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Zoonotic Infectious Diseases: Local Origins, Global consequences

Engage! – Discussions on active involvement in personal health and global wellness

On December 31, 2019, twenty-seven cases of pneumonia of unknown origin were reported in Wuhan, China. By the second week of January 2020, the first case outside China was reported in Thailand. On January 30, 2020, the WHO declared an international public health emergency. Since those events transpired none of us have escaped the effects of the waxing and waning of SARS-CoV-2 as it has raged around the world over the past 18 months. 

If there is a positive fallout from this event, it is the explosion of international scientific efforts to find a way to control this deadly virus. The first sequence of this coronavirus was publicly available in January 2020, and vaccines were created within the next six months, both achievements as epic as the urgency created by this unprecedented (at least in our lifetime) international crisis. Simultaneously, the origin of this virus is being investigated, and expanding upon the knowledge that bats are the natural host of previous coronaviruses that caused human epidemics, namely SARS-CoV and MERS-CoV, it appears that SARS-CoV-2 managed to jump to humans from bats. In order for the jump to human infectability to occur, mutations occurring in the virus genome create a viral surface protein that can bind specifically to a human cell surface protein; in the case of SARS-CoV-2, this could be a mutation that allows the viral Spike protein to bind the human cell surface ACE2 protein and cause infection. 

COVID-19 structure
COVID-19 structure

This process of zoonosis, involving the adaptation and transmission of infectious agents from a primary host that is either a mammal or a bird to humans, is an evident aspect of over a hundred infectious diseases known to afflict humans. The infectious agent involved could be bacteria, fungi, parasites, or viruses and in addition to known diseases, there is a continuous roster of emerging zoonotic diseases as these opportunistic microorganisms try to find new hosts to live and breed in. Transmission from animal to human may be through direct contact through potential scratches or bites, airborne through droplets for instance, through vectors such as mosquitoes, ticks, and lice, ingestion of contaminated food or water, and by contact with infected vegetation, soil, water, wild animals, etc. Transmission of pathogens across oceans and borders after they have adapted to humans can, unfortunately, become a reality with the ease of international travel, especially if they can achieve efficient human-to-human transmission and become highly infectious, as in the case with SARS-CoV-2. 

Commonly known extant zoonotic diseases include rabies, plague, chagas disease, brucellosis, anthrax, bovine tuberculosis, Japanese encephalitis, zika virus, ebola, and AIDS. All these, and many more, are of direct relevance to India and other tropical and sub-tropical countries including south-east Asia, Africa, South America, western Pacific islands, and parts of Australia where they can be a burden on the public health system and economy. In India, 13 zoonoses are associated with 2.4 billion cases of human disease, and 2.2 million deaths per year. The National Center for Disease Control in India coordinates efforts at early diagnosis and effective containment, and a specific focus is in the handling of animals and regulation of human-animal contact. Peri-urban areas have grown rapidly in India, and are a link between agricultural areas and densely populated sites. They present a risk as there is unregulated livestock-based food production in these areas to meet the increased demand for food products. 

In addition to these existing illnesses, it is estimated that 60-80% of emerging infectious diseases are zoonotic diseases. Change in land use is thought to be a major underlying cause of this especially in Southeast Asia and in tropical and developing countries, coupled with wildlife diversity. Depending on the use that the deforested land is co-opted for, be it monoculture forests, crops. poultry, livestock. housing, etc., different groups of zoonotic species came to the fore. For instance, strong associations of vector-borne diseases were found with monoculture plantations (for instance, rubber), and bacterial and viral diseases are among others associated with livestock farming. In India, which is one of the hot spots for emerging zoonotic diseases, potential reasons for the emerging disease include changing land use, dairy farming, rodent infestations, wild-animal trading, climate change, and improper farming practices. Coupled with these conditions there is a lack of awareness, poverty, and poor access to medical and diagnostics services. Endemics, epidemics, and emerging zoonotic diseases in Australia have been a constant presence between livestock, horses, and humans. These are mostly viral and vector-borne diseases, and a few examples are Nipah virus, Menengle virus, and JE virus

Examples of zoonotic diseases and their affected populations.
Examples of zoonotic diseases and their affected populations.

Triggered by the ongoing SARS-CoV-2 pandemic, the World Wildlife Fund has published a report on the zoonotic disease risk posed by wildlife markets in southeast Asia that are involved in wildlife trade and consumption. They urge governments to impose regulations on these activities and reduce demand for high-risk wildlife products. Other comprehensive and phased efforts to prevent and control known and new pathogens have been reported from Congo (monkeypox virus), Ethiopia (rabies), and Georgia (a new zoonotic virus). Of particular concern to India is the potential for it to become a hotspot for future variants of SARS-CoV-2, with global consequences. With its density of population, a priority is to exercise COVID19-related behaviors of masking, social distancing, and vaccination. A second priority is sequencing variants as they arise and following them epidemiologically with outbreaks of COVID19. 

In urban settings, most contact with animals is relegated to pets, household pests, and the consumption of meat and dairy products. Obviously, food needs to be handled with care and cooked well, and pests ranging from rats to mosquitoes and flies need to be eradicated. Although specific viruses can infect dogs and cats, there is currently no evidence that these transmit to humans and cause disease. However, there is some evidence that pets can test positive for SARS-CoV-2, with infection transferring from infected humans. Import and close continuous contact with exotic and wild animals as pets is not recommended. 


L. Iyengar has lived and worked in India and the USA. A scientist by training, she enjoys experiencing diverse cultures and ideas, and writing. Her short story will be included in an anthology showcasing a group of international women writers, to be published in 2021 by The Nasiona. She can be found on Twitter at @l_iyengar and www.liyengar.com.


 

Can COVID Burst America’s Bubble While The World Battles The Virus?

On May 13, after combating three waves of the coronavirus, the CDC released guidelines stating that  Americans who are fully vaccinated against Covid-19 can resume activities without wearing masks or physically distancing in most settings, indicating that the pandemic may be near an end.

“If you are fully vaccinated you can start doing the things you had stopped doing because of the pandemic,” announced CDC Director Dr. Rochelle Walensky.

But experts at a May 14 Ethnic Media Services briefing questioned whether it was too soon to go back to normal.

“Bubbles are beautiful, but bubbles do not last long in this world,” remarked Dr. Ben Neuman, Chief Virologist at the Global Health Research Complex at Texas A&M University.  “Any vaccine bubble that may exist is going to be fragile, unfortunately.”

As Covid-19 outbreaks occur in Michigan, Florida and Puerto Rico, the AMA reports  there is potential for a fourth pandemic surge.

And yes, the Indian B.1.617 variant is here, says the CDC. It’s monitoring the Indian mutation that the World Health Organization classified as “a variant of concern at a global level” because it may spread easily. According to the CDC, new mutations of the virus are more transmissible and are resistant to treatments or vaccines. These include five notable variants – B.1.1.7: (UK),  B.1.351 (S. Africa), P.1 (Japan/Brazil), B.1.427 and B.1.429 (identified in CA).

Going back to normal could expose adults and children to deadly new strains of the virus and its variants, rippling across the US and elsewhere in the world.

 

Can America survive in its Covid-19 bubble?

Variants can burst our bubble said experts, voicing concerns about our vulnerability to virus mutations and the prospect of ever reaching herd immunity.

Dr. Neuman has been sequencing the virus strains in Texas, and has identified different variants thriving even locally. At the peak of Covid-19 in January, he found that 30% variants of concern were from the B.1.1.7. UK variant. By late April and early May however, he added, “every single virus …has been a variant of concern.”

The virus is changing in unexpected ways, explained Dr. Neuman, driving certain lineages of the virus out of existence.  It’s a Darwinian process that  showcases “an increase in viral fitness.”

But, without any checks or balances on the virus which operates on a short-term risk-reward cycle – a 6-to-8-hour timetable – scientists find it difficult to predict long-term movement.

You can trust a snake, a chicken, or a cat to act in its own best interests to the best of its ability said Dr. Neuman, but “a virus has no such impulse.” Instead, it has an evolutionary incentive that drives it not in the direction we would hope or expect, but in the direction of more severe, sustained disease.

Over time the virus will continue to mutate, and vary unpredictably, warned Dr. Neuman, and solutions will have to be updated continually.

“In this particular place and time, there is approximately a 100% chance that you will run into something that grows faster, and has the potential to spread farther, and perhaps hit harder than one would be expecting otherwise.”

The world has underestimated the virus over and over by relaxing restrictions and causing a virus resurgence, reiterated Dr. Neuman.

 

The question is, “Can we do the wrong things and still expect the right results?”

