Since March, the second wave of the Covid-19 pandemic has viciously spread throughout the country, with cases rising again. The second wave came rapidly and broke all records of the pandemic set last year. Daily cases are at an all-time high. Since April 7 2021, the country has reported more than one lakh (1,00,000) daily cases. Each coming day is setting a new record of positive cases. On April 19 2021, the country added 2,59,167 cases. The second wave also broke the record for the highest daily death toll due to the pandemic. It reported 1,761 deaths on April 19.
On April 12, India overtook Brazil to become the second-most Covid-19 affected country in the world. Many states in the country have already announced a wide range of lockdown restrictions that are just shy of a complete lockdown. The second wave has brought the country’s Healthcare Infrastructure to a breaking point. Social media is flooded with harrowing stories of patients waiting for days to find a hospital bed. Finding a hospital bed also does not ensure that patients get access to Oxygen. Social Media has also become a platform where people reach out for help as the system fails to reach those in need.
In this article, we look at what led to the current woes of the healthcare system in the country. Read ahead to find out.
Lack of Hospital Beds
Patients who have tested positive for the virus find it challenging to find hospital beds in their city as there is an acute shortage. In many cities, patients have to wait for days on end for one hospital bed. Even before the pandemic, India had an acute shortage of hospital beds. The country had about 0.5 beds for 100 people against the global average of 2.9 beds. The shortage has been so severe that the Indian Railways had to turn its empty train coaches into Covid-19 wards at the pandemic’s beginning last year.
During the second wave, more people are getting tested due to paranoia. The mutation of new variants of the virus, which are more transmissible, has also led to a sharp increase in cases. This excess load on labs testing Covid-19 samples has increased the turn around time to 2 to 3 days, preventing quick isolation of positive patients.
During the first wave last year, many exceptional covid hospitals were erected and run by respective state governments. These dealt with the acute shortage of beds but were closed as cases reduced gradually and demands fell. Now that the cases are at an all-time high, and the number of beds is alarmingly low due to the absence of such exceptional covid hospitals, it will take some more time to get such facilities running again. Even if 15% of the patients who have tested positive require hospitalization in Maharashtra, hospitals won’t cope with the demand. There is an acute shortage of beds in Uttar Pradesh, Bihar, Gujarat, and NCR Delhi.
Shortage of Oxygen Cylinders
As the second wave worsened and hospitalizations increased, the demand for Oxygen also soared. Maharashtra has reported a severe shortage of Oxygen, and demand has gone beyond its daily production capacity of 1,250 tonnes. The Delhi government has also said that it is facing an acute shortage of Oxygen. The Indian Government has banned the supply of Oxygen for industrial use and restricted it to only nine industries. The Indian Railways has also started transporting Oxygen across the country.
The central Government put the onus of oxygen shortage on the states. Commerce Minister Piyush Goyal asked the states to keep their oxygen demand under control. When the pandemic began last year, it was clear that Oxygen would be a life-saving necessity in the coming days. India would have had to ramp up its production quickly to meet the demand. However, it took the Government eight months to float tenders for bidders to set up Pressure Swing Adsorption Oxygen Plants in 150 district hospitals across the country in October 2020. Even as April 2021 approached, the health ministry said that 59 such plants would be installed in the country by the month-end. Most of the installed plants are not even functional.
One of the other reasons India faces an oxygen shortage, even after multiple players pitching in, is that it doesn’t have enough cryogenic tankers to transport Oxygen round the clock. It is taking almost a week to transport Oxygen from manufacturing plants to hospitals.
Shortage of Ramdevsir, Tocilizumab and other critical drugs Remdesvir is an injectable antiviral drug used to treat severe and specific cases of coronavirus infection. India’s Drug Controller approved it for emergency use in June 2020, and since then, there has been a surge in its demand. However, it is interesting to note that the WHO says the drug has little to no effect on mortality. It should also be noted that Remdesvir, and other drugs like Tocilizumab, are effective only in some instances and should be used only after a doctor prescribes them.
