Comment by throwawaysea | Hacker News Reader

Comment by throwawaysea | Hacker News Reader

This article notes that opposition political parties are trying to leverage the new wave of cases to attack Prime Minister Narendra Modi, but that just seems like an opportunist political tactic. Reading this article and others, this situation sounds like bad luck and tough circumstances more than anything else. Some of the approaches being taken there seem far more restrictive than anything I've seen in the US:

> For example, apartment buildings where people test positive for the coronavirus have been sealed off, with no one allowed to enter or exit. Police patrol their perimeter. In India's two biggest cities, Mumbai and Delhi, local lockdowns are already in place. Only essential travel is allowed, with a permit. Everyone except for front-line workers have been told to work from home. Residents aren't allowed to go for a stroll or jog, or they'll be fined.

It seems that Modi previously had announced a charitable policy of exporting half of India's vaccine doses to other countries that need it. One article (https://indianexpress.com/article/opinion/indias-vaccine-com...) notes that over 60 million doses have been exported, and 52 million were administered to Indians. Another article (https://timesofindia.indiatimes.com/blogs/jugglebandhi/vexin...) notes that India even donated vaccines at no charge to some countries. I'm sure Modi is facing immense pressure to focus on Indians first, and some articles note that they've temporarily paused exports, but their export approach hardly seems like it deserves blame as much as applause.

India is the world's largest vaccine producer, and while they pursue a charitable strategy, they're themselves facing export constraints from countries like the US. India's Serum Institute (world's largest vaccine manufacturer) has asked Joe Biden to relax export constraints for vaccine components (https://apnews.com/article/joe-biden-global-trade-india-coro...). While many are using this moment to find a way to critique India's handling of the virus, it makes me feel bad as an American to see others attempt to be generous leaders for the world while we do the opposite. I don't think anyone is "evil" for putting their nation first - but putting COVID to rest requires we eradicate it worldwide.

All countries that did well during the pandemic did a few steps:

- immediately recognize the risk and call on domestic producers to increase mask production

- freely, easily and regularly distribute masks to everyone, either for free or subsidize

- rigorous regulation (not necessarily lockdown) of mask usage in places with either centralized(china) or decentralized(taiwan) contract tracing in every building.

- a leadership that publicized and communicated the risks regularly

- a leadership that led by example by wearing masks themselves

- and a population that had some sort of sense of unity(common enemy)

ALL countries that downplayed the pandemic ended up with second or third waves. I don't understand why you think it's bad luck.

I hate to be that guy, but these are all measurable claims and it would benefit the discussion here if you provided references.

100% agreed. However, these anecdotal tales have no science and research behind them so references cannot be produced.

I think "did well" is a spectrum. Some countries chose to enact very authoritarian lockdowns, and achieved success that way. Others balanced between freedoms and restrictions. Still others have to work within the bounds of their political system - what their laws permit and don't permit.

From some quick web searches, it seems to me that India did many of the things you mentioned. I'm not sure if they did all of them, or to what extent they did each one - understanding that precisely is probably not possible without being involved in those particular actions. But it doesn't seem to me like they did nothing.

> ALL countries that downplayed the pandemic ended up with second or third waves.

Do you think India downplayed the pandemic? I don't get the sense given that they did building by building lockdowns and have police patrols ushering people back into their homes. We should keep in mind that each country is different - they have different population sizes, city densities, wealth levels, infrastructure quality, Internet access, cultural priorities, and so on. China is not India - it has an authoritarian governmental system. Taiwan is not India - it's small and rich and is an island. I'm not sure these comparisons are fair.

> I think "did well" is a spectrum. Some countries chose to enact very authoritarian lockdowns, and achieved success that way

And other countries had fourteen months of rolling half-assed lockdowns, and have achieved a few million sick, with tens-to-hundreds of thousands dead.

At this point, I can't imagine who in their right mind would prefer what we got, compared to one hard lockdown that solved the problem, requiring only minimal follow-up measures.

Not everyone with mental health issues or depression agrees with lockdown regardless of suicide statistics.

> Not everyone with mental health issues or depression agrees with lockdown regardless of suicide statistics

I don't understand this argument against public health measures. People should die because we have an unchecked mental health problem?

Because getting one disease doesn't mean you get to condemn the rest of the public to misery? Look at what makes people vulnerable to Covid and you'll understand.