One outcome that scientists predict could keep the virus at bay or banished altogether is Herd Immunity, a popular concept that is mired in misconception and misunderstanding. Dr. Marc Lipsitch, Professor of Epidemiology and Director of the Center for Communicable Disease Dynamics at the Harvard School of Public Health, described herd immunity as a state in which completely immune completely or partially immune people in a population slow down transmission by making it impossible for the virus to pass through them from one person to another in a sustained way, “till the virus essentially goes away.”

Will vaccinations and infections create herd immunity in the current phase of the pandemic? Dr. Lipsitch believes that’s an unlikely scenario – even with the vaccines we have.

At the start of the pandemic, before lockdowns and social distancing, a person infected up to 21/2 or 3 people each. But compared to early versions of the virus, contagious new variants have increased transmissibility by up 4 to 5 persons each. To reduce transmissibility by a factor of 5, explained Dr. Lipsitch, means immunizing 80% of the population,  a challenge that may be impossible given a number of factors.

At the moment, every variant in the world is present in the US.  Immunizing the nation won’t be easy because vulnerable populations – especially racial/ethnic minority groups and economically and socially disadvantaged communities – lack equitable vaccine access, children under the age of 12 are ineligible, and vaccine hesitancy is prevalent.

In the US vaccine hesitancy is based on a lack of trust in its efficacy. At issue also, is that all vaccines currently available in the US do not offer 100% protection. But added Dr. Neuman, “I trust the virus less!”

While Yale Medicine rated Pfizer-BioNTech at 95% for preventing symptomatic disease, its stability depends on strict storage requirements; Moderna has a similar high efficacy of 90% upon full immunization, while the single shot Johnson & Johnson vaccine has a 72% overall efficacy.

There is also concern about waning immunity and about revaccination. Limited studies that exist clarify that antibodies decrease over time, but there is uncertainty about at which point a person is no longer protected.

Annual boosters may be necessary at a minimum, confirmed Dr. Neuman, but although each of the vaccines is reasonably effective against each of the variants, there is definitely a lower effectiveness against some, like those coming out of Brazil and South Africa.

It’s more the virus changing than waning immunity that will drive the vaccination cycle.

 

Defanging Not Defeating the Virus

In the wake of the CDC’s new mask guidelines, Dr. Neuman noted that people calculating what precautions to take – to mask, social distance, or get vaccinated – are making decisions predicated on the original versions of the virus.

As ‘stay-at-home’ lockdown measures gradually ease, NIH reports also say that much of the population may return to spending increasing amounts of time in inadequately ventilated workplaces, offices, schools and other public buildings, where they may be exposed to a risk of acquiring viral infections by inhalation.

So, in the midst of an ongoing epidemic, as social barriers to transmission are lowered without reaching herd immunity, and high-risk populations in the other parts of the world face vaccine shortages, we are “in some sense “ said Dr. Lipsitch, “not ‘totally defeating, but simply defanging the virus,” – just making it less dangerous to have transmission.

He predicts “a quiet summer” followed by “some virus resurgence in the fall” as people move indoors and continue to lower their guard.

 

Fighting the Virus at Warp Speed

All the experts argued that the only way out of the pandemic is to ensure that more vulnerable populations across the world get vaccinated.

Peter Maybarduk, Director of Public Citizen’s Access to Medicines Group, called for a global response at warp speed for the world – a catalyst for more funding, sharing resources and technical assistance, more manufacturing, and a definite plan to vaccinate everyone, everywhere, with at least 8 billion doses of MRNA vaccine within a year to make up the global shortfall.

Apart from the moral argument, added Dr. Lipsitch, “we like having interactions with the rest of the world, and for all the reasons we value the rest of the world, we should value their health as well.”

Dr. Neuman called for a single global solution to vaccinate everyone within a window of six months to a year.

Maybarduk, an expert on the Covax initiative which partners with the World Health Organization to get vaccines to low-income countries by sharing vaccines equitably, pointed out that wealthy countries have purchased much of the global supply of doses in bulk, so less than 5 % of the world’s population – only 340 million (one quarter of the doses already administered in the US alone) – have been vaccinated worldwide.

In Brazil only 17% of Brazilians have been vaccinated, said Dr. Rosane Guerra from the Department of Pathology, Biological and Health Sciences Center at the Federal University of Maranhao (UFMA). Brazil does not have an adequate supply of medication to prevent or control the virus.

Covax aims to vaccinate 20 percent of the world with a 2 billion dose target for 2021 but has only been able to ship 64 million doses, stated Maybarduk.  Worldwide access to vaccines is hobbled by the lack of manufacturing capacity, inefficient distribution channels, and low production volumes, access to raw materials, export controls, meeting regulatory requirements for safety and efficacy, obtaining qualifications from WHO for manufacturing facilities, and by politicians prioritizing their own citizens for vaccination first.

Sharing vaccines and vaccine knowledge (like the Trips waiver) is imperative to overcome the vaccine shortfall Maybarduk suggested, and getting vaccines to those who desperately need it in other countries..

“We should not cross our fingers and assume all is going to work out.”

Fighting the virus is like mobilizing for a world war which requires collective, integrated human effort towards achieving one goal. “I don’t think halfway solutions are going to get us there,” said Dr. Neuman. Getting to the next stage requires an integrated effort that scientists know is doable but is ultimately a political decision that world leaders must make.

“It’s impossible to have any kind of bubble in a world when people can move between countries in the middle of an epidemic. We have to close every border to control the disease,” Dr.Guerra concluded.

The bubble could burst as restrictions are relaxed before the pandemic is under control, said Dr. Neuman. “I don’t think that is the path that leads to the fastest extinction of the virus.”

“Get the vaccine, wear a mask, and when the numbers go down, then you know it’s safe to relax!”


Meera Kymal is the Contributing Editor at India Currents

Photo by Marc Sendra Martorell on Unsplash

Photo by Fusion Medical Animation on Unsplash


 

Stanford’s Dr. Nirav Shah on Vaccines VS. Variants

Breaking news that virulent variants from Brazil, South Africa, and the UK are multiplying across borders even as homegrown strains are mutating on US soil, has raised a number of questions.

Are variants more contagious?
Will they cause worse infections?
Are current vaccines effective against mutating variants?
And should we take different precautions to keep safe?

Dr. Nirav Shah, MD, MPH, of Stanford University’s Clinical Excellence Research Center, fielded questions and concerns from ethnic media reporters at a press briefing on March 19. Along with other COVID 19 experts from the Bay Area, Dr. Shah shared information about new strains of the virus and safety net information for communities of color who want to sign up to get their vaccine shot.

“We cannot start to celebrate just yet,” said Shah, even though America reached an important milestone when the 100 millionth vaccine was administered on March 19.

The Story of Virus Variants

The emergence of variants has raised the specter that the current generation of vaccines might be rendered obsolete before they have even been fully rolled out. Are variants gaining ground and will they be immune to distinct vaccines before we reach herd immunity?

“It’s a race between how fast we get people fully vaccinated versus the level of disease in a community and how much transmission is going on,” explained Shah, about how a variant becomes dominant.

In heavily infected communities, the more virus particles there are, the greater the chance of one being different. All you need is a spike protein change, said Shah, which will give the variant a better chance of attaching to cells, so it spreads better and faster, becoming the dominant strain.

Simultaneously, as more people get vaccinated to combat COVID19, “the selective advantage of some particles relative to other particles, allow them to spread much faster.”

Now the race is on to get everyone vaccinated before the B.1.1.7. variant – the most dominant variant takes over.

“The story of virus variants is the story of evolution and natural selection,” added Shah.

Investigations of Variants

Currently, the CDC and WHO are studying the spread of three designated variants. Variants of interest -like the P2 which have ‘caused a cluster of infections’  in some countries, seem to be driving a surge in cases, though less is known about their transmissibility and lethality, or even if vaccine recipients are ‘fully neutralized against them or not’.

Their genetic sequence has some changes which suggest they may be more contagious, said Shah, and likely to be resistant to immunity bestowed by vaccines, treatments, or tests.

People are at greater risk from variants of concern that could reinfect survivors of certain Covid19 strains. Therapies and vaccines may be less effective against these strains which have “proven to be more contagious and cause more severe disease,” explained Shah.

Recent studies report that COVID-19 survivors and fully vaccinated people seem able to fight off infection from the virulent B.1.1.7 variant but may have less protection against the B.1.3.5.1 variant. Shah referred to research that shows the B.1.1.7 variant spreads about 50% faster and is more lethal, relative to prior strains of the virus.

