EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

6 EDITORIAL CHENNAI

WEDNESDAY, MAY 26, 2021

THE HINDU
EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

One­state solution, the way forward in Palestine

The whole premise of the two­state solution is wrong, providing Israel the immunity to continue its ethnic cleansing
would not be content with just half were put under the Palestinian doubled and tripled and took over
of the country and intended to Authority, which optimistically the fertile land, leaving no space

Calibrated closures take as much of it as possible and

leave in it as few Palestinians as
calls itself the state of Palestine,
but in essence has no power what­
for Palestinian expansion. The
presence of more than 600,000
possible. This ominous prediction soever, unless the one given to it, Jewish settlers, with a very high
With no short road to universal vaccination, turned out to be chillingly accu­ and withdrawn from it, by Israel. rate of natural growth, means that
lockdowns should be precise and painless Ilan Pappé rate and true in less than a year af­ Israel will never consider moving
ter the UN insisted that partition A Bantustanisation them out; and without that, even a

S
everal States have extended the coronavirus lock­
downs beyond May 31, while fresh cases appear to was the only solution for Pales­ The Gaza Strip was divided too. soft version of a two­state solution

F
or more than 50 years, well­
show a downward trend, but India’s COVID­19 bat­
intentioned and more cyni­
tle lacks strategic focus. Although a cessation of activity cal, local and external actors
tine. Under the guise of UN sup­ But the Jewish part was small and is impossible.
port, the new Jewish state took ov­ could not be defended from the lo­
er nearly 80% of historical cal national movement’s wrath. Decolonise, build a new state

