To deal with China, understand it better
The crisis has shown the lack of domain knowledge within India. Invest in it
There is now no doubt that China will remain India’s greatest strategic threat in the decades to come. Beijing is not just interested in taking control of strategic areas or in stopping India’s infrastructure build-up at the border. As is visible in the statements emerging from retired officials and its State-controlled media, China wants to send a message to India — to accept Chinese dominance in the Asian hierarchy of power, stop deepening the partnership with the United States, and reconcile to a curtailed global role.
New Delhi cannot do this, for its own national interests are at stake. While there is a need for a diplomatic reset, enhanced military capabilities and economic policies to reduce dependence on China, one other area which requires greater investment is the expertise on China in India. India is too dependent on a very limited set of retired diplomats and military officials who have engaged with China, select intelligence officials and diplomats who speak Mandarin, and a small set of academics outside government. This is not tenable. To understand Chinese motivations better, India needs more experts on the decision-making apparatus in China, the functioning of the Chinese Communist Party, the dynamic between the party and the People’s Liberation Army, China’s economic drivers and changing social dynamics, and its quest for digital dominance. For this, India must invest in language training, field visits, fellowships, and dedicated institutes. To battle China, understand it better.
As the cases of Covid-19 increase, many are wondering what they can do if they or someone close to them gets the infection. First, some reassurance. A vast majority of those infected with SARS-COV2 is asymptomatic or have minimal symptoms which require no treatment. This proportion is highest among the young, more than 90% in children and young adults, but is less in older adults with co-morbidities such as diabetes and hypertension. In seroprevalence studies, where we look for the presence of antibodies in people’s blood, indicating they have been infected and are recovering or have recovered, most who test positive do not recall any unusual symptoms. This indicates widespread asymptomatic or minimally symptomatic infection and recovery.
While this is good at a population level and should reduce the panic associated with Covid-19, the more symptomatic patients should not think of this as just another flu. In this group, especially for the elderly or those having diabetes, hypertension or other co-morbidities, there is a small but real risk of severe illness which could be fatal.
What are the available treatments for those with moderate to severe disease and when or to whom should they be administered? The answers are still evolving. The treatment can be broken down into three categories. First, general supportive care targeted at managing the symptoms and general complications. Second, antiviral treatment directed at killing or limiting the growth of the virus. Third, modulating the immune response of the infected person such that it is strong enough to clear the virus, but not so much that it kills the host.
The first category, access to good quality supportive care, is simple in concept but needs a strong public health focus. There must be timely testing so that people are diagnosed early, with simple monitoring for common danger signals such as low oxygen levels in the blood that can be monitored by a simple pulse oximeter. If this is done, patients likely to become more ill can get necessary care in time — oxygen supplementation, with face down positioning (proning) and ventilator support, if needed, preferably non-invasive. Attention can also be paid to preventing, detecting and treating blood clots.
The second category is antiviral treatment. This ranges from true antiviral drugs, such as favipiravir and remdesivir, to commonly available medicines that may additionally reduce viral entry or replication such as zinc, vitamin C, chloroquine/hydroxychloroquine, azithromycin, doxycycline, ivermectin, niclosamide, ciclesonide and indomethacin. There is no authentic evidence that any of these are effective, but data so far offers some hope. Remdesivir seemed to accelerate recovery in one randomised controlled trial (RCT). In moderately ill patients, it may reduce death. Favipiravir is cheaper, has fewer side effects, and can be given orally, making it more attractive but lacks any quality RCT data and is thus used for mild to moderate illness only. Zinc and vitamin C are being commonly used by patients with mild illness, due to lack of any known or postulated side effects, with some observational data of zinc being potentially useful. Treatment with chloroquine or hydroxychloroquine has not been very promising so far. While recent reports of high toxicity turned out to be false, side effects may occur at high doses, especially in those with existing heart disease.
The last category, immune modulation, looks promising since much of the severe disease is either due to uncontrolled viral infection in people with compromised immunity, or due to an exaggerated immune response causing damage to the lungs and other tissues.
Increasing natural immunity through vaccines appears distant at the moment and externally providing antibodies via the plasma of recovered patients (plasma therapy) is neither risk-free, nor easy to do at scale. The only published RCT for plasma therapy was inconclusive. In fact, the first clear winner in immune modulation is the widely available and cheap steroid, dexamethasone. It is expected that when used correctly, steroids will dampen excessive immune response, limit damage, and promote recovery. However, it also suppresses immunity and should not be used early in the disease. More sophisticated immune modulators like tocilizumab that can selectively block cytokine storms, without compromising immunity, have also shown promising results. Many other approaches have been suggested for immune modulation, ranging from mycobacterium w vaccine to traditional remedies that boost immunity. What works remains to be seen.
