The editorial in the Lancet regarding India’s fight against covid is biased and misguided – a detailed rebuttal.

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 YorkLondon 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.

Published by Chaturvedi Pankaj

Deputy Director, Center for Cancer Epidemiology, Tata Memorial Center, Mumbai. Professor, Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai

82 thoughts on “The editorial in the Lancet regarding India’s fight against covid is biased and misguided – a detailed rebuttal.

      1. डॉ पंकज चतुर्वेदी,
        उत्कृष्ट जवाब. हमें आपजैसे लोगोंसे गौरव की अनुभूती होती है! सादर प्रणाम! भारत माताकी निंदानालस्ती यह गोरोंकी और कुछ भारतीय कपूतोंकी आदत बन गयी है!

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  1. sir, you have nailed it to the core and I am proud of you giving a befitting reply. it only saddens me to see that the damage has been done. I have my reservations if they have the guts to print this article again in the esteemed journal.
    rather than pointing mistakes it would be heartening to see if they could write an editorial requesting the world to bring out a solution or improve the situation since the main purpose of a scientific journal should be for the benefit of the masses.

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  2. Great rebuttal dr pankaj
    I think this should go to lancet
    And the rejection letter should be an evidence of a biased journal on the face

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  3. A befitting rebuttal to the article in Lancet. Ur writeup is full of facts and figures which I hope will make writer of article in Lancet realize the truth. Ur taking this initiative is commendable.

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  4. Compiling reply & present relevant situation in single post..
    There are biases in Lancet Editorial, but many facts can’t be denied.
    Covid part is known to everyone.
    UK or Great Britain is none of the three, U, K & Great!
    There are people who failed India, we don’t need an outsider enemy!
    20000 traders came & occupied 30 crore Indians few centuries back.
    When they left, we are left with a division with the menace still continuing.
    After independence we lost lands while Israel (1948 independence from British) kept on acquiring lands!
    Israel vaccinated majority of it’s citizens & bacame covid free while we are still struggling.
    In this scenario some are saying India must help Israel!🤔
    If we control covid, action will speaks louder than words. We don’t need to write blogs.

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    1. Israel 9 million people total population, do not compare the Indian Vaccine distribution with Israel
      Instead of making ctriticisam we may give our good suggestions to Governments

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    2. हिरण्मयेन पात्रेण सत्यस्यापिहितं मुखम्।
      तत् त्वं पूषन्नपावृणु सत्यधर्माय दृष्टये ॥१५॥
      — ईशावास्योपनिषत्
      “The face of Truth is covered with a brilliant golden lid; that do thou remove,
      O Pusan, for the law of the Truth and dharma, for sight.”
      1. There is no stat for post-covid complications & death– hiding the truth!
      2. What about the PM Care Fund– again hiding the truth!

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  5. The concerned authorities should also take Newsweek international to task for their similar biased reporting and multiple photos of funeral pyres

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  6. Point by point rebuttal on the subject matter. Extremely organised reply with facts, figures & statistics. We need to understand, that no government in this world anticipated this severity of pandemic and thus health infrastructure preparation of this magnitude could never be envisaged in wildest of thoughts and planning. This hold true for the most developed nations of the world leave alone India. We must tell the world ” We shall overcome this too”. Sincere appreciation for the detailed rebuttal.

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  7. Sir, your response is apt and timely. Our scientific community is very well aware about the flaws in system and they are the right one’s to make suggestions and amendments. As we know, no country/community was (& will never be) prepared for this kind of calamity so holding ON in this situation and doing everything possible to alleviate the impact is the only option.
    My only sincere hope that, we learn our lessons quickly and innovate, improve and implement learnings at scale to save human lives.
    Thank you.

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  8. Despite shortage of vaccine in India, our government had the magnanimity to export 66 million dosage abroad on humanitarian grounds.
    This statement has created mess. Previously our govt has announced that we have prepared vaccine. So all citizens believed that its our product and should be used here. While the fact was that vaccine wss developed by Astragenasia and under UK license of TRIPS of WTO we have to send 84% to the countries who contributed for development of this vaccine.
    Here also govt of India publicised that they are giving this free under MAITRE project.
    This also has created narration that in place of giving this to our citizens why its given free of cost to other countries.

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  9. Pleasure reading the article with facts .
    India will overcome the dreaded Corona and the so called Corrupt politicians and the Yellow journalism.

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  10. I read the Lancet report and your response to the same. Appreciate you taking time out from your work to do so. This is a country that has run multiple vaccine programs successful, notwithstanding our challenges of a developing country. We also house the largest vaccine manufacturer in the world and act as a pharmacy to poorer nations. The Lancet article did not mention the challenges faced by SII with regard to induced shortages to raw materials for vaccine manufacturing, but did recommend to import vaccines.
    Such rebuttal must continue when ever necessary and we as citizens are forever indebted to you.

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  11. Brilliant article well articulated and well debated with facts and figures which noone can ignore.. very proud of you Dr Chaturvedi… because of people like you our country survives – no – lives… Thank you for serving Indians in India! Jai Hind!

