THE CORONA COMBAT - SECOND REVIEW BY LT GEN P R SHANKAR (R)

This is a follow up of the first review @ https://palepurshankar.blogspot.com/2020/03/the-corona-combat-review-of-situation.html

General

We are now into Day 10 of our lockdown. Midway point of Phase 1 of the battle with the Chinese Virus. Approaching Phase 2 shortly. Critical times ahead. Time for a review of the situation. The PM has spoken to us today. He has just told all of something very important. India is with Indians and Indians are with India. Though we are isolated we remain collected in this fight. Have faith. Economic packages have been rolled out for the poor and for taking care of the common man as well as the industry. At this point of time, I guess that is what the government can do, and it has done that. If the need arises more will be done. I am confident of that. At least for the needy. Overall, we are winning it where superpowers, wannabe superpowers, have been superpowers are losing / lost it. The collective response of India has been simply fantastic notwithstanding the blips of some uncontrolled migrant movement, the Markaz fiasco and some incidences of indiscipline. It is battle. Win some. Lose some. We are now into the second half of the lock down and it is important to now seriously consider options for Phase 2 of our battle.

Enemy

The enemy has not changed course. The Chinese Virus is continuing its merry path of infection. It has adversely affected many parts of the world. However there is no evidence that it has mutated.

Own Forces

The infection count has gone up in India. Presently it stands at 2567 infected, 72 deaths and 192 recoveries. The graph for the past 14 days is shown below. In comparison to others, we are doing rather well. We are about two weeks behind USA in the infection cycle. At that point of time, USA had about 25000 cases and over 300 deaths. Two weeks back Russia had the same number of cases as us and today it has 3548 cases. We are a week ahead in the cycle. The lockdown seems to have its effect. The SWOT table has held good.

Co-Relationship

A co-relationship was carried out based on several reports which came out. These pertained to Climate, Vaccination, Tropical effect, Cambridge Univ study and a few others. These are highlighted below to give a bird’s eye view so that the correct picture emerges. 

Climatic Co-Relationship

Studies have come out suggesting that with increase in temperature and humidity, the infection rates go down. This is also borne out by empirical data. Infection and deaths are high in temperate countries vis a vis tropical country. This is clear from the map below.   

                              

As per one of the studies infection rates tend to drop off when absolute humidity is above 10 g/cubic m and temperatures are higher than 17 deg C. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3556998 ). The oncoming summer will satisfy both these conditions almost all over India. The mean figures for the NCT and Tamil Nadu are indicated in the graphics below.  More than 90 % of Chinese Virus cases have occurred in the red portion in the graphic below. India is well below and to the right of the red swathe. From a temperature perspective it appears that India might have a low infection rate. However the summer seems to be coming in late. Hence, I do hope and recommend some research lab in India to carry out some temperature related study of this stupid Chinese Virus. It will be our lifeline.    

       

Tropical Co-relationship

A comparison of three tropical countries was made – India, Mexico and Saudi Arabia. Mortality was focused upon. Mortality tells us the ultimate price we must pay. In my opinion and that of some researchers, death rates are a more robust measure.  It gives us a better idea and has less dependence on the levels of testing. To give you an idea, Saudi Arabia has gone in for heavy testing. Mexico is nowhere there in testing. We are some where in between. The infection, mortality and recovery rates are shown for an idea. India remains ahead of the curve. It is also clear from the above mortality rates; the infection is not as widespread as feared.

  

	INFECTED	DEATHS	RECOVERED
INDIA	2543	72 (0.05/M)	191
MEXICO	1510	50 (0.5/M)	35
SAUDI ARABIA	1885	21 (0.6M)	328

                                                      

                           

Vaccination Co-Relationship

As per a study, BCG vaccination has been reported to offer broad protection to respiratory infections. Empirical data suggests that countries without / discontinued BCG vaccination programs are having high infection and mortalities. Italy, USA, Lebanon, Nederland, Spain, France, Belgium and Switzerland are in this bracket. Iran is also heavily hit. However BCG vaccination commenced only in 1984. Any one over 36 years old is unprotected. China had a universal BCG policy since the 1950’s. However during the Cultural Revolution (1966-1976), vaccination programs were disbanded and weakened. Our BCG vaccination program is our Kavach.

