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COVID-19: International Perspectives From India · The SHEA Podcast

• 0:09
  SPEAKER_02: Welcome to the Rapid Response Podcast, Broughton Humanist Society for Healthcare Epidemiology of America today, promoting the prevention of healthcare and studies together and finds identified resistance and speaking to advance the field of healthcare epidemiology and doctors studying for instance, the professional epidemiology at the University of Florida, and also modern perspective, and multiple perspective, and having together, students and students and hardware, and updates and the National First Active from India.
• 0:57
  SPEAKER_02: Thank you for joining us today.
• 0:58
  SPEAKER_02: Before we start our discussion, I'd like to turn it over to Dr.
• 1:01
  SPEAKER_02: Iran Kamalaman to get us started with a brief news and guidance update for the week.
• 1:07
  SPEAKER_00: Hello.
• 1:08
  SPEAKER_00: For the global update, as of June 22nd, 2021, there have been 178 million confirmed cases of COVID-19, including 3.8 million deaths reported to the World Health Organization.
• 1:22
  SPEAKER_00: A total of 2.4 billion vaccine doses have been administered.
• 1:26
  SPEAKER_00: In the US, compared with the highest peak on January 10, 2021, the current seven-day average decreased by 94.4%.
• 1:35
  SPEAKER_00: The community transmission is at moderate level, and 65.5% adults are now vaccinated with at least one dose of COVID-19 vaccine.
• 1:45
  SPEAKER_00: As for the variant news, on June 18, 2021, the Public Health England provided a technical briefing on a detailed surveillance of B1617, also known as the Delta variant.
• 1:57
  SPEAKER_00: Delta, which is now the dominant variant in UK, demonstrates an increased risk of hospitalization when compared to Alpha variant.
• 2:05
  SPEAKER_00: However, the vaccine effectiveness against hospitalization is maintained for Delta.
• 2:11
  SPEAKER_00: Secondary attack rates and household transmission studies support increased transmissibility.
• 2:17
  SPEAKER_00: It is highly likely that Delta is more transmissible than alpha.
• 2:21
  SPEAKER_00: It is, however, too early to assess the case fatality ratio compared to other variants.
• 2:27
  SPEAKER_00: In June 2021, the National Homeland Security Consortium published its COVID-19 Pandemic After Action report.
• 2:36
  SPEAKER_00: NHSC's 22 associations represent a diverse cross-section of thousands of state, local, and private sector professionals who are responsible for the safety and security of the nation.
• 2:47
  SPEAKER_00: The report had two objectives: to clearly articulate problems and issues encountered throughout the COVID-19 response and to create a list of best practices.
• 2:57
  SPEAKER_00: The consortium identified more than 90 recommendations and 37 best practices.
• 3:04
  SPEAKER_00: Five overarching insights into nation's emergency preparedness were identified.
• 3:10
  SPEAKER_00: These were, number one, politics played a much larger role than anyone planned for.
• 3:16
  SPEAKER_00: Number two, unity of effort was not always achieved.
• 3:21
  SPEAKER_00: Number three, responding to the COVID-19 pandemic has more closely resembled a response to a catastrophic earthquake than recent public health emergencies.
• 3:32
  SPEAKER_00: Number four, the strategic national stockpile fell short of expectations.
• 3:38
  SPEAKER_00: And number five, the pandemic affected responder availability.
• 3:42
  SPEAKER_00: The whole report is available at www.apwa.net.
• 3:49
  SPEAKER_00: Now for the sum of the studies published in the last two weeks.
• 3:53
  SPEAKER_00: On June 17, 2021, the New England Journal of Medicine published an article on preliminary findings of mRNA COVID-19 vaccine safety in pregnant persons.
• 4:05
  SPEAKER_00: The authors concluded that, although not comparable, in this study, calculated proportions of adverse pregnancy and neonatal outcomes in persons vaccinated against COVID-19 who had a completed pregnancy were similar to incidences reported in studies involving pregnant women that were conducted before the COVID-19 pandemic.
• 4:28
  SPEAKER_00: Preliminary findings did not show obvious safety signals how among pregnant persons who received mRNA COVID-19 vaccines.
• 4:37
  SPEAKER_00: However, follow-up of large number of women vaccinated earlier in pregnancy is necessary to inform maternal pregnancy and infant outcomes.
• 4:47
  SPEAKER_00: On June 21st, 2021, the Journal of the American Medical Association or JAMA Internal Medicine published an original cross-sectional study that suggests that birthdays, which likely correspond with social gatherings and celebrations, were associated with increased rates of diagnosed COVID-19 infection within households in counties with high COVID-19 prevalence.
• 5:15
  SPEAKER_00: And finally, two mental health and COVID-19-related MMW are published in June.
• 5:22
  SPEAKER_00: The first study published on June 11, the authors found that parents, unpaid caregivers of adults, and parents plus caregivers had significantly worse mental health than adults not in these roles, including five times the odds of any adverse mental health symptoms.