The good news is that the existing range of vaccines (Pfizer, Moderna, Oxford/Astra Zeneca, and Novavax) have proven effective against this variant.  But less is known about the transmissibility and lethality of the P1, B.1.4.2.7, and  B.1.4.2.9 strains.

So far, however, assured Shah, no variants have met the definition for variants of high consequence which refer to strains that cause “more severe disease, more hospitalizations, and have been shown to defeat medical countermeasures” – like vaccines, anti-viral drugs, or monoclonal antibodies.

In the contest between vaccines and variants, “We will win the race by …vaccinating people as quickly…and broadly as possible” noted Shah.

An Annual Shot

Infectious disease experts liken variants to flu viruses which require new flu vaccines every year; scientists are even considering the possibility of multivalent vaccines designed to immunize against two or more strains of the virus.

“It’s a race of the mutant viruses against the vaccines…and to date, none of the mutants have escaped fully the major vaccines. The hope is that with minor modifications, we can get the continued evolution of the vaccines to match the evolution of the viruses.” It wouldn’t be surprising if the COVID vaccine was administered like a flu shot every year, added Shah.

Getting to Herd Immunity

The likelihood of reaching herd immunity will be a reality if at least  70% or more of the population are resistant to existing strains of the virus. However, as states relax public health restrictions as well as mask and social distancing mandates, herd immunity may be challenging to achieve.  “More people getting infected simply means more chance of variants,” cautioned Shah.

I asked Dr. Shah if we would need a new generation of vaccines before the current vaccine roll is complete and if boosters would be introduced. “I am an optimist”, said Shah. “I imagine we would have booster shots by the fall but what’s important is that we all get that first shot, and make sure the vulnerable and elderly get theirs. That will make us collectively win”.

Dr. Shah reiterated that the Moderna, Pfizer, and Johnson & Johnson vaccines authorized by the Food and Drug Administration (FDA) for emergency use, are still the most powerful tools to fight all the strains of COVID-19.

“This is a race for the world,” said Dr. Nirav Shah. “We know the virus doesn’t respect any borders, and so we should be as broad as possible in our thinking about getting the vaccine to everyone across the world.”

Helpful links:


Meera Kymal is the Contributing Editor at India Currents

COVID Creates Hunger Crisis in India

As the COVD-19 tsunami began its global spread, it exacerbated crises that were already taking a toll of vulnerable populations across the world.

In India the pandemic triggered a domestic migrant worker disaster. In Yemen it threatened a death toll far worse than the one inflicted by civil war.  And in Central America, where farming was destroyed by years of extreme climate events, the pandemic wrecked food security for 1.7 million people, according to the United Nations World Food Programme (WFP)

“COVID is making the poorest of the world poorer and the hungriest hungrier,” said Steve Taravella, a senior spokesperson for the WFP, at an ethnic media press briefing on February 26 to discuss the fallout from the pandemic. Advocates warned that a coronavirus-induced global famine loomed for millions.

“270 million people marching towards the brink of starvation need our help today more than ever,”  WFP’s Executive Director, David Beasley, told the UN Security Council last year. “Famine is literally on the horizon.”

The pandemic has inflicted its heaviest toll on poorer communities in the developing world, exposing the inequities driven by poverty and economic inequality that plague marginalized populations.

In India nearly 1 in 3 people face moderate or severe food insecurity, said Parul Sachdeva, India Country Representative for Give2Asia, a non-profit that supports charities in the Asia Pacific. India has the distinction of being the country with the largest number of food insecure people, and accounts for 22% of the global burden of food insecurity. When the pandemic hit, people were already struggling with poverty and socio-economic crises that gave them less food to eat. The lockdown that followed disrupted both the harvest and the food supply chain. More than a hundred million people and their incomes were affected by the inability to harvest crops in time.

When India enforced a shutdown to stop the coronavirus spread, it forced tens of thousands of migrant workers to make the long trek back to their villages after they lost jobs and wages. Without ration cards or money to buy food, the disruption to food chains put thousands at risk of hunger, leaving them to rely on NGOs and charitable civic organizations like Akshaya Patra, rather than the government, to provide food aid.

In a double whammy, the pandemic lockdown that increased food insecurity also fueled gender-based violence (GBV).

During lockdown, reported cases of gender-based violence more than doubled during the pandemic, said Aradhana Srivastava, of WFP’s India office. “The extent of suffering is actually much larger than what is being seen.” Research shows that domestic violence closely correlates with income levels, said Srivastava, and GBV is higher among lower-income households and food-insecure families. Increased food insecurity causes mental stress in households and triggers domestic violence towards women. “The increased incidence of domestic violence is linked to loss of livelihoods, loss of access to food — so there is a direct bearing.”

Since 2014, prolonged drought and excessive hurricanes in Central America have destroyed staple crops. But severe climate events and poverty – the key causes of food insecurity – have worsened with the pandemic. “The face of hunger In Central America has changed,” stated Elio Rujano, a Communications Officer for the World Food program. In Nicaragua, El Salvador, Honduras and Guatemala, food insecurity has now spread from rural communities into urban areas. COVID lockdowns have taken away income from daily wage earners – 50% of the economy depends on informal labor – which has made it harder for people to meet basic needs like food.

Six years of conflict inYemen has ripped apart the country’s infrastructure and fragile heath system, displacing almost 4 million of its 30 million inhabitants. Conflict has become the main driver of hunger, as food prices skyrocket, and frontlines move. With COVID and the ensuing lockdown, the hunger situation hit new peak in Yemen. WFP forecasts a severe risk of famine and acute malnutrition in 2021 for 2 million children aged 1 to 5, which will have severe long term impact felt by “generations to come.” But famine has not been declared in Yemen even though “people are dying of hunger,” said Annabel Symington – Head of Communications for the WFP in Yemen, calling for funds to mount programs and interventions. “The time to act is now.”

The WFP feeds 100 million in 88 countries every year divided between 3 initiatives:1.Natural disasters, typhoon, cyclones, 2. Conflicts, and 3. Ongoing non-emergency aid such as school meals, pregnant women new mother nutrition, community help, and small farmers. In 2020, WFP was awarded the Nobel Peace Prize for its efforts to combat hunger.

“We provide basics for sustainability till long term solutions can be developed,” said Taravella.  For years the WFP “chipped away” effectively at hunger rates. But conflict, climate and COVID-19 are causing  humanitarian crises of catastrophic proportions, making it impossible for people to access food. Before COVID-19 there were about 135 million hungry people in the world. Today nearly 690 million people don’t know where their next meal is coming from. WFP projects they need $13.5 billion to bridge the gaps in their budget.

According to Taravella, a small group of 2200 billionaires hold about $8 trillion in global wealth. They could help to overturn the tidal wave of food insecurity washing over the world’s poor.

“We are making an appeal to the world’s exceptionally wealthy people to help us close that gap,” he added.

To donate

https://secure.wfpusa.org/donate/save-lives-giving-food-today-donate-now-7?ms=2000_UNR_wfp_redirect_EX&redirected=UShttps://secure.wfpusa.org/donate/save-lives-giving-food-today-donate-now-7?ms=2000_UNR_wfp_redirect_EX&redirected=US

https://sharethemeal.org/en/index.html


Meera Kymal is the Contributing Editor at India Currents.
Image by billy cedeno from Pixabay

Kusum Lata Sawhney’s Poems Ponder Chaos in COVID Times

What might we have done differently when the coronavirus invaded our lives? Kusum Lata Sawhney explores the possibilities through poetry.

Sawhney’s book of poems ’We Might Have …’ chronicles the unprecedented times we are facing with the COVID crisis. The poems look at events as they unfold, and the many stages the world faces as it confronts the unknown.

Her vivid accounts of the first appearance of the virus, the lockdowns and the fear, the isolation, the anger, the kindness, the chaos, the suffering, the economy in chaos, and subsequently, the global response inextricably linked to humanity’s inherent quest for survival, remind us of the completely unexpected and abnormal year that 2020 was.

Sawhney lucidly explores the themes of mass consumption and greed, which she terms ‘the deceit of excess’, going on to describe humanity’s shortsightedness in exploiting nature and the lack of respect for the natural world – a few of the many factors that have contributed to nature’s retribution, in the form of the pandemic.

In a poem, she explains,

“We might have spawned wildlife transmissions,

Encouraged callous breeding, hosts and mutations,

We might have ruthlessly plundered and aided to our plight.”

The poems are a mirror to the destructive nature of man and the viral darkness. In addition, they are also an attempt to capture the period that was, what is and what might be. She stresses on the need to reflect and bring about a radical change in the way we live and work, to move away from being divisive and selfish. A transformation is in order to usher in a kinder, more thoughtful, and harmonious world.