AFP
has been imposed, there is not much clarity on the fu­ involved in the attempts to bring Palestine and ethnically cleansed So, the settlers were taken out in The whole premise of the two­
ture threat from virus variants, notably B.1.617 that now peace and reconciliation to histor­ almost a million Palestinians the majority in historical Pales­ 2005 and Israel hoped that anoth­ state solution is wrong and that is
has three sub­types and the dominant one, B.1.617.2, is ical Palestine have religiously ad­ (more than half of Palestine’s pop­ tine. er Bantustan, like the one in areas why it did not materialise. It is
estimated to be 50% more transmissible than another hered to the two­state solution as ulation), and in the way demol­ A and B, would be established based on the assumption of parity
variant of concern, B.1.1.7. Neither is there a road map the only way forward. ished half of Palestine’s villages It is Israel that decides there under the Palestinian Auth­ and of framing the conflict as one
The idea of partitioning Pales­ and most of its towns in nine The two­state solution, offered for ority’s rule and under the same fought between two national
for vaccine availability ahead, with direct imports by
tine between the settler move­ months in 1948; an event known the first time by liberal Zionists conditions. But the people of Gaza movements. But this is not a “con­
States hitting a roadblock and vague assurances of a ment of Zionism, and later the by the Palestinians as the Nakba, and the United States in the 1980s, opted to support a new player, Ha­ flict” as such. This is a settler colo­
domestic ramp­up from July substituting for firm com­ state of Israel and the indigenous the catastrophe. is seen by some Palestinians as the mas, and its ally, the Islamic Jihad, nial reality which began in the late
mitments. Some States are unwisely taking the foot off population of Palestine is not new. best way of ending of the occupa­ which resisted this offer. They sup­ 19th century and continues until
the testing pedal, making it that much harder to map It was first offered by the British in Incremental cleansing tion of the West Bank and at least ported them not only because today. The late scholar, Patrick
the course of transmission. A miasma of confusion has 1937 and rejected by the Palesti­ In 1967, Israel occupied the rest of the partial fulfilment of the Palesti­ there was a return to religion in Wolfe, described settler colonial
come to pervade COVID­19 policy, where the Centre no nians already then. The Zionist historical Palestine, and in the nian right for self­determination the face of the ongoing predica­ movements as motivated by a logic
movement was hardly 50 years old process expelled another 300,000 and independence. This is why the ments but also because there was he called “the elimination of the
longer has an appetite for leadership, even if it means
and was already offered by the Palestinians. Like all settler colo­ Palestine Liberation Organization big disappointment from the com­ native”. Sometimes it led to geno­
shunning responsibility for universal vaccination, and new British occupiers of Palestine, nial projects, it had to navigate was willing to give it a go in 1993, pliance of the PLO with the Oslo cide, as it happened in North
the only tool available with States is a lockdown. But as a chunk of the Palestinian home­ between a wish to take over indi­ by signing the Oslo Accords. But arrangements. Israel responded America, sometimes it translated
Tamil Nadu Chief Minister M.K. Stalin has pointed out, land as a future state. This in the genous territory while downsizing the Palestinian position has no im­ by imposing a callous siege and to an ongoing ethnic cleansing op­
a lockdown does not provide a solution, and comes 1930s and 1940s would have been the number of native people living pact in the current balance of pow­ blockade on the Gaza Strip that, eration, which is what has unfold­
with its own economic side­effects that hit the working akin to an offer to decolonise India on it. It was impossible after 1948 er. What mattered is how Israel in­ according to the UN, made it un­ ed in Palestine. The two­state solu­
class poor the hardest. The time has come for a pan­ by partitioning it between a British to repeat a massive ethnic cleans­ terprets the idea and the fact that liveable. tion is not going to stop the ethnic
India and local India or to propose ing, so it was substituted by incre­ there is no one in the world that To complete its strategy that in­ cleansing; instead, talking about it
demic policy reset that reflects scientific insight, en­
the decolonisation of Algeria by di­ mental ethnic cleansing (the last could challenge its interpretation. cluded the partition of the West provides Israel international im­
courages safe public behaviour through persuasive viding it between a French Algeria stage in this process was one of the The Israeli interpretation, until Bank, its Bantustanisation, and munity to continue it.
communication, monitoring, and, importantly, incor­ and a local Algeria. Neither the In­ root causes that ignited the cycle the rise of Benjamin Netanyahu to the siege of Gaza, Israel passed in The only alternative is to deco­
porates medical interventions of scale. dian anti­colonial movement nor of violence last week — the pro­ power in 2009, was that the two­ 2018 a citizenship law, known as lonise historical Palestine. Which
