As India braces for third Covid-19 wave, concerns around availability, quality and consistency of data remain

Experts say that while work needs to be done on sequencing and accessibility of data, the focus must be on disease surveillance and ramping up of testing.

Indulekha Aravind Shailesh Menon
  • Updated On Jan 9, 2022 at 02:22 PM IST
In April last year, as India was desperately struggling to come to grips with the Delta wave coursing through the country, over 900 scientists wrote an appeal to Prime Minister Narendra Modi, seeking his intervention to address the lack of availability of data, which was hampering pandemic management.

The letter emphasised the need for “the systematic collection and timely release” of data under four broad heads: large-scale genomic surveillance of new variants, testing and clinical data, clinical outcomes of hospitalised patients and the immune response to vaccination in the population.

Nine months after that appeal, as India looks poised to be swept up in another surge of cases, scientists, epidemiologists, economists and others involved in researching, analysing and using Covid-19 data say that while there has been some improvement, more progress is imperative to manage the pandemic, particularly in making data public, quickly.

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Among the most significant changes after the appeal became public was that India began sharing data with GISAID, a global initiative that promotes the rapid sharing of data on all coronaviruses causing Covid, says Dr Partha Majumder, founder of the National Institute of Biomedical Genomics, who was among those who spearheaded the appeal.

“This is a welcome, perceptible change,” he says. Still, India needs to shorten the time lag between collecting and depositing data. “That way, data-driven policymaking can be more rapid.” If progress has been made on one front, more work needs to be done in sharing testing and clinical data, outcomes of those hospitalised and the immune response to vaccination, he says.

Dr Gautam Menon of Ashoka University, another signatory, says not much has changed in the longer term, though the principal scientific adviser had promised prompt action within a day of the appeal becoming public. Data from the Indian Council of Medical Research remains inaccessible, while the National Centre for Disease Control (NCDC) is yet to respond to the scientists’ appeal to share data, he says. In a recent column Menon wrote with virologist Dr Gagandeep Kang, they said the lack of public data when cases were likely to spike was akin to flying blind into a storm.

It’s a metaphor Dr Bhramar Mukherjee, head of the biostatistics department at the University of Michigan, also uses while discussing the lack of public access to granular data on the pandemic. “India is suffering from disintegrated data systems. The testing, vaccination, genome sequencing and clinical outcome data are not linked, at least in real time, to yield meaningful estimates of reinfection and breakthrough infection rates.”

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This leaves questions such as the effectiveness of Covaxin vs Covishield unanswered. At the national level, we still don’t know what percentage of Covid cases needed hospitalisation in 2020 or 2021. “Without this basic data/ metadata, we are flying blind.”

A major gap, says Menon, is in sequencing, which is important to know the level at which Omicron cases are increasing and whether there are more transmissible mutants. “We need states to cooperate in sending metadata that accompanies sequences, so severity etc can be correlated to the specific variant, prior history of infection or vaccination, and the patient’s own medical history in terms of preexisting conditions. Only then can we piece together India-specific information regarding the impact of Omicron. The need really is to tie different databases together to form a fuller picture of Omicron’s impact.”

NUMBER OF ISSUES
In December 2020, India had announced the setting up of the India SARS-CoV2 Genome Consortium (INSACOG), consisting of 10 labs and 18 satellite labs, to sequence a certain share of all coronavirus positive samples in the labs and keep track of changes in the coronavirus and new variants. Last month, Union Health Minister Mansukh Mandaviya told Parliament that there are currently 36 laboratories for genome sequencing, with the capacity to sequence up to 30,000 positive samples.

According to the website maintained by the CSIR Institute of Genomics & Integrative Biology, India has so far sequenced 8.6 lakh genomes. Dr Rakesh Mishra, director of Tata Institute for Genetics and Society, says that while the capacity is adequate, we need to sequence more and publish the results in the public domain at the earliest. “The world can benefit from this data being made public rapidly. If it’s not, it will be underutilising the investment we have made.”

There is also a wide disparity among states when it comes to consistency in collection and update of data on Covid-19, and making it accessible. Most Indian states quickly built Covid websites and dashboards but the quality of disease surveillance and, therefore, the coverage and quality of data vary considerably, says Paul Kattuman, professor of economics at the University of Cambridge’s Judge Business School, which has been producing a Covid tracker monitoring India.