• 5:43
  SPEAKER_00: Persons who had someone to rely on for support had lower odds of experiencing any adverse mental health symptoms.
• 5:51
  SPEAKER_00: The second MMWR published on June 18 found that during the COVID-19 pandemic, emergency department visits for suspected suicide attempts began to increase among adolescents aged 12 to 17 years, especially girls.
• 6:05
  SPEAKER_00: During the one-month study period, suspected suicide attempts emergency department visits were 50.6% higher among girls aged 12 to 17 years than during the same period in 2019.
• 6:20
  SPEAKER_00: Among boys aged 12 to 17 years, suspected suicide attempt emergency department visits increased to 3.7%.
• 6:30
  SPEAKER_00: That's all for today.
• 6:31
  SPEAKER_00: Thank you.
• 6:32
  SPEAKER_02: Thank you, Dr.
• 6:33
  SPEAKER_02: Kabalaman.
• 6:34
  SPEAKER_02: Now I want to move into the discussion with our speaker.
• 6:38
  SPEAKER_02: Can you tell us uh some of the work that you've been doing and the research you've been doing around COVID-19 in India, Dr.
• 6:44
  SPEAKER_02: Singh, and what has your data been showing you?
• 6:47
  SPEAKER_01: Thanks, Cindy, for that introduction and thank you for the invite to all the Shay members.
• 6:52
  SPEAKER_01: So India had gone through some tough times during COVID-2.
• 6:56
  SPEAKER_01: I am from Ambrita Institute of Medical Sciences, which is a 1350-bed university teaching hospital.
• 7:02
  SPEAKER_01: We also have outreach facilities like rural health center, tribal health center, and hospice center.
• 7:08
  SPEAKER_01: So during COVID-1, we converted our all outreach centers at COVID facility, and we also had intensive care facilities in these units.
• 7:17
  SPEAKER_01: But since we were flooded with so many cases, we were forced to reject one of our 500-plus teaching hospital bed as COVID center.
• 7:25
  SPEAKER_01: During COVID-2, the surge was so rapid that two blocks of the main hospital and all outreach centers were converted.
• 7:32
  SPEAKER_01: So up till now we have seen close to 3,500 plus cases, out of which 580 were in intensive care facility.
• 7:39
  SPEAKER_01: We had our turns of mortality, but now we run a multidisciplinary post-COVID SQL clinic, which extensively is following up with pulmonary medicine, cardiac, infectious diseases, neurosciences, internal medicine, geriatrics, and a rehab facility.
• 7:56
  SPEAKER_01: Our integrated medicine unit also were actively involved, included the Indian System of Medicines along with the alternate systems.
• 8:04
  SPEAKER_01: So our team of School of Medicine, Nanomedicine, Biotechnology, they developed many monitoring facilities, low-cost ventilators, 3D printed masks.
• 8:13
  SPEAKER_01: So there was a lot of work which did go through in phase one and which was put in use in phase two.
• 8:20
  SPEAKER_01: Phase two was such a rapid search that we were caught off guard.
• 8:24
  SPEAKER_01: But the facility got ready thanks to fantastic work by all the healthcare provider and good leadership support.
• 8:31
  SPEAKER_01: And we also saw a lot of post-COVID SQL and mucore mycosis.
• 8:36
  SPEAKER_01: So we up till now we have seen close to 16 patients, which was very unique, which is not seen in the rest of the world.
• 8:43
  SPEAKER_01: And it had been a tough journey in COVID 2.
• 8:46
  SPEAKER_01: As far as the research work you had asked, there's a lot of work which happened with a lot of collaboratives.
• 8:51
  SPEAKER_01: ICMR runs a collaborative on solidarity trial where we were participating in convalescent plasma therapy trials where we did participate.
• 9:00
  SPEAKER_01: We also participated in the in the Bharat Biotech co-vaccine trial.
• 9:06
  SPEAKER_01: And there is some work which is happening with the state.
• 9:09
  SPEAKER_01: So it gave us a lot of opportunity to work with the variant of trains as a variant of interest.
• 9:16
  SPEAKER_01: And there is huge publication which also came through during this period.
• 9:21
  SPEAKER_01: Lots and lots of learning.
• 9:22
  SPEAKER_01: And I must say that I would like to congratulate all the healthcare workers, all the frontline warriors who have done fantastic work, all the family members who supported this group of people to be at the facility and take care of all these patients.
• 9:36
  SPEAKER_01: It was tough two months, but nevertheless, we did perform well.
• 9:40
  SPEAKER_02: Yeah, it is.
• 9:41
  SPEAKER_02: Sounds like it is incredibly admirable what everyone was able to do in responding.
• 9:46
  SPEAKER_02: You know, we we have so many people who are listeners who are either from India or, you know, know people who have family in India.