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  12. I don’t understand how by writing a blog we reply!

    Bhutan – all vaccinated, 1 covid death.

    Israel – Covid free & fighting with Hamas.

    USA/Europe – We are crying comparing case & death/million.

    Africa – 134 cr population & as of today (17 may) cases are 1/8 th that of India & death 50% that of India.

    Who else left?

    Understand, Lancet editorial is all about mismanagement of covid 2nd wave, it’s not questioning 10000 old Indus civilisation.

    We are hell bent on proving that lancet questioned India’s 10000 old history, spirituality, it’s non-violence & बसुदेव कुटुम्बकम!

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  13. Very well said. Good you took it up ! boldly , intelligently. You shared many interesting observations and perspectives . Thanks for representing us.

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  14. Thank you Pankaj ji for your effort to educate us.
    I think ,
    Bigger enemies of Indian COVID situations are some of the home grown opposition parties irresponsible individuals & some media.
    Lancet is one of the foreign element , may be ignored.
    All of them are exposing themselves by showing that , they can only bark, but can’t extend little support.
    People will remember the tall leaders only
    Let’s pray for all the COVID victims .

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    1. Appreciate the data based rebuttal. Very well written.
      Surprised why the Lancet article did not delve into comparing apples with apples – based on per capita population.
      Great job 👍

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  15. Please allow me to salute you on behalf of our whole nation, Sir.
    What tremendous research you have done with solid arguments.
    You reminded me of famous Sunny Deol dialogue ” ये ढाई किलो का हाथ जब उठता है तो आदमी उठ जाता है !!”
    Lets all wait
    ” ये लांसेट कब उठ जाता है ”
    Time to say No to the *POLITICAL* Lancet unitedly by all subscribers from India.

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  16. Dear Pankaj,
    Most powerful, relevant and backed by evidence
    Very interesting, good job and thanks for sharing your views
    👍👍👍👍

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  17. Salute Dr. Chaturvedi on this brilliant rebuttal to Lancet’s gutter inspector report . This is what a rebuttal should be like. Tone throughout was calm and firm. Demolition, based on facts, logic and common sense, was total

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  18. Dear Dr. Pankaj Chaturvedi, It is a very reasonably and cogently argued piece. In a different context, as the former chief epidemiologist of Sweden Johan Giesecke had said last April, it might take two or three years or longer for an objective analysis of the Covid management by countries. Hence, journals commenting episodically are doing so to fit their critique to the agenda they already have.
    You have done well to bring that out.
    As for the second wave, the Government of India, in retrospect, committed more errors of optics than errors of substance.
    Post-second wave, the response has to reflect lessons learnt including on vaccination, on communication and on lockdowns which states are handling. Some are doing it sensibly and some are adopting a sledgehammer approach.
    There is one more issue – assigning geotags to the variants and not to the original is a sign of intellectual bankruptcy and moral corruption and capture of the West. Many Indian journalists and commentators writing for the West too are fully guilty of falling in line.
    One small error: the study that was published and retracted from Lancet and NEJM questioned the efficacy of HCQ and not ‘claimed effectiveness’. You may need to fix it.
    The last paragraph is emotional. Very understandable. But, considering the overall tone of the article, it did not seem to fit. A more reasonably worded conclusion but equally punchy would have been a fitting conclusion to an important and extremely well argued article.
    My compliments, Dr.

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  19. You gave a wholesome perspective to genuine ignorant fools.
    Indian healthcare infrastructure never collapsed but yes its seriously overwhelmed. Had it been collapsed like European union or USA hospitals would have shut or doctors would have quit. Nothing like that happened. Rather they have done 200% of their capacity.

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  20. Two basic errors in the blog. First of all, Health is a state subject, but prevention of contagious diseases and infections from travelling between states is on the concurrent list, where the Union has supremacy. This is the category that Covid-19 falls under.
    Second, the DMA and Epidemic Diseases Act are in operation, which has allowed the centre superseding powers over the states to deal with Covid. Hence, the Union government must own up to the failure.
    If you did better research, perhaps this could be published on the Lancet itself, and not on your own blog.

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  21. We should ask for closure of the LANCET medical journal which has turned Political and Biased and has lowered the dignity of a Medical journal. No Political comments along with comments on the Public Affairs of a country and naming a Head of State are to be permitted in any medical Journal. Is it shameful on the part of so called respected elite “editors” of the journal who instead of permitting medical review articles have permitted such a blasphemous article to be published in its pages. With this it has now become obvious that the Politicised and Racist Editorial Board has stooped to such low heights to permit criticism of a country and its head of state in an article in the journal. Shame on them. If any decency is left in them,, they should apologise and resign from the board.

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    1. Sir, banning such a false diatribe by vested interests have made our people vulnerable. Rather a strong rebuttal like the one in hand is the only remedy for the polluters of the brains of the naive and vulnerable subject of imperial exploitation, as well as for arousing the awareness of the victims. We need more persons like the Professor, the author of ‘compassion, commitment, courage’.