Currently, we have both a shortage of proven treatments and an excess of unproven ones. With exaggerated claims from every quarter, it is difficult to subjectively determine the best treatment. Objectively, uncomplicated disease in otherwise healthy subjects usually requires no specific treatment beyond general support. In fact, such support is probably both necessary and sufficient to prevent most Covid-19 deaths. More specific treatment, including new antivirals and targeted immune modulators, will certainly be beneficial in specific settings but are not required for everyone. We should treat based on what we have learnt and keep learning as we treat. For this, patients, doctors and researchers must come together and share information at covbase.igib.res.in, a site meant for this specific collaborative purpose.
Prime Minister (PM) Narendra Modi recently stated that 20 jawans were martyred but not before they taught a lesson to those who had dared to raise an eye towards
Mata”. PM assured the nation that, today, it has the capability that no one could eye even an inch of its territory. He suggested that the infrastructure in the border areas had improved greatly, leading to heightened patrolling and close monitoring of movements at the border. PM also made it clear that India would respond firmly to any attempts to transgress the Line of Actual Control (LAC).
China has always made a creeping annexation part of its policy towards India. The Congress, when in power, turned a blind eye to the encroachment on India’s territories by the Chinese through continuous transgressions and border violations. Though the country entered into as many as six bilateral agreements in 1988, 1993, 1996, 2005, 2012 and 2013, it did not address the dispute over LAC. When the Chinese intruded and pitched tents deep inside India’s territory at Depsang, in 2013, the then Prime Minister Manmohan Singh merely spoke in Parliament about the Chinese having a different perception about LAC. Confidence-building Measures (CBMS) were misused by the Chinese to resort to psychological warfare and “salami slicing”. This is because, after 1962, defence forces were neglected and infrastructure was shoddy.
After Modi assumed power, strengthening infrastructure became a national priority. Today, there has been a great leap in infrastructure development at the Indo-china border on the Indian side which has served as a deterrent to China. Had the infrastructural development started in past regimes, India would have been in a more dominant position today. After 2014, India created a strong road network through the Border Roads Organisation and the Central Public Works Department despite the small window, during the year, for construction, due to the harsh winter. The Border Area Development Programme (BADP) has been allocated ~784 crore in the fiscal year 20202021. BADP stipulates that “10% of the total allocated funds will be additionally allocated to the states/union territories abutting Indo-china Border (Arunachal Pradesh, Himachal Pradesh, Ladakh, Sikkim and Uttarakhand) for taking up works in the districts abutting Indo-china border”. The creation of infrastructure “would help integrate these area with the hinterland, create a positive perception of care by the country and encourage the people to stay or in the border areas leading to safe and secure border” as per the ministry of home affairs.
Infrastructure has developed on all borders through the comprehensive Integrated Border Management Systems — be it border out posts, border fencing, mobile towers, the use of technology at the border and lighting. On the Indo-tibet border, roads, helipads, tunnels and bridges have been built.
At the same time, there has been an increase in patrolling — be it long-range patrols, short-range patrols or joint patrols by the Army and the Indo-tibetan Border Police. India has held its ground in several face-offs. Regular patrols also enable us to assess China’s activities, identify features of tactical importance, dominate infiltration routes, corroborate inputs and assert our presence. Post-2014, our patrols have been actively engaging, confronting and preventing any incursions. We have not allowed any construction activity in our territory within LAC. In Doklam, India stalled the construction of a road by the Chinese, which would have adversely affected the nation’s strategic interests. It is only after this that China became more wary of India’s diplomatic and military might.
Work on a link road, part of an infrastructure project of a strategic road in Ladakh, is one of the factors which seems to have pushed China into its misadventure on June 15. They were given a bloody nose by Indian soldiers. Another reason which could have irked China is the fact that India did not support the Belt and Road Initiative (BRI), which was not advisable from the country’s security point of view. BRI was to establish China’s dominance in global trade. This included the China-pakistan Economic Corridor, which is not acceptable to India as it goes through Pakistan-occupied Kashmir. Other factors which angered China could have been the friendly relations between India and the United States and the formation of the two Union territories of Jammu and Kashmir and Ladakh as well as the abrogation of Article 370. This reflects China’s vulnerability and the Galwan Valley aggression seems to be the desperate act of a frustrated country.
PM Modi’s policy towards China has been a judicious mix of diplomatic, military and economic options. He and President Xi Jinping have had as many as 18 summit meetings over the past six years, including two informal meetings at Mamallapuram and Wuhan. Several meetings have been held at different levels. The 15th meeting of the Working Mechanism for Consultation and Coordination, was held on June 24, where India stressed on respecting LAC and both sides agreed to expeditiously implement the understanding on disengagement and de-escalation.
While diplomatic parleys should continue, it is imperative to continue the PM’S policy to strengthen both the nation’s infrastructural and military build-up to contain the Dragon if it challenges us again. No one can challenge a determined India. Though India is a peaceful nation, we will negotiate only from a position of strength. And this can happen when strong leadership under PM Modi is guiding India’s security policy based on national interests.