The medium­term outlook does not point to a steep the Algerian one would have ever posed eviction of Palestinians state solution is another means of the nationality law, which made means that we should aspire to a
rise in vaccination by the end of the year to cover most consented to such a post­colonial from Shaykh [Sheikh] Jarrah, an having the territories, the West sure that the Palestinian citizens state for all its citizens all over the
of the population, making it imperative for States to arrangement; nor did the British East Jerusalem neighbourhood, as Bank and the Gaza Strip, without who live in Israel proper (which is country, based on the dismantle­
and French dare to offer it when part of an overall attempt to Ju­ incorporating most of the people Israel prior to the 1967 occupation ment of colonialist institutions,
prepare for potential future surges. Although claims
they reconciled with the fact that daise East Jerusalem). living there. In order to ensure it, of the West Bank and the Gaza fair redistribution of the country’s
have been made of a large volume of three vaccines be­ they will have to leave their colo­ Incremental ethnic cleansing is Israel partitioned the West Bank Strip) and who are supposedly natural resources, compensation
coming available between August­December, the road nial empires and go back to Eu­ not the only way of achieving the (which is 20% of historical Pales­ equal citizens of the Jewish state, of the victims of the ethnic cleans­
to universal immunisation is going to be long. The pro­ rope. old Zionist goal to turning histori­ tine) into a Jewish and an Arab will in essence become the “Afri­ ing and allowing their repatria­
cess is complicated by the finding in Britain that it takes cal Palestine into a Jewish state. part. This was in the second phase cans” of a new Israeli Jewish apar­ tion. All this will be so that settlers
two doses of Covishield for 60% protection against the Catastrophic event Imposing military rule in the West of the Oslo Accords, known as the theid state: living in a permanent and natives should together build
dominant virus variant that is also found in India; the But even when decolonisation was Bank and the Gaza Strip after they Oslo II agreement of 1995. The Pal­ regime that discriminates against a new state that is democratic,
second dose, therefore, should be administered after achieved in India in 1947, not only were occupied was another means estinians were forced to accept it them in all aspects of life on the ba­ part of the Arab world and not
the British but also the so­called ci­ which enclaved the people there under American and Egyptian sis of their nationality. against it, and an inspiration for
eight weeks, not 12 or 16. What States can do imme­
vilised world through the United without basic human and civil pressure. One area, called area C, The endless negotiation on the the rest of the region which des­
diately is to arrive at a good lockdown protocol, sparing Nations insisted that the Palesti­ rights. Imposing a version of an which consists of 60% of the West two­state solution was based on perately needs such models to
people frequent shocks. Tamil Nadu’s recent move to nians should give half of their ho­ Apartheid regime on the Palesti­ Bank) was directly ruled from 1995 the formula that once the two push it forward towards a better
intensify the lockdown, and, inexplicably, allow even meland to the settler movement of nian minority in Israel is another until today by Israel. Under Mr. states become a reality, Israel will future.
jewellery and clothing shops to open for a day before Zionism. The Palestinians attempt­ method and the constant refusal Netanyahu, Israel is in the process stop these severe violations of the
that, led to massive crowding triggered by induced de­ ed to convince the international to allow the 1948 refugees to re­ of officially annexing this area Palestinian civil and human rights, Professor Ilan Pappé is the Director of the
mand. Clearly, measures to shut down everyday activity community that the problem was turn completes the matrix of pow­ while at the same time ethnically wherever they are. But while the European Centre for Palestine Studies and
not only about dispensing with er that allows Israel to retain the cleansing the Palestinians living in wait continued, more Palestinians Senior Fellow of the Institute of Arab and
lead to fear and panic, and leave less affluent sections,
half of their homeland but that the land and disregard a demographic it. The remaining 40% of the West were expelled and the Jewish set­ Islamic Studies, University of Exeter, U.K.
the disabled, migrant workers and many single indivi­ settler movement of Zionism reality by which the Jews are not Bank, areas A and B under Oslo II, tler community in the West Bank He is the author of 20 books
duals unable to cope. The golden mean would be to
shut all non­essential shops, encourage remote transac­
tions, open street sales and home deliveries, actively
monitor compliance with COVID­19 protocols in public
places and vaccinate workers in services, including
Slowing the pace of India’s mucormycosis threat
domestic workers, on priority. Free food distribution The experience of oncologists who rely on steroid­based protocols offers lessons in preventing and managing cases
must be a central feature of lockdowns. most 70 times higher than what is sections. Additionally, there are li­ cial to avoiding mucormycosis.
reported in other countries. In a mited antifungal drugs available When patients are medicating

