As early as April 2020, molecular biologist Partho Sarothi Ray had warned India of mutant variants and of a deadlier second wave of the coronavirus. Ray is an associate professor in the department of biological sciences at the Indian Institute of Science Education and Research, Kolkata, and is now abroad on a research project. In a new interview with THE WEEK, Ray discusses India’s response to the second wave. Excerpts:
Q/ Where did things go wrong with the response to the second wave?
A/ This is a manmade disaster. [This has happened] because of incompetence, unscientific handling and premature triumphalism by the [Narendra] Modi government.
Q/ Unscientific handling?
A/ In my interview with THE WEEK, as early as in April, 2020, I had stressed the possibility of mutants and the need to prepare for them. Nothing was done. Sequencing of virus samples was not started before December, when the INSACOG (Indian Sars-Cov-2 Genomics Consortium) was set up. I had also spoken about a resurgence with higher mortality.
Q/ Many people say mass vaccination could have prevented the catastrophe.
A/ Vaccination has its limitations. Vaccinating 1.3 billion people in a short while is a logistical impossibility. It is clear now that vaccine production facilities are woefully inadequate. Two doses have to be given to achieve an adequate level of immunity. It should have been made clear that vaccination could not and would not prevent a second wave.
Q/ And what about a possible third wave?
A/ That will also happen. But people who are talking about the third wave in the middle of the second wave, for which they had no preparedness, are just trying to escape responsibility.
Q/ But why did the World Health Organization not warn of a possible second wave in India?
A/ Everyone knew there was going to be a second wave. Europe and the US also had their second waves. This is not rocket science that there should be a special warning for India. And the Indian government was already proclaiming to the world in February that it had defeated Covid-19. It did not care about any warning given by anybody.
Q/ But the US and Europe were also badly hit by the second wave.
A/ It is more catastrophic in India not because it is different, but because the countries in Europe and the US, and even other places, were much better prepared. In India, there was no preparedness because of complacency. But states such as Kerala, which had better preparedness, have handled the second wave better.
Q/ But we were told about a massive number of deaths in the US, the UK and Italy.
A/ Not in the second wave.
Q/ So they learned from their first waves and we did not.
A/ Yes. I have seen their preparedness with my own eyes. Hospitals were much better equipped, health workers were much better prepared, testing was going on at a very high rate and emergence of mutants was being monitored by large-scale sequencing of viral samples.
Q/ How did the Indian variant originate?
A/ Variants arise in the normal course of viral evolution. The viral RNA, when it gets copied, incorporates mistakes. These mistakes are called mutations. If any of these mutations gives an advantage to the virus, it will be carried over in progeny (reproduced) viruses. Now the advantage that comes is in terms of higher transmission and immune evasion, [which means that it is] able to evade the immune system of the host. So, any variant that has even a little advantage in these terms will spread rapidly. This is how variants in India also originated.
Q/ What about the Bengal variant, which is called a triple mutant?
A/ There is no Bengal variant. What we are seeing are same or similar mutations all over the world, but in different combinations. The combination that has come up in India, B.1.617, seems to be highly transmissive and possibly immune evasive. What is being called the Bengal variant has one of the known mutations, E484K, together with some others.
Q/ So the triple variants are nothing to worry about?
A/ It is called a triple mutant because there are three specific mutations in the spike protein. There is no data to show whether it really has any effect on the infectivity of the virus.
Q/ Why is India so helpless?
A/ In India, there is no data showing the actual effect of these mutations. Labs in India were not prepared to do these experiments.
Q/ Is it possible that such mutations are similar to those in Brazil and South Africa, and therefore could have originated there?
A/ It cannot be ruled out. But because it does not seem to have spread so much in other countries, it appears that the double mutant has arisen in India.
Q/ In terms of monitoring the variants, where does India stand globally?
A/ India has been sequencing less than 1 per cent of virus samples while countries like the UK have been sequencing more than 5 per cent.
Q/ How important is gene sequencing to combat the virus spread?
A/ With gene sequencing, it is possible to know early on whether a variant is spreading or not. This makes it easier to counter the spread. Moreover, [the mutant virus’s] immune-evasive nature can also be investigated if we know what changes have happened to the viral genes.
Q/ But India has many institutes and labs that meet international standards.
A/ Yes, [but] it was not done. It is a collective failure of the scientific establishment.
Q/ Covid-19 originated in Wuhan, China. But why is China not that affected by the second wave?
A/ They also had a second wave, but they managed it well.
Q/ How can India manage the second wave?
A/ Very high testing and tracing, and highly equipped medical preparedness.
Q/ What about the threat of fresh mutations in places such as Africa?
A/ See, a variant… can arise anywhere in the world. But the problem [lies] with some specific countries, or rather governments. It was [Donald] Trump in the US, [Jair] Bolsonaro in Brazil and Modi in India. The US seems to have tackled Covid-19 well after Trump was voted out. Now the problem is with India and Brazil. The reason is that people like Modi and Bolsonaro do not value the lives of their people.
Q/ Many Indian states have passed the buck to the Centre.
A/ I do not think the states really had the power to act in this situation. Much of the Covid response was centrally controlled, including funds. However, states that have a tradition of strong health care and responsive government have done well. For example, I saw that Kerala has one of the highest rates of infection, but lowest mortality. This indicates a strong government response.
Q/ How effective are vaccines in checking the spread of infection?
A/ It is possible that vaccines might fail to work against some variants. Therefore, vaccines might need to be continuously updated. [For instance,] the influenza vaccine requires an [update] every year. The utility of the vaccine is to reduce the severity of the disease. But, I do not think that the vaccine is a miracle cure. The government gave an impression to the people that, with the vaccine, the pandemic would be gone.
Q/ So, how frequently would people have to take the Covid-19 vaccine?
A/ There is no data yet on how long the protection will last. There are some studies from other countries. Also, current vaccines may not be effective against a new variant; they are not fully effective against variants like B.1.167.
Q/ But some reports suggest that Covaxin is very effective against the Indian variant.
A/ There is no real data to come to such a conclusion.
Q/ Many opposed the Indian government’s move to export vaccines. But, given the chance of new variants emerging in neighbouring countries, was it not a good move?
A/ There is no problem in exporting vaccines anywhere, provided you have enough production and supply to meet your own country’s needs. Else, it just becomes a way to show off.
Q/ What does India need to do at this stage?
A/ I do not think there is any easy way out. First, responsibility for this mess needs to be ascertained at the highest level and changes have to be made.
Q/ There is an urgent need to ramp up health care facilities.
A/ The US was so badly hit during the first wave that it decided to address it politically. It handled the pandemic by voting Trump out.
Q/ How long will the second wave last?
A/ I do not think it will last long in the cities. Because of the very high rate of infection, many people will gain immunity. But I am afraid that the second wave has reached the rural areas of India, which have a nearly limitless population for the virus to spread in.
Q/ How should India prepare for the third wave?
A/ First, there cannot be any let down in medical preparedness, in terms of oxygen supply, ICU beds, ventilators, ECMO (extracorporeal membrane oxygenation), etc. Second, large-scale sequencing of viral samples to constantly monitor the emergence and spread of variants. Third, transparent data available to scientists and the public alike, to understand the real dynamics of the pandemic. Fourth, free vaccination at the broadest possible level, with proper monitoring of the vaccines’ effects. And finally, and most importantly, ascertaining responsibility for the disaster from the highest level. If that is not done, we will never be able to do a course correction.