On Friday, India reported 401,326 new cases of COVID and 4,194 new deaths. Saturday it was another 409,300 cases and 4,133 new deaths. The new cases stats are probably off by 20-30% and the death stats are probably off by 100%. India's reported 245,256 deaths are probably closer to the U.S.' 595,619. And speaking of the U.S., I don't recall seeing a day this month where Florida didn't lead the country in new cases, beating states like Texas and California, with many more people, by over double. Yesterday, Florida-- with a population of 21,477,737-- reported 3,977 new cases, while Texas and California-- with a combined population of 68,508,104-- a 2,819 new cases together.
There has been talk lately of the cruise industry-- a huge money-maker for Florida-- leaving the state off its itineraries going forward. Jesus Jiménez explained why in a piece for the NY Times yesterday. Trying to get back on their feet again, the cruise lines are assuring clients that they require iron-clad documentation that other passengers and crew have been vaccinated. DeSantis and his crackpot GOP legislature has made that verboten in Florida. "Norwegian Cruise Line," reported Jiménez, "is threatening to keep its ships out of Florida ports after the state enacted legislation that prohibits businesses from requiring proof of vaccination against Covid-19 in exchange for services. The company, which plans to have its first cruises available to the Caribbean and Europe this summer and fall, will offer trips with limited capacity and require all guests and crew members to be vaccinated on bookings through at least the end of October. During a quarterly earnings call on Thursday, Frank Del Rio, chief executive of Norwegian Cruise Line, said the issue had been discussed with Florida’s governor, Ron DeSantis, a Republican. Mr. Del Rio said if the cruise line had to skip Florida ports, it could operate out of other states or the Caribbean. 'We certainly hope it doesn’t come to that,' Mr. Del Rio said. 'Everyone wants to operate out of Florida. It’s a very lucrative market.' The clash between Norwegian Cruise Line and Florida is one of the many that are likely to surface about how states and businesses address whether proof of vaccination will be required. While some states have yet to take a position on businesses requiring vaccines, others are already operating with such protocols in place."
In 2019 about 60% of all U.S. cruise embarkations were from Florida ports and Norwegian, Royal Caribbean and Carnival are all headquartered in Florida. DeSantis's insane, anti-Science, ideological ravings could drive the whole industry out of his state. Some at Norwegian believe that cutting Florida out of their pie is going to be so profitable for the company that they will never return to the state, which will cost the state an immense amount of money and tens of thousands of jobs. When signing a a statement on Monday, DeSantis declared that "In Florida, your personal choice regarding vaccinations will be protected and no business or government entity will be able to deny you services based on your decision."
Pretty bad-- but almost nothing compared to another right-wing extremist, Indian Prime Minister Narendra Modi. Oddly enough, though, the latest condemnation of Modi came from the editorial board of the wards most prestigious medical journal, The Lancet.
The scenes of suffering in India are hard to comprehend. As of May 4, more than 20.2 million cases of COVID-19 had been reported, with a rolling average of 378 000 cases a day, together with more than 222,000 deaths, which experts believe are likely to be substantial underestimates. Hospitals are overwhelmed, and health workers are exhausted and becoming infected. Social media is full of desperate people (doctors and the public) seeking medical oxygen, hospital beds, and other necessities. Yet before the second wave of cases of COVID-19 began to mount in early March, Indian Minister of Health Harsh Vardhan declared that India was in the “endgame” of the epidemic. The impression from the government was that India had beaten COVID-19 after several months of low case counts, despite repeated warnings of the dangers of a second wave and the emergence of new strains. Modelling suggested falsely that India had reached herd immunity, encouraging complacency and insufficient preparation, but a serosurvey by the Indian Council of Medical Research in January suggested that only 21% of the population had antibodies against SARS-CoV-2. At times, Prime Minister Narendra Modi's Government has seemed more intent on removing criticism on Twitter than trying to control the pandemic.
Despite warnings about the risks of superspreader events, the government allowed religious festivals to go ahead, drawing millions of people from around the country, along with huge political rallies-- conspicuous for their lack of COVID-19 mitigation measures. The message that COVID-19 was essentially over also slowed the start of India's COVID-19 vaccination campaign, which has vaccinated less than 2% of the population. At the federal level, India's vaccination plan soon fell apart. The government abruptly shifted course without discussing the change in policy with states, expanding vaccination to everyone older than 18 years, draining supplies, and creating mass confusion and a market for vaccine doses in which states and hospital systems competed.
The crisis has not been equally distributed, with states such as Uttar Pradesh and Maharashtra unprepared for the sudden spike in cases, quickly running out of medical oxygen, hospital space, and overwhelming the capacity of cremation sites, and with some state governments threatening those asking for oxygen or a hospital bed with national security laws. Others, such as Kerala and Odisha, were better prepared, and have been able to produce enough medical oxygen in this second wave to export it to other states.
India must now pursue a two-pronged strategy. First, the botched vaccination campaign must be rationalised and implemented with all due speed. There are two immediate bottlenecks to overcome: increasing vaccine supply (some of which should come from abroad) and setting up a distribution campaign that can cover not just urban but also rural and poorer citizens, who constitute more than 65% of the population (over 800 million people) but face a desperate scarcity of public health and primary care facilities. The government must work with local and primary health-care centres that know their communities and create an equitable distribution system for the vaccine.
Second, India must reduce SARS-CoV-2 transmission as much as possible while the vaccine is rolled out. As cases continue to mount, the government must publish accurate data in a timely manner, and forthrightly explain to the public what is happening and what is needed to bend the epidemic curve, including the possibility of a new federal lockdown. Genome sequencing needs to be expanded to better track, understand, and control emerging and more transmissible SARS-CoV-2 variants. Local governments have begun taking disease-containment measures, but the federal government has an essential role in explaining to the public the necessity of masking, social distancing, halting mass gatherings, voluntary quarantine, and testing. Modi's actions in attempting to stifle criticism and open discussion during the crisis are inexcusable.
The Institute for Health Metrics and Evaluation estimates that India will see a staggering 1 million deaths from COVID-19 by Aug 1. If that outcome were to happen, Modi's Government would be responsible for presiding over a self-inflicted national catastrophe. India squandered its early successes in controlling COVID-19. Until April, the government's COVID-19 taskforce had not met in months. The consequences of that decision are clear before us, and India must now restructure its response while the crisis rages. The success of that effort will depend on the government owning up to its mistakes, providing responsible leadership and transparency, and implementing a public health response that has science at its heart.