Rules and rulers multi­centre study across several

tertiary­care hospitals in India, pu­
for mucormycosis. The gold stan­
dard drug is liposomal amphoteri­
themselves at home, monitoring
of capillary blood glucose is essen­
The Govt. must hear out the social media blished in Clinical Microbiology cin B, which is priced out of reach tial. If high blood sugars are en­
and Infection (https:// for many. Amphotericin B deoxy­ countered, a tele­consult with a
industry, and shed its arbitrary rule­making
VIJAY SONEJI

Nikita Mehra bit.ly/3fkLzV8), the rough estimate cholate (conventional) is cheaper, doctor is advisable. Going a step

I
t does seem that most if not all global social media of proven mucormycosis was but is associated with an unfavour­ further, health authorities may
giants will miss complying with the new IT rules of around 40 cases on an average ov­ able toxicity profile including kid­ consider arranging for blood glu­

T
intermediaries, which come into effect today. It he alarming rise in India re­
cently in the incidence of
would be unfortunate if this non­compliance were to
mucormycosis — a rare fun­
trigger a further worsening of the already poor relation­ gal infection — in patients who
ship between some social media players and the Go­ have been diagnosed and treated
vernment. The new rules were introduced in February. for COVID­19 has come as no sur­
Among other things, they require the bigger social me­ prise to those of us in the medical
dia platforms, which the rules referred to as significant oncology community. This out­
social media intermediaries, to adhere to a vastly tight­ come was our greatest fear as the
administration of dexamethasone
er set of rules within three months, which ended on
and other steroids began to be­
May 25. They require these platforms to appoint chief come common. As oncologists
compliance officers, in order to make sure the rules are who rely on steroids in many of
followed, nodal officers, to coordinate with law enforce­ our protocols, and having man­
ment agencies, and grievance officers. Another rule re­ aged several cases of mucormyco­
quires messaging platforms such as WhatsApp to trace sis, we are acutely aware that treat­
problematic messages to its originators, raising uneasy ment protocols need to differ from
patient to patient due to the com­
questions about how services that are end­to­end en­
plexities in clinical presentation
crypted can adhere to this. There are indeed many pro­ and an individual’s tolerance to
blems with the new rules, not the least of which is the treatment.
manner in which they were introduced without much However, we find ourselves in a
public consultation. There has also been criticism different position today because of
about bringing in a plethora of new rules that ought to the magnitude of cases being re­
be normally triggered only via legislative action. ported, and the inability of treat­
ing physicians to create individual­
But non­compliance can only make things worse, es­
ised treatment protocols under
pecially in a situation in which the relationship between this burden. Some States, includ­
some platforms such as Twitter and the Government ing Tamil Nadu, have declared mu­
seems to have broken down. The latest stand­off bet­ cormycosis as a notifiable disease
ween them, over Twitter tagging certain posts by BJP under the Epidemic Diseases Act.
spokespeople as ‘manipulated media’, has even result­ Guidelines and protocols need to
ed in the Delhi Police visiting the company’s offices. be adapted and modified rapidly
Separately, the Government has been fighting What­ to arrest this growing epidemic.
Why did the risk of mucormyco­
sApp over its new privacy rules. Whatever the back­sto­
sis overwhelming us come as no
ry, it is important that social media companies fight the surprise? The estimated burden of
new rules in a court of law if they find them to be pro­ mucormycosis in India is 14 per
blematic. The other option, that of engaging with the 100,000 in a study published in
Government, may not work in these strained times. But Current Fungal Infection Reports
stonewalling on the question of compliance can never (https://bit.ly/3oOe4xv). This is al­
be justified, even if it is to be assumed that the U.S. Go­
vernment has their back. Facebook, on its part, has LETTERS TO THE EDITOR
made all the right noises. It has said that it aims to
comply with the new rules but also needs to engage Toolkit hunt
er a 21­month period observed at
each centre.
Focus on diabetes
It must be made absolutely clear
that mucormycosis is not transmit­
ted from one individual to the oth­
er, the way COVID­19 is. The most
common cause is uncontrolled
diabetes mellitus (raised blood su­
gars). Other causes include the
treatment of some cancers; ste­
roids, chemotherapy or immu­
notherapy, and solid organ or
stem­cell transplantations. The
common sites of presentation in­
clude rhino­cerebral involvement
(i.e., the fungus can damage the
nose, paranasal sinuses, the eyes
and the brain), and pulmonary in­
volvement (i.e., the fungus can
cause pneumonia).
Raised blood sugars being a
cause is of particular concern for
multiple reasons. According to a
study in The Lancet (https://
bit.ly/3bV2fAC), the number of pe­
ople with diabetes increased to 65
million in 2016 in India. The high­
est prevalence of diabetes was ob­
served in Tamil Nadu, Kerala and
Delhi. The crude prevalence of
diabetes above 20 years of age has
increased to 7.7% in 2016, from
5.5% in 1990. Further, there is an
underlying higher genetic suscep­
tibility to diabetes in Indians;
some of these cases could get un­
earthed only after exposure to ste­
roids.
The treatment of COVID­19 is,
Letters emailed to letters@thehindu.co.in must carry the full postal address and the full name or the name with initials.
country. One wonders how
unfortunately, only worsening this
situation. In a lab study published
in Nature Metabolism (https://
go.nature.com/34dEn6L), SARS­
CoV­2 can potentially multiply in
pancreatic cells and contribute to
increased blood sugar levels in CO­
VID­19 patients. Steroids form a ve­
ry important aspect of treatment
for COVID­19 because they lower
death rates by reducing the cyto­
kine storm phase which can deve­
lop in some patients. However, ste­
roids when used excessively or
prematurely, and without medical
supervision can be harmful. Be­
sides causing reduced immunity
levels, steroids can also increase
blood sugar levels which can cause
additional harm if left unchecked.
Dexamethasone, methylpredniso­
lone or prednisone are among the
steroids used in the treatment of
COVID­19.
Treatment approach
Mucormycosis is associated with
very high morbidity and mortality.
Its treatment requires a multi­dis­
ciplinary team approach that in­
cludes microbiology, pathology,
radiology, infectious diseases, sur­
gery, pediatrics, hematology, in­
tensive care, dermatology, and
pharmacology. A multi­disciplin­
ary approach is simply not feasible
on a large scale, especially in areas
with limited medical access.
Surgery for mucormycosis can
be debilitating requiring major re­
Remarks on allopathy slams Ramdev’s view”, May
ney problems, abnormalities in
electrolyte levels; reduced sodi­
um, potassium, calcium and mag­
nesium levels can lead to other
toxicities. Some other expensive
treatment options include posaco­
nazole and isavuconazole. All
these medicines often have to be
administered for prolonged dura­
tions, making treatment protocols
difficult to sustain on a large scale,
given the cost implications and dif­
ficulty in drug administration due
to its side­effects.
When a patient is recovering
from COVID­19 infection, it is cer­
tainly going to be a challenge to
perform debilitating surgeries and
administer these antifungal drugs
for a prolonged duration. In the
case of rhino­cerebral mucormy­
cosis especially, surgery is usually
required in addition to antifungal
drugs. If these surgeries cannot be
performed, the outcome is dismal.
It is also important to keep in mind
that treatment for mucormycosis
will require prolonged hospital ad­
missions. Given the health­care
constraints we are faced with, this
infection should be avoided at all
costs.
Monitoring is essential
What can be done to reduce the
number of cases and the intensity
of mucormycosis? Steroid use at
home for COVID­19 should be only
under the supervision of a health­
care worker. The control of blood
sugars during steroid intake is cru­
medical world and
cose monitoring for patients at
home on steroids, and also pro­
moting awareness campaigns on
the importance of controlled
blood sugar levels.
Patients on steroids for CO­
VID­19 should report symptoms of
mucormycosis at the earliest.
Among other symptoms, they
should look out for facial swelling
on one side, protrusion of the eye­
ball, new­onset visual disturbanc­
es, headache and vomiting, new
onset swelling or ulcers with
blackish discolouration, and pro­
longed fever. COVID­19 treatment
experts and policy­makers may
consider widespread training of
health­care personnel including
Accredited Social Health Activists
(ASHAs) and nursing professionals
to raise awareness on mucormyco­
sis while educating people locally.
The prolonged requirement for
hospital admission linked to CO­
VID­19 will also lead to a rise in
other hospital­acquired infections
necessitating the use of multiple
antibiotics. We are staring at the
grim reality of managing large
numbers of patients with other
long­standing side­effects of ste­
roids. Additionally, the concern is
the alarming increase in multi­
drug resistant bacterial infections
for which we are grossly
unprepared.
Dr. Nikita Mehra is Associate Professor of
Medical Oncology, Adyar Cancer Institute
(WIA), Chennai
To read more letters
online, scan the QR code