Other Studies

One report has come out which suggests that the public dirt and squalor in India might have given us far greater general immunity to protect us against the virus. Another report suggests that the Virus has mutated and the strain in India is less virulent. However these studies are isolated without any corroboration. Hence, we should not lay too much store by them.

Cambridge Study

  

The study carried out in Cambridge Univ has been widely circulated in print, electronic and social media.  (the graphics are below)However the study is about ‘Age-structured impact of social distancing on the COVID-19 epidemic in India’. It is a mathematical model and does not consider the variables outlined above. If the variables are factored in some manner, then the results would probably be more encouraging. That is my sense. IT NEEDS A PROPER STUDY. SOME ONE IN THE GOVERNMENT MUST DO AN INTERDISCIPLINARY STUDY IMMEDIATELY. HIGH PRIORITY. However the significant issues highlighted in the Cambridge study are as under: -

a.       The study confirms the urgency of the lock down and need for sustained application of mitigatory social distancing.

b.       Indian homes are the main channel of transmission since three generations tend to stay in one house. There is significant contact between children and grand-parents and hence the possibility of substantial internal transmission.

c.        Maximum mortality rates will be in aged people and max transmission rates will be in younger people. High transmission rates can be expected in work areas where adults interact and in schools where children interact. 

                   

                               

Analysis

The following issues are relevant: -

a.      Most studies are preprint versions without a peer review. They cannot be the basis for any definitive action individually.

b.     The study by Johns Hopkins suggests that India is likely to have a transmission rate of 1.8 

c.     When the climatic, tropical and vaccination co-relationships are factored together some sense emerges. That sense is that India will experience far lesser transmission rates as compared to other temperate countries.

d.      India has not got into widespread community transmission stage yet. It is at the local transmission stage which ends in hot spots. Hence hot spot management is important. Hot spots if left unattended will turn into community transmission.

d.     Transmission also depends on other factors including testing, population (density), community structure, social acceptance / dynamics, cultural ethos and governmental policies.

e.     It hits urban areas first and then goes into rural areas.

f.      It can be concluded that while we might have the advantage of relatively less transmission rates, we need to focus on fundamental issues like social distancing, testing, tracing, isolating, quarantining, urban areas, population density reduction, public hygiene. Protection of the aged, infants and vulnerable is important.  

g.     There is an undeniable need to protect the aged from the young.

Phase2 : Key Lines of Operation

High Priority Operations.  Operations which must be given highest priority are as under: -

a.      Isolation, Social Distancing and Enhance Private and Public Hygiene. These are being enforced and practiced quite well. Since I can talk of Chennai alone, I see a distinct improvement in these aspects. The Chennai corporation is carrying out house to house spraying of insecticides and disinfectants. Streets are being kept clean and garbage disposal has not missed a step. A feedback on public forums in other cities and localities to respective authorities should be done. It needs highlighting since it is the first and main line of defense. If we falter in this aspect we are done.

b.      Capacity Enhancement. Capacity enhancement has commenced in earnest and must continue. Priority must be given to medical equipment. Simply nothing more to say.

c.       Testing, Tracing, Isolating and Treatment.  The scope, pace and extent of this four-step activity must be expanded.  Testing rates are still low. For a country of our size just 66000 tests till now are low. Some speculative testing must be done across the board. At least 10-15% must be speculative.

d.      Protect the Protector. Highest priority must be given to Doctors and all medical staff. Their protection is very important for our survival.

Monitoring and Deployment of Armed Forces. There is no substitute for having an ear to the ground. There is no substitute for immediate response and action. There is no substitute for stiffening morale. The monitoring, reporting and response system needs stiffening. An overlay skeleton deployment of Armed Forces must be done immediately in all districts.  The moment Armed Forces appear on the scene, the civil administration gets galvanized and a degree of urgency and confidence comes into the public.  

Population Control. Population control measures must come into place. It includes migration control. Also some thought must be given to decongest high density areas. This will be a long- term issue and states must organize and facilitate this. When the lock down is lifted reverse migration will start and that will have its own problems. Migration will be a two-way affair.

Protect the Aged from the Young. There must be a special drive to protect the aged, infants and the infirm from the young. This must be thought through at individual, societal and governmental levels. Especially applicable to densely populated areas and gated communities. Extensive advisories and door to door campaigning must commence for this.

