An increasingly asked question is, “If COVID-19 cases were to suddenly rise now, in a third wave of the disease , would India be better prepared than we were for the second wave in April-May of 2021 ?” In the past two weeks, such a question has been motivated by reports of Indian cases of the Omicron variant , despite India reporting record low case numbers currently and there being considerable relaxation in COVID-appropriate behaviour. Worryingly, Omicron cases across the United Kingdom are set to constitute, by some modelling predictions, more than 50% of all COVID-19 cases there in two to four weeks, displacing the Delta variant. Omicron cases in Denmark are rising steeply. It has been reported that the severity of these cases appears less than was associated with the previous Delta wave, but these are early days for a new variant reported three weeks ago.
The two sides
So where do we stand? There are positives. The extreme shortages of oxygen that we saw barely six months ago will hopefully not be a feature of a third wave. We have now vaccinated more than 50% of the adult population with both doses of vaccine, and approximately 85% have received one or two doses. Vaccines for the 12 year-18-year-old population as well as booster shots for frontline health-care workers, those who are immunocompromised, and those above 60 years are being discussed currently. When implemented, these will protect those currently most vulnerable, based on booster and variant data from elsewhere. Ramping up testing to deal with a spike should not require an increase in capacity. We have more vaccine doses than in May 2021 and the potential for oral antiviral therapy in the near future.
But there are negatives. Several of these have been discussed since the novel coronavirus pandemic began. Of those we could list, we highlight an urgent and important one — the lack of publicly available data on the pandemic from Government sources, particularly in regard to testing, but also in terms of being able to correlate disease severity with age, prior medical conditions, locations and other variables.
A letter and action taken
In April 2021, we and 900 other scientists, co-signed a letter addressed to the Prime Minister of India. The letter contained the following message, among others: “While new pandemics can have unpredictable features, our inability to adequately manage the spread of infections has, to a large extent, resulted from epidemiological data not being systematically collected and released in a timely manner to the scientific community.” Within a day of this letter becoming public, the Principal Scientific Adviser, Prof. K. VijayRaghavan promised prompt action, with his office listing nodal personnel in the main agencies responsible for COVID-19 data collection which could be contacted for these data.
Now, six months later, what progress has resulted? As far as we can see, none. Data from the Indian Council of Medical Research (ICMR), India’s premier medical research agency, remains inaccessible. The National Centre for Disease Control (NCDC) has not responded. The CoWIN data (The Government web portal for COVID-19 vaccination registration) contains valuable information but beyond the real-time data on vaccine delivery by doses, as displayed, it is of little value for future planning and prediction unless it can be tied to testing data and clinical information at the level of individuals.
Data is pivotal
Why are these data needed? If we knew that a person had tested positive on successive tests separated by, say four months or more, with a negative test in-between, that would suggest a reinfection. We could then infer the probability of such a reinfection. With information about testing and vaccination status, we could compute the probability of a vaccine breakthrough event. By checking to see whether the positive test happened after the first but before the second dose of vaccine, or after the second dose, the relative efficacy of such single vaccine doses at preventing disease could be derived. By examining symptoms reported after a vaccine breakthrough event, we could understand the extent to which vaccines reduce disease severity. Add to this a layer of sequence information, and we could study the impact of new variants.
The Indian Council of Medical Research holds data on every COVID-19 test conducted in India. At this stage of the novel coronavirus pandemic, it seems unfathomable that these data are not correlated to the vaccine data in the CoWIN platform.
Data on hospitalisations, etc. are apparently available at the State level, but seem inaccessible which, considering both the enormous resources devoted to COVID-19 across government agencies and the use of universal health IDs and records, demonstrates that we have a long way to go. If we cannot do this for COVID-19, what is the likelihood that we will accurately record other health conditions?
The most trustworthy and granular data on cases in India have resulted from the remarkable and public-spirited work of a volunteer organisation, Covid19India.org . Their volunteers maintained a public website where data were culled from individual reports by States, even sometimes from informal sources, such as journalist groups or citizen science reports. Their work has now been taken over by several other voluntary groups, all operating on the same broad principles of data accessibility: covid19bharat.org, incovid19.org and covid19tracker.in.
For the COVID-19 data void in India to be filled by volunteer groups and not by the Government is unusual by any means. The Government has access to more data than these groups. Yet, it is the data put out by these groups that appears to be trusted more, even by those in the Government.
We have laid the stress on data availability because this is the one area where a swift realignment is possible. Setting right a public health system that has been underfunded — and, in some cases, neglected — over decades, is a harder task, but we must not fail to recognise that data is a public good. The more widely data are shared, the greater the likelihood of integration of the rapidly shifting scientific frontier with clinical practice.
South Africa’s experience
South Africa’s actions with its sequencing data when the Omicron variant was first detected are illustrative. With the advantages of a relatively high-quality surveillance system among low- and middle-income countries (LMIC) countries, bolstered by a commitment towards transparency and data accessibility, South Africa’s rapid sharing allowed the world to prepare swiftly for the appearance of the highly mutated Omicron variant.
From the experience of other countries, it is likely that Omicron will spread in India, as it has elsewhere in the world. We do not know currently — and it would be irresponsible to extrapolate on the limited information available to us so far — about what this might lead to, but it is clear that pre-emptive decisions on vaccination and other measures could be made faster and better if more integrated data were available. Now, more than ever before, is the time for us to urgently re-assess our attitude towards data for public health purposes and the role of national health agencies in sharing data, generated with public funds, with scientists in India and across the world.
The title of our piece is ‘... Flying blind into the storm”. If we do not pay attention to this now, that is indeed what we will be reduced to in the months to come.
Dr. Gagandeep Kang is Professor of Microbiology at Christian Medical College, Vellore, Tamil Nadu ; Gautam I. Menon is a Professor at Ashoka University, Sonepat and at the Institute of Mathematical Sciences, Chennai.
The views expressed are personal