“Not all states have reliable hospitalisation or deaths data, and almost none have cross classification by age and sex. Only some manage to correct errors within a reasonable period of time. Almost all have proved cagey in making data easily accessible.” The southern states follow a reliable bulletin format. States like Kerala, Tamil Nadu and Nagaland provide demographic information of every deceased person, says Rukmini S, data journalist and author of the recent book Whole Numbers and Half Truths: What Data Can and Cannot Tell Us About Modern India.

Meanwhile, there are large states like Uttar Pradesh and Bihar which do not publish Covid data on government websites, either releasing it on social media or only to journalists. But a bigger lacuna is on the part of the Union government. “The Union government continues to not provide a centralised website on which all state and district disaggregated data is made available every day, 22 months into the pandemic,” says Rukmini.

While some states regularly publish districtlevel data, what would be really useful is to have all the states and Union territories publish the data on their official sites with districtlevel granularity, says the team behind InCovid19, which began publishing a Covid-19 tracker just before the volunteerdriven Covid19India ceased operations last October. “This will enable multiple downstream applications and research efforts and modelling the pandemic using government published data.”

Kattuman adds that many of these issues are not specific to India alone. “The fundamental problem is lack of transparency driven by political costs outweighing public health benefits…. When the history of Covid-19 is documented in due course, there will be many instances of authorities hiding outbreaks and under reporting infection leading to worsening public health.” Epidemic forecasting models, an important tool in pandemic management, thus need to work on the basis that Indian states will vary hugely in the extent of data incompleteness, he says. The model that the Cambridge tracker uses focuses on the growth rate of infection. So if the extent of under-reporting remains a relatively constant proportion, however large that proportion might be — as long as it’s not 100% — the growth rate of infection can be estimated reliably, he says.

But predicting the trajectory of a fast-moving pandemic can be tricky. Inconsistent datasets, presence of too many variables (in the prediction model) and policy-therapeutic interventions lead to erroneous readings and inapt conclusions. The SUTRA Consortium — a collective of academics, health experts and scientists working on the Covid-19 supermodel — has stalled its ‘Omicron projection report’ of January, as they claim to have “underestimated” the new variant in their first two reports released in December 2020. The consortium had projected about 2 lakh daily infections by February 2022.

“We had to recalibrate our model a bit because now it is almost certain that Omicron bypasses both natural and vaccine immunity. The government has suggested to stop testing asymptomatic people so ‘case counts’ won’t mean much. If we had continued with the old protocol, we would have hit 5 -7 lakh cases, but now we won’t,” says M Vidyasagar, distinguished professor, IIT-Hyderabad & member, National Covid-19 Supermodel Committee.

“Our estimate is that Omicron spreads 1.2-1.5 times faster than Delta; hospitalisation rates seem to be around 3.5-4%. Oxygen requirement is for about 1% of admissions,” he adds. Most epidemiologists and doctors, who structure Covid trajectory models, rely on ‘informed projection methods’ by using data sets from other countries and extrapolating them to the Indian context. Dr Subramanian Swaminathan, director — infectious diseases, Gleneagles Global Health City, Chennai, plots his Omicron model from data received from South Africa, UK, US, Japan and South Korea. “Epi curves don’t lie — the Omicron wave is going to be huge in India. We may see 15-20 lakh cases per day over the next two weeks,” he says. “I am worried seeing the pace at which medical personnel are catching the infection; we may face a shortage of trained medical personnel,” he adds.

Experts say that while work needs to be done on sequencing and accessibility of data, the focus must be on disease surveillance and ramping up of testing. “As far as sequencing goes, you don’t need to sequence according to the rise in cases because it looks like all cases will be Omicron in a couple of weeks. However, testing is key. If you test more, you will know where the virus is and you can isolate those people and defeat this virus. If we depend only on symptoms, we won’t go very far,” says Mishra. “It’s more important to put out the fire, than to see how big the fire is.”
  • Published On Jan 9, 2022 at 02:20 PM IST
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