Hotspot Management. Hotspots will appear and they will surprise us. This Chinese virus preys on people’s minds and their frailties. Hotspots will appear at national, state, district, city and town levels. Local representatives must be on the ball. They will have a large role to play. That is why they have been elected!  SOP / guidelines must be disseminated immediately on Hotspot management in a day or two.  Anticipation is the key.  

Security of Medical Staff. Medical staff must be given highest priority and protection. Protection can be given through detailment of security guards. Additionally local social organizations and NGOs should be co-opted to take responsibility and provide local assistance and coordination.   

Awareness and Social Acceptance. In a country as diverse and complicated as India there is a major need for an extensive awareness and strategic communication system to be put in place. Part of the campaign should be to make the entire fight against the Chinese Virus into a societal fight. That can be achieved through social acceptance which cuts across caste and creed barriers.

Discipline. There are a lot of people in our country who lack essential discipline. These people should be taken to task in an exemplary manner either departmentally or judicially. Special mobile courts can be set up for this job.

 Options for Lockdown. At the outset, it is mentioned that lockdowns do not eradicate the infections. They are only postponed to flatten the curve and give time for our medical infrastructure. .Also they are bad for the economy and daily life. Hence we can not be on a lockdown mode always. Also , we must use lifting of lockdowns to build herd immunity. Herd immunity must be built in our young through controlled exposure. This can be achieved through a layered lifting of lock down. Based on all issues factored in , the options for lock down are as under:-  

Option 1. Complete lift of lockdown. As evident in the Cambridge Univ study, the lock down if lifted fully will invite the virus back in force, despite the onset of summer.

Option 2. Extending the Lockdown. Extension of the lock down will need an iron hand to implement. The effect on the economy will be drastic. The effect on the poor, marginal and infirm will be severe. However taking all issues into consideration, if the situation does not improve, we might have to get back to this. Hence this option should always be in the background.  However the public has to explained and taken into confidence early.  

Option 3. Partial Lifting of lockdown. Taking into consideration all issues, it will be prudent to lift the lockdown layer by layer in parts with an option to roll back or modify at any stage. It could broadly be as under:-

Stage1. 4-5 days. Allow local movement in time windows within the locality with essentials made available. Contiguous localities to be closed. Enhanced move and availability of essentials.

                          Stage2. 4-5 days. Local businesses to be opened. No intercity move. No public transport.

Stage 3. 7 days. Within city move. Limited public transport. Intercity move of goods permitted by road by special permit.  

Stage 4. 7 days. Limited Intercity travel.

Stage5. Till end July. All move permitted. Exclusions to remain throughout.

Stage 6. The harvest season is approaching. Prepare guidelines for it.

Lockdowns could be spatial in nature with differing levels for different areas.
A Herd immunity program must commence as the lockdown is eased.    

Exclusions. All activities where crowds can gather should be banned. These would include public/ religious/ political/ social meetings, congregations and conferences. Sports activities. Malls. Shopping centers, Cinemas, Crowded Recreational Facilities. Tourism. Schools, Colleges incl Coaching classes. Overcrowding of busses, trains, metros and all public transport should be strictly avoided. This is only a suggestion. The list would need to be more exhaustive.

Research.  A multidisciplinary research project should commence to analyze international research on COVID and to commission and coordinate local research and data collection. All IITs, IIMs, IISc and NITs, AFMC, AIIMS, JIPMER, must carry out research on one aspect of COVID as they see fit. Each state must commission a research in respect of their state problems. These research efforts must start immediately. Some of them should be short term research to get local and national solutions immediately.

Conclusion

The fight ahead is tough. Well.  India is a tough country and we Indians will fight through it. This stupid Chinese Virus is a small Prick which we will get rid of . We just have to fight a coordinated battle. Look at it this way , All these great powers will learn how to battle from us. Of that I am sure. Let us have faith; the hidden power of India is being unleashed and it will teach everyone a lesson. 

On a different note. There is a lot of pessimistic chatter about the Economy. Like the PM said  - Jaan hai toh Jahan Hai. What is the worst case? Go back to pre 71 days. Get back into isolation. Grow as per Hindu Growth Rates - 3-4%. In our consumption driven economy, that is guaranteed. Actually that is not bad. If we can grow at 4%  under the circumstances, we are damn Good.  

Cheer Up India

We will break through. 

and then

We will break out

not as an epidemic 

but 

from our bridge heads

Sorry for the typos and crooked graphics.

I am a man without a dog  operation at present.