Describing change and an altered way of living, she writes,

“Where tech online at home is safe

We might reduce mass gatherings too

Learn to eat and pray in solitude

We might have to educate, adapt and change

Plenty will be lost but there will be gains.”

Learning to change, adapt and look within, in a deeply fractured world requires magnanimity and empathy. Where do we go from here and which path do we take? A time of reckoning, learning new skills and perhaps a gentler way of life are the lessons of the pandemic. In her words,

“We might have been ruthless, selfish and short

Strength and alternatives to whimsy
an agile plot

We might have to relearn, retool and rethink

And in this darkest of times truly learn a new link”.

The message ultimately is one of hope. Perhaps the transformative power of poetry will help us recognize and achieve that.


Shonali Madapa is a brand designer and photographer who runs a design studio Lumos Design. She follows patterns of culture, nature, society, and behavior through travel photography and writing.

Edited by Meera Kymal, the Contributing Editor at India Currents.

COVID Slams Ethnic Minorities

As the COVID-19 vaccination program rolls out erratically across the US, research increasingly shows that health inequities underlying who gets infected will also affect who gets vaccinated.

In telling statistics reported by the CDC and KFF, people of color are more likely to be infected or hospitalized, and more likely to die from the coronavirus.

The numbers are stark.

Compared to whites, American Indians are 1.9 times more likely to be infected, African Americans nearly 3 times more likely to be hospitalized, and Latinx people 2.4 times more likely to die.

Asian Americans are the highest risk for hospitalization and death among any ethnic group. In San Francisco, it’s reported that  Asian Americans consistently account for nearly half of COVID-19 deaths.

It’s impossible to ignore the disproportionate toll of the pandemic on racial and ethnic minorities. Even though all communities are at risk for COVID-19, the socioeconomic status of people of color, and their occupations in frontline, essential and infrastructure jobs puts them at greater risk of exposure to the coronavirus.

For minority communities, it means that where you live and where you work shapes how the virus impacts your health, while inadequate access to healthcare makes you more vulnerable to its consequences.

“The pandemic has exposed the “underlying health disparities, social determinants of health, systemic inequalities and discrimination contribute to the disproportionate impact the virus has had on all communities of color,” said Adam Carbullido of AAPCHO, at an EMS press briefing on February 12, about health inequities in the pandemic.

Health advocates predicted that an inequitable distribution of vaccines was inevitable, given the high rates at which Blacks, Latinos and other ethnic groups were being infected and dying in each wave of the pandemic.

This is borne out by data from the Kaiser Family Foundation (KFF) which is tracking vaccine distribution. For example, fewer black people are getting vaccines despite a higher rate of COVID 19 cases. In Delaware only 6% of Blacks were vaccinated though 24% were infected, and in Louisiana, only 13% of Blacks received vaccines though 34% were infected, while in Mississippi, 38% of Blacks were infected but only 17% got the vaccine.

However, the lack of disaggregated racial data at the state and national level is hobbling equitable distribution of the COVID-19 vaccine, noted Dr. Daniel Turner-Lloveras of the Latino Coalition Against COVID-19. Currently only 20 US states are reporting racial data.

Given that it’s primarily Black and Latino workers in essential jobs,  it’s imperative to consider who’s at high risk when making decisions about reopening the economy, he added.

If we cannot quantify racial disparity in vaccine distribution, warned Lloveras, it will be difficult to develop interventions to ensure vaccines are given to those who need it most.

Health disparities between whites and people of color that are impacting vaccine distribution, are “gaps that have become chasms,” said Lloveras. The vaccine roll out “inherently prioritizes a population that is not reflective of the people who are disproportionately affected by the coronavirus”, added Virginia Hedrick, of the California Consortium for Urban Indian Health.

In American Indian country, inequitable vaccine distribution is merely a reflection of the historical trauma inflicted on indigenous communities that has negatively impacted their health and wellbeing over the long term, said Hedric resulting in the highest rates of diabetes, heart disease and substance use disorders. Its only because of advocacy that the Indian Health Service has a separate vaccine reserve allocated to urban and tribal Indian American communities.

Barriers to Better Health  & Vaccines

Several other factors create barriers to better health and getting a vaccine among people of color.

Ethnic minorities tend to live in densely populated areas which makes social distancing difficult, and often in multi generation family homes which put elders at risk. They may use public transportation which could expose them the virus, and lack health insurance or healthcare access.

Farmworkers and the elderly face similar barriers in the form of digital literacy, language barriers and internet access, said Lloveras.  With stay at home orders in place, telehealth depends on who has access to technology. He suggested providing Internet access hotspots and community classes on computer literacy to expand digital access for underserved minorities.

The lack of a robust public healthcare system requires that we provide the technology to help people see a doctor and register for vaccines.

In Asian communities, added Carbullido, patients of Asian descent report fear in getting help they need because of emotional trauma caused by racism and xenophobic attacks associated with the virus.

Yet, many ethnic minorities are reluctant to get their shot because they mistrust the government. Kaiser Family Foundation’s vaccine tracker data reports ‘fear of side effects” prevents people from obtaining the vaccine.

Lloveras proposed ‘a gigantic digital patient engagement project’ to address vaccine hesitancy to set the path to herd immunity and a semblance of normal life .

Missteps in California

Each state’s scramble to acquire and distribute vaccines signaled an unpreparedness for a public health crisis like the coronavirus, said Dr.David Carlyle, President and CEO of the Charles R. Drew University of Science and Medicine, calling California’s missteps in the pandemic a “failure of public policy.”

When MLK Community Hospital, a 130-bed facility at the epicenter of the pandemic in Los Angeles County tried to transfer its sickest patients to nearby tertiary hospitals for oxygenation, they were repeatedly refused because because their patients did not have health insurance. When the vaccine roll out flatlined mid-February, high volume vaccine centers (LA Forum, Dodgers Stadium) in LA county closed mid -February, because supplies of vaccine doses ran out. Commercial pharmacies placed vaccination sites in smaller, less diverse towns like Huntington Beach, Irvine and Newport Beach, while Los Angeles, a city of 8 million was allotted just one site.

“In my estimation we weren’t prepared for COVID 19.” Carlyle concluded.

A Robust Rescue Package

Given the lack of a robust public health system, panelists urged Congress to bolster the public health infrastructure with a bold COVID 19 rescue package for testing, treatment, vaccine distribution.

They called for increased investment in public health and community-based organizations (CBOs) that serve marginalized communities which have more chronic medical issues and higher risk factors for complications of COVID19.  CBOs are vital in reaching communities of color and other hard hit communities, by providing culturally and linguistically appropriate services where government and private institutions have fallen short. Supporting CBOs could mitigate the health inequities of the COVID19 crisis, said Carbullido.

The pandemic overwhelmed most healthcare systems which were not prepared or adequately funded creating crises like the MLKCH that Carlyle called “a  perfect example of the inhumanity of equities in healthcare.”

But “the pandemic has not created these inequities,” concluded Hedrick, “it’s simply highlighting them.”

More information is available at:
https://bit.ly/vaccines-race-data
https://ccuih.org/


Meera Kymal is the Contributing Editor at India Currents
Photo by Ivan Diaz on Unsplash

Key South Asian Players in the New Administration

South Asians in the house! — my cousin cheers between mouthfuls of samosa and peanut chutney as Kamala Harris is sworn in as Vice President of the United States on screen. It’s a day as celebratory as it is surreal — especially for the ‘South Asians in the house’, who are scattered across the country watching one of the most unprecedented inaugurations in history. I knew I was going to see a female president or vice-president hold that Bible on camera during my lifetime. The world has seen female presidents and Prime Ministers from Golda Meir to Indira Gandhi to Angela Merkel; the world is growing up, and growing out of the trappings of a patriarchal society. Although we’re late, I knew I would have the honor of watching America catch up. 

But watching a South Asian-American woman help shatter America’s legislative glass ceiling was a wholly different honor altogether. 

According to the Carnegie Endowment for International Peace, Indian-Americans make up less than 1 percent of the United States’ registered voter base. It’s a fact that’s difficult to forget, considering how under-studied and under-appreciated South Asian Americans are as a voter demographic. Civic engagement organizations have a history of not visiting South Asian American neighborhoods out of fear of ‘mispronouncing their names’. In the past, South Asian-American politicians at the local level have been questioned for their religious or ethnic identities, rather than their qualifications or political stances. Although the 2020 elections have marked a tremendous increase in political participation among our community, historically South Asian Americans have often been under-represented and overlooked at the polls. 

The new administration is a game-changer for our community — and not simply because of Kamala Harris. Here are some members of the wave of South Asian Americans introduced by the Biden-Harris administration. 