• 9:54
  SPEAKER_02: And I think a lot of us have paid attention to what was going on, and your second wave was tragic, and our hurts definitely go out to you.
• 10:02
  SPEAKER_02: Why do you think that second wave was so devastating?
• 10:05
  SPEAKER_01: So I think there are multiple reasons.
• 10:07
  SPEAKER_01: It would be a multimodal reason which would have led to this devastating COVID-2.
• 10:14
  SPEAKER_01: Personally, I think India took it very casually.
• 10:16
  SPEAKER_01: The team of experts, both at the government as at the state and the epidemiologists, did not anticipate and saw it coming, though we knew that the virus is mutating and is changing its structure very fast.
• 10:28
  SPEAKER_01: The pathogenicity, the transmissibility of the mutant strain coming from UK, B1.1.7, South Africa, Brazil, they just took over by storm initially in the two states, State of Punjab and Maharashtra.
• 10:43
  SPEAKER_01: But very soon, since there was migration, there was travel which was uninhibited during those times.
• 10:49
  SPEAKER_01: We realized that these three wild strains surge engrossed major cities in northern India, and maximum calamities were there in two of the states, Maharashtra and Delhi.
• 10:58
  SPEAKER_01: So the reasons are plenty.
• 11:00
  SPEAKER_01: I think there's a lot of things we need to learn.
• 11:03
  SPEAKER_01: The expert team needs to pull up their socks and needs to look at the epidemic curves, need to look at the mathematical modeling and to gear up to the preparedness.
• 11:14
  SPEAKER_01: The infrastructure which was developed during COVID-1 was good enough to handle just COVID-1.
• 11:20
  SPEAKER_01: So there is a lot of new work, additional work in all fields, whether it is bed, whether it is oxygen, whether it's medicine, whether it's vaccine, that preparedness was not up to the mark.
• 11:31
  SPEAKER_01: The epidemiological surveillance needs to be strengthened, it was weak.
• 11:35
  SPEAKER_01: Public-private participation was not what we considered would be important to handle such kind of a pandemic.
• 11:43
  SPEAKER_01: The non-government sector was also caught unawares, though there was a lot of participation from them, but then it could have been much better.
• 11:51
  SPEAKER_01: The center, the federal state, and the center coordination did lack, and that is how the availability of the resources was inequitable.
• 12:01
  SPEAKER_01: The surge versus availability of the beds could not be gauged, and so there were a few states which just couldn't manage, and it was so sorry to understand that there were few people who could not be admitted, who could not get into a hospital bed, who could not get oxygen, who could not get into an intensive care facility, and we feel extremely sorry for them.
• 12:24
  SPEAKER_01: Oxygen requirements were not calculated and planned, and that led to increase in the demand and the and the and the demand plus supply gap was not filled.
• 12:34
  SPEAKER_01: Some of these medicines need to be imported, they were not available, and procurement was slow.
• 12:39
  SPEAKER_01: There is definitely a monopoly of this medicinal product, which is a cause of concern and which led to also hoarding and lack of supply on time, and the market conditions were abysmally poor to be able to meet the demand for COVID-2.
• 12:56
  SPEAKER_01: Laboratory tests since the surge was so high that we were seeing close to 4 lakh cases per day, and because of that, the laboratory tests were late, and it was when you book a test, it was taking close to 48 hours to get the tests done.
• 13:10
  SPEAKER_01: So if we say that we were 4 lakhs, it must then the numbers must definitely be higher.
• 13:15
  SPEAKER_01: And the results was also coming in 48 to 72 hours.
• 13:19
  SPEAKER_01: So we were losing those critical times when you need to be quarantined or isolated, and that also led to the spread of virus.
• 13:28
  SPEAKER_01: Healthcare workers did burn out during this time because they were just not able to handle the criticality, the mortality, the morbidities, and non-availability of beds to admit patients.
• 13:40
  SPEAKER_01: Isolation facilities, whatever was created, were all flooded.
• 13:45
  SPEAKER_01: So we saw a cumulative number of confirmed cases did increase to 1 lakh 58,000, which increased to close to 4 lakhs.
• 13:54
  SPEAKER_01: We also saw a sharpest spike in the country, which was much more than the America and Europe.
• 14:00
  SPEAKER_01: When other countries saw 75% increase in new cases, India has much more than that between the spikes.
• 14:08
  SPEAKER_01: Just in the city of Delhi, we saw 25,000 new Delhi infections, which was doubling every fifth day, which was really devastating.
• 14:18
  SPEAKER_01: The rate of ICU patients were 353 per million, which is much, much higher than any of the country's intensive care facility admissions.
• 14:28
  SPEAKER_01: The test positivity rate was in 17 most populated state was above 10%.
• 14:33
  SPEAKER_01: So and that is how it became so unmanageable.
