Phase1
Successfully executed.
Phase 2
New guidelines issued by government of India as outlined by
PM.
Battle continues without a pause.
Voices and articles questioning the lockdown are surfacing. Hindsight
is always clear. It is so clear that you can conclude that Trump, Subramaniam
Swamy and Rahul Gandhi have the same IQ. One must listen to the media briefing
of the Governor of New York to get clarity to realize where we are. New York daily
gets cases more than Delhi has had so far. Daily deaths in New York is as much
as our daily number of cases. New York has run out of resources. It is broke. USA
was two weeks ahead of us in the Corona timeline. That is the reality we have
evaded. In foresight, two weeks from now we will be discussing our path to
economic recovery while New York will continue to be plagued and struggling. We
are on top the curve when we examine this ‘sight’ through our heads and not
through our ‘hinds’.
Economy will take a hit. There will be a global recession. No
brainer. Is there a single country which will escape economic contraction,
including China? Despite its mask diplomacy and predatory economics it will
have huge issues. India has the best credentials to recover since we have our
people intact. However we cannot live in a lockdown forever. That is fortress
mentality. We need to move ahead with plan till such time we have a vaccine. The
present guidelines have some conditionalities which are contrarian. These need
resolution.
Enemy
The Chinese Virus has not mutated but shown traits of
re-infection. A Second wave is expected in winter. In the meantime there is a
study in Germany gives some hope. It suggests that lifestyles might not need to
be as Brahminical as is now. We need to wait for the full findings of the
study.
Own Forces
Climate.
April- May will get progressively hot. After that, the South will
experience monsoons while hot summers will continue in the North. Eventually
once the monsoons set-in all-over India, we will see muggy humid conditions.
This is the time when transmission rates of the Chinese Virus will be the least. The time
window till September is critical for us to move to long term solutions.
SWOT Table. A new SWOT table has been
evolved based on Phase 1 experience to help us navigate through Phase2.
STRENGTH
SOCIO
ECONOMIC
SOCIAL ADAPTATION TO ADVERSE
SITUATION
YOUNG DEMOGRAPHIC.
INBUILT IMMUNITY OF TROPICS
EXPERIENCE AND KNOWLEDGE GAINED BY
OTHER COUNTRIES.
VOLUNTARY PARTICIPATION IN
EXTENDED LOCKDOWN.
MEDICAL
LOW INCIDENCE, TRANSMISSION AND
FATALITY. GAINED TIME.
EXPERT HEALTH CARE PROFESSIONALS
POOL.
MODELS OF SUCCESS – KERALA AND
BHILWARA.
EXPERIENCE IN HANDLING EPIDEMICS
AND DISASTERS.
NATIONAL
LEADERSHIP - DECISIVE, CLEAR,
INFLUENTIAL AND CONSULTATIVE (PM &CMS).
RESPONSIVE GOVERNMENT.
PREPARATION AND CAPACITY
ENHANCEMENT.
INDIAS INNER STRENGTH (X FACTOR)
STRATEGIC COMMUNICATION
|
WEAKNESS
SOCIO
ECONOMIC
LAW
OF DIMINISHING RETURNS OF LOCKDOWNS
CURRENT
LOCKDOWN IS A PARTIAL SOLUTION
POPULATION
DENSITY
DIFFICULTY
IN MAINTAINING SOCIAL DISTANCING.
AWARENESS
LEVELS ARE POOR AT LOWER STRATA OF SOCIETY
PUBLIC
HYGIENE (PUBLIC URINATION AND SPITTING)
MEDICAL
AGED/ VULNERABLE / CO MORBID
PEOPLE.
MALNOURISHMENT
AND LIFESTYLE DISEASES.
