CORONA COMBAT: THE EIGHTH REVIEW. GRADED EXIT by Lt Gen P R Shankar(R)

Seventh Review: https://palepurshankar.blogspot.com/2020/04/corona-combat-seventh-review-attaining.html

                          

GENERAL

Eighth Review. We are now looking at a graded exit from the lockdown. Are we ahead? Yes Sir, we are. The Corona is still panting to catch up. However as we exit from the safety of the lockdowns, we will be exposed and hunted down by the Virus mercilessly if we are not careful. Till now we had the government to herd us collectively into a defensive huddle. Hereafter we will be on our own. The individual matters more. The state can only enable and empower us. Beyond that it is up to us. The lessons of history should not be ignored.

THE ENEMY

Mutation

The enemy has not mutated. However it has been studied a little bit more. 

Vulnerability

The Virus is very severe on the elderly and those with life style diseases. A study was carried out in New York of 5700 infected patients who were admitted in hospitals. Median age was 63 years. The most common comorbidities were hypertension (3026, 56.6%), obesity (1737, 41.7%), and diabetes (1808, 33.8%). Elderly people with lifestyle diseases beware.

Asymptomatic Cases

The Submerged Iceberg. Asymptomatic cases are submerged icebergs. New York Government randomly tested 7500 people at grocery stores and shopping locations across 19 counties in 40 localities using antibody testing. 13.9% of the New Yorkers tested positive. They might have had Covid-19, according to preliminary results. New York population is 19.4 million. It means about 2.7 million New Yorkers might have had the virus and recovered from it. This corroborates with the German study in Hinesberg, which said that 15% of the residents there have already experienced an infection or are currently infected.  (https://palepurshankar.blogspot.com/2020/04/the-corona-combat-fifth-review-thinking.html)  Even the CM of Maharashtra has said that many recent cases in his state are asymptomatic.

Fatality. A positive aspect of the asymptomatic cases is that, in the overall sense, the Virus is not that fatal. As of now we are judging fatality based on the number of cases identified through testing. If the unseen / unfathomable asymptomatic cases are also factored in, the fatality rates will plummet.  

Awareness. India needs to do a similar study to get a correct picture. We need to know how many people are silently getting infected, at what rate and where. Are we going towards herd immunity automatically? We also need to be aware that the person whom we are interacting with could be infected and be a carrier unknowingly. Most importantly, the public needs to be aware of this. This is not getting due importance in our public communication to the common man.

Testing. In case we must get a handle on this Virus, we must uncover the iceberg through widespread testing. We must come up with an affordable and practical testing regime.  

Immunity

All studies about immunity are educated guesses. If one is infected immunity varying from 6-12 months is expected. No more.

Reinfection

Reinfection has not flared as feared but the danger is lurking.

Second Wave

The way the Chinese Virus is circulating, the second wave is almost a surety. How it will manifest in the oncoming monsoons is an unknown factor which needs some study in our context.

Severity in India

For some strange reason, the disease has not affected Indians as much as feared. Till last Sunday, of the 21632 active cases only 2.17% were admitted in ICU, 1.29% needed oxygen and only 0.36 % needed ventilator support. Only 80 ventilators have been used so far! (https://www.readwhere.com/read/c/51431125). The availability of ventilators in India is far in excess at around 40000.  

OWN FORCES

Current Status

The current status of cases and the spread is in the graphic below. While the overall numbers have increased, the number of recoveries (about 25%) are also increasing steadily. Most importantly, the healthcare system is nowhere near being overwhelmed.   

    

                                  

       

International Comparison

When our status is compared internationally, we continue to hold steady as before either in terms of number of positive cases or fatality. The graphics below are a clear indicator of this continuing trend. 

FATALITY RATES (% OF CASES)

POSITIVE CASES (% OF TESTS)

Two articles caught my attention. Both question India’s low death rate. Julia Hollingsworth , CNN, reports that “Could more people be dying than we know? And there's already evidence that some deaths may be flying under the radar” ( https://amp.cnn.com/cnn/2020/04/28/india/india-coronavirus-outbreak-explained-intl-hnk/index.html?__twitter_impression=true ). Soutik Biswas, BBC , reports that “The other question is whether India is "missing" Covid-19 deaths. Trying to get a count from funerals at crematoria and burial grounds would be equally tricky. Many of India's dead are cremated in the open in large swathes of the countryside. Funeral services cater only to a small sliver of the population (BBC)…. India might be missing some deaths and not diagnosing every patient correctly for Covid-19” (https://www.bbc.com/news/world-asia-india-52435463). Both are motivated, ignorant, snide and condescendingly Western media reports. I will only quote a Reuters report , which I read from a Pakistani Paper -   “While death rates in some countries have risen sharply in recent weeks, in India the opposite seems to be happening, at least in some places, leaving hospitals, funeral parlours and cremation sites wondering what is going on…. In central Mumbai death rates have gone down by 21% in March. …deaths plummeted 67pc in Ahmedabad…… data from at least two other cities… show a similar pattern…..” (https://www.dawn.com/news/1551861/mystery-of-indias-lower-death-rates-seems-to-defy-coronavirus-trend).  Grapes seem to be sour for BBC and CNN.