• 14:37
  SPEAKER_01: Plus, then, because all this chaos, panic within the system, within the society, that it led to a lot of psychological trauma.
• 14:46
  SPEAKER_01: So it had been a tough experience, it has been a learning experience, and we just hope and pray that we do well in the future waves to come.
• 14:56
  SPEAKER_02: So, Dr.
• 14:56
  SPEAKER_02: Singh, given everything that you've been through, which is just devastating, what's the situation now?
• 15:02
  SPEAKER_02: What's happening now with that second wave?
• 15:05
  SPEAKER_01: So I think we are much better placed.
• 15:07
  SPEAKER_01: Our number of cases have come down.
• 15:10
  SPEAKER_01: So we uh in the cities like Maharashtra and Delhi, which was the largest affected areas, we are seeing cases to the tune of 200, which is much much manageable.
• 15:21
  SPEAKER_01: We were seeing close to 30 to 40,000 per day.
• 15:25
  SPEAKER_01: The positivity rate has dropped down to 0.22, which was close to 34 percent during the search.
• 15:32
  SPEAKER_01: The infrastructure is available.
• 15:35
  SPEAKER_01: If the patient now, the the testing facility is available, it is on the turnaround time, is much much better.
• 15:43
  SPEAKER_01: If you are falling sick and you require if you are between category B or C, moderate to severe, you get bed.
• 15:51
  SPEAKER_01: The oxygen facility, which was required 910 metric tons, so 750 metric ton facility is available, and there are a lot of PSA oxygen constants, which are also there in many of the university teaching hospitals, and then the medicines which was not available during that time, the government did play a major role.
• 16:16
  SPEAKER_01: So they are have all have been imported.
• 16:18
  SPEAKER_01: So remdecivice are available, methylpredniscons are now available, liposomal lampoteres and D for mucormycosis and treatment is available, there is a decent production for vaccines.
• 16:30
  SPEAKER_01: So, in a nutshell, we are much better placed.
• 16:34
  SPEAKER_01: Those two to two and a half, three months were tragic, were extremely pathetic.
• 16:40
  SPEAKER_01: We couldn't manage it well.
• 16:42
  SPEAKER_01: But now, because there were lockdown in the containment zones and there is a breaking of chain, which did happen, we are much better placed.
• 16:51
  SPEAKER_01: The positivity is low, and we are able to manage this post-COVID sequally as of now.
• 16:56
  SPEAKER_02: So it sounds like you're in a period of recovery, and yet what we're hearing are predictions that there could be a third wave in India in October or even sooner.
• 17:06
  SPEAKER_02: So, what are your thoughts?
• 17:08
  SPEAKER_02: Are you concerned about a third wave and what is the country doing right now proactively to prepare for that?
• 17:14
  SPEAKER_01: So there are two schools of thoughts.
• 17:16
  SPEAKER_01: One through a mathematic model, they think that it would be somewhere around September or October.
• 17:22
  SPEAKER_01: There are reasons for that too, because there are lots of religious congregation which happens during that particular time.
• 17:28
  SPEAKER_01: There are festival times too, and if our vaccination is not going to be good enough, then that is the time when the third wave is going to strike us.
• 17:36
  SPEAKER_01: There is another school of thought where IIT Delhi and All India Institute of Medical Sciences have worked together in another modeling base, they think that it could be earlier, and they think that it would be somewhere around late July.
• 17:48
  SPEAKER_01: That if we don't follow COVID-appropriate behavior, and if through unlock, if there is the crowding as it is right now, the third wave could be definitely pre-pone.
• 18:01
  SPEAKER_01: So, what we need to do, what we need to recommend to the state government, to the central government, and to the people, that first we need to follow COVID-appropriate behavior.
• 18:10
  SPEAKER_01: There also needs to be less dependence on government of doing something.
• 18:14
  SPEAKER_01: I think the procurement, the participation, every citizen needs to be aware.
• 18:20
  SPEAKER_01: The masking, the social distancing, and hygiene, that bit of participation needs to be there from every citizen.
• 18:27
  SPEAKER_01: The vaccination drive, mobile as well as mass vaccination, 9 million vaccines per day for coming three months is what is estimated to prevent the third pike in October.
• 18:38
  SPEAKER_01: We need to fulfill that promise.
• 18:40
  SPEAKER_01: During COVID-2, one of the other things which we saw, which we didn't see in COVID-1, is the presence of virus in semi-urban and rural communities where the infrastructure is poor and the testing facility and isolation facility is not very good.
• 18:59
  SPEAKER_01: So that is where I think our preparedness in the semi-urban and rural area should be much stronger.
• 19:06
  SPEAKER_01: We need to follow the WHO motto of keep testing, tracing, and quarantining or isolating.
• 19:15
  SPEAKER_01: So that norm should be there because we still see some of the states are not performing adequate tests, and that's a bothersome number.