Garima Verma 

Formerly a content strategist for the Biden-Harris campaign, Garima Verma was named by First Lady Jill Biden as the Digital Director for the Office of the First Lady at the White House. Born in India, Garima grew up in Ohio and the Central Valley of California. Her journey in marketing and brand strategy shows her passion for both civic engagement and digital storytelling, as Garima has worked for major corporations like Universal Pictures Home Entertainment and nonprofits like the St. Joseph Center alike. Hopefully, Garima will bring her unique talent of telling compelling stories through the digital medium to the First Lady’s team. 

“While in the entertainment space at both Paramount Pictures and ABC, my passion has always been working on diverse and boundary-pushing content that allows more people to feel seen and heard, and to authentically engage and empower those communities through marketing campaigns,” Garima says. “My ultimate goal is to combine my love of marketing and storytelling with my passion for social impact and advocacy in a meaningful and impactful way.” 

Neera Tanden 

Massachusetts-native Neera Tanden has contributed to America’s political landscape for years, from advising Hillary Clinton’s 2016 primary campaign to drafting the Affordable Care Act during the Obama administration. For her work in founding the Center of American Progress (CAP), Tanden was named one of the 25 “Most Influential Women In Washington” by the National Journal in 2012. She has used her platforms to advocate for universal, multi-payer healthcare, and cites her childhood experiences living on welfare as a reason behind her passion for healthcare reform and economic empowerment. As Biden’s pick for budget chief, Tanden hopes to bring her years of political experience to the US Office of Management and Budget.

After my parents were divorced when I was young, my mother relied on public food and housing programs to get by,” Tanden said in a 2020 tweet. “Now, I’m being nominated to help ensure those programs are secure and ensure families like mine can live with dignity. I am beyond honored.”

Her nomination, however, did not come without controversy. Tanden has been often criticized by her Republican counterparts for her outspoken nature on Twitter, where she fired back at Lindsey Graham for calling her a ‘nut job’ and referred to Mitch McConnell as ‘Moscow Mitch’. Many Republicans criticize Tanden for her ‘partisan’ approach to politics — an ironic appraisal, considering how nearly every politician has contributed to the radioactive battlefield that is Twitter in recent years. 

Shanthi Kalathil 

Formerly a senior democracy fellow at the US Agency for International Development, Shanthi Kalathil has been named as the White House’s Coordinator for Democracy and Human Rights in the National Security Council. Kalathil’s years of dedication towards advocating for human rights and worldwide democracy demonstrate her preparedness for this role. She is known for her commitment towards addressing techno-authoritarians, or the role that modern technology plays in reinforcing the rigidity of authoritarianism. In fact, she addresses this phenomenon in her 2003 book, Open Networks, Closed Regimes: The Impact of the Internet on Authoritarian Rule. Within an increasingly digitized society, Kalathil’s careful attention towards the Internet in relation to human rights is certainly a step forward for the White House. She also carefully avoids implicit biases while addressing human rights abuses in other countries, discussing the importance of separating “the Chinese people from the Chinese party-state” in a podcast published by the National Democratic Institute. 

“You know one area where I think all democracies have to be careful is in making sure that there is a clear distinction between referring to the Chinese party-state and the Chinese people. Whether it’s the Chinese people within China or people of ethnic Chinese descent all around the world, that would be one area in which I think there does need to be great care”, Kalathil said. “I think in all policy discussions, it’s important to use a scalpel rather than a sledgehammer, to really deal with very specific problems and specific issues that pose a challenge to democracy, but that we shouldn’t conflate broad-based backlash.” 

The United States government has a history of intervening in the human rights abuses committed by the other regimes of the world as an effort to maintain peace and justice. Kalathil’s balanced, nuanced approach towards democracy and human rights will certainly enrich her platform. 


Uzra Zeya 

American diplomat Uzra Zeya has been nominated by the Biden-Harris Administration to serve as the Under Secretary of State for Civilian Security, Democracy, and Human Rights. Like Tanden, Zeya has years of political experience under her belt, as she was the acting assistant Secretary and Principal Deputy Assistant Secretary in the Bureau of Democracy, Human Rights, and Labor during the Obama Administration. Before that, she worked in Paris’s Embassy of the United States. Her work in diplomacy has taken her all over the world, from New Delhi, Muscat, Damascus, Cairo, and Kingston. Similar to Tanden’s experience, Zeya is also a contentious choice for this position. In 2018, Zeya quit her job in the state department, owing her resignation to the racism and gender bias promoted by the Trump administration. Calling the administration a ‘pale male’ club, Zeya advocated for the diversification of her department. 

“In the first five months of the Trump administration, the department’s three most senior African-American career officials and the top-ranking Latino career officer were removed or resigned abruptly from their positions, with white successors named in their place,” Zeya wrote in an article for Politico. “In the months that followed, I observed top-performing minority diplomats be disinvited from the secretary’s senior staff meeting, relegated to FOIA duty (well below their abilities), and passed over for bureau leadership roles and key ambassadorships.” 

If chosen as the Under Secretary of State for Civilian Security, Democracy, and Human Rights, Zeya hopes to use her prior political experience to address key global issues such as peace in the Middle East, Russia’s increasing aggression in Europe, and climate change. 

In my 25+years as a diplomat, I learned that America’s greatest strength is the power of our example, diversity & democratic ideals,” Zeya said in a 2021 tweet. “I will uphold & defend these values, if confirmed, as Under Secretary for Civilian Security, Democracy, and Human Rights.

Vidur Sharma

A former health policy advisor on the Domestic Policy Council, Vidur Sharma has been named by Biden as a testing advisor for the White House’s COVID-19 Response Team. Sharma played a key role in shaping health policy during the Obama administration, where he advocated for the implementation of the Affordable Care Act. A Harvard graduate, he also has years of experience working in the medical industry, as he has worked for Avalere Health, CareMore Health, and the Dana-Farber Cancer Institute in the past. As a testing advisor at the White House, Sharma will promote equity in the healthcare space, as he was a Deputy Research Director for Protect Our Care, an organization dedicated to “increasing coverage, lowering health care costs, and addressing racial inequities in our..system.” 

Amid a global pandemic, equity will play a major role in the distribution of the COVID-19 vaccine. As the coronavirus is reportedly 2.8 times more likely to kill people of color, implicit biases in our healthcare system can have potentially fatal consequences. The Biden-Harris administration, in fact, recently established a COVID-19 Health Equity Task Force to aid “medically and socially vulnerable communities.” Sharma’s emphasis on inclusivity and equity certainly fits the values of the administration and will help ensure that the vaccine and coronavirus treatment plans reach all Americans.

Closing Thoughts 

There are so many threads of commonality among the South Asian Americans introduced to the White House — all passionate about government reform, all aware of our nation’s existing inequalities, all incredibly qualified for their positions. As a South Asian American hoping to enter America’s legislative process later in life, our community’s representation at the national level is both empowering and inspiring — a fond reminder that America, after years of underrepresentation for minority groups — is finally catching up.

Kanchan Naik is a senior at the Quarry Lane School in Dublin, California. She is the 2019-2020 Teen Poet Laureate for the City of Pleasanton, as well as the Director of Media Outreach for youth nonprofit Break the Outbreak. She is the founder and editor-in-chief of her school newspaper, The Roar, as well as the Global Student Editor for the summer edition of Stanford’s Newsroom by the Bay publication. 

The Virus & The Vaccine

Getting the COVID19 vaccine out of the freezer and into people’s arms has been slow. And, even as people battle unsympathetic websites to find slots for a shot, there still are many unanswered questions.

Will people who have been vaccinated still be asymptomatic and carriers who could infect others?

Will non-vaccinated people still need to wear PPE when interacting with them?

Will the vaccine protect against two new contagious strains of the virus?

What will the Biden administration do differently in its COVID19 response?

These questions and more, were answered by experts at an Ethnic Media Services briefing on January 13.

One of the biggest concerns to the country is the slow pace of the vaccine roll out. Though the US has 20 million doses of the Pfizer & Moderna vaccine, we face innumerable challenges at both the federal and state level, in getting the vaccine out to people. Only 5 million vaccines have been distributed as of January  11th.

According to Dr. William Shaffner, Professor of Preventive Medicine and Health Policy, and Professor of Medicine in the Division of Infectious Diseases at Vanderbilt University, a number of bottle necks choked a smooth vaccine roll out. At the national level, the uncertainty in vaccine shipments put a strain on the local level. States were not sure when vaccines would arrive, sometimes delivery was delayed, or fewer doses were received than anticipated. Occasionally shipments were sent to the wrong state in error.

