8 June 2020
Now that 150 days are well past us, we know what the pandemic is. We particularly know that as of now, either the strains or subtypes of this virus discovered so far are not clinically significant or right now, is not our priority in so far as the vaccination development programmes that are well on their way through Phase 1 Human Clinical Trials. We are also aware that Remdesivir a known antiviral agent developed to fight Ebola virus is fairly successful in that it is available, as we also know how Plasma harvested from Covid19 recovered patients can also be useful to a larger extent. We are aware that Israelis and Iceland have developed Human Interferon therapy and monoclonal antibodies which will reverse the pathology of Covid19 and these are likely to come for clinical use after trials in due course of time.
From what we can see, whether it is Chinese or Brazil or India, the exception being South Africa, BRICS countries behaved like the G7 while the G7 with the exception of Russia behaved like the BRICS, espousing the cause of science, putting money into where benefits would accrue to maximum people. In India particularly, the shocking failure to make testing for Covid19 free and readily available even a full three months after the country recognised the pandemic as a local problem is something that has now started to haunt our administration and health systems. In Twitterverse tweets on how people are struggling to find tests, to find beds and to report loss of their dear ones is such that now folks are using api, GitHub, python, R and Stata as digital resources and platforms to make sense of all these inputs. For me individually numbers are statistical muse, they merely act like a confirmatory bias, that is within me. Of course, in the context of Surgisphere and Dr Sapan Desai based in Chicago, statistical bias appears to be a dubious phrase, after NEJM and Lancet both pulled several research papers based on statistical inferences drawn from the datasets provided by this firm.This has other disastrous effects too…https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwin3Z7Dk_HpAhWT8XMBHTiPD4kQFjANegQIBBAB&url=https%3A%2F%2Fwww.the-scientist.com%2Fnews-opinion%2Fsurgisphere-fallout-hits-african-nonprofits-covid-19-efforts–67617&usg=AOvVaw0NIkeZU2tLW669BFgRSmXP
We know that neither Chloroquine nor ivermectin nor HCQ with Macrolide combination (Hydroxychloroquine plus azithromycin) has any pathology reversing properties and it this is a confirmation from several Randomised Control Trials in UK, USA and China. Now medical fraternity is doing what Germany did from day one, source Chinese data, study the data for infirmities and bias and then use the data. So Germany was the one outlier in Western science to not use HCQ/Ivermectin or combination repurposed drugs for treating Covid19.(https://www.dw.com/en/why-the-world-is-hungry-for-a-coronavirus-drug-made-in-india/a-53077879)
Today we know that the SARS CoV2 virus is not one that has patterned itself after the common flu, as it has continued its progression, despite clear changes in weather in both Europe and America, only temporally it seems for follow a calendar of 150 days, where the first 50 are the build up phase, then it tends to stretch the peak or keep rising depending on actions by host countries to #BreakTheChain and finally show signs of waning. In no country is the authority confident of seeing the back of this virus, despite their targeting to not just flatten but to hammer the curve out of existence like the Kiwis tried. Perhaps the only country that has a very successful Covid19 containment strategy from day 1 is Taiwan. Sweden is being talked of as an outlier model, which is largely a misunderstanding of the ground reality for a country that is already socially distanced in normal times, which further provisioned for clearer social distancing and which saw deaths in the old age homes and care homes which its authorities regret, but which levels did not ever threaten to bring their hospital capacity to bear against the pandemic. At the peak, Swedish hospitals did have between 20-25% reserve capacity of ICU and acute beds, even as the government stepped up to increase that capacity even further in anticipation of worse.
So now, it is clear, no country can sustain a lockdown for indefinite periods. It is clear from how India, the world’s largest democracy and largest according to me by population since 01 January 2020, has begun to unlock its economy and society exactly when disease prevalence officially is hitting a peak. However, it could be different if powers that be know that we had hit our peak already and were now in a plateau. Remember how the government kept shifting the goal posts on Demonetisation, when RTI replies revealed much later that the decision makers knew that no black money was coming in, that nearly 100% of the notes were exchanged save for those stuck in Nepal and in the hands of illiterate Indians or some highly secretive ones who had stashed old money in grain sacks or mattresses in their homes, which relatives reported too late! So given that track record, I am not going to think that Mr Modi or his Cabinet is blindsided. #AtmanirbarBharat is a signal that government offers to us indirectly to tell us that now it thinks it can leave us to our devices because the larger threat of this pandemic overwhelming this country has receded!