• 19:23
  SPEAKER_01: The infrastructure preparedness should be with the state, and public-private partnership sufficient should be there for adequate number of beds, creating COVID care facilities, the oxygen tanks availability, medicines, non-invasive ventilators, ventilators, and so on so forth.
• 19:42
  SPEAKER_01: There also needs to be a standardization on evidence-based guidelines because what we saw is a some bit of a cocktail therapy where everything was prescribed.
• 19:52
  SPEAKER_01: And that also there was a panic within the community, and the panic was transmitted to the prescriber, and then somewhere the non-standardized irrational prescription did take place.
• 20:04
  SPEAKER_01: I think we need to be very careful about that.
• 20:08
  SPEAKER_01: There needs to be a more dynamic center-to-state coordination between the Ministry of Health and Family Welfare so that there isn't an inequitable distribution of resources and manpower.
• 20:20
  SPEAKER_01: There needs to be a better communication strategy, and information, education, and communication rollout should happen on time, which we saw massively lacking in COVID-2.
• 20:32
  SPEAKER_01: Because who's the front face, who's leading it, and what all has been done, and it needs to be communicated to the public so that they feel at ease that something is being done.
• 20:43
  SPEAKER_01: So need for lockdown and targeted ease of restrictions would be also important.
• 20:49
  SPEAKER_01: But the lockdown need not be comprehensive, but it would be contained to the locations where we have the maximum number of cases.
• 20:55
  SPEAKER_01: And we should get back to normalcy, at least 80% of the population should get vaccinated so as to create that herd immunity.
• 21:03
  SPEAKER_01: So I think in summary, I would say that there needs to be an awareness, there needs to be COVID-appropriate behavior, there needs to be adequate vaccination.
• 21:12
  SPEAKER_01: Though we are our vaccination drive would be highest globally, but since our population is so high that we are still at close to 4% of the second dose.
• 21:21
  SPEAKER_01: So that needs to be really driven fast.
• 21:24
  SPEAKER_01: Plus, looking at infrastructure, manpower, logistics, and various planning preparedness strategy, we cannot afford another COVID-2 like situation whenever third wave strikes us.
• 21:39
  SPEAKER_02: You mentioned that need to get these vaccines rolled out with a pretty aggressive target that you mentioned to try to prevent the third wave.
• 21:47
  SPEAKER_02: So how does India do that?
• 21:48
  SPEAKER_02: How is India going to be able to rapidly increase the number of vaccines?
• 21:51
  SPEAKER_02: And along with that, are you seeing the same vaccine hesitancy or distribution inequity that other countries have been seeing with vaccine rollout?
• 22:00
  SPEAKER_01: So I think we are seeing both.
• 22:02
  SPEAKER_01: We are seeing vaccine hesitancy.
• 22:04
  SPEAKER_01: We are also seeing vaccine exuberance.
• 22:07
  SPEAKER_01: There is a decent communication which has gone through.
• 22:10
  SPEAKER_01: There are various social media approaches which the government, state governments have adopted.
• 22:15
  SPEAKER_01: A lot of non-government organizations have also participated.
• 22:18
  SPEAKER_01: But parallelly, we also see a lot of hesitancy, but it is in semi-urban and rural areas.
• 22:24
  SPEAKER_01: So what we need to do with our experience over the period, we started our vaccination drive on the 16th of January.
• 22:31
  SPEAKER_01: A very good example is US Operation RAP, where they had already booked their 4 billion doses with all the production companies for vaccines.
• 22:41
  SPEAKER_01: So their citizens were protected.
• 22:43
  SPEAKER_01: India did play a major role for distribution of vaccines.
• 22:47
  SPEAKER_01: They distributed, they did a vaccine diplomacy, and that was fantastic on the part of the government.
• 22:52
  SPEAKER_01: They reached out to 84 countries which did not have access to vaccines.
• 22:57
  SPEAKER_01: But there needs to be a balance between the vaccine availability and vaccination your own citizen versus the diplomacy.
• 23:05
  SPEAKER_01: So I think that is one bit which is important.
• 23:08
  SPEAKER_01: We also need to have a political strategy towards vaccination.
• 23:14
  SPEAKER_01: There was a divide between a center and state, and fortunately, the government, the Ministry of Health and Family Welfare took that note and immediately center took the whole responsibility, which I think was a rapid and a very, very good decision.
• 23:29
  SPEAKER_01: So that is going to help.
• 23:31
  SPEAKER_01: Any change in policy needs to be communicated with evidence and with science.
• 23:36
  SPEAKER_01: Because when we started our vaccination, it was the second dose was for at 28 days, then it shifted to six to eight weeks and then to 12 weeks.
• 23:46
  SPEAKER_01: So this bit needs to be communicated with evidence and we need to reach out to the public.
• 23:52
  SPEAKER_01: There was a superb work which was done by the government where they developed an app which is called as COVID, where everybody needs to register with their social security and identification number.
