Surge in COVID cases proves centre wrong; pandemic response marked by theatrics, not science
On 5 May, just days after the home ministry extended the nationwide lockdown, India reported the highest spike of COVID-19 infections and deaths so far, with 3,829 new cases and 194 deaths. For the second time, a national task force constituted by the Indian Council of Medical Research to advise the Narendra Modi administration on its pandemic response was not consulted on the extension, according to multiple members of the team. The centre had not discussed the extension of the lockdown into its second phase either. The task force, comprising 21 scientists, had met just hours before the announcement of the third phase, on 1 May. Yet, according to task-force members, the government did not discuss the matter with the committee of experts appointed to advise it on policy decisions.
Three months into the pandemic, as India struggles to contain growing cases, the sidelining of expert advice has become a trademark of the Modi administration’s response to the novel coronavirus. It has brought to boil the tensions between India’s scientific community and the administration leading the response. “While policy decisions involve more than just the science, the near total absence of scientific input and a spirit of scientific temper in the decisions and their communication is frustrating,” a member of one of the eleven empowered groups constituted by the centre in response to COVID-19, told me. One of the clearest indicators of this disregard for a scientific response to the crisis was the centre’s prediction, during a national press briefing on 24 April, that the pandemic would end on 16 May.
During the press briefing, Vinod Paul, a member of the NITI Aayog, presented a slide that ambitiously claimed that India would see no new cases of COVID-19 after 16 May. The empowered-group member said that the prediction relied on a “discredited theory” of mathematical modelling. The mathematical model that predicted the decline of the pandemic was depicted in a graph that was a part of Paul’s presentation in the briefing. It projected that the number of new infections would start dipping in early May, peaking with a little over 1,500 new cases around the time the second phase of the lockdown would end. It then made the optimistic forecast that the number of new cases would drop to about a thousand by 10 May, and that India would see no new cases after 16 May. Soon after the briefing, the Press Information Bureau tweeted the mathematical model, noting that Paul had said, “No need to fear of hidden spike in #COVID cases, the disease is in control.”
Paul is the chairperson of the 21-member task force and also the chairperson of the first empowered group, on a “medical emergency management plan.” His presentation was titled, “India tackles the COVID-19 outbreak effectively,” and most of his briefing appeared focused on projecting that the lockdown was a categorical success. “The country has shown that the lockdown was effective,” Paul said. Though he refrained from discussing the prediction on the graph, which was projected on a massive screen behind him, he repeatedly referred to the slide to praise the lockdown and the government’s response to the pandemic. “Today, we can say that the steps taken by this country to overcome this epidemic were timely, good and fulfilled, and with great strength, we are prepared to completely control and defeat this disease,” Paul said.
But the prediction in Paul’s graph has been far from the reality. Within two weeks, it was proven wrong by the relentless virus, which still shows no sign of ebbing. On 2 May, India reported over two thousand new COVID-19 infections within 24 hours, marking the first time the country recorded such a rise since the pandemic began. That day, the health ministry reported a total of 37,776 positive infections, with an increase of 2,411 cases from the previous day. Each day since has seen over two thousand new cases. The number of deaths from the virus has risen dramatically as well—India had consistently seen less than fifty deaths per day till mid April, and less than hundred till 5 May, when it suddenly recorded 194 deaths in 24 hours. As of 8 am on 7 May, India had recorded a total of 52,952 confirmed cases, and 1,783 deaths.
Since the press briefing, Paul’s slide has become an albatross around the government’s neck, especially as India showed a rapid increase of COVID-19 infections just around the time the presentation predicted it would nosedive. During the press briefing and in subsequent interviews, Paul did not explain why the number of new cases would dive in such drastic fashion, in perfect alignment with the Modi administration’s lockdown dates.
On 4 May, I spoke with Dr Siddharth Ramji, a professor of paediatrics at Delhi’s Maulana Azad Medical College, who had prepared the slide. Ramji told me he had made the slide for an internal exercise at Paul’s request, not knowing that it would make its way to the national media briefing. He said he was taken by surprise when the slide was presented at the briefing. During the interview, Ramji admitted that the projections had already been proven wrong. “Mathematical modelling curves are limited by the assumptions and data we have,” he explained. “If you look at it now, the graph would be going up exponentially—it doesn’t curve like that anymore. Last few days we have seen a huge spurt. We are still not at the peak, we are going up.”