The pandemic induced paranoia meant that the drug was flying off from shelves rapidly, and there have been reports of its black marketing. The demand increased so much that the Government banned the exports of the drug and its Active Pharmaceutical Ingredients (API). India also exported close to 11 lakh Remdisvir injections in the last few months, which led to a shortage in the country. Manufacturers had also cut back on their production since demand fell during December-February. Some even had to destroy stocks of expired drugs as these come with a limited shelf life.
It is ironic that India, the world’s largest vaccine manufacturer, is going through a vaccine shortage right now. States do not have enough vaccines, and some even had to suspend vaccination drives for a few days until they have replenished their stocks.
While India has the manufacturing capacity, vaccine producers say they are working overstretched to meet its huge demand. The manufacture of vaccines is also hampered due to the USA’s temporary ban on exporting raw materials required for vaccine production and similar restrictions around vaccine production in Europe. Vaccine producers and even the Government are saying that they are trying to diversify imports and use homegrown materials to reduce US imports. This will, however, take some months to accomplish.
There is, however, friction between the state governments and the central governments. The centre has maintained that there is no shortage of vaccines, and they are being supplied to states in a timely manner. The centre refuted the states’ claims and said that the states have a problem with planning. The Government has also approved the import of vaccines. It said it would fast-track the emergency approval of vaccines approved by the WHO or authorities in the USA, UK, Europe and Japan. This move will ensure more vaccines are available for the population, but it will take a few months for foreign vaccines to be readily available. The country’s phase three of the vaccination drive is yet to be seen amid such vaccine shortages.
India is in dire straits right now. The second wave is sweeping across the country and crippling our health infrastructure. Vaccines are our safe bet, but until you are vaccinated, stay inside and stay safe.
Hypocrisy of Federalism: Reply on Oxygen Related Deaths
On Tuesday, the Union Health Ministry reported to the Parliament that no deaths were recorded due to a lack of oxygen across the country during the second wave of the pandemic.
The officials and ministers in eight states also denied fatalities due to the lack of oxygen. Whereas reports indicate that approximately 320 patients may have died in the second wave of the COVID-19 pandemic due to oxygen shortage.
The report by the Union Health Ministry to the Parliament has triggered massive criticism across the country. It has also prompted some significant accusations against the Bhartiya Janata Party [BJP].
The denial of the officials and ministers of the eight states regarding the same has also triggered a major rebuttal from within their parties, accusing them of aiding the Centre in hiding oxygen-related deaths.
According to a volunteer-driven data collation effort, DataMeet, Media from across 20 states report that there were approximately 619 deaths recorded due to lack of oxygen. However, later the cause of deaths was disputed with other factors that attributed to the fatalities.
The state health minister of Maharashtra, Rajesh Tope also sided with the Centre’s stand of no-oxygen-related deaths.
“As far as Maharashtra is concerned, we have never said that any death due to oxygen shortage,” he said to a local TV channel on Wednesday.
However, in April and May, the shortage of oxygen supply in the state had prompted the Chief Minister, Mr. Uddhav Thackeray, to request the Prime Minister, Narendra Modi, to inspect the proposal of pressing the Indian Air Force to arrange additional oxygen supplies for the state.
A medical board in Hisar- a region in Haryana, had openly established oxygen shortage as a cause of deaths in the region.
Additionally, after an inquiry, 22 patients succumbed to Covid due to the lack of oxygen in Haryana.
According to the reports of DataMeet, figures indicated that approximately 68 deaths took place across the state of Madhya Pradesh due to lack of oxygen.
However, Vishwas Sarang, the medical education Minister, stated, “We received at least 10-12 complaints related to deaths due to oxygen supply disruption. Medical experts found the cause of death was other medical complications, not hypoxia,”
In Goa, between May 10- May 14, approximately 83 patients succumbed to death.
But according to Dr Shivanand Bandekar, the Dean of Goa Medical College and Hospital stated, “We can’t put this as a direct answer. People who come to GMC, they are all referred because we are a tertiary (care) center where criticality is high and most of the patients die because of Covid pneumonia where oxygen is a part of the treatment. So we cannot directly say this (disruption in the oxygen supply) is the reason why they have died,”
However, during the hearing at Goa at the time of these deaths, the state government had admitted that “some of the casualties may have taken place” due to supply disruption.