• 24:04
  SPEAKER_01: And moment you get vaccinated, you get a certificate which you can download.
• 24:08
  SPEAKER_01: It worked fantastically well, but the sheer number reaching out to this app led to sometimes blockage of the COVID app.
• 24:17
  SPEAKER_01: And unfortunately, there is no alternative.
• 24:20
  SPEAKER_01: So I think that bit the government needs to really take care of.
• 24:25
  SPEAKER_01: Whenever a new vaccine which comes in, so we have co-vaccine and COVID Shield as of now.
• 24:31
  SPEAKER_01: We are also seeing Johnson Johnson and Pfizer vaccine coming in.
• 24:35
  SPEAKER_01: And simultaneously, Serum Institute have developed the second vaccine and Cynovac vaccine.
• 24:41
  SPEAKER_01: So India would require close to six to eight vaccine promoters and companies because the sheer magnitude is so high.
• 24:49
  SPEAKER_01: But we need to bring in all these players as soon as possible because if we need to look at the numbers of having 9 to 10 lakh vaccines per day, we need to open more vaccine centers.
• 25:01
  SPEAKER_01: Though as of now we have close to 18,000 vaccination centers, but we need to have more.
• 25:07
  SPEAKER_01: The rural reach towards this vaccination should be appropriate.
• 25:12
  SPEAKER_01: We somehow have fallen behind on clinical trials for pediatric age group.
• 25:17
  SPEAKER_01: It started late, and I think we need to catch up very early because hopefully this is just a rumor.
• 25:23
  SPEAKER_01: There is no epidemiological data to suggest that the third wave will impact children more.
• 25:29
  SPEAKER_01: But if it is true, they need to be vaccinated.
• 25:32
  SPEAKER_01: So these clinical trials, which are going on right now, need to finish, and then that strategy should come in.
• 25:38
  SPEAKER_01: And we need to definitely incentivize vaccine drives, which I think US is doing fantastically well, and identify a few vaccine champions so that the key opinion leaders reach out to the community and tell people that they need to vaccinate.
• 25:53
  SPEAKER_01: So overall, today's status, we have done close to 4.15 of second dose vaccination and 21.2 of first dose vaccination.
• 26:04
  SPEAKER_01: And that is pretty good, second in number globally.
• 26:07
  SPEAKER_01: Per day vaccination, it is the best.
• 26:10
  SPEAKER_01: So just sheer number one day we vaccinate almost equivalent to the population of New Zealand.
• 26:17
  SPEAKER_01: But we are the most populous and we need to reach out to the community, we need to do much more.
• 26:23
  SPEAKER_01: So I think there's a lot of work to be done there.
• 26:25
  SPEAKER_02: It sounds like you're making good progress, though.
• 26:28
  SPEAKER_02: I have to say, I really like the term you used of vaccinated.
• 26:32
  SPEAKER_02: We focused so much on hesitant thing.
• 26:34
  SPEAKER_02: And I like that as a counter term to have terms of how much some people have just really appreciated and wanting to get into vaccines.
• 26:42
  SPEAKER_02: With so many people living in India, you have about a billion people.
• 26:45
  SPEAKER_02: You've mentioned some infrastructure challenges that you had.
• 26:49
  SPEAKER_02: Do you think the country has enough medical infrastructure to support everyone?
• 26:53
  SPEAKER_02: And do you think anything will change because of the pandemic?
• 26:56
  SPEAKER_01: So I think when the COVID pandemic has given us a huge opportunity.
• 27:01
  SPEAKER_01: Though there has been devastating lessons, it has been a pathetic state, but the opportunity for improvement is enormous.
• 27:09
  SPEAKER_01: Foremost is the GDP spending on healthcare.
• 27:13
  SPEAKER_01: We have been spending almost lower than most of the low middle income countries.
• 27:18
  SPEAKER_01: So it was it is close to 1.8% of GDP.
• 27:22
  SPEAKER_01: And if you also include the private institution spending, so we would be close to 3.8 to 4%, and which is which is not good at all.
• 27:30
  SPEAKER_01: So if we need to look at an incredible health infrastructure which needs to be developed to take care of pandemics like this, and even for non-communicable diseases, the government needs to really have their strategies clear and spend more on infrastructure, on workforce, on providing all resources which are required.
• 27:52
  SPEAKER_01: There needs to be also faster decisions because somewhere that the trust between the doctors and the public, which got lost because of lack of infrastructure, lack of treatment, and few people losing their life.
• 28:05
  SPEAKER_01: There had been few instances of violence.
• 28:08
  SPEAKER_01: So government did act.
• 28:10
  SPEAKER_01: There were faster decisions, but I think more support needs to be there for healthcare workers who at this juncture have done enormous work.
• 28:18
  SPEAKER_01: We also need to set up some epidemiological institutes who will do phenomenal work, look at the mutants, look at the numbers, do the surveillance, understand the modeling, and alarm if there needs to be a better preparedness and better work.