Dr. William Shaffer

The Pfizer Deep Freeze

A key challenge for local distribution outlets was storing the Pfizer vaccine which requires “a really deep freeze” to keep it stable and intact. So only large medical centers with appropriate freezer storage capacity and personnel trained to handle it, first received the vaccine.  Fortunately, the Moderna vaccine does not need similar storage requirements and was distributed more easily, so vulnerable populations and frontline healthcare workers in long term care facilities, nursing homes and smaller community hospitals were able to access the vaccine.

Not Just Another Flu Campaign

“Quite frankly,” said Dr. Schaffer, many facilities assumed it would be “just another flu campaign,” but they were wrong. Insufficient preparation to administer the COVID19 vaccine rather “gummed up the works.”

                      Dr. Robert Wachter

California did get the science right, added Dr. Robert M. Wachter, Professor and Chair of Medicine at UCSF, “but did not get the logistics right.” Based on the way California managed its PPE and testing protocols, he was not surprised that vaccine distribution fared poorly. It’s a complicated process which ‘would have benefitted from a thoughtful national plan’ to determine for example, how to get a vaccine from a manufacturing plant in Michigan into a Fedex box that arrives in a central Californian distribution center. Glitches occurred because states, left to devise their own distribution process, “handed off responsibility to local institutions” which improvised protocols in “the last mile” of the roll out.

The lack of national guidance allowed too much “wiggle room” for error, stated Dr. Wachter.

Health Equity Gridlock

Another problem was created by rules about which cohorts got the vaccine first in a well-meaning effort to ensure health equity and that certain groups  – frontline healthcare workers, the elderly and essential workers – were prioritized for the vaccine. But how does a “Walgreens decide if you are a pre-school teacher or a grocery store worker or someone with a pre-existing condition,” argued Dr. Wachter. Do you need a note from your doctor or employer? “I haven’t received a convincing answer from anybody.”

‘We’ll Figure It Out’ Won’t Work

The lesson to learn is that “we’ll figure it out is not going to work with COVID19,” declared Dr. Wachter. He called it ‘scandalous’ that only 30% of all vaccines distributed have been injected when “millions of people should have received the vaccine by now.”

Congress only passed a coronavirus relief bill in late December 2020, to provide supplies necessary for distributing and administering the COVID-19 vaccine.

What we have  is a “9/11 or a Pearl Harbor worth of people dying a day” when we should be treating the distribution of the vaccine as an emergency, added Dr. Wachter.

Vaccines Going to Waste

Stories about vaccines going to waste make great news stories, but that’s not the real problem, said Dr. Shaffer. The issue is that doses are sitting in refrigerators and freezers but not making it into the final phase of delivery.

At UCSF, medical, 84% of vaccines have been distributed -15 thousand of about 18 thousand doses have been injected. The worry is how doses will make their way into rural or underserved communities.

Interestingly, Dr Shaffer reported that at Vanderbilt, a survey of healthcare providers found that they were hesitant and skeptical about the vaccine before it arrived. Vanderbilt responded with a major effort to educate its staff and address concerns to reassure reluctant people and change their minds. For example, the program had to counter fears  that the vaccine is not safe for pregnant women.

Both physicians reiterated that the vaccines were safe and effective to use.

Single or Double Dose

Data from all clinical trials find that two doses are required. The first shot offers partial protection after ten days and up to 80% to 90% protected  up to the minute before getting the second dose. “The second dose boosts  you up to the ultimate number of 95% and creates more durable immunity,” confirmed Dr. Wachter.

While models show that giving more people a first shot of the vaccine will save more lives than withholding doses for the follow up shot, there are legitimate concerns about delaying the second dose – will immunity fall off, will it promote mutations by having more people partly vaccinated, or will people forget to come back for their second dose? A single dose only will not work in the long term, but deferring a second dose will get more people vaccinated sooner. So the Biden administration’s plan to get more first doses out is ‘a good strategy’ agreed Dr. Shaffer.

Will You Still Be Contagious?

Preliminary data from a Moderna study indicated that ‘a substantial proportion of people vaccinated would not be able to transmit the virus. However, until final data sounds the all clear, warned Dr. Shaffer, people should continue to observe precautions with masks and social distancing.

Biden Roll Out

The best first step for the new administration must be to lead its Covid19 response based on science and clearly communicate its national policy, emphasizing “public health and scientific principles,”  said Dr. Shaffer. They also need to address the bottlenecks in vaccine distribution and reinforce they will work together with state and local levels to troubleshoot and resolve problems. Instituting a federal policy to ensure consistency in the COVID19 response across the country will be invaluable, he added.

Challenges Ahead

There is a real risk of politically driven resistance to the vaccine especially in rural areas and persuading people that it is safe and necessary will be quite difficult, Dr. Shaffer pointed out. But as demand grows for the vaccine, websites will have to handle thousands of people going online to make appointments, and venues will have to manage large cohorts arriving for their shot. A fair system needs to be established to ensure health equity in who gets the vaccine.


Meera Kymal is the Contributing Editor at India Currents
Image by Wilfried Pohnke from Pixabay

Despite the Challenges, I Will Always Be a 49ers Fan

As the seconds wound down on the clock for Super Bowl 53 in early 2020, I watched my beloved 49ers squander a 10 point lead in the fourth quarter to lose the biggest game in American sports to the Kansas City Chiefs. The loss was devastating. But the feeling was not unfamiliar. I remembered feeling that same feeling of acute dismay as a mere 8-year old when the Niners lost the Super Bowl in 2013. My tension had risen to fever pitch after the missed holding call on 49ers wide receiver, Michael Crabtree, late in the game.

    Aaryan Ravi’s view

It is perhaps normal to feel tumultuous emotion when watching our favorite teams struggle valiantly, on the verge of victory before eventual heartbreak, in the final minutes of the game. This year, though, it was something more than the game that sent us Faithful into a tailspin. On Nov. 28, Santa Clara County imposed a ban on contact sports, as part of the coronavirus restrictions,  displacing the San Francisco 49ers from their home in Santa Clara, California to Arizona, where they will play out the rest of their home games this season at the Cardinals’ State Farm Stadium in Glendale.

To say that it has been tough being a loyal San Francisco 49ers fan is an understatement. From 2014-2018 the 49ers were among the most atrocious teams in the National Football League. They did not have a single winning season during that span. But, I told myself, there would come a time, when things would change. I pinned my hopes on the “Revenge Tour of 2020,” the Niners quest to return to the grand stage. I banked on the possibility that this would hopefully yield a Super Bowl victory. And I imagined watching the winning game unfold from my place at the home stadium. 

Back in November 2019, I experienced the thrill of watching my team dismantle a formidable Green Bay Packers squad. The calls of “Turnover” and “3rd down” echoed as the Niners humbled a Packers team led by the legendary Aaron Rodgers by a score of 37-8. The electricity that the Faithful brought to Levi’s Stadium in Santa Clara that Sunday was truly remarkable. I remember sitting alongside 65,000 of my comrades, cheering for my favorite team until I lost my voice on that cold fall night. Sporting a throwback Anquan Boldin jersey, I sat alongside my family and some close family friends as we witnessed the outstanding performance of the Niners on that Sunday night. 

I was convinced I would be able to see that same magic play out once again; that they would be able to repeat their heroics, even after losing the Super Bowl. 

 The Niners have endured a painful and frustrating year, from injuries to coronavirus infections. Added to this is the stress of having to be relocated to another state in the midst of the holidays. Many of the players have little kids, parents, siblings, partners, and spouses that they have had to leave behind in California. In a year when sports teams are struggling to keep their leagues running smoothly, a sudden move to an unfamiliar area is just an added complication for the franchise. 

After less than a day of finding out that they were left without a home stadium, the 49ers achieved a big win against the Los Angeles Rams that helped to keep their playoff hopes alive on Nov. 29. “I can’t be more proud of our team. I mean what they’ve gone through all year, but especially these last two weeks and especially these last 24 hours,” Shanahan said during the postgame press conference.

On Wednesday, Nov. 5, Niners wide receiver, Kendrick Bourne, tested positive for COVID-19. He immediately went into self-isolation and his close-contacts, LT Trent Williams, WR Deebo Samuel, and WR Brandon Aiyuk all did the same. Even though they were down four starters, the 49ers got no help from the NFL to reschedule the game due to the virus outbreak and were forced to host the Packers on Thursday night primetime. Later, it surfaced that Bourne had received a false positive on his test prior to kickoff on Thursday night. However, there was nothing that the Niners could do to get back their four starters as they had found out on the day of the game and had already ruled their players as out by that point. They were forced to play with a starting lineup of mainly backup players and incumbents and ended up losing. Despite a valiant effort to make the best out of a bad situation, this was yet another tough break for a San Francisco team that had already suffered its fair share of frustrations during the COVID season. 