Within the same hearing, the Bombay High Court had said, “We have long passed the stage of determining whether patients are suffering from the lack of oxygen or not. The material placed before us establishes that patients are indeed suffering and even in some cases succumbing for want of the supply of oxygen, in the State of Goa.”
Officials and ministers of several states like West Bengal, Odisha, Bihar, and Uttar Pradesh took a similar stand while siding with the Centre on their “no deaths due to Oxygen shortage” statement.
Even though various reports and data reflect a significant number of deaths due to a shortage of oxygen supply within different states, the Center and the state officials have refused to acknowledge them and have denied that these fatalities are attributed to the lack of oxygen supply.
Health Activist Amulya Nidhi from Madhya Pradesh, claims that volunteer groups from across the country have clear case studies and data that report deaths of patients across various states due to a lack of oxygen supply. “If they are so sure about it, they should allow an independent team of experts to probe the matter,” he said.
Why Are people Not Taking Covid Vaccine?
Since the beginning of the Pandemic in 2020, all people have wanted is to find a way back to normal. A way from virtual lives to real, social lives. Being trapped at home with limited movement has been fun for no one. And yet, when a solution is finally being offered, people are hesitant to embrace it. Vaccines are the solution to once and for all immunise us against this virus, but many people fail to embrace the cure. Even though the vaccination reduces risks in exposure to the mutating variants of the Novel Coronavirus, there are people reluctant to take the possibly life-saving shot.
A vaccine race began throughout the world to curb the spread of Covid, India being one of the leaders. Immunisation is proven to be the most successful means to prevent diseases. Still, there is always hesitance that follows with the process. Many reasons cause vaccine hesitancy, but three of the main reasons are inadequate knowledge and fear of side effects, the speed of vaccine development, and rumours and myths.
The biggest fear that prevents people from taking the vaccine is a fear of side effects caused by inadequate knowledge. Many of us might show reluctance in taking the vaccine, fearing the severity of side effects. This tends to happen because most people do not understand how a vaccine works and nudges our bodies to create antibodies in our system to immunise us to the virus.
Many people reason that the side effects make them sick when they have been in perfect health for so long. They believe that it is the vaccine that makes them sick. This cannot be further from the truth. The public needs to be made aware of the workings of the vaccine to promote the vaccination drive around the world.
The other cause for hesitancy is the speed at which the vaccines have been developed. Many people believe that simply because the development speed of Covid immunising shots was quicker as compared to past viruses, corners have been cut in the process. It is essential to know that this is not true as all the procedures have been followed during the development of vaccines. None of them have been permitted for distribution without clinical trials and the approval of the FDA.
The last reason is that of rumours and myths. The rural population, a key demographic in our country, is reluctant to take the vaccine due to a lack of information provided to them. The inadequacy makes them quick to believe in rumours and myths surrounding immunisation, consequently making them reluctant to participate in the process. Reports of death post the vaccine have fanned the rumour mills in rural areas regarding the fatality of the vaccine.
Hesitancy in vaccination can also be seen in another key demographic, women. The proof for this in India is the disparity in men’s vaccination ratios which are starkly contrasting. Rumours and myths surrounding vaccines have led the population to believe that taking the jab affects fertility in women. It is essential to know that vaccinations do not cause infertility in men or women. It is this kind of rumour-mongering that causes fear in people.
Misleading tweets by prominent figures also cause vaccine hesitancy. One prime example is senior advocate Prashant Bushan, whose tweets about the efficacy and safety of covid vaccines were tagged as “misleading” by Twitter.
Misinformation being spread by prominent people is another cause of reluctance in people not taking the vaccine, which must be stopped to defeat the Pandemic.
Many people who have already suffered from Coronavirus also believe that they do not need the vaccine as they are already immune to the disease. This is a falsehood that needs to be cleared as a vaccine prolongs the effectiveness of the immunisation, keeping the person safe for a more extended period.
Vaccines are preventative medicines that allow us to acquire immunity against the virus, preparing our bodies to protect us in case of exposure to the disease. While vaccination may not provide complete safety, it reduces the severity of the infection and the chances of death.
