Prof Pankaj Chaturvedi. Tata Memorial Centre
Mumbai
I read the editorial in The Lancet titled India’s Covid -19 emergency published on May 8, 2021. Let me quote from the article “India will see a staggering 1 million deaths from COVID-19 by Aug 1. If that outcome were to happen, Modi’s Government would be responsible for presiding over a self-inflicted national catastrophe.” It is reminiscent of news reports in the British colonial era in India. To justify their forceful occupation of India, there was an orchestrated attempt of the western media and their political leaders to portray India as the country of fakirs and snake charmers that didn’t deserve to be independent. When the India’s Independence Bill was being debated in 1947 in the British Parliament, Winston Churchill had unabashedly said, “Power will go into the hands of rascals, rogues, and freebooters.” I felt indignant with a similar vitriolic rant in the editorial leading to poor portrayal of my country. Being in the frontline for last one year in Mumbai, I have witnessed death, disability, disaster and despair. I have lost several of my own near and dear ones. Having said that, criticism is an essential part of any progressive community. I wouldn’t have bothered to write this rebuttal if the editorial was without malice or contempt. As Mahatma Gandhi had said ” Silence becomes cowardice when occasion demands speaking out the whole truth and acting accordingly.”
While the crisis is indeed alarming and saddening, the editorial is suitable for a politically motivated tabloid rather than a reputed academic journal. When things were going wrong in US and UK, we were praying for them rather than writing stinging editorials that too in academic journals. It is time for an end game and not the blame game.
In order to create a sensation, the editorial mentions statistics of mortality and morbidity to suit the purpose. Mark Twain has once described three grades of lies – “Lies, damned lies, and statistics”! Let me present the Indian statistics in a different manner. USA with a population of 0.3 billion population has lost 0.6 million citizens, Brazil with its 0.2 billion population has lost 1.5 million lives, UK with its population of 0.06 billion lost 127000 citizens and France with a population of 0.06 billion lost 106493 of its citizens. India with its 1.3 billion population has lost 262000 Indians and I accept that it is likely to rise further. One may argue about under reporting in India due to low Covid testing in many parts of India. Therefore, let’s look at the case fatality ratio – the number of deaths divided by the number of confirmed cases. India’s CFR of 1.1 % is less than that of the US, France, Italy and Germany! India’s Covid-19 recovery rate is amongst the highest in the world. However, this cannot be a reason for any complacency.
USA started vaccination on 14th December 2020 and vaccinated 256 million to date. UK started on 21st December and vaccinated 53 million till now. Australia started on 22nd Feb and vaccinated 2 million till today. India started on 16th Jan 2021 and has vaccinated 180 million citizens (atleast one dose) as of today that is nearly 9% of its entire population! There are more reasons to appreciate the Indian Government. It lifted the ban on export of HCQ and exported HCQ and Paracetamol during the height of epidemic. Despite shortage of vaccine in India, our government had the magnanimity to export 66 million dosage abroad on humanitarian grounds.
The editorial makes several contradictory remarks and one of them says that the “Local governments have begun taking disease-containment measures, but the federal government has an essential role in explaining to the public covid appropriate behavior.” The fact is that Government has launched a massive multi-pronged Covid awareness campaign and developed a dedicated portal to share all the statistics – https://www.mygov.in/covid-19 . I am also surprised that author is unaware of the several viral genome sequencing data published by the Indian labs. Needless to say, this virus keeps mutating very frequently just like any other influenza virus. Contrary to the claims in the editorial, the central and state governments regularly conduct press conferences to share the emerging data or newer information.
In India’s federal structure, as per the Constitution, health care is a state subject. It is likely that dramatic reduction in the Covid case load during the winter led to a false belief that the pandemic was getting over. Therefore many states were not prepared for the second wave that turned out to be a Tsunami. Even if they had planned, it would be impossible to create an efficient system in less than 6 months. States like Kerala, Maharashtra, Karnataka and Delhi that have better health care systems suffered the most. If we take example of the worldwide mortality, the countries with the best health care infrastructure (US, France, Italy etc) seemed to have the highest mortality. In short, biology trumped technology and pharmacology! With virtually no effective medical treatment currently available, state and central governments have resorted to lockdown multiple times in this entire pandemic. The arm chair critics may not realize that lockdowns are politically challenging decisions. Let us not forget that these measures have profound socio-economic impact that may turn out to be more hazardous than Covid itself especially among the impoverished groups. I am appalled by the Editor’s statement that “government’s attempt to stifle criticism and open discussion during the crisis are inexcusable.” I am confident that the editor has never watched the Indian television debates where such criticisms happen ad nauseum. In fact, the vehement criticism of the Indian vaccines by some political parties made some gullible citizens believe that the vaccines were useless leading to lukewarm response in the beginning.
