Covid-19: What we should do now
Testing is fundamental for identifying suspects harbouring Covid-19 and very soon we will need diagnostics which can be operated on a doctor’s desk.
THE DISEASE
The Covid-19 pandemic ravaging the world is unparalleled. Viruses earlier spread easily, e.g., viral epidemics like Ebola, MERS, SARS, Nipah, which had higher mortality but were controlled by isolating the infected persons. But SARS Coronavirus 2, which causes Covid-19, breaks all barriers. The virus is fragile but runs its course, the difference being its binding to receptors which control our metabolic and immune functions. It creates dysregulation (abnormal overreaction) and inflammation, and patients who progress to the severe stage may end up with an auto immune reaction, often fatal. Among those requiring ventilators, 80% may not survive.
In such a scenario, the entire armoury which we control must be deployed. Past experience of the Spanish Flu and H1N1 suggests that around two years elapse before pandemics abate.
WHAT WE DID WELL
For managing any disaster, leadership is most important and in this respect India’s response has been unparalleled. We did not do piecemeal lockdowns like in Italy, Spain, the United Kingdom and the United States. The national lockdown was executed by the authorities and accepted by millions—an effort which will go down in the history of controlling pandemics.
Looking at how countries like the UK, Spain, Italy and now the US have been caught unawares and are floundering, we have reason for satisfaction. State governments have made Covid containment a mission— even seeking an extension of the lockdown in the interest of public safety, giving time for ramping up the processes for testing, tracing, isolating and treating. Advisories and protocols for management of the disease were issued within days, with the response checked every day.
The National Disaster Management Act 2005 empowers the Union Health Ministry, state chief secretaries and district magistrates to exercise extraordinary authority to manage disasters.
The National and State Disaster Relief Funds were opened up for creating infrastructure. At the district and municipal levels beds and quarantine facilities have been commandeered from hotels, schools, resorts and lodging houses. Free food was provided by government orders, with shining examples in Bhilwara district in Rajasthan and Delhi where 6.5 lakh people are being fed cooked meals daily. Cash transfers have flown into bank accounts and a financial package was announced, which would normally have taken weeks.
The banging of thalis and lighting of lamps, although ridiculed as serving little purpose, managed to unite a population of hundreds of millions transcending boundaries of region, language, caste, religion and economic status. It was a singular display of social cohesion unseen anywhere in the world.
WHAT WE COULD HAVE DONE BETTER
The oft-repeated criticisms have been four-fold the impact of which is still being debated.
First, when a country like Singapore, the population of which is half of Bengaluru’s gave four days’ time to people to prepare for the lockdown, why did India have to clamp down with just four hours’ notice? It resulted in panic buying, hoarding, and far worse, an avalanche of migrants trying to get home by any means.
Second, it led to enormous hardship to thousands of hapless people—something which could have been anticipated and avoided had the states been given time.
Third, the assembly of people at Anand Vihar interstate bus stop and the congregation at Tablighi Jamaat was a failure of several agencies, leaving a trail of infected people within the Tablighis and the migrants, the former a worse calamity for curbing the spread of the virus.
Fourth, the procurement and supply of personal protection equipment has been slow and many more agencies were needed to start manufacture on a war footing.
The story is far from over.
WHAT WE SHOULD DO IN FUTURE
Testing is fundamental for identifying suspects harbouring Covid-19 and very soon we will need diagnostics which can be operated on a doctor’s desk. Fortunately, products which can locate infection in 5-15 minutes are available and are under evaluation in India and elsewhere. Innovations for sample collection like self-swabbing or picking up samples at the street corner or at a nearby drive-in are becoming realities.
But more tests mean more questions. How far are we geared to do this when it comes to millions of people? The availability of antibody tests will be a great addition but the next question will be, can a person with antibodies go to work? Germany is considering an “immunity passport” for persons to go out in the community after being cured. We need to decide what we must do.
Testing is essential but it is not a remedy. There can be no finality until a vaccine is found and the assumption that testing will protect us can be belied because without a vaccine there can be no guarantee against infection from the virus.
Opening up international travel and movement across the country will need utmost caution, particularly as legitimate demands to re-start manufacturing will strive to overshadow the risk from the virus.
One reason for the rapid development of diagnostics has been availability and sharing of data between scientists across countries. Modellers have worked with WHO and national governments to predict the pattern of the spread, the best measures needed and their potential impact. India too needs to strengthen its big data analysis systems and capabilities for modelling and forecasting.
The scenarios that are emerging from environmental damage, critical water depletion, the close proximity of human and animal habitations, climate change, urbanisation and deforestation are subjects that today come under the umbrellas of six different ministries and scores of institutions across the country. When the origin of the coronavirus is being attributed to bats, onto civet cats and finally onto human hosts, we need to think laterally and collectively. We need seamless movement of data from medicine, virology, public health, engineering, modelling and data analytics to foresee what can happen.
Covid-19 pandemic is a wake-up call to put our house in order so that all agencies forget about their turf and work for a common purpose, avoid duplication and make more effective use of resources.
We should also be tracking countries that are ahead of us on the epidemic curve. China,
Italy and Spain seem to be past their first peak and what they do next can result in unforeseeable consequences.
We must capitalise on our strengths, which are several. India’s primacy in information technology has the ability to create a big data platform to monitor human health in real-time.
We are already a manufacturing hub for essential drugs and vaccines. India produces 70% of the world’s supply of hydroxychloroquine (HCQ), recently in the news because of demands from the US. India not has only has sufficient stocks but also the capacity to ramp up production for export. India managed HIV/AIDS because of indigenous manufacture of drugs, the export of which has saved millions of lives in Africa.
Our social cohesion and family support systems work better than any other country, given our size. We have a structure and a system that work in times of disaster.
Given our strengths we can overcome. But the road ahead is arduous and fraught with imponderables that only time can unfold. Shailaja Chandra was Chief Secretary, Delhi and until recently, Secretary in the Health Ministry. Dr N.K. Ganguly is former Director General of ICMR.