• 28:37
  SPEAKER_01: We lack emergency infectious disease pattern or a system in place, and there is no team which works on EID.
• 28:46
  SPEAKER_01: And I think that would be important learning which would come through this pandemic.
• 28:51
  SPEAKER_01: We also need to modernize some of our regulatory act.
• 28:55
  SPEAKER_01: So we still work on our old 1895 Epidemic Act and a disaster management act.
• 29:02
  SPEAKER_01: So we need to modernize, we need to forego some of it which is old, which doesn't work well and help in the resource allocation.
• 29:10
  SPEAKER_01: And there needs to be a better participation.
• 29:13
  SPEAKER_01: The learning which has come for the society that they are bonding better, they are surviving with the minimalistic resources.
• 29:21
  SPEAKER_01: There is a lot of seva groups or charity groups which have been established, and people are reaching out for help, which is a phenomenal exercise, and it is so fulfilling to see that there is a larger group who, on a short notice, establishes oxygen banks, they establish distribution of food, they also arrange for migrant population, say hoarding and things like that.
• 29:45
  SPEAKER_01: So it is so fulfilling to see that.
• 29:47
  SPEAKER_01: Our preparedness drive for emergency handling has to be better.
• 29:52
  SPEAKER_01: Because of the COVID-1 and COVID-2, we have become more self-reliant.
• 29:57
  SPEAKER_01: We were dependent on multinational companies to give us all biomedical equipment, ventilator, non-invasive ventilators, monitors, syringe infusion pumps, or be it just personal protective equipment.
• 30:10
  SPEAKER_01: Now we are manufacturing all of it within the country, which is a fantastic sign.
• 30:14
  SPEAKER_01: So we are manufacturing PPEs, we are manufacturing high-hagene products, we are manufacturing test kits, we are manufacturing vaccines.
• 30:22
  SPEAKER_01: And we are also getting into medicine.
• 30:25
  SPEAKER_01: So those are very, very good signs.
• 30:27
  SPEAKER_01: And thanks to the opportunity which the pandemic gave us, there are good clinical trials and the participation from the community towards clinical trial happenings, which was not there earlier.
• 30:38
  SPEAKER_01: There is definitely a faster action and emergent use authorization for the drugs by the drug control authority and drug controller Journal of India, which also was very bureaucratic.
• 30:52
  SPEAKER_01: So it is so good to see that they all have come together for a cause so that the public and this particular pandemic is handled well.
• 31:00
  SPEAKER_01: There are definitely concerns over the catastrophic expenditure during this COVID illness.
• 31:07
  SPEAKER_01: And government has responded with economic stimulus, and economy is looking to bounce back.
• 31:14
  SPEAKER_01: But I think that is again a great learning to understand whether that resilience exists within the country and within the public.
• 31:23
  SPEAKER_01: The government control on pricing of essential drugs, consumables, and vaccines was also important to bring in equity.
• 31:32
  SPEAKER_01: So what I personally feel is there are there are huge learning which came through this pandemic.
• 31:39
  SPEAKER_01: There are huge opportunities for improvement.
• 31:41
  SPEAKER_01: And I think these all lessons need to be learned well.
• 31:45
  SPEAKER_01: It all needs to be put in as a white paper document.
• 31:49
  SPEAKER_01: And every bit of whether it is government, whether it is private institution, whether it is non-government institution, whether it is an academic institution, the public needs to come together to be able to fight pandemic if there are multiple waves, which we think may happen.
• 32:04
  SPEAKER_02: You know, it's interesting that throughout the world, so many different countries have had their own experiences as you were just describing for India.
• 32:12
  SPEAKER_02: Can we learn for ourselves?
• 32:14
  SPEAKER_02: But then what can other countries learn from what's happened in India?
• 32:18
  SPEAKER_02: What can they take away from what you've experienced?
• 32:21
  SPEAKER_01: I think first India also needs to learn from other countries.
• 32:24
  SPEAKER_01: They've US has managed it so well, Europe, UK have managed it so well, Australia, New Zealand have done it so well, Israel, Gibraltar have vaccinated their population so well.
• 32:36
  SPEAKER_01: So I think it's it's mutual.
• 32:37
  SPEAKER_01: India needs to learn some with some of these good examples and good working processes.
• 32:42
  SPEAKER_01: What other countries can learn from India is good public-private participation and coming together as a society to help.
• 32:52
  SPEAKER_01: I think that social bonding and coming together was enormous during COVID-1 and COVID-2.
• 32:59
  SPEAKER_01: People have just volunteered to help, whether it is in healthcare institutions, whether it to create oxygen banks, to create additional COVID care centers.
• 33:09
  SPEAKER_01: The COVID care centers got created in just the Zifi, in schools, in near airports, the hotels got converted.