Now let’s discuss about the failure of the Indian Election commission in deferring the elections. The editor blamed Indian government for failing to heed the warning of the second wave of the pandemic! If that is the case, predictions are being made of a much larger third wave in India! Will the editor please let us know when India could have conducted the elections safely? Is the author aware of the consequences of indefinite postponement of elections in politically sensitive states of West Bengal, Tamil Nadu and Kerala? Having said that, large gatherings were completely unacceptable.
Kumbha Mela is one of the largest voluntary religious congregations of human beings on earth that happens every 12 year in the months of January to April. It was not a wise things to permit it during the pandemic. However, Let me share a thought provoking perspective on this issue. The entire Kumbha area was spread over 150 square kilometer and over 9 million people voluntarily visited it between January till April 2021. The maximum number of people visiting the Kumbha area on a single day was 3.5 million in an area of 15 square kilometres. On that day of peak foot fall, the population density at Kumbha area is estimated as nearly 200000 people per square kilometer. With nearly 17 and 13 million population respectively, Delhi and Mumbai are the India’s two largest cities. The population density of Mumbai is approximately 30,000 per square kilometer of that nearly 40 per cent live in the slums. That means Mumbai and many metropolitan cities lives with Kumbh like situation every day. Dharavi, a locality in Mumbai, is Asia’s largest slum that has population density of nearly 277136 per square kilometer. Compare it to London that has population density of 6000 per square kilometer. Mumbai’s local trains, the life line of the city, carry 7.5 million people (population of Hongkong) every day with nearly 6000 passengers packed into a 12 or 15 car rake during the peak hour. When the lockdowns were lifted during the pandemic (February and March, 2021), nearly 4 million passengers travelled every day in the Mumbai local trains. While the developed world may look down upon these as uncivilized conditions, it probably gave this population a distinct advantage. In August 2020, a seroprevalence study reported presence of antibody among 54 percent of the slum population and 16 percent of the non-slum population. The study concluded that asymptomatic spread of covid led to significantly lower fatality rate among slums compared to non-slums. The reasons why slum dwellers fared better than the rich was because of the high population density, poor hygiene and non-adherence to Covid appropriate behavior! Similar high prevalence of protective antibodies were reported in the other parts of India as well – Delhi (56%), Mumbai (up to 75%) and Hyderabad (54%) and Bengaluru (57.9%). In contrast, the highest level of antibody achieved in New York, London and Paris was 20%, 13% and 12% respectively. Is Indian’s high level of herd immunity responsible for the low case fatality rate? Herd immunity (also called population immunity) is due to the presence of antibodies that occurs when a population acquires it through either the infection (asymptomatic or symptomatic) or vaccination. As I said, this is only a hypothesis generating thought and by no means a logic to defend Kumbha or such large gatherings. Allowing infection to ravage the population is not the best way to achieve Herd immunity. With vaccine as the only hope to combat the spread, it is time to make it more affordable and accessible. Ironically, while thousands are dying every day, Word Trade Organization has failed to prevail upon member countries to waive patents and intellectual property rights linked to vaccines and technologies. The waiver is being fiercely opposed by many developed countries such as UK and European Union. Even an international association of Pharmaceutical Manufacturers warned WTO that waiving the patents and copyrights will be counterproductive and dangerous.
With hopelessness all around, society tends to hold the political leadership as the ultimate cause of their miseries. I agree that political leaders are accountable and they cannot shift the blame for this failure. However, there are many stakeholders in this pandemic whose accountability needs to be questioned. How about those researchers whose misleading recommendations were later proven to be ineffective or even harmful? What about those journals who shortened the publication pipeline to improve citation index only to end up with substandard articles? We can’t forget the retraction of an article from a reputed journal claiming effectiveness of HCQ. We still remember the allegations of pharma industry – journal nexus in publishing pharma funded studies of questionable benefits. What about those Television channels whose round the clock broadcast of horrifying news mainly for TRP has aggravated the mental agony of the gullible viewers and exhausted frontline workers ? What about the pharma companies who failed to communicate about lack of efficacy or appropriate usage while selling lopinavir, ritonavir, oseltamivir, remdesivir, interferons, tocilizumab, hydroxychloroquine, azithromycin etc? Will the scientists, institutions and the rich nations apologize to the world for holding on to the patents/copyrights of the lifesaving drugs and equipment while thousands die every day?
The Lancet editorial made a ludicrous statement that “Government has seemed more intent on removing criticism on Twitter than trying to control the pandemic”. It is well known that the states and the center have been tirelessly working against this Tsunami that has inundated our already constrained infrastructure. We need to be better prepared for the possible third wave.
