosmetic Law of 1940
A 71-year-old colonial-era piece of legislation called the Drug and Cosmetic Law of 1940 is still functional in India and the country should modernize it to “give immediate conditional approval to COVID-19 drugs and vaccines,” Chalil said.“So, there are several new therapeutics available worldwide. ... There are so many phase three studies showing 70 percent reduction in mortality, 70 percent or more benefit from ventilator-free survival.”
While COVID-19 infections trigger immune system responses, known as a cytokine storm, or uncontrolled inflammation that may cause people to die, there are small molecules like interleukin-6 (IL-6) inhibitors that are made in the United States and can reduce the disease’s severity and help a patient survive, said Chalil.
“Antiviral drugs and anti-inflammatory medicine from several manufacturers like Pfizer, GSK, and Regeneron are finishing pivotal studies. India should encourage local manufacturing of all these drugs and or import for immediate need,” he said. “Let these drugs come into India, give them conditional approval, and let’s save lives right now.”
He said “giving oxygen cylinders is not the solution” and that the country should plan a long-term benefit of the change to its health system by overcoming the “nexus” preventing that from happening.
“If the whole world can do it, why can’t India?” he said.
“Be careful about the way they wear the mask, because they don’t mean to take risks, they believe that they’re younger and those are the people that spread the disease. If they don’t have to go out if they can work from home, please do,” he said.