LACK
OF INDIGENOUS RESEARCH
LACK
OF MEDICINE OR VACCINATION
LIMITATION
OF TESTING
LIMITED
KNOWLEGDE OF DISEASE BEHAVIOUR
LIMITATION
OF TESTING EQUIPMENT
NATIONAL
POVERTY
LEVELS AND UNORGANIZED SECTOR
FRAGILE
ECONOMY
DIVISIVE
CULTURE
|
THREAT
NATIONAL
ACCEPTANCE OF FOREIGN PRESCRIPTIONS/IDEAS
APPROACHING SUMMER – WATER STRESS IN ALL MEGA CITIES
ECONOMIC STAGNATION
OVER CENTRALISATION
SOCIO
ECONOMIC
INDISCIPLINE AND LAWLESSNESS.
HUNGER AND POVERTY
IDEOLOGICAL POLITICS
LOCKDOWN FATIGUE
REVERSE MIGRATION
OUTLIER EVENTS
PERSONAL INDISCIPLINE
LACK OF
COMMUNICATION
MEDICAL
A BREAKOUT CAN OVERWHELM FACILITIES.
MUTATION OF VIRUS
SECURITY OF HEALTHCARE PROFESSIONALS
SECOND WAVE
REINFECTION
AGED AND VULNERABLE
|
OPPORTUNITY
NATIONAL
INDIA CAN SHOW THE
WAY TO THE DEVELOPED WORLD
YOUTH AND HERD
IMMUNITY.
LOW OIL PRICES.
REBUILD ECONOMY
SOCIO ECONOMIC
LEARN FROM EXPERIENCE
MEDICAL
TIME GAINED
CLIMATE AND ON
COMING SUMMER. WEAKEN THE VIRUS
LOW MORTALITY
|
Current Status. The current status of cases is
tabulated below. While cases and mortality has increased, recoveries have also happened.
This data needs to be dis-aggregated to get a clearer picture.
State of the States. A look at
the State of the States will tell us
where we are. The graph below is of the “Top Order” of infection - Maharashtra,
Delhi and Tamilnadu. These states have high numbers now. Equally they have high
capacities. However they are showing signs of stabilization and there is a
glimmer of flattening of their graphs.
The graph below is of the “Middle Order” – Rajasthan,
UP, MP and Gujrat, popularly also known as the ‘cow belt’. While the numbers
are presently low in these states, their graphs are on the rise. In my opinion,
tough times are ahead for these states.
The graph below is of the “Lower Middle Order” -
Kerala, Andhra, and Telangana. Their trendlines are declining and curves
flattening appreciably. Special mention of Kerala is in order. Its number of
daily cases is lesser than recoveries and the curve is dipping. Needs emulation
by other states.
The rest of the states are mercifully the “Tail Enders”.
Hope they stay that way. Hope a pinch hitter does not emerge. Overall,
heartland India needs focus. The South, East and North are generally stable and
under control.
Case Discovery and Mortality. The percentage
of cases detected for the tests carried out and the percentage of mortality/ deaths
for the cases detected is compiled from 05 Apr, till date. It is given in the
graphics below in comparison with other countries and for some states taken as
a random cross section.
It is noticeably clear from the
graph above that the prevalence of the disease in India is far lesser than other
countries. As the number of tests have increased, the figure is tending towards
stabilization. It further emerges that the infection/ transmission rates in
India needs to be studied post haste. The mean Transmission rate (Ro) needs to
be fixed for each region. This has a long-term implication.
As states have increased the
testing rate and have tightened their responses, the rates and number of cases
have changed. We must expect undetected / unreported transmission which could
break out in clusters. The rates detected now, are likely to increase as lockdown is
eased, despite best efforts. Outlier events have contributed to increase in
cases. The effect of the outlier event at Bandra will surface in about ten
days. Prepare for more outliers. This is India.
The overall fatality rate continues to be one of the lowest
in India. Even in individual states, the rates are low. However when one looks
at numbers closely, Maharashtra, Delhi, MP and Gujrat seem to be on the higher
side. These states need to introspect.
Options
What are the options ahead? Prior to that let us see a few
issues.
Vaccines and Drugs. A detailed and
illuminating assessment on progress of drugs for management and cure as also
vaccines has been done by Reuters. (https://uk.reuters.com/article/us-health-coronavirus-lifeline/reasons-for-hope-the-drugs-tests-and-tactics-that-may-conquer-coronavirus-idUKKCN21V1YR/
). While there is lot of research going on, it is amply clear that a Vaccine is
far away. A cure could be in the offing a little earlier.