This game was difficult to watch from a fan’s perspective because it was evident that the NFL did not make an effort to reschedule the game and that the Niners were being set up to fail. Had the 49ers record been more impressive, the league would have made more of an effort to reschedule the game to boost its ratings for a marquee matchup between the two teams that competed in last year’s NFC Championship game. 

“As a season ticket holder myself, I would do anything to be back in the moment, cheering on my childhood team from the stands. I’m hoping that by next season we can all safely return back to Levi’s [Stadium] and the Niners end up using the momentum of their fans returning to go the distance and win Super Bowl 55,” said Rohan Patel, a senior at Middle College. 

Coach Kyle Shanahan

Players and coaches alike remain hopeful that there will be a definite resolution to the pandemic soon and that they will be able to proceed with a normal season next year. The San Francisco 49ers have done a solid job remaining positive about the uncertain future ahead despite all the obstacles that they have had to endure in 2020. 

Despite the hardships that sports teams go through, we fans are committed to sticking with our favorite teams through thick and thin. The pain of losing stings, sure. But the highs of victory are worth the patience. 

Here’s to a hopeful 2021! 


Aaryan Ravi is a junior at Carlmont High School in Belmont, California. He is a sprint runner on the track team and enjoys keeping up with football, basketball, and baseball in his free time.

 

Sources:
https://uk.finance.yahoo.com/news/san-francisco-49ers-kyle-shanahan-upset-sports-ban-santa-clara-county-coronavirus-covid19-pandemic-032053269.html
https://ninerswire.usatoday.com/2020/12/04/49ers-kyle-shanahan-mental-health-covid-19/
https://people.com/sports/49ers-facility-shuts-down-after-player-tests-positive-for-covid-19-1-day-before-playing-the-packers/

 

Dharavi slum in Mumbai

India’s Low COVID Death Rate Is Puzzling

Though the COVID-19 crisis hit India hard – over 9 million cases have been reported and more than 138 thousand people have died  – the mortality rate from COVID-19 is inexplicably lower compared to other countries.

For instance, while the US leads the world with more than 14 million cases and over 276 thousand deaths, according to the John Hopkins Coronavirus Research Center, India accounts for only 10% of deaths globally and has the highest number of recovered patients of COVID-19 at 94%, even though its coronavirus caseload is second only to the US.

With such a significant share of the world’s coronavirus cases, shouldn’t COVID-19 have been more devastating in India?

Krishnaraj Rao

“Then again it has not,” announced Krishnaraj Rao, an investigative journalist from Mumbai, India, at an EMS briefing (November 20) on the pandemic.

“Something strange has been happening within the Indian subcontinent and neighboring regions,” said Rao. “For some strange reason our mortality rate per million is one eighth and our total cases seem to be in the region of one sixth per million.”

As COVID-19 began its inexorable spread across the world, the WHO recommended safety precautions to protect against the virus – physical distancing, wearing a mask, well ventilated rooms, avoiding crowds and close contact, and regularly washing hands.

But in an outcome that has puzzled epidemiologists and scientists alike, India seems to be experiencing a low mortality rate from the coronavirus, stated Rao, despite the crowded conditions in which many urban Indians live.

A large proportion of urban dwellers in a developing country like India lack access to adequate healthcare facilities and maintain poorer sanitation and hygiene practices which are known to be responsible for a higher incidence of communicable diseases.  So the virus was expected to have caused many more deaths in densely populated communities in India than it has.

Urban Indians are ‘badly housed,’ explained Rao, using Mumbai as an example to explain why crowded Indian cities offer a fertile petri-dish for catastrophic coronavirus outbreaks.  “I would say that close to 60% of the population of urban India lives closely packed together in slums.”

In a metropolis like Mumbai, home to over 20 million and India’s largest city, nearly one million people live cheek by jowl in Dharavi, one of the world’s largest slums.

“Houses are no more than two feet apart. Each house is no larger than a 10 by 12 room,” said Rao.

Each home houses about 10 to 12 people, closely packed together. It makes social distancing nearly impossible, while access to basic hygiene essentials, including toilets and hand washing are limited.

“There is only one public toilet per every two or three hundred slum dwellers,” explained Rao, highlighting the less than hygienic conditions in slums like Dharavi. “Face masks, social distancing…are close to non-existent. We take things like face masks, temperature checks and sanitizing very lightly,” he claimed.

“If it were a pandemic that was ravaging us because of a lack of social distancing,” asked Rao, why are the slums relatively less impacted than expected? And, despite overcrowding on the suburban railways, he adds, “the crisis has hit us less hard than anticipated.”

While epidemiologists attribute India’s low mortality rate to under-reporting, and even though Rao himself expected undercounting, he alleged that at least in Dharavi, there is no evidence of it. “I don’t see the bodies piling up in the streets… or the hospitals,”  nor has he noted any alarming rises in the body count.

Rao claimed he is voicing “a mainstream belief” felt across economic classes and demographics in India, that the coronavirus is not causing the high mortality rates that were anticipated.

In Dharavi, officials say that concerted public health efforts to trace, track, test and treat cases, have helped to contain community spread.

Now, recent research by Indian scientists seeking to explain why India’s death rate is so low, suggest that more Indians may be immune to COVID-19 because they live in unsanitary conditions which have created an unexpected shield from the virus.

According to one study, more than 70 percent of all COVID–19 deaths have occurred in high income countries like Italy, Spain, UK, France and USA. It hypothesized that more people died in richer countries with older populations, because better hygiene and safe sanitation practices lowered levels of immunity and made people more susceptible to the virus.

In another study scientists report, “It appears that countries with better health care, clean environment, clean food and water have higher COVID associated mortality, whereas developing and underdeveloped countries have lower mortality in terms of deaths per million population.”

Both research studies (not yet peer reviewed), suggest that in low GDP countries like India, lives of people in densely populated areas may have been saved because of poor hygiene and sanitation practices.  Unsanitary conditions and exposure to diseases from childhood may have increased their ability to ward off infections, and boosted immunity against COVID-19. Experts also suggest that the early lockdown and a younger population helped stave off a higher death toll in India.

The science is intriguing. Does greater exposure to a variety of viruses in the slums of low income countries provide a better level of protection against the coronavirus, than the overly sanitized environments of richer nations?

“Paradoxically, better sanitation leads to poor immune training and thus could be leading to higher deaths per million,” says the study. But it cautions that while the research offers a possible explanation, poor hygiene is not a solution to the pandemic.

India, and Dharavi in particular, may have pulled off a remarkable reprieve against COVID-19 for now. But the pandemic is far from over and science is still learning about this young virus. So, public health experts warn, SMS (social distance, mask, and sanitize) must remain the global mantra to keep Covid 19 at bay, until vaccines become easily available to the general public.


Meera Kymal is the contributing editor at India Currents.

photo credit: Baron Reznik

Fork in the road

How Certain Are We About Uncertainty?

Certain and Uncertain

They seem to be separate antonymic words, but they are like Siamese twins. Their separate bodies, facing from opposite sides, are fused together, nurtured by the same sanguineous source. Their interdependence is the reason why they survive. If one dies, the other will follow, sooner or later.

There are many anecdotal stories in Indian, American, and global folktales that give a clear message of how we can be misled by confusion between certainty and uncertainty in real life. Heisenberg, a German physicist identified Uncertainty Principles even in Quantum Mechanics. But how do these considerations apply in our practical life?

Our Recent Pandemic:

Let us trace our own circuity of thoughts developing in the short span of this pandemic.

First, we thought it was a hoax.

Then we were certain it would be confined to China.

“It will pass away on its own.”

“No masks are necessary.”

“Masks are mandatory as advised by highly trained scientists.”

“Only old and previously diseased people die in this Pandemic.”

“Children can die too.”

“The virus kills by compromised respiration.”

“It can affect other systems too.”

“We should keep a social distance to prevent it.”

“No, We find distancing and masks to be an insufferable obstruction!” 

In short, we kept on lengthening and shortening our rubber band of the certainty-uncertainty spectrum while our rings were getting sparklingly shiny because of incessant hand washing! Washing hands was the only acceptable way out! The upcoming generation of children will put an end to this Pandemic’s uncertainties because they will know better by then. That will not stop them, however, from generating new uncertainties since the times, circumstances, and the strain of the virus are likely to alter when the next Pandemic strikes us.