with the Government on a few issues. What is impor­ The ruling party’s
tant is that the genuine concerns of social media com­ obsession, and also the
panies are taken on board. Apart from issues about the Government of India’s, with
“toolkits” is absurd. In the
rules, there have been problems about creating condi­
midst of a raging pandemic,
tions for compliance during the pandemic. As reported
the urge to engage the
by The Hindu, five industry bodies, including the CII, police and central agencies
FICCI and the U.S.­India Business Council have sought to investigate so­called
an extension of 6­12 months for compliance. This is an toolkits ends up being a
opportunity for the Government to hear out the indus­ facade to divert an ordinary
citizen’s attention from the
try, and also shed its high­handed way of rule­making.
real problems haunting the
a social media site would Yoga guru Baba Ramdev’s 24). The facts and motives progressive­minded
have more information derogatory and illogical behind such utterances by individuals and such remarks.
about an alleged conspiracy remarks against allopathy the yoga guru should be organisations must express Dr. Surinder Singla,
than India’s elite should not stop the central exposed. Intellectuals, the their strong protest against Sangrur, Punjab
investigation agency itself. government from initiating corrections & clarifications:
One hopes that the legal action against him — A report headlined “Thousands from Karnal reach Singhu” (May 24, 2021, some editions) talked
government gets down to even if he did express about farmers from Punjab’s Karnal and nearby areas reaching the Singhu border to join a protest
setting the country right regret later — for causing against the farm laws. Karnal is in Haryana.
rather than look for a fear and confusion besides A front­page report titled “Gujarat emerges as hotspot of mucormycosis in India” (May 23, 2021)
toolbox. deeply hurting the feelings erroneously referred to the Epidemic Diseases Act, 1857. It should have been Epidemic Diseases Act,
of health professionals 1897.
Aswin S.,
Thiruvananthapuram (Inside pages, “Vardhan The Readers’ Editor’s office can be contacted by Telephone: +91-44-28418297/28576300; E-mail:readerseditor@thehindu.co.in