With newer and stronger variants emerging as mutations of the Coronavirus, all of us must be fully vaccinated. It is the only way to ensure the safety of ourselves and those around us. It is also the only way to make a return slowly but surely to what we knew as “normal” and stop living life as we have known for the past one and a half years.
"No one from govt has come to visit us or order an enquiry into my wife's death.I still curse myself for persuading my wife to take the vaccine.I thought it would save us from the virus, but it killed her".
The govt is not monitoring adverse events from vaccine nor releasing data pic.twitter.com/pcJv9cqUYW
— Prashant Bhushan (@pbhushan1) June 28, 2021
ZyCov-D Proposed As World’s First DNA COVID Vaccine
With the Delta Variant setting its wave globally, ZyCoV-D, India’s first Plasmid DNA Covid-19 vaccine, is in the running for an Emergency Use Authorization from the Drug Controller General of India (DCGI). Vaccine maker Zydus Cadila, which already has anti-Covid treatments on the market, claims to have conducted the largest clinical trial in India so far at over 50 centres, with over 28,000 volunteers ranging in age from 12 to 18 years old.
According to the firm, with its 66.6 per cent effectiveness for RT-PCR positive patients in the interim study, ZyCov-D has already demonstrated solid immunogenicity, tolerance, and safety profile. It went on to say that no moderate instances of Covid-19 were seen in the vaccination arm after the third dose was administered, indicating a 100 per cent effectiveness for mild illness.
What is Zydus’ approach?
By mid-August, the business intended to be manufacturing 10 million doses each month, according to managing director Sharvil Patel. “We are currently only focusing our efforts on making sure we can make doses available for India,” Patel said in a virtual news conference. If the injection is approved, it will become the country’s sixth vaccination to be approved for use.
Patel added that data on immunogenicity for the adolescent children subgroup would be submitted in the next four to six weeks.
The pharmaceutical company has also provided data on a two-dose regimen for the injection.
What are DNA vaccines?
ZyCoV-D, if authorized, will be the world’s first DNA vaccine, according to Zydus, since it uses a piece of the SARS-CoV-2 virus’s genetic code – DNA or RNA – to trigger an immune response against the virus’s spike protein.
How are DNA vaccines Different from mRNA vaccines?
In contrast to the viral vector vaccines or inactivated vaccines like Covishield and Covaxin, DNA and RNA vaccines trigger an immune response by using a portion of the virus’s genes.
The distinction between DNA and RNA vaccinations is that the latter is passed on to a different molecule known as messenger RNA. The DNA vaccination also uses a tiny electrical pulse to convey the message to the cell.
DNA and RNA vaccines are less expensive than standard protein vaccinations. They are praised for their efficacy and capacity to be produced more quickly. Because DNA and RNA vaccines rely on genetic code rather than a live virus or bacterium. They may theoretically be made more widely available.
According to research published in the medical journal Frontiers in Immunology in 2019, “preclinical andclinical trials have shown that mRNA vaccines provide a safe and long-lasting immune response inanimal models and humans.”
According to WHO, DNA vaccines have a variety of potential advantages over traditional methods, including activation of both B and T cell responses and improved vaccine durability.
Is ZyCov-D needle-free?
A needle-free injectable method is reported to be used to deliver ZyCoV-D. (NFIS). In most NFISs, a jet of fluid is accelerated to a high enough speed to penetrate the skin through a tiny diameter nozzle. The vaccination may have a greater acceptance rate among youngsters who are afraid of needles, according to Sharvil Patel, managing director of Cadila Healthcare.
The three doses of Zycov-D should be given on days 0, 28, and 56, according to Zydus Cadila. The firm is, however, working on a two-dose vaccination.
According to the company’s information, the vaccine candidate may be stored for a long time at two to eight degrees Celsius and for a brief time at 25 degrees Celsius.
What does the Government have to say about the indemnity of the Vaccine?
The Government is still deliberating whether vaccine makers should be indemnified, as Pfizer and Moderna have asked. While a final decision is still pending, key authorities have stated that there is agreement.
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