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  22. Sir,
    You should be represending India in the olympics. You have excellent mental gymnastic skills.
    Take care,
    Concerned Indian

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  23. Well said Prof Pankaj Chaturvedi. The editorial in the Lancet is create a scare among the citizens instead of giving a feedback to the Government machinery for corrections, particularly for generating a sequence of performances to control the pandemic. I believe if the experts like you, Prof Pankaj, you could work on a sequence of actions to fight the carona virus could be designed and produced for a long term solution.
    It is reported that another stream of corona virus highly infectious for children is on its way from Singapore. May be we could prepare ourselves in time, with cooperation from ICMR. Thanks with best wishes,

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  24. Excellent reply with well supported statistical data. This kind of reply was very much required. It is very unfortunate that some of the political parties in India too are supporting such anti-India movement.

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  25. Sir, The imperial mindset is a psychic disease and the result of the British Imperialism over India is perhaps best expressed by Will Durant in his ‘The Case for India’ (1930) as follows “I came away resolved to study living India as well as the India with the brilliant past; to learn more of this unique Revolution that fought with suffering accepted but never returned; to read of Gandhi of today as well as the Buddha of long ago. And the more I read the more I was filled with astonishment and indignation at the apparently conscious and deliberate bleeding of India by England throughout a hundred and fifty years. I began to feel that I had come upon the greatest crime in all history.” Enlightened Indians have always felt one with the entire ‘mankind’, or better, entire cosmos and always prayed for the sufferers anywhere. On the contrary, these children of opulence based on loot let loose by the ‘adventure’ of violence and deception of European ‘nation’ states have forgotten their own records, their own admission of guilt when confronted with the well-informed replies to their misdeeds with evidences. James Mill in his History of British India perhaps gleefully narrated “THE Portuguese had formed important establishments in India, before the British offered themselves as competitors for the riches of the East” and ” The discovery therefore of a new channel for this opulent traffic, and the happy experience of the Portuguese, inflamed the cupidity of all the maritime nations of Europe, and set before them the most tempting prospects. An active spirit of commerce had already begun to display itself in England. The nation had happily obtained its full share of the improvement which had dawned in Europe; and the tranquil and economical reign of Elizabeth had been favourable both to the accumulation of capital, and to those projects of private emolument on which the spirit of commerce depends.” Even the heart of Dr. Pentecost, the Christian priest, when confronted with the enlightened Virchand R Gandhi, a very young barrister from Bombay who represented India’s Jain religion in the famous Chicago’s Parliament of Religions over his remarks on India based on falsehood, changed for good and later he wandered throughout Asia and reported in New York Times in 1912 (February 11) ‘America not a Christian Nation’ pointing therein the misdeeds of the western proselytizers and traders in the East.
    Lala Lajpat Rai’s England’s Debt to India (1917) could not change their hearts, and even Shashi Thuroor’s friendly revelations recently have evoked only gleeful ignorance on the part of those afflicted with this deadly disease of imperial superiority.
    You have done a great job to point to the mischievous editorial reporting in the Lancet; however, more unfortunate part of such episodes is the distortions and misinformation campaigns let loose by our greedy politicians and their agents/aids in the same sick imperial mindset. A very humane corona-warrior doctor observed in a corona ward ‘This is not a disease but a warning of Nature to man’. Those who took it as a wise counsel are at peace; others are contesting, confusing, and creating chaos and indulging in a blame game.

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  26. Dr. It would be more impactful if could send it to Lancet, NY Times, and Time. They should be able to give you a platform to amplify the facts.
    Prabhat

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  27. Prof. Pankaj Chaturvedi
    Appreciate very much your timely and appropriate rebuttal to the vicious and maligning propaganda planted especially from a widely communicated scientific journal. Hope this serves as a reminder for everyone to be cautious regarding such mal intended articles. Thank you for your service to us. Best regards 👍🙏

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  28. Leave nationalism in its place – that’s not going to solve India’s covid crisis. If we can’t hold the current govt responsible for what we are going through, your might as well want to hold The Lancet responsible for it! Acceptance of criticism and learning from mistakes should be the way forward instead of censorship and hollow rebuttals.

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  29. Wonderful article dr pankaj –
    I personally feel that people themselves could have and still can take better care –
    1. When the vaccine was freely available many centres were begging people to come but were empty
    2. Even now I see so many people who are unmasked,do not use sanitizers and do not wash their hands when required
    3. They do not go for testing or isolate themselves inspite of having symptoms- delay results in serious consequences
    4. Even if kumbh or rallies were open it was the foolish to attend those and common sense demanded avoiding them – I have seen weddings with so many guests without any precautions .
    With the sudden reappearance of the deadly mutant strains I wonder if things would have been better even with the best of governments
    We as people should take responsibility to do what is in our hands and help the governments- state or centre to fight the enemy at all levels

    Like

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