The early data suggests suicide rates dropped, so however these people feel, the fact is that fewer died from suicide.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...

Ah, so fuck depressed people as long as they didn't die?

Also, I said "regardless of suicide statistics." Did you miss that part?

The lockdowns were pretty close to a scenario of ‘fuck everyone, but at least this way they won’t die’.

I’m not sure what you wanted, depressed people to feel a little better but have rampant covid?

Except you're spreading misinformation. Not everyone was at risk of dying.

You're not sure what I want? I've clearly spelled it out.

> Except you're spreading misinformation.

We locked down hard and kept New Zealand’s death toll to 26. Other places have done other things, but I prefer our approach.

What does your response have to do with the quote? It's a clear straw man.

New Zealand and Australia likely won't open until 2023 because vaccination campaigns are slow and public health authorities are afraid of variants. I'm perfectly fine with people in these countries making those decisions. I just think they should be a little more understanding about the rest of the world that prefers open borders to hysteria.

Also:

https://www.theage.com.au/national/victoria/five-hour-ambula...

> Patients with heart attack symptoms and spinal injuries are being forced to wait in ambulances outside hospitals for as long as five hours in what paramedics and the Australian Medical Association have described as a deadly public health emergency.

> Ambulance response times are at their worst since 2016-17 and Ambulance Victoria has instigated emergency protocols – where patients can be instructed to take taxis to hospital instead of waiting for ambulances – three times more this year than in the previous two years combined.

I've been reading a lot about how NZ's health system is overwhelmed too.

I am allowed to criticize other nations just as you have criticized the US. Debate is allowed here.

You're quite rude and unpleasant yourself.

You want understanding from us and understand our perspective but our approach is hysteria?

> I've been reading a lot about how NZ's health system is overwhelmed too.

What has this got to do with covid? There isn’t any in the community. It’s eradicated.

This is an odd thread and it isn’t contributing anything, altering prior comments also makes this hard to follow.

I'm talking about the healthcare system in general.

https://www.wsws.org/en/articles/2021/03/30/nzhe-m30.html

If it's so odd you can cease responding if you like. It's pretty clear you can't handle criticism at this point and choose to lash out instead.

HN was slowing down my posts so I edited the one above this one.

Am in Australia a country that did quite well.

You answer seems very mask focused. Masks are good but my unexpert opinion of why things went well here include more;

- We had strict lockdown early.

- We has free and fast readily available testing. Generally fast both for walk in and get swabbed plus results back in less than 24hr both times I had a cold so got tested.

- There was restricted travel, so states locked themself off from other states. This I feel had a double effect as some state leaders were US style 'cant hurt the economy' and trying to keep things open. The lockdown states essentially erraticated covid and went back to normal while keeping the other states with covid locked out. This put pressure on less strict states to deal with covid more effectively + stopped them spreading across the country via their lack of containment.

- Keeping covid levels low allows contact tracing teams to work effectively on mini outbreaks and be effective. Essentially once overwhelmed govt can't deal with the issue well.

- We have fast and short lockdowns as soon as there are any cases to restrict spread, these lockdowns tend to be regional or state so only parts of the country are effected.

- Our population has largely supported government. Recently my state of QLD had a lockdown and people distanced in shops and wore masks without question or complaint for about 2 weeks even though there was only a handful of cases. Now it's gone and life is normal. These people online that scream about govt trying to control you seem so stupid... Deal with it quickly and you are more free.

Anyway, loads more detail and while I agree masks are great tool for COVID, I think the lockdowns, testing, keeping it under control initally and fast reactions are worth recognising as key components.

You're right on the benefits of a combined strategy right from the government to personal responsibility by citizens. Indians complied with most of these in the early phases of the pandemic but got complacent later on. I wrote about some of this in my visit late March - https://rahulrevo.substack.com/p/indias-covid-conundrum. India is also very complex because of the diversity and scale.

After this second wave is done, people will be more compliant again towards covid-safe behavior at least for a short term. Ultimately a large section of the population will need to be vaccinated to meaningfully end the pandemic.

> We have fast and short lockdowns as soon as there are any cases to restrict spread

This is not a world I would want to live in.

There is a start at opening up borders with safe countries (currently Au and NZ) and free travel between them. I’m not sure anywhere else has achieved this.

What way would you have it?

> We had strict lockdown early.