German Study. The study carried out in
Hinesburg (Germany’s Wuhan) by virologist Hendrik
Streeck is interesting. As per him 15 % people in Hinesburg have experienced an infection or are
currently infected. This is based on antibody testing. In effect the process of
herd immunity has already begun.
According to current estimates, the people under study are immune for
six to 18 months. Mortality rate was .37%. Virus found on doorknobs and
surfaces was dead and could not lead to infection. Hence lifestyle changes
might not be so drastic. This study needs to be followed up and corelated with
our environment to get to a correct and deducible picture.
International Trend line. On one hand the Chinese
Virus is threatening our lives. On the other we might end up losing them due to
the economic deprivation which we have to face because of protecting ourselves
against the Chinese Virus. A ‘lives vs lives’ debate has commenced. The
international trend is now to look at life after lockdowns. Many countries are
looking at herd immunity seriously since that is the only option. Sweden has gone in for it. “On Monday 6th April 2020 Denmark announced plans to open kindergartens
and schools and a staggered return to work, Austria plans to lift Covid-19
restrictions, Germany may reopen schools if infection rate stays low. On the
11th April, it was reported that France and Germany are discussing herd
immunity as a strategy to help lift restrictions. Without a vaccine and with a
hemorrhaging economy, the fact is many countries have, or are looking to,
promote a controlled spread of COVID-19 in the healthy population to achieve
herd immunity. Humanity needs to accept that a vaccine will be not
available in time for this current wave of COVID-19 and that herd immunity is
not an option; it is the only option. No one supporting
herd immunity supports a rapid spread of COVID-19 in vulnerable
populations. Herd immunity is a controlled distribution of COVID-19 among
groups that are least at risk and involves introducing restrictions and
suppression measures as necessary”. Many more
countries are on this line of thought. (https://www.carahealth.com/health-articles/immune-food-allergy-infection/coronavirus-covid-19-countries-adopting-herd-immunity) https://www.sciencemediacentre.org/expert-comments-about-herd-immunity/
Short Term- Lock Down. In the short term, we can continue with the
lockdown – loosening or tightening it as planned per the color codes. Of course
this will be accompanied by short term containments, sealing, hotspot
management and quarantining routine. Testing, tracing, isolation and treating
will continue aggressively. Social distancing, masks, hygiene, and sanitation
will soon be the norm. All these help in reducing transmission rates and keep
the infection in check. However the infection will not be eradicated. It will rear
its head in different places at different times. This will continue till the
next three years.
Long Term
- Herd Immunity Herd immunity was used to
eliminate smallpox virus and almost wipe out polio. So it is a main line
option. Whether we like it or not we will develop herd immunity by infection. Uncontrolled
development will overload our healthcare system beyond capacity and take a toll
on high risk individuals. So the only alternative we have left is Targeted /
Controlled herd immunity. We need to seriously start thinking about it and plan
to move towards herd immunity beyond 03 May.
How Do We Go About It?
Herd immunity is guided by a herd immunity threshold which is 1-1/Ro.
Where Ro is the rate of transmission. The global estimate of Ro
for the Chinese virus is 2-3. Johns Hopkins estimated Ro for India was 1.8
(based on environmental factors). At a Ro of 1.8, 45% of our population
will have to be infected to achieve herd immunity. Too much. That is prior to
lockdown. However the lock down (partial or full), behavioral changes, social
distancing, mask wearing, and other interventions would have lowered this figure.
If the Ro figure is 1 then the threshold is zero, implying that herd immunity
is achieved. If Ro is 1.2/1.3/1.5 then 17%/23%/ 33% must be infected to achieve
herd immunity. So the primary inescapable and essential task is to fix a Ro for India with its attached conditionalities.