CM A CH-CHE
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THE HINDU
WEDNESDAY, MAY 26, 2021
CHENNAI
EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
Vaccination is our only weapon
It is important to hold manufacturers to account on efficacy data
Joseph Britto
On May 14, 2021, the Indian govern­
ment announced that over two billion
doses of vaccines against SARS­CoV­2
will be produced in India from August
to December. The government can be
applauded on its intent: vaccinating a
billion Indians with two doses each
should in theory give India herd im­
munity. But while the number 2.1 bil­
lion doses makes sense, little else does.
Vaccines don’t save lives; rapid, mass,
repeated vaccinations do.
Vaccinate on a war footing
In the 2019 general election, in just five
weeks, about 610 million Indians voted
at one million polling stations that
were supervised by 10 million election
officials. If the nation can be mobilised
every five years for the general elec­
tion, there is no reason why India can­
not vaccinate one billion Indians in five
weeks. On a war footing, India needs to
vaccinate 75% of the population in five
weeks, not five months.
Up to May 23, only 10.9% of the pop­
ulation had received one dose and only
4% had been fully vaccinated with two
doses. On average 1.5 million Indians
have been vaccinated every day since
the vaccination programme started on
January 16. If in the 150 days between
August and December this year, about
2.1 billion doses are produced, India re­
quires not just the production but the
administration of at least 14.4 million
vaccines per day. But it lacks the infras­
tructure to administer the produced
vaccines at 10 times the current rate. It
will fail in this critical task unless it mo­
bilises the armed forces for logistics.
Every health worker not working in a
hospital and every medical, paramedi­
cal, and nursing student will have to be
on vaccine administration duty. Unless
every Indian is protected either by vac­
cination or herd immunity, India will
remain unprotected.
Spreading viruses mutate. The only
way a host can break the cycle of repli­
cation and mutation is if the host’s im­
mune system neutralises the virus. Im­
munity is acquired in only two ways –
either by natural infection or vaccine­
derived immunity. The problem with
the current rate of vaccination is that in
Still grappling with online classes
State universities require funding if online
education is to continue in India
Milind Kumar Sharma
A year since the outbreak of CO­
VID­19, online education remains a
chimera in India. Notwithstanding
their preparedness, higher education
institutions were directed by the go­
vernment to shift from classroom
education to online education. This
was mandated even though the go­
vernment spent merely 3.2% of its
GDP on education in 2020­21. Univer­
sity administrations too released or­
ders overnight in haste. They in­
structed teachers and students to
move to online classes without taking
cognisance of changes needed in in­
frastructure, training, etc.
Differences within institutions
The financial health of state universi­
ties in the country is an open secret.
While centrally funded elite insti­
tutes such as the IITs, IIMs, NITs and
Central universities launched video
channels and uploaded e­content on
institutional websites and digital plat­
forms, a majority of the state univer­
sities still struggle without proper In­
ternet connectivity and bandwidth in
their campuses. State universities are
only able to provide salaries on time.
The move to online learning especial­
ly came as a surprise for overbur­
dened teachers given that there are
several vacant faculty positions in
universities across India. This move
also came as a shock for the students,
many of whom are distressed by the
COVID­19 situation. Many of them al­
so lack the facilities to attend online
classes. Teachers and students had a
sense of déjà vu as they had a similar
experience when the annual scheme
of teaching and regular courses was
replaced by the semester scheme of
teaching and the choice­based credit
system earlier.
A transition from conventional
classroom teaching and learning to
online education needs to be done in
a phased manner. State universities
should first equip their infrastructure
(both hard and soft) with whole­
hearted government support. A sled­
gehammer approach to adapt to a
new setting won’t serve anybody’s in­
terests. On the contrary, it may prove
to be a counterproductive exercise.
There are 993 universities, 39,931
CM
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PTI
the large population groups which re­
main unvaccinated or under­vaccinat­
ed, the virus is spreading, replicating,
and mutating. Unless it resorts to mass,
rapid vaccinations, India will be con­
demned to new variant pandemic cy­
cles that will keep surging and receding
with cyclical and devastating conse­
quences on lives and livelihoods.
Like influenza, SARS­CoV­2 is here to
stay. There is a high possibility of
another wave of infections, with anoth­
er strain if not this. Many more will get
infected. The aim is to downregulate
the virus with rapid, mass and repeat­
ed vaccinations from an epidemic to an
endemic infection that has seasonal
outbreaks with lower number of cases,
morbidity and mortality, allowing us to
safely open up and keep the economy
open.
Sadly, many decision­makers forget
that vaccinating the nation is not a one­
off; we will have to repeat this hercu­
lean exercise every season with updat­
ed and re­engineered booster vaccines
to prevent the next pandemic cycle
which will be driven by new and
emerging variants.
All vaccines are not equally effective
– high efficacy equals high economic
benefit. The primary driver of the
choice of a vaccine manufacturer is not
just the ability to produce large quanti­
ties in the time frame required; it is the
efficacy of the vaccine following peer
reviews, publications and rollout.
Equally important is the ability of the
manufacturer to quickly re­engineer
and produce updated vaccines against
the prevalent strains and future ‘var­
iants of concern’.
Both the Russian Sputnik V and the
Chinese Sinopharm vaccines were
rolled out widely and ahead of suffi­
cient phase 3 trial data. Mostly low­ and
middle­income countries have given
emergency use licence to both these
vaccines and millions have been vacci­
nated with them. Both vaccines remain
under review by the European Medi­
cines Agency. On May 7, the World