So if we can avoid getting distracted by debating about whether we are the number 1 or we are 7th in world statistics, we can move forward to devise strategies to help ourselves. ( I think that we are number one in cases, in fatalities and those hospitalised and recovered, we will get there in testing too, because no country is as populous than India, and because China appears to have controlled the pandemic to a large extent, that her factory output in most sectors has reached threshold of 30% and in some sectors where global demand is there, even 60% of pre 2020 levels.)
- Working on an Index R: We need an R to work on. ( The R0 (R Naught) we are familiar with on western TV is the initial stage of pandemic outbreak as indicator of how many persons get the disease from one infected individual. An R0 less than 1 means the disease will not propagate to epidemic proportions and can be contained through simply quarantine measures of infected alone.)So can we test the traced contacts of the first 100 cases of each State, for starters the bigger states which are also our economic hubs like Maharashtra, TN, AP, TS, Karnataka, NCR (Delhi) and Gujarat. MP and UP with Bihar need testing for a sense of population overweight that they statistically are, but priority 2 in our scheme as of now. So when we test the contacts of these 100, and then trace and test the contacts of these contacts who turn positive, we could create an index R for that state. We do this for four weeks, we will have a clear statistical base to confirm whether the disease is plateaued or on the descendent in respective states.
- Antibody Survey:We need antibody surveys, like poll surveys, across the various economic segments of India, initially only to be carried out in the Super 10 hotspots of India as its major metros, like Delhi, Mumbai, Chennai, Kolkata, Bengaluru, Hyderabad, Pune, Ahmedabad, based on economic and population criteria in that order. This will allow us to chart prevalence, and weekly surveys when published will offer the public confidence and health planners another clear indicative factor on which to base their strategies further.
- Testing Reboot: We need to remodel our testing strategy. If Covid19 RT-PCR of Mylabs India is successful and now production is 5 lakh kits per day, then we need to fund this entirely and offer this as free testing capacity for India across the states, first beefing up capacities in states with highest economic activity and then sequentially down the order. If the new NIV ELISA test Kavach is as good as claimed then it too needs to be ramped up for production to at least a million tests( Remember Cepheid and Abbott are producing 30-50 million tests per month now) and used to test in that same order. We need to have a midcourse correction, and by using in-house testing we can finance a Make In India in testing arena. We can even selectively offer testing to Bhutan, Bangladesh, Myanmar, Nepal and Sri Lanka as our immediate extended neighbourhood, initially for their citizens willing to travel to India for business and later for their wider population. We need to assist UAE too on priority. Private laboratories can be allowed to test using imported kits, charge as per their actual costs without any fetters, offer mail test services as is being offered in US, so that Indians who can afford, can get tested from the comfort of their homes.
- Information Strategy:We have failed in our broader public campaign on Covid19 messaging as we allowed rampant WhatsApp theories about 12 hour life of the virus, its susceptibility to weather, to sound, to light and then to the mythical Indian gene! Now when we are unlocking, we need Bolly/Kolly/Tolly and whatever matinee idol out there to launch a campaign on TV where for hours people take turns to link to studios and carpet bomb our folk with a folksy take on hand hygiene, on face covering, and social distancing. This we need to have as a sustained campaign in dialects of India, in dialogues Indians relate to and for a whole fortnight.
So going forward, there is no escape from having a data base, any data base for us to develop a measure of public confidence and return to normal. Remember that people will take risk in any business activity only if they have a fair idea of variables, not if they are clueless. I am not saying that doing these measures will restore the confidence of our migrant working populations who are even now reaching back after a Himalayan ordeal to their ancestral homes. But those who stayed behind, or those who had not such option of going back from our cities, at least they will venture out with a degree of confidence that we need on priority!
indiarubberman.com 