After that there must be a plan to keep the Ro there and achieve Targeted Herd Immunity
Targeted Herd Immunity. Targeted herd immunity is a long-term process. It will
be an extension of the current lockdown and must be meshed with the calibrated
exit policy. It will involve the following.
Principle. The fundamental principle is to expose the healthy
young and protect high risk people.
Set
and Control Transmission Rate. Set a
transmission rate and take measures to achieve it based on climate, experience,
and data of outlier events. This must be controlled through methods adopted
during lockdown. The trick is that transmission rate should be below or match healthcare
facilities capacities. If the desired R0 is achieved , we will know how much of
the population we need for immunity.
Youth
Exposure. Based on medical
evaluation and testing expose healthy youth to normal activities. If affected,
treat them, and put them back into circulation. It includes setting up special
quarantine hostels and hospitals.
Increase
Low Cost Testing Procedures. Evolve low
cost testing methodologies indigenously to ascertain asymptomatic
infected people and those youth in circulation. This is critical.
Introduce
Social Barricading of High-Risk People. The
government advisory for the aged is only a start point. Protect the high risk through
isolation, separate enclosures, separate flights, buses, parks, cinemas, railway
compartments, hospital times and so on. Apart from Social Distancing, start
talking of Social Barricading.
Data
Collection. Rigorous data collection
and research must be initiated for monitoring the implementation process of
herd immunity.
Mainstream
Outliers. Outlier events like that of Tablighi, Migration
fracas and Bandra station chaos have already contributed to the spread to the
Chinese virus and has in fact contributed to Herd Immunization indirectly. This data must be mainstreamed.
Unreported
Infection. In our country there is a lot of infection
which is happening but unreported. This must be uncovered and factored including
recovery. In turn it means extensive testing.
Recorded
Infection. The official recorded
cases also have contributed to herd immunity. Factor them in.
Schools
and Colleges. Opening and attendance in schools / colleges
should be based on medical examination and monitoring.
Preparation
for Outliers. Some outlier event
will occur. Prepare for it.
Conclusion
The haul is long and hard. The choice is stark. Our economy
will recover only if the Chinese Virus Situation is in control. Henceforth the
Chinese Virus situation will be in control only if our economy is recovering. It is a catch 22 situation. It
comes back to the fundamental issue. This is a fight that we have to fight
together irrespective of caste creed or religion. All for one and one for all.
So far we have done that admirably. There is no reason to think that we will
not do it hence forth.
Postscript
The battle against the Chinese virus will succeed only if we take care of our weaker sections. Our economy will revive only if our corporates reach out to the needy and help them in their hour of need. If our business houses can copy and emulate L&T , I do not see why our economy will not come through. Take care of our workers, they will take care of you. In the Army I learnt that our men are the most important asset. For the nation the people are the most important asset. let us take care of them
Well researched and enlightening article sir.
ReplyDeleteExcellent as always.
ReplyDeleteHerd immunity section is really interesting.
Very good projection of reality as well as continuity of thought..The Army Way.
ReplyDeleteAppreciable..
Very well researched and put forth with remedial methods.
ReplyDeleteHope you have brought this to the notice of the concerned authorities at all actionable levels sir!
Well reseached and great presentation.Wonderful piece of work and advice.
ReplyDeleteAn excellent analysis. Self discipline, resolve and compassion is the need of the hour.
ReplyDeleteAn excellent analysis. Self discipline, resolve and compassion is the need of the hour.
ReplyDeleteWell explained in simple terms .... enjoyed reading it.
ReplyDeleteYou have nailed down the issues clearly in your typical way. Simple language.
ReplyDeleteNeed to address threats in the SWOT matrix as has been enumerated.
Govt initiatives are well projected Sir.
Hopefully we will be out of this threat,by the time the next series comes from you soon.
Well researched
ReplyDeleteA great analysis sir. Identifying which sectors will recover soon and which will lag behind due to behavioral changes of people post COVID will have a bearing on our economic recovery.
ReplyDeleteVery well analysed Sir
ReplyDeleteDear Shankar, this is another feather in your cap! Well done, keep it up! Press on regardless!
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