‘India was headed for a very severe second wave yet there was no action’

India is facing the worst surge of Covid-19 infections as a second wave of the pandemic has pushed the death toll close to 200,000 and starved hospitals of life-saving medical oxygen and beds. Ashish K Jha, Dean, the Brown University School of Public Health, spoke to Sunetra Choudhary about the crisis. Edited excerpts:

A few weeks ago, the world was celebrating India as a global vaccine manufacturer and today we are looking for help from other countries. As someone who has been following the Covid scenario in India, did you see this coming?

Unfortunately, many of us saw it coming. By mid-February, you could start seeing cases rise and by early March, it was very clear that India was headed for a very severe second wave, and yet there was no action. The rallies continued. There were no real efforts for public health mitigation until the numbers were horrible and that is where we are now. One of the lessons of this pandemic is if we wait too long, we are going to have a much bigger crisis. It is very unfortunate that India could have easily stemmed this by acting a few weeks earlier, but it did not.

You saw it coming, can you elaborate on the signs?

A lot of it is the numbers and a lot of what was happening. I was looking at pictures of mass rallies, I was looking at cinemas opening up, cricket stadiums, and I just thought the pandemic Is not over. And then in the numbers. Around February 8, the number of cases bottomed to near 10,000 which was very low and two weeks later the cases jumped to 20,000 which was a double increase in just two weeks. For those of us watching, that was a very concerning sign. ...by early March, the numbers started to climb. At that point, alarm bells should have gone off, people and policymakers should have started changing the behaviour. Certainly, by mid to later part of March, I and other people were on TV saying this is a problem and India was heading for a second wave but there was still not enough action.

During the first wave, election rallies were held in Bihar. Why was there no visible rise of cases given such huge gatherings? Do you think this encouraged the Election Commission (EC) to take another chance?

That probably contributed and that makes sense to me. Look no one piece of information is ever alone. The other factor is that by February- March, you were starting to see a major wave of infections in Europe and Brazil, and other parts of the world. The US and UK too were coming off of major waves, a lot of this being driven by B117, the variant originally found in the UK. So, India should have also had a perspective of this risk as we live in a global economy. You can look at any one piece of information and ignore it. But when you put the whole thing together, by late February, early March, it was starting to become very clear.

Do you agree with the Madras high court which held the EC responsible?

While I do not want to get into the politics of culpability, I do think policymakers are held to account through the ballot box. But I do believe that policymakers should have acted earlier. That is clear to every expert who has been watching India. What happened with Kumbh Mela was very irresponsible and surely has been a major source of infections across the country. So, there are many contributing factors, not just the political rallies. The bottom line is here we are now, and we have got to find a way to save lives now and reduce suffering as much as possible.

Do you think the US is finally responding to the crisis?

I think the Biden administration is taking everything happening in India very seriously and there are lots of signs of it... When we have all the major leaders, publicly talking about something that means that the issue has reached the highest level and they are taking it very seriously. I am very happy with the list of the things that they are doing. The thing that I had tried to point out is that allies come to each other's aid in a moment of crisis and India and America, two major democracies, have a special obligation to each other, as friends and as allies. And therefore, in this moment of crisis, it is essential that America acts, and America does as much as it can. I am hopeful and optimistic that we are going to see some real action from the US government.

What kind of help can India expect from America?

I have been speaking confidentially to various senior policymakers in India's health ministry and its states to get an assessment of what does India really needs. It is very clear to me looking at the data that India does not have enough testing capacity for the level of infection that exists. Test positivity rates are way too high, and America has a lot of capacity for testing kits. That is an area where America should absolutely be helping. We have been manufacturing a lot of high-quality masks and PPE kits. Universal masking is a very essential part of the pandemic that needs to happen in India. High-quality masks are an important part, which should be sent. We have talked about vaccines, the raw materials as well as finished vaccines, oxygen, and medicines that hospitals are running out of. Then there is this conversation about field hospitals. India can do that on its own, but the size of the problem is such, that any country would need help from others.

Masks like N95 are very expensive and people here cannot afford them. What kind of masks do you suggest that people should be using?

N95 masks are essential for health care providers. But there are other high-quality masks like KF94s, which are largely made in South Korea, and I have recommended that for the American public. The US government has been working for many months under the Biden administration for the production of high-quality surgical masks. There are a lot of private companies too which make masks not as good as N95 but very close. I personally do not use N95 mask when I am moving around but high-quality surgical or cloth masks. They are all going to be very useful especially with the very contagious set of variants that are out there right now. So, there are many options as long as they are well fitting and have high filtration capacity.

There is a perception in India that since the Modi government was seen to be close to the Trump administration, Biden is cold towards it...

I do not agree with that. I have been speaking to people very high up in the administration. The administration understands that these are not issues of Donald Trump or Joe Biden or Narendra Modi. These are long-standing relationships between two countries, two peoples and they have to transcend who the political leaders are at any given moment. That is the attitude that Biden is taking, and Modi too. ...we have to put politics aside and focus on the issue at hand. The issue at hand is not about helping Biden or Modi, but it is helping the Indian people at a moment of crisis, where friends come to each other's aid, whoever is in charge.

A lot of people here say that the international attention, showing cremation sites, and other visuals are portraying the situation in India incorrectly...

India has a lot of capacity. I talk publicly about how it is the manufacturing capital of the world for vaccines. But the bottom line is those cremations, those pictures seen outside the hospitals or those cremations, those are also the reality of India right now. I do not think it is unfair in any way to show any weakness of India. It is a complex and wonderful country. But the idea that everything in India is perfect and nothing negative should be shown is neither helpful nor is it true. In general, the global media have done a good job. They did the same for the US as well when patients here were struggling to find a bed in Los Angeles. The media tends to do that a little, but I think showing the broader picture is important. India has strengths and weaknesses, and we need to see all of them.