The Lancet editorial seemed to be solely for the media attention and trending on twitter while maligning India globally. In the word of German Scholar, Max Mueller, “If I were asked under what sky the human mind has most fully developed some of its choicest gifts, has most deeply pondered on the greatest problems of life, and has found solutions, I should point to India.” Wait till India recovers, it will lead the world soon.
Prof Pankaj Chaturvedi's thoughts 
Great. Nobody should publish one sided content. Nobody likes written without learning facts in field. However one fact remains as I am in field against COVID. O2, Remidisivir, ventilators etc. Which are required are distributed by whom. GOI OR GOM ? This wave is destroying rural india. Home isolation in villages is not followed. In it is to be implemented which force other than police are there? Population is not cooperating. We in public domain trying our best. We not more budget for health services. Forget lancet I doubt if they reach our villages. Let’s improve what we feel see and suffer. Dr. C why our top virologist resigned. Please enlighten. Rest you have done great job.
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We should learn patriotism from you sir. Hats off your thoughts and visionary wisdom. I am proud that I am your student.
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Lancet editorial & its rebuttal are true but it is also true the BJP Govts in States & Centre did not understand the gravity nor propose any scientific remedies.
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Why do you think the Lancet cares? What is in it for them or any other medical / professional to throw mud on any particular country? I am sure they have better things to do with their time and the print space. Surely they could care less what any given country’s politicians and governments do or don’t do. They are not a political or religious journal. They are a professional peer reviewed medical journal for professionals who just care about open journalism and learning from experiences and mistakes of others. Professionalism and pursuit of knowledge don’t see national boundaries.
Perhaps it would be more useful if the point in question is addressed and pondered over and alternative views, if any, are offered rather than find justifications and defend all the utter failures with misplaced patriotism.
res ipsa loquitur……. the thing speaks for itself…. one just has to walk out of their front door and look around on the streets taking off the goggles of the so called patriotism. It shall all be revealed! ……..It doesn’t need an editorial from a medical journal!
My SINCERE apologies if it offends any body. No offense meant… please forgive me if it did.
Written only in the spirit of what my school teacher once taught me when I was a lad – “Shokena slokamagatah” – As it did for Valmiki. One has to have the dignity and honesty to acknowledge and understand one’s own deficiencies and be disgusted with themselves / situation first. Only out of such intense desire is any meaningful change possible
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In the article itself , Dr. C detailed how and why even the great peer reviewed journals go wrong. Best ex HPQ. Being in the field of research , I can safely say even great journals are not above board. Coming to Indian virologist, to the best of my memory in my informal discussions with one of close friends and a science journalist , the said virologist was against rolling out Covaccin despite ICMR data which is showing promising results.. Obviously some people do not like certain people, whatever they do , they criticise. Whether it is March 2020 lock down, agewise roll out of vaccines etc
I regret to say , we have a crop of scientists patronised by earlier regimes have become a gang of award vaapsi, collective signatures grps etc. Based on their comments one of the Indian states CM Mr Baghel sent back the entire lot of Covaccine , denying his citizens protection.
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Please read Lancet’s articles directed against India and you would be surprised my brother. It is totally political, nonscientific and biased journal now for atleast one and a half decades.
Just read their articles on NDM by Walsh and David Livermore . Read it carefully and look at the disjointed conclusion. Please do ask yourself whether it is a scientific article or a geopolitical salvo from acountry hit by Indian tornado on Medical Tourism
Another one : What has Lancet to do with Article 370?Published Online September 4, 2019 http://dx.doi.org/10.1016/
S0140-6736(19)32077
“British medical journal The Lancet publishes anti-India propaganda on Article 370, maintains silence over Islamic terrorism”- news
I hope you would think many times now to question India’s defense of its strategies by some really established patriots
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Raman,
I looked up the articles you mention in your reply.
1. The article on NDM-1 gene by Walsh and Livermore is quite a detailed research and something that most health practitioners in India would be happy to read (to help in diagnosis). If you are a Doctor, you should read it as well.
2. The DoI link you provided does not work but the reference to S0140-6736(19)32077 is actually a correspondence published by Lancet that quite supports the Indian Government move to repeal article 370. It concludes “This integration will give a boost to investment, innovation, growth, peace, and prosperity.”
3. While the OpIndia news article (the title of which is quoted in your reply), does claim that lancet conducts propaganda, if you read the contents, you will notice that Lancet regularly ventures into geopolitical conflicts beyond their competence or mandate and hence does not work on a specific ‘anti-India’ mission.
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Eye opener for us , a science magzine writing political content.
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A well narrated real and comparative analysis of world- wide COVID situation from the desk of an eminent personality of our country. Let’s study the reality behind the present scenarios , refrain ourselves from simply criticizing the government and cooperate the administration to overcome the situation
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I SALUTE YOU PROFESSOR for the EXCELLENT ARTICLE!