I’m in New Zealand and saw your lockdowns as very soft compared to ours. Here almost zero shops were open - supermarkets and some dairies. Medical practices and pharmacies were open. One could not associate with anyone outside their household.

However Australia’s approach worked. It does make me wonder if ours was too strict.

Any successful mitigation will look like an overreaction in hindsight.

Honestly I don’t think masks have been the key to success in those places that did get down to zero. Instead, the key seems to have been:

* Border controls. Including internal borders in large countries.

* Tests

* Lockdowns implemented when needed and kept till cases zero, then lifted. These can be really short if you do it with small caseloads

* Acting fast with whatever action they take. No wait and see.

Masks are a great complematary tool, and they help limit the damage of reintroductions when they do happen. But if everyone wore masks but travel were open and testing was insufficient, you’d have plenty of covid.

Also strict border controls with supervised hotel quarantine. The formula is:

1. Implement border controls so few/no cases get in 2. If you already have an outbreak, do a lockdown (possibly targeted to a city or province) 3. Once you have few cases, aggressively test/trace. This is not possible with lots of cases.

If you have an open border though, this won't work, because you're going to import lots of cases, and those people, by the nature of being travelers, are going to be staying in hotels, eating in restaurants, taking public transit, exposing lots of people. They then leave the country and so are hard to contact trace.

If you look at the countries that have the fewest per capita deaths, they essentially universally implemented early border controls with supervised quarantine for arrivals. Everyone talks about SK, Taiwan, Hong Kong, Australia, and New Zealand, but there are lower income countries that succeeded with this too like Vietnam. Rwanda has also done very well with a requirement that arrivals test on arrival and undergo supervised quarantine for 24 hours while waiting for test results.

The Serum Institute of India was basically contracted by Astra Zeneca to make doses for Covax. The Indian government had never placed a substantial order or prepaid for an order to the SII in order to ramp up production until the numbers started spiking. The SII at one point was running out of storage space so they resorted to selling to western countries at higher margin to free up some space and get more capital.

Here is an article about Indian orders for vaccines early this year: https://i.redd.it/r4ybk9b3w3u61.jpg

Regarding the raw materials export ban I agree we should share but I wonder if it is just supply constrained. I've read even in the US they have washed and reused single use filter bags to extend life. I've read that despite the US not exporting AZ vaccines, AZ was exporting vaccine liquid to Europe to overcome their shortfall in production.

https://www.politico.eu/article/astrazeneca-vaccine-shortfal...

Thanks for this info. That was part that always confused me about India and SII. I couldn't believe that they were exporting vaccines a while back. It just didn't make sense to me given the size of India's population. The only explanation I could think of was that they were being overly altruistic. My more cynical friends said maybe SII was being overly capitalistic. But your explanations makes more sense.

I would say SII is pretty capitalistic. Its charging $8/dose in India vs $3-4/dose that AZ is charging in US and EU. And that is before any markups in public hospitals from what I hear. And remember SII got $250M from Bill Gates and didn't have to do vaccine development like Oxford/AZ. The Covaxin vaccine developed in India is even more expensive but they had to do their own development.

https://indianexpress.com/article/india/serum-institute-covi...

Sorry that is misinformation. The article you have quoted is also completely incoherent. What is the point of comparing dates of when India placed first order with when UK targets complete vaccination ?

- The Indian government had never placed a substantial order or prepaid for an order to the SII in order to ramp up production until the numbers started spiking.

India had placed order for 14M vaccines in January. an by March 16 had placed order for around 120M vaccines. Cases spiked after that.

- The SII at one point was running out of storage space so they resorted to selling to western countries at higher margin to free up some space and get more capital.

The space has nothing to do with the exports. SII is obligated to export vaccines as per their licensing terms with AZ. (Indian government might engage in coercion and prevent them from honoring it, but that is a different tale).

> https://i.redd.it/r4ybk9b3w3u61.jpg

This article is some kind of shoddy job of stiching unrelated facts to create a story.

Indian government made a major goof up. They put unreasonable price controls on the vaccine manufacturer and harassed a lot of people involved in the process. With low price controls there was no way for SII to raise capital, not to mention their gamble of stockpiling vaccines did not pay off because of that. Indian government passed down the responsibility of subsidizing the vaccine to SII instead of taking it on itself.

Some government folks even openly wondered why GoI should even bother paying SII. This is the old socialist mentality.

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