The mathematical fallacy in the graph is its reliance on a theory known as Farr’s Law of Epidemics, first promulgated in 1840 by William Farr, an epidemiologist from the United Kingdom. The theory states that epidemics tend to rise and fall in a roughly symmetrical pattern that looks like a bell curve. But such a mathematical model, which assumes that the rise and fall will be roughly symmetrical, fails to reflect the reality of how diseases spread within communities. It was most famously—and wrongly—used to predict the end of the HIV pandemic in 1995. It projected that the HIV pandemic would see around 200,000 cases. As of 2018, there were 37.9 million people living with HIV.
When I reached out to Paul on 4 May, he completely denied having suggested that the number of new infections would go down to zero on 16 May. “That was a trend line,” Paul said. “You are interpreting this wrong. It only goes to demonstrate that you do not know how to read a graph. Show me where it says zero.” Given that the graph clearly shows the line depicting the number of new cases hit zero, on the x-axis, on 16 May, it is unclear how Paul interpreted the graph.
When asked if the scientific task force or the empowered group, had weighed in on this presentation, Paul said that journalists were not letting the task force do its job and cut the call. But epidemiologists working with the empowered group said they were never consulted. One of them, who requested not to be identified, said that the slide was “wildly inaccurate.” The epidemiologist added, “We have been meeting daily but we were never consulted on this study.”
Paul’s use of the graph itself is a symptom of a larger malaise within the government of its disregard for science-based decision making. “It makes no sense that they asked a paediatrician for a mathematical model, while having an entire team of epidemiologists at their disposal for this very purpose,” a member of a different empowered group told me. The first empowered-group member said, “I am not aware of any valid models which suggest a peak of the epidemic in May in India, let alone an end.” The first member added, “There are a couple of statistical models out there, but they suffer from common mistakes and are not based in epidemiology. While there is a lot of work emerging on COVID-19, it is important for policy makers to seek help from the relevant scientists to filter it and separate out the meaningful results.”
Several scientists whom I interviewed after the lockdown extension, including the members of the task force and the empowered groups, expressed their frustration and dismay at science having to play third fiddle—coming after politics and theatrics—during this public-health crisis. The theatrics referred to fly-pasts conducted by the Indian Air Force and the Indian Navy on 3 May, accompanied by helicopters that strewed flower petals over India’s hospitals, which would later have to be cleaned. The gesture, like similar ones before requesting Indians to bang their plates or light diyas, was meant to boost the morale of health workers on the front line fighting the pandemic.
During a pandemic, it is of utmost importance for the government to heed the advice of its public-health experts. A failure to do so could have a serious impact on India’s preparation in terms of keeping ventilators, beds, testing kits, and other facilities ready. It is similarly important for the government to maintain transparency about the nature of the pandemic, so that decisions can be taken accordingly. But the health ministry has steadfastly denied that India has seen any community transmission—even though the national borders have largely remained shut for around five weeks.
In the press briefing on 4 May, Lav Agarwal, a joint secretary in the health ministry, stated that India’s epidemic curve was “relatively flat” and that depending on how the public responds to the virus, the peak “may never come.” It is blatantly inaccurate to claim that the epidemic curve is flat by any metric—relative or otherwise—during a period of rapid rise, and it is unclear what Agrawal meant by claiming the peak will never come. As of now, India is at its peak in new cases so far, and it appears likely that the peak will rise higher. But in another measure that only increases the opacity of the crisis in India, on 5 May, the health ministry announced that it would only release the numbers for the scale of the virus once a day, as opposed to twice as it had been doing so far. The ministry offered no explanation for the decision.
The disregard for science has been evident in the daily press briefings. The government appears to have benched Dr RR Gangakhedkar, the lead epidemiologist at ICMR and the only representative of the scientific community on the panel. Until 21 April, Gangakhedkar was a regular appearance at the briefings. It is unclear why he is no longer a part of the briefings, because Gangakhedkar declined to comment and Balram Bhargava, the ICMR’s director general, did not respond to an email or messages. On 4 May, Maitri Porecha, a health reporter with the Hindu Business Line, tweeted, “Absence of @ICMRDelhi from @MoHFW_India press briefings is glaring. Whatever little scientific at times sane voice we had, we are now robbed of. Why is there no scientists or a doctor on a press conference, who can update is about the scientific/clinical progress?”
The first week of May appears to show that India is on the cusp of a tailspin that will witness an exponential growth in infected cases. It has brought to the surface an issue long ignored in independent India: the need to invest in science, listen to scientists, and allow room for evidence-based policies. Cardiologists, paediatricians and private-hospital entrepreneurs cannot substitute for epidemiologists, scientists and health-policy experts. If the government continues to sideline scientists, while relying on ignorant political and theatrical measures, India will turn into a disastrous incubator for the virus.