New Delhi: Mexican author Luís Alberto Urrea wrote in his book The Devil’s Highway: “Numbers never lie, after all: they simply tell different stories depending on the math of the tellers.” His context was illegal immigration across the US-Mexico border. But the lines are just as apt in a different frame of reference — India’s progress report on the Covid-19 pandemic.
Over the past 16 months since the first Covid cases was detected, India has lived by the “all is well” motto. Be it making strategy out of limitations — take, for example, India’s counter of “isolate isolate isolate”, to the WHO’s “test test test”, early on in the pandemic, when testing kits were in short supply — or selective dissemination of information to give a “positive message”.
Almost every week at its Covid briefings, the government presented India’s cases and deaths as rates per million of population, instead of absolute numbers. This was meant to emphasise that the country’s infection and fatality rates are among the lowest in the world.
At the same time, testing and vaccination figures were offered in absolutes, to make the report card look better. If the vaccination figures were shared as a percentage of the population, it would have shown India is far behind nations like Israel, the US, and Brazil, among others.
Even as India registers its worst daily numbers so far, the Government of India denies mutant strains have got anything to do with it. It also denies there is an “Indian” strain of the virus, even as experts claim otherwise.
All this, say epidemiologists, has created and upheld a notion that “India is special”, and this false confidence in part contributed to violations of Covid-appropriate behaviour.
In recent months, the government has often blamed the public’s irresponsible attitude — shunning prevention measures such as masks, distancing — for Covid spurts. However, experts say it was probably the government’s optimistic communications that caused the general public to underestimate the pandemic, and set the stage for the new Covid wave, which has seen the country record over 2 lakh cases for two consecutive days Thursday and Friday.
The shifting of goalposts — from breaking the chain of transmission at one point, to increasing the doubling time at another — hasn’t helped either, say experts, adding that it contributed over time to eroding public trust in government messaging on Covid-19.
ThePrint reached the Union Ministry of Health & Family Welfare and Press Information Bureau Principal Director General Jaideep Bhatnagar by email to seek a comment for this report, but there was no response by the time of publishing.
Jugglery of numbers
India has, for the past many months, looked at its Covid-19 burden through the lens of its population of roughly 138 crore. Calculating deaths and infections as rates per million, India arrived at figures significantly lower than in other countries.
These figures were presented at the government’s weekly Covid media briefings to suggest India was doing well.
Even at a time when the daily positives have surpassed the 2-lakh mark, India’s cases-per-million figure stands at 9,977 against a global average of 17,711. The deaths per million stand at 124 against a global average of 381.4.
As of 16 April, India had registered 1,74,308 Covid-19 deaths.
This figure itself has come into question because of doubts about the veracity of death reporting in the country. With various states deciding on their own criteria of what constitutes a “Covid death” — is it a Covid fatality if a heart patient dies because the coronavirus infection worsened their existing condition? — questions about coronavirus fatality figures have only intensified.
A completely different yardstick has been employed for the testing and vaccination numbers. These figures have been announced shorn of the population criterion because using that benchmark exposes that the picture is not all that rosy.
At 1,89,459 tests per million (as of 16 April), India is behind the US, France, the UK, Russia, Turkey and many other countries.
An estimated 7.27 per cent of Indians have so far got at least one dose of the two-dose Covid-19 vaccines. The comparable numbers are 61.47 per cent in Israel, 47.42 per cent in the United Kingdom, 35.65 per cent in the US, 15.80 per cent in Germany, 12.93 per cent in Turkey, and 9.72 per cent in Brazil.
“I don’t think we are in a whole country approach any longer and rightly so. But the messaging is inconsistent and does need to be national. Is this a serious disease or is it not?” said Ramanan Laxminarayan, Affiliate Professor, Global Health Director and Senior Fellow at the Center for Disease Dynamics, Economics & Policy, a public health research organisation.
“If we play down disease severity, and misproject mortality rates, then it is but natural that the man on the street doesn’t comply with masks and distancing. We are oscillating between fear and complacency and neither is the right approach.”
India started on its pandemic journey with a bang — a lockdown that was to “break the chain of transmission”. Less than a month down, the goal had changed and the country was rejoicing its “success” in pushing up the “doubling time” — the amount of time it takes for the number of infections to double.
When the numbers kept looking grim, the onus started shifting, first to states and then to people whose “irresponsibility” has become an important part of the central government’s pandemic communication.
India’s outlook on testing has evolved now that the supply of testing kits has eased. However, go back to March 2020, and the scene was different. Responding to the World Health Organization’s advocacy of “test test test” to beat the virus, India said its motto is “isolate isolate isolate”.
“Mixed messaging throughout this pandemic, saying we are doing well when we are not, is a constant problem. People do not listen to public health messaging unless they trust those messages. That is what seems to have happened here,” said virologist Dr Shahid Jameel, the director of Trivedi School of Biosciences at Ashoka University.
The government has gone to great lengths to deny community transmission, the stage where the source of new and emerging infections is no longer known and the virus is loose in the community without the system having any knowledge of how the transmission is happening.
The denial continues even though technocrats, in off-the-record conversations, laugh it off as “delusional”.
“If there is no community transmission, how did we come from the February low to the April high? It is because we could not track the infection. That denial is also why we are still talking pointlessly about testing and tracking,” said a government epidemiologist who has been closely associated with the framing of the pandemic control strategy. “Appearances have become more important than reality.”
A similar vehement denial has been reserved for the existence of an Indian variant of the coronavirus, even as the government has acknowledged others.
“Mutation is a natural process. It is foolish to assume that the virus has not mutated when we have had 13 million infections. This time, the virus is more infectious — in Delhi, we have done some studies that show that it is 50 per cent more infectious,” said Jameel.
“It is also well documented that there is an Indian variant. There is a UK variant, a Brazil variant, why can’t there be an Indian variant? What is so special about us?” he added.
What did India in
Last year, just as India hit its first peak, medical journal The Lancet carried an editorial that dwelt on the country’s need to give a positive spin to Covid-19 numbers.
“The epidemic in India is far from over, with a potentially huge burden of mortality and morbidity to come unless public health measures are used and adhered to. Without clear and honest communication of the risks of Covid-19 to the population, stemming the epidemic will be impossible,” the journal wrote on 26 September 2020.
“According to news reports, hours before announcing the national lockdown, Prime Minister Narendra Modi told owners and editors from India’s largest media organisations that it was important to tackle the spread of pessimism, negativity, and rumour. This pressure to avoid negative news, and to offer reassurance, appears to have been felt by several professional scientific organisations in India,” it added.
Anand Krishnan, professor of community medicine at AIIMS, said communication failure has been an international phenomenon during the pandemic.
“To strike a balance between how much of the truth to tell so that not to alarm but to ensure that there is compliance on the public health measures is difficult. I do not think we have tried well enough to balance the two,” he added.
Speaking to ThePrint on the condition of anonymity, a public health expert said it was not “the positivity per se that did us in”.
“It is the fact that we believed it and stopped preparing. (UK Prime Minister) Boris Johnson talked positive but prepared. We somehow thought the second wave did not happen and now we are facing shortages of beds, oxygen etc already,” he added.
(Edited by Sunanda Ranjan)
This is the second report in a three-part series on what went wrong in India’s Covid response. You can read the first report here.
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