Health Organization listed Sinopharm
colleges, 3.73 crore students and
14.16 lakh teachers in India, accord­
ing to All India Survey on Higher Edu­
cation (2018­19). If such a drastic de­
cision was to be taken, there should
have been wider consultation bet­
ween the government and all the aca­
demic stakeholders to find a way for­
ward. With Internet penetration still
low in India, it is incumbent on the
government to allow suitable finan­
cial aids to state universities to obtain
appropriate IT tools, platforms, dev­
ices, provide training, etc. before in­
itiating such an exercise. Else, given
the difference in students’ access to
digital education, their performanc­
es are also bound to differ. This
creates an asymmetrical society and
leads to anxiety among the students.
Most importantly, education is de­
nied to the less privileged student
community.
Study material
Another predicament in online edu­
cation is the preparation of appro­
priate study material. Policymakers
need to acknowledge that merely
uploading scanned lecture notes or
power point presentations does not
serve any meaningful purpose. There
is no imaginative thinking and ex­
ploring, no application­based learn­
ing for students. For practical field
and laboratory­based learning, the
whole idea of online education could
prove to be a disaster.
Given that there is talk of more CO­
VID­19 waves, it is imperative for the
government to embrace a pragmatic
approach by engaging all academic
stakeholders and investing generous­
ly in online education as suggested
by the Fifteenth Finance Commission
in its report. Development of massive
open online courses (MOOCs), direct­
to­home (DTH) content develop­
ment, digital classrooms and provi­
sion of devices (laptop/tablets) for 25
lakh students belonging to the social­
ly and economically weaker sections
of society, especially in state universi­
ties, would help.
Milind Kumar Sharma teaches in the
Department of Production and Industrial
Engineering, M.B.M. Engineering College, Jai
Narain Vyas University, Jodhpur, erstwhile
University of Jodhpur. Views are personal
OPED 7
Interpreting deaths in Chennai
Excess deaths data show that COVID­19 causality is being underplayed
for emergency use and is expected to
do the same for Sputnik V shortly. Ho­
wever, absence of transparency in clin­
ical trial protocols and of the data and
its analysis have cast doubts on appro­
val of these vaccines in developed Rukmini S.
countries with access to other vac­
cines. Chennai saw over 12,000 more deaths
in 2020 than the average of the five pre­
Surge in the Seychelles ceding years — a 20% increase over
Policymakers and vaccine manufactur­ those years and a 10.66% increase over
ers would be wise to pay close atten­ 2019 alone, the highest single year
tion to what is happening in the Sey­ change in a decade. Officially, the city
chelles with respect to the efficacy of recorded just 4,000 deaths from CO­ deaths were reported than the pre­ to estimates of ‘excess mortality’ — the
vaccines. Despite being the most vacci­ VID­19 in 2020. It is unclear how many vious five­year average. With the de­ difference between deaths from all­
nated nation in the world, with more of these ‘excess’ deaths were uncount­ cline of the first wave by September causes in pandemic years and those in
than 60% of its population fully vacci­ ed COVID­19 deaths or were due to oth­ 2020, excess mortality in Chennai be­ ‘normal’ years. Countries around the
nated, the Seychelles is battling a surge er causes including lack of access to gan to fall too, but remained more than world including several Latin Ameri­
of the virus and has had to reimpose a health services. This pattern is likely to 10% above the five­year average. From can, European and North American
lockdown. In the fully vaccinated pop­ repeat itself in 2021. More deaths have February 2021, this ‘excess mortality’ countries publish updated data on
ulation in the Seychelles, 57% were gi­ been reported in the first four months began to rise too, and in April 2021, their usual and current mortality. In­
ven Sinopharm (donated by the United of the year than during any similar pe­ deaths were over one­third higher than dia, however, has not published mor­
Arab Emirates), while 43% were given riod in the last decade. The ‘excess the five­year average. The data for April tality statistics since 2018. Some better­
AstraZeneca (produced by the Serum mortality’ in 2021, which could include 2021 in particular are likely to be an un­ run States and cities have published
Institute of India). On a per capita basis other deaths, is also nearly four times derestimate as people have up to a year this data themselves. Mumbai’s ‘excess
of reported cases, the Seychelles out­ the reported COVID­19 death count of to register deaths. mortality’ for 2020 closely mirrors
break is worse than India’s. All vac­ 730 deaths for the same period. All over the world, cities and coun­ these findings about Chennai; in 2020,
cines do not necessarily demonstrate tries have accepted that the official toll Mumbai reported 1,12,000 deaths as
the efficacy that the manufacturers Excess mortality from COVID­19 does not represent the against its 2015­19 average of 90,100
tout. Manufacturers must be held to ac­ Chennai’s municipal corporation accurate or full toll. The U.K. and some deaths, an increase of nearly 20%.
count not just on their production tar­ maintains information on every death jurisdictions in the U.S. like New York These findings on Chennai raise im­
gets but on efficacy data. Transparency certificate issued for over a century. City report both confirmed and sus­ portant questions. One, even relatively
in clinical trials including post­vaccine The data presented here are based on pected or probable COVID­19 deaths. well­administered cities like Chennai
rollout analysis is mandatory. deaths counted by the date on which The latter category includes people and Mumbai reported a 20% increase
Until all Indians are protected, none the actual death took place, as report­ who did not test positive prior to in mortality in 2020, and Chennai is
of us is protected. The government’s ed in the death certificate. The city cor­ death. Despite this being part of India’s seeing a further rise in 2021. This
announcement that 2.1 billion doses poration says that it registers virtually official protocol on the counting of CO­ should put an end to speculation over