Domestic Analysis

While the overall analysis for India is fine and cases are doubling in about 9-10 days, there is a clear trend emerging when an analysis is based on the active cases in a state. The active cases give the correct picture of what is happening and what needs to be done.

Ascenders.  In seven states the Virus is in the ascendance mode. The table below gives the data.

                                     

The graphs for the total cases (red) and the active cases(blue) is given for each state below.  In these seven states most of the parameters are on the rise. The total cases and active cases continue to rise. Maharashtra, Gujrat and MP contribute to 70% of the deaths in the country and about 50% of the cases. Worrisome. Worrisome. West Bengal and Bihar are fast risers. Potential problems. These states have been ascending even during lockdown! Tells its own story. India’s success in defeating the Virus revolves around how well these states cope with the situation ahead. One can see extended lock downs in these states.

                                    

 

Descenders. Eight states are near stabilization or in descent. The table below gives their data.

                                            

In these eight states, the cases are increasing but the recoveries are also significant. As a result the active cases are fattening out or in some cases decreasing. Though these states seem to have things under control there are flutters. They need to redouble their efforts. The equation between new cases and recoveries needs to swing favorably. If not careful, things could get unstuck. These states will see alternate periods of lockdown and selective opening. The states in the bottom half of this table are better placed than those in the first half since they have low numbers.  

 

                               

Decliners. The table below gives the states in which the Virus is on the decline. These decliner states have less than 100 active cases overall. With a little effort they can snuff out the Virus. They will be able to have enough open periods if they remain focused.  

                                       

Recliners. The table below gives states that have negligible number of cases. They are in a situation to clearly blank out the Virus. With proper surveillance and monitoring, they will be able to have large periods of open activity. Their efforts must be to prevent expansion of footprint of the Virus.  

                                             

Key LIines of Operations

Individual Care. From now on the individuals will start mattering more. How we behave individually will dictate national outcome from now on. We might have to get into a fussy Brahminical ethos. So be it. However the state matters quite a bit and should focus on empowering the individuals. Individual care and consciousness to wear masks, wash hands, maintaining social distancing and hygiene must be built in. In India, this must be reinforced and brought about by a disciplined approach since public consciousness is poor. Team effort is a difficult concept in crowded areas. Hence social campaigns must be extensive. 

Zoning. The government has already intimated the zoning criteria. The Red, Orange and Green zones are outlined below

                     

                           

Each state and district will come out with their methods of ensuring permissible limits of  movement and activity in each zone. I will not second guess it. However many things are not clear. States/ Districts/tehsils/ wards need to be more communicative and clearer to people as to what are the ‘do’s and don’ts’ in everyday life. Some issues which need clarity are: -

Intercity/ district / area travel guidelines should be clearly disseminated.

Permissible economic activity and timings should be clear.

Containment areas and zones need to be clearly promulgated.

Crowd control must be focused upon in public places.

Surveillance and monitoring have to be continued and known to people.  

Stigma. There seems to be societal stigma developing about this Virus. As a result, one hears of people hesitating to disclose their symptoms and attempting home cure. Nothing more stupid. Medical evidence reveals that the faster one gets tested and is under medical care the better the chances of recovery. Moreover recovered patients are the source for Plasma therapy cure. There needs to be a social message at national level to eradicate cultural stigmas.   

Leadership. The leaders of this nation who are at our doorstep for votes at election times are conspicuous by absence now.  Where are all the MPs. MLAs and MLCs? They should be up and around to reach out to people and provide leadership.

Testing. India needs to improve testing capability to fight this virus in the long run. We need to develop indigenous solutions instead of depending on faulty and substandard Chinses kits. When will we learn our lessons? Unless we develop mass testing capability , we will not be able to effectively handle this virus.

Water. With the approaching summer, water problems will commence. The States must plan for water sensibly. In cities like Chennai where water is at a premium, this assumes great importance. How can we expect individuals to wash hand for 20 seconds when he does not have water for even five seconds? Deserves thought for action. 

Public Hygiene. Once the lockdown is lifted, public hygiene will become a causality. This must be strictly monitored.   

Vulnerability Analysis. I do not find any analysis and data on vulnerability of populations in various areas. Unless we can carry out a data driven analysis, we cannot protect the vulnerable and high-risk people. As of now talks of “Protecting the Aged from the Young” is all on paper only. Need to give it practicality.

CONCLUSION

This virus will continue to behave like a smoldering fire. If we are vigilant and aware it can be stamped out and prevented from spreading. Even with great vigilance, we will have to fight out eruptions occasionally. However if we are negligent it will erupt and engulf us. Exiting from lockdown is great. However the dangers are also great. It should not unnerve us. We need to fight ahead with resolve.