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Poor homework by Lancet. Lancet has a conflict of interest. Even last year they have to withdrew an article. Superb rebuttal Dr Pankaj. Proud of you!! You spoke for millions of proud Indian.
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You penned the thoughts of Indians sir… Thank you
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I have a question. why did the top advisors of the world took so much time to tell the world that the virus is airborne and must use masks which made the situation in US worse and then spread everywhere in the world. I just dont understand why an academic journal like Lancet should comment like any other political party blaming another party. If lancet says that the health infrastructure and education levels of Indian people are far worse every body can understand it. I acknowledge it. Instead of not seeing how Modi government working hard to vaccinate not only the Indian public but whole world must be appreciated. Unfortunately I never read it anywhere. we must understand that while whole world was developing their infrastructure around the world India was keeping its head under the mud of socialist stupid ideologies till 1990’s. Even china started liberalization 1975. Why western media want to fail a governement which promotes liberalization. During vaccine approvals several chief ministers of opposition ruled parties even called out that they wont take BJP vaccines. How stupid it was and now they are crying for the same vaccines. I want to say that this catastrophe is the failure of the so called medical giants who don’t have a solution other than economic lock down for this virus even after 1.5 years. America just didn’t agree for a lockdown even when their people were dying. Why are you criticizing Modi for this? Now the second wave was in the making in three states (Maharashtra, Delhi and Kerala). Everybody knew this (Indians know it but anti modi people are lying to western media and people ) and please go to the statistics for that. Kumbh and regional elections happened in uttarakhand and West Bengal Kerala Tamil Nadu and Assam. India is a large country and it is unnecessary and stupidity to lock down entire country when virus peaks in 1000 to 2000 km away (though there can be travel restrictions from these states). And it should be the responsibility of respective state governments to take care of their own people. State governments controls transport and health ministries. Not Modi. Modi government can give advisories but can’t enforce it. Probably whole country should come together to mitigate this problem. One option for Modi is to take over health and education sectors from state governments. But then why we should spend so much money to keep state governments. I would like to ask Lancet and all other academicians for introspections instead of blaming the politicians of the world. Politicians of the world tried to fund maximum from the taxes of the people to have solutions to this menace. So please come together discuss and work for the betterment of the world instead of worrying about losing money from patents.
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Respected Dr Pankaj sir, You are absolutely right. You made it clear with lots of facts ( not just data). Only people who know India and its culture can understand the reality. Hats off to you for upholding our feelings. I like to mention here yout 2017 talk of highest level of professionalism for doctors. I think that is missing in today’s journalism. Thanks a lot
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The saddest part of such incidents is the manner in which such Anti Govt articles are reported in certain English newspapers. In fact these newspapers don’t bother to publish even comments that offer a rebuttal. Kudos to the Prof for giving Lancet editorial it’s due.
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Well done Professor.
These white dogs are still seething with jealousy at a country which they had looted for over 2 centuries having got the better of them when Covid 19 first struck in 2020.
Yes, Winston Churchill had unabashedly said, “Power will go into the hands of rascals, rogues, and freebooters.” And his successor Atlee handed over the reins to their lapdog Nehru to make it a prophecy. And they would have succeeded had it not been for Narendra Modi at the helm of affairs now.
We know that a few Prime Ministers- Lal Bahadur Sastri, P V Narasimha Rao and Atal Bihari Vajpayee- before Narendra Modi had tried to pull out this country from the abyss. But even they could not be free from the strangle hold of the treacherous Nehrus. It is only Narendra Modi who has been able to put the traitors in their place, though not eliminate them altogether.
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I think Lancet should stick to reporting on efficacy of medicines and comment on pharma subjects only. It has lost all my respect on objective reporting on important medicines by resorting to heavily political govt bashing without understanding different countries.
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Prof Chaturvedi’s article is insightful and forceful. It also bears the sentiment and experience of having served thousands of patients over the years and especially during the past year or so. I do feel convinced that the Lancet article was misguided for sure and definitely did not adhere to their competence or purpose but the claim on ‘bias’ appears unsubstantiated. Even after accounting for Prof Chaturvedi’s standing as a leading health practitioner, the claim of a bias is not borne out by the arguments in the article (There is a maxim – probatio vincit praesumptionem or proof overcomes presumption). Lancet in terms of it’s editoral group, although based in UK, is as diverse as a scientific group should be. It has been critical of governments of UK, US, China and many other nations around the globe. In the past, they have been accused of being ‘misguided’ and beyond its mandate by each. However, to claim bias without facts and reasoning is a pointer for the need to ruminate.
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