Let us also look at our own selves

Some of the commonest phrases that we generously use every day are: ”Wait and watch,” “ I hardly can wait,” “I changed my mind,” “Are you sure?”, “ How can you be so sure?” etc. We always will be engaged in weaving a web of uncertainties as a modus operandi of our reflex habits.

There is a common aphorism in the Sanskrit language, “Tunde Tunde Matirbhinna,” meaning each head thinks differently. But even the same head can think differently at different times! One night we buy an item with absolute certainty, and the next morning it changes its appeal. Even in a vital matter like choosing a life partner, our certainty fluctuates until marriage seals it. In India, we often try to resolve this uncertainty by “matching horoscopes” to finalize our decision.

”Uncertainty is the very essence of romance,” said Oscar Wilde, the famous Irish author.

There are only two points that are certain in our tenaciously tethered life: Birth and Death. These two extreme points are fastened together by life itself, a miscellany of deep disappointments, Joi De  Viver, and  “delicious ambiguities”, a term coined by the famous actress Gilda Redner who succumbed to ovarian cancer at a very young age. 

 Perhaps we need to undertake a perceptive analysis of what constitutes certainty and uncertainty. 

A different approach to certainty-uncertainty complex

It helped me a great deal just by looking at the synonyms of these two enigmatic words:

Certainty: confidence, trust, conviction, faith, validity, dogmatism, clarity, composure, contentment, happiness, peace, security, calmness

Uncertainty: changeability, variability, anxiety, ambiguity, concern, confusion, distrust, suspicion, trouble, worry, dilemma, oscillation, lack of confidence

Although these synonyms depict uncertainty in darker colors, a closer analysis will reveal that certainty too, can have its drawbacks. It can push us to a blinding dogma impairing our vision. It will be judicious to build a bridge between these two extremes and skillfully traverse from one point to the other, navigated by an internal call, and cautiously master the shades between the two. It is true that the cautious seldom err, but it is also true that those who are excessively cautious seldom move. Many shades of grey connect the black and the white.

All uncertainties are likely to be experienced by someone at some time, but maturity is the capacity to endure and outgrow them. No progress or creativity is ever possible without uncertainty casting its alarming shadow on the road ahead. You pause, you ponder, you proceed, and prepare for an inadvertent result. “ Medicine is a science of uncertainty and an art of probability,” said William Osler, a mastermind of practicing and teaching medicine in this country. We all have no choice but to learn how to stay afloat in an ocean of uncertainty. 

An “Aha” or “eureka” moment may hatch after an incubation period spent in a meaningful, self-searching meditation. Many leading psychologists support this viewpoint.

In the end, I will quote our visionary poet, Robert Frost: 

I shall be telling this with a sigh, somewhere ages and ages hence,

Two roads diverged in a wood and I– I took the one less traveled by

And that has made all the difference.


Bhagirath Majmudar, M.D. is an Emeritus Professor of Pathology and Gynecology-Obstetrics at Emory University, Atlanta, Georgia. Additionally, he is a priest, poet, playwright, Sanskrit Visharada and Jagannath Sanskrit Scholar. He can be contacted at bmajmud1962@gmail.com. 

Vaccines Bring Hope As COVID’s Third Wave Hits

In welcome news and within a week of each other, pharmaceutical giants Pfizer and Moderna announced breakthrough vaccines to combat the deadly coronavirus.

Pfizer and its German collaborator BioNTech, say their vaccine may be 90% effective in preventing COVID19 in participants, while Massachusetts-based Moderna expects a vaccine efficacy of 94.5%.

It’s a promising sign in the yearlong battle against an out-of-control pandemic. But though the trends in clinical trials seem positive, don’t throw out your face masks just yet. Experts warn of a long wait before the general public gets access to these newly minted vaccines.

It may be spring 2021 before the vaccine is widely available, which means the coronavirus will continue unabated for a few months more. COVID19 positivity rates reported by the Kaiser Family Foundation indicate that every state is now a blood-red ‘hotspot.’

As epidemiologists predicted, the third wave of coronavirus ‘forest fires’ are raging across the country with devastating effect. Currently the US leads the worldwide COVID death toll at over 250K and counting; we also have surpassed the 11 million mark in total COVID cases.

Despite warnings from experts, the federal coronavirus task force failed to deliver a comprehensive plan to counter the coronavirus threat. In fact, their strategy has been to “just let the infection run…which is not based on science,” remarked Dr. Ashish Jha, Dean, School of Public Health at Brown University, at a November 13th EMS briefing on the pandemic.

Without adequate federal funding or guidelines, each state has devised its own COVID19 response, but many did not heed the science on containing the spread.

That haphazard approach has had catastrophic consequences. Coronavirus cases are surging across the country. Since November 1, more than 1000 Americans have died of the coronavirus everyday and that number is steadily rising.

“This is not a surprise,” said Dr. Nirav Shah of Stanford University’s Clinical Excellence Research Center. “We predicted that in the fall, with people staying indoors and without broad protections ..such as masking, and not gathering in large groups, the numbers would continue to rise.”

Desperate to jumpstart their economies and reopen businesses and schools for a populace weary of quarantines, lockdowns and job losses, states made some bad choices by ignoring the science, said Dr.Jha. Several states (the Dakotas for example), raced to get back to normal by rolling back restrictions on large gatherings, travel and mask mandates.  According to the AARP only 35 states mandated face coverings in public. In Boston for example, schools closed but casinos stayed open. “Those are the wrong tradeoffs,” added Dr. Jha.

Inevitably, the subsequent spike in COVID19 rates has left the country scrambling to reimpose certain restrictions; even so, cases are mounting. The Kaiser Family Foundation reports hotspots in every state. In fact, ‘super spreader’ events are happening even at the White House.

The COVID Tracking Project currently (as of Nov. 15) has recorded a staggering 76,000 hospitalizations and over 155,000 confirmed cases a day. Experts at the briefing say that figure is much higher.

“Hospitals are being overwhelmed,” warned Dr. Tung Ngyuen (Professor of Medicine, UCSF), as they face bed shortages and burnout from healthcare workers who have “been doing this close to seven or eight months now.”

“We are in the worst moment in the pandemic” said Dr. Jha. He admitted he is baffled by the disconnect between how bad things are and how little attention the country is paying to it. “Right now we have about 150 thousand new cases being identified every day. But the truth is that the true number of infections occurring in the US right now, is between 300 and 400 thousand a day, maybe even closer to 500 thousand. We’re missing them because our testing is inadequate. All those people who are not being identified are of course out there spreading it to others. We are in a moment of exponential growth. We will get to two thousand deaths a day by mid-December.”

Calling it ‘unconscionable,’ Dr. Jha estimates that a 100 thousand more people will die between now and Inauguration Day (January 20th).

However, the advent of two promising vaccines may be a start in the right direction, even though the world has a long wait before it’s rescued from the virus.

“The reality is that it’s just 10 to 20 million doses maximum by the end of the year,” said Dr. Shah. “But it’s going to be some time before we get the kind of widespread availability of multiple vaccines, with secure supply chains to get everyone the two doses they need to actually start to achieve even partial herd immunity.”

It’s unlikely the ‘mRNA vaccines’, created from brand new technology and currently awaiting FDA approval, will arrive before the year end warn experts. Initially, limited supplies of the vaccine will likely be rationed and given to frontline healthcare workers, the vulnerable and the elderly. It could be spring before most of America gets the vaccine.

Though the clinical trials have produced strong results, enough data is not yet available to determine the longevity of the vaccine’s effects, or even its side effects. No one knows what level of protection it will offer younger vs older people, or whether we will need regular vaccinations like the flu shot.

The logistics of storing and distributing the vaccine are equally difficult. The vaccine has to be stored at extremely low temperatures which will make its distribution to remote and rural areas challenging and especially so among communities of color, where “skepticism is high and strong.”

Realistically, to reap the benefits of having a vaccine, states global health expert Tom Bollyky, at least 75% of the population will need to be vaccinated and that will take time.

“We are entering the hardest days of the pandemic,”  said Dr. Jha on Twitter. “The next two months will see a lot of infections and deaths. But he added, “There is a light at the end of the tunnel. Today, that light got a bit brighter.”

The disregard for advice from health experts and a lack of trust in science have precipitated some of the worst outbreaks so far, so it’s time say experts, for leaders and the general public to “rebuild the trust” and to stop politicizing the science.

Getting back to normal in the short term will mean that people have to take precautions to avoid transmissions until they can roll up their sleeves to be immunized.

Testing has to ramp up. But in the meanwhile, said Dr. Jha, “Wearing masks are a good thing to do for yourself, you family and community.”


Meera Kymal is the contributing editor at India Currents

Photo by CDC on Unsplash