• 33:17
  SPEAKER_01: So the willingness to help was enormous.
• 33:20
  SPEAKER_01: And I think that character was, I think, something which we would really cherish.
• 33:25
  SPEAKER_01: And that is one thing to be very proud of, and with other countries could learn.
• 33:30
  SPEAKER_01: The strategy towards handling such a pandemic was so new because it's it's such a new virus, it's such a new pathogenesis, it's such a new technology that we are all learning.
• 33:41
  SPEAKER_01: There isn't a cooked formula, and one size may not fit all.
• 33:46
  SPEAKER_01: So I think in the given constraints, as a low-middle-income country, India did perform very well.
• 33:52
  SPEAKER_01: There was a decent non-government organization group participation.
• 33:57
  SPEAKER_01: Vaccine coverage, the production, the self-reliance is what I think other countries also can learn.
• 34:04
  SPEAKER_01: Now India is manufacturing all biomedical equipment: the ventilators, the syringe pumps, the non-invasives, the personal protective equipment, the infection control products, the vaccines, and also they are able to and test kits.
• 34:19
  SPEAKER_01: So they are able to give it to other countries.
• 34:22
  SPEAKER_01: So I think the society, the resilience, the coming togetherness, the self-reliance, and the willingness to participate and a decent state-central coordination is what other countries could learn.
• 34:37
  SPEAKER_01: But there's a lot of things to learn from other countries, which I think India should be open to.
• 34:42
  SPEAKER_02: And you mentioned how much your own healthcare professionals have stepped up to really try to help take care of things during the second wave.
• 34:50
  SPEAKER_02: Are there ways that healthcare professionals like those who are listening to this podcast can help India?
• 34:56
  SPEAKER_01: We would like to seek help from every healthcare worker who can share good practices, the best practices, how they were able to handle this devastating COVID-2.
• 35:08
  SPEAKER_01: During this difficult times, there were a few institutions in the US who reached out and who shared their protocols.
• 35:16
  SPEAKER_01: I think one thing which would be very, very key, very critical, would be sharing good practices.
• 35:22
  SPEAKER_01: So if any healthcare personnel who's listening to this podcast and who gets excited or encouraged, please kindly share some of the good practices.
• 35:32
  SPEAKER_01: We would also like to learn or understand more the evidence which comes through various clinical trials and research so that our basic treatment modality to handle mild, moderate, and severe cases are dynamic and we are not clinging on to the earlier hydroxychloroquines and ivermectins and various antibiotics and looking at all kinds of cocktail therapy.
• 35:57
  SPEAKER_01: So if anybody is listening and if they have good evidence-based standardized treatment guidelines, it would be much more than welcome.
• 36:05
  SPEAKER_01: If there are any testing methods which are more rapid and point of care, that would be extremely helpful because waiting for an RTPCR report for 6 to 8 to 12 hours causes a lot of delay and failure for immediate action to isolate or quarantine.
• 36:24
  SPEAKER_01: Standardized approach would be important.
• 36:27
  SPEAKER_01: I think the research and development is one where we would like to know more from all the healthcare professionals and any best practices if you can share that would be extremely helpful.
• 36:40
  SPEAKER_01: I think I would really like to thank Barry, thank Cindy for this podcast.
• 36:45
  SPEAKER_01: And if we are able to do justice, if we handle COVID-2 well, are we prepared enough to handle COVID-3?
• 36:52
  SPEAKER_01: Are there any epidemiological triggers?
• 36:55
  SPEAKER_01: Are there any alarms?
• 36:56
  SPEAKER_01: Are there any good practices?
• 36:57
  SPEAKER_01: Are there any standardized rational practices?
• 37:01
  SPEAKER_01: Any way, any anecdotes, anything which you come across, kindly share.
• 37:06
  SPEAKER_01: And we would like to share with various professional bodies, societies, and state and central government.
• 37:12
  SPEAKER_01: And together, I think we will be able to handle if there is a third wave and fourth wave coming by.
• 37:18
  SPEAKER_02: Dr.
• 37:18
  SPEAKER_02: Singh, thank you so much for joining us today.
• 37:21
  SPEAKER_02: You know, we are with you and just hopeful that you will be able to avoid that third wave or at least minimize the effects of it.
• 37:29
  SPEAKER_02: And so we we wish you all the time.
• 37:31
  SPEAKER_01: Thank you, Cindy, and thank you, Shay, for giving this opportunity.
• 37:35
  SPEAKER_01: Um it has been a real pleasure.
• 37:37
  SPEAKER_02: Thank you very much to our online education center.
• 37:48
  SPEAKER_02: Under the Rapid Response Program, you'll also find other resources which include recorded webinars COVID 19 town hall.
• 37:56
  SPEAKER_02: This concludes today's episode of the Rapid Response Podcast.
• 38:00
  SPEAKER_02: Thank you for tuning in.