will be provided in five months, with­ every death that takes place within the VID­19 deaths, it is not being followed whether or not the pandemic drove
out any mention of a central vaccine city corporation limits. in practice. Officials in States including death rates up. Two, these differences
agency managed by experts to govern With the rising population, the num­ Tamil Nadu, Kerala, Maharashtra and cannot be explained away by the offi­
the purchase, procurement and pro­ ber of registered deaths has gradually Delhi have told this author that they cial death toll from COVID­19. London,
duction centrally for all States, will gone up every year. While data since only count deaths among people with a a city of comparable population to
create and promote vaccination 2010 have been analysed, the five most positive test prior to death as COVID­19 Chennai, has reported over 15,000 ex­
asymmetry. It will exacerbate the pre­ recent pre­pandemic years (2015­2019) deaths. Reporting from States includ­ cess deaths from March 23, 2020 to
existing healthcare iniquity and inequi­ provide the best comparison as their ing Gujarat, Uttar Pradesh and Bihar now, an increase of nearly 30%. Ho­
ty in India. To the rich­poor, rural­ur­ mortality statistics are closest to what a has indicated similar trends. wever, the city has seen over 19,000
ban, digital divides we now appear to ‘normal’ year should have looked like. To get past this lack of data, some re­ deaths with COVID­19 mentioned on
be adding a new vaccination divide. Between 2015 and 2019, Chennai saw porters have attempted to collate data the death certificate. That is a clear in­
India has to learn from its colossal 62,457 deaths every year on average from crematoria and burial grounds. dication that although mortality has ri­
mistakes. It must set aside its hubris (the average was substantially driven However, this method too is fraught sen, the city is certifying many of the
and exceptionalism. It must on a war up by high mortality in 2019, which re­ with error — crematoria do not main­ deaths as COVID­19­related, unlike In­
footing coalesce behind the only wea­ gistered an increase of 7% from 2018). tain complete records; in some cities, a dian cities. Finally, Chennai’s data sug­
pon that works — vaccination. The pan­ In 2020, Chennai saw over 74,000 few crematoria are carrying out all CO­ gest that other cities and States would
demic cycles have left in their wake in­ deaths — an increase of 19% over the VID­19 cremations giving the impres­ do well to release their all­cause mor­
calculable but preventable loss of life, five­year average and 10.7% over the sion of a greater increase in cremations tality statistics and provide estimates
human suffering, financial ruin and 2019 figure. From the end of March than the data warrant; and many cre­ of excess mortality. Cities like Chennai
economic decrepitude. If we fail, gen­ 2020 through April and part of May, mations and burials are being carried and Mumbai with strong administra­
erations of Indians to come will ask the city was under lockdown. As would out following COVID­19 protocols even tive systems are also likely to have
why we did not come together and do be expected for a city that sees over when the death in question is not ne­ stronger health systems — they might
the right thing. 100 deaths in road accidents alone ev­ cessarily from COVID­19. be missing some COVID­19 deaths, but
ery month, monthly deaths in Chennai we have greater reason to fear that
Joseph Britto is former consultant and declined in March and April. However, Mortality statistics States with under­developed capacity
honorary senior lecturer in Paediatric Intensive from May to September, there was a Given the inadequacy of official data might be missing many more.
Care at Imperial College at St. Mary’s Hospital, large spike in deaths, particularly in and the loopholes in novel sources,
London June, when more than 50% more many researchers are turning instead Rukmini S. is an independent journalist
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FROM THE ARCHIVES
FIFTY YEARS AGO MAY 26, 1971
Recognition of Bangla Desh
External Affairs Minister, Swaran Singh de­
clared in the Rajya Sabha to­day [New Delhi,
May 25] that the Government had not taken
any “fixed position” on the question of re­
cognition of Bangla Desh. “If at any stage we
feel recognition is necessary we will not hes­
itate to do so.” Replying to a five­hour discus­
sion on Bangla Desh, Mr. Swaran Singh said
the Government would not hesitate to ac­
cord formal recognition if it was in the “in­
terest of peace, our national interest and in
the interest of the people of Bangla Desh.” In
the Lok Sabha a strong demand for recogni­
tion of Bangla Desh followed by material aid
to the freedom fighters was made by several
members. Mr. Swaran Singh, however,
pointed out that the question had to be
viewed from a larger angle. “There were cer­
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tain norms which have to be carefully
DATA POINT weighed such as the extent of the territory
controlled, the quantum of support, the ex­
tent of writ and the repercussions of recog­
nising a country which till now was part of
Pakistan.” Mr. Swaran Singh also pointed out
that the situation continued to be fluid.
A HUNDRED YEARS AGO MAY 26, 1921
The Nankana case
In addition to the oral examination by the
Magistrate, Mahant Naraindas of Nankana
who has just been committed to the Ses­
sions, put in a lengthy written statement
which was read out in the court to­day. The
Mahant said that he had been apprehending
attack from Akalis and renovated the gates,
walls and entrances of the Nankana temple
not with a view to attack but for his own
shelter and protection. Holes in the doors
were made in order that he might watch
what was happening outside and not for
shooting. He was asleep on the 20th Febru­
ary morning when he was roused by the
noise of shots. He stirred out only once to in­
form the police but Akalis chased him. So he
concealed himself in his house for fear of
Akalis. It was only when the Deputy Com­
missioner arrived that he came out and saw
Akalis lying dead. More than two cans of ke­
rosene were daily used in the temple. He
therefore bought oil in large quantities
which cost him cheaper. He denied having
shot anybody or ordering firing. He also stat­
ed that he had approached the Local Go­
vernment, members of the Executive Coun­
cil, Commissioner, Mahatma Gandhi and
others for advice and assistance, but without
avail.
A CH-CHE