First Review: https://palepurshankar.blogspot.com/2020/03/the-corona-combat-review-of-situation.html
Second Review
: https://palepurshankar.blogspot.com/2020/04/the-corona-combat-second-review-by-lt.html
Please pass it on to your fiends. They will feel proud to be Indians.
Others will wake up to India. We are ahead of the curve. We will stay that way.
It is Day 15 of the
lock down. 3/4th of Phase 1 done.
Phase 2 fast approaching. That stupid
Chinese Virus has not made much head way in India. We are ahead of the curve. India
battles bravely and resolutely. The world is starting to look at us and say –
hey , what are these Indians doing right? Even WHO has praised us. The PM has
spoken to all the CMs, Cabinet, Past PMs, Past Presidents and the Opposition.
That is good. There is no politics in Corona. All states are in full swing. We
are in it together – all for one and one for all. All communities can sink or
swim together – no choice baby.
The Corona Virus has
done some good also. Pollution levels are low. CO2 emissions are down by more
than 25%. Climate change negotiations could not achieve this. Do not say this
loudly. The Chinese will say it is because of their global leadership!
Incidentally there were reports that people in Jalandhar were able to see
Himalayas . A few days more and all the Sardars
there will start seeing Rockies! Then you will have to wonder which Corona
effect they were talking of? The Virus or the Beer?
The government has
taken very stringent action as per the data put out by Oxford COVID 19 Government
Response Tracker. That is clear from the map above and graphic below. It is
indeed commendable. The worlds most populous democracy with such a high rate of
success in implementation. Sure there have been blips. That is to be expected. The
economic stimulus response may seem low. However businesses can wait. The needy
need to be attended to. That is being done. I am also sure that the Government
has kept its powder dry and has some reserves left. In this battle, the
reserves, their deployment and recreation will matter. Take it from a salty old
Gunner. The least cost approach will do well ultimately. We must be proud of what
we have achieved so far. We need to just do more.
Enemy
The enemy has not
mutated as yet but has clearly revealed it’s
a slow festering fuse which attains critical mass and erupts with a fission rate
of 2.5 if left unchecked. It has not yet surfaced fully in India. It has started
spreading through asymptomatic people also. Stealthy. In China, Singapore and
Japan it is re-appearing in a second wave. Singapore has gone into a 30 day lockdown.
Japan has declared Emergency.
Overall Assessment.
We have to kill it or it will hit us hard in multiple waves. Its either the Chinese
virus or us. Take your pick. However till we get a vaccine we have to live with
it. It will be an endemic disease till we attain herd immunity either naturally
or by design.
Own
Forces
Current Status
Climate. The temparature are
varying between 29-36 deg C with night time temps around 21-24 degs.
Cases . The current status state wise is as below
STATE/UT
|
CONFIRMED
|
ACTIVE
|
RECOVERED
|
DECEASED
|
WEST BENGAL
|
91
|
75
|
13
|
3
|
UTTARAKHAND
|
31
|
27
|
4
|
-
|
UTTAR PRADESH
|
332
|
308
|
21
|
3
|
TRIPURA
|
1
|
1
|
-
|
-
|
TELANGANA
|
404
|
348
|
45
|
11
|
TAMIL NADU
|
690
|
664
|
19
|
7
|
RAJASTHAN
|
348
|
321
|
25
|
2
|
PUNJAB
|
99
|
77
|
14
|
8
|
PUDUCHERRY
|
5
|
4
|
1
|
-
|
ODISHA
|
42
|
39
|
2
|
1
|
MIZORAM
|
1
|
1
|
-
|
-
|
MANIPUR
|
2
|
1
|
1
|
-
|
MAHARASHTRA
|
1018
|
875
|
79
|
64
|
MADHYA PRADESH
|
290
|
248
|
21
|
21
|
LADAKH
|
14
|
4
|
10
|
-
|
KERALA
|
336
|
263
|
71
|
2
|
KARNATAKA
|
175
|
146
|
25
|
4
|
JHARKHAND
|
4
|
4
|
-
|
-
|
JAMMU AND KASHMIR
|
125
|
118
|
4
|
3
|
HIMACHAL PRADESH
|
27
|
24
|
1
|
2
|
HARYANA
|
143
|
110
|
31
|
2
|
GUJARAT
|
175
|
136
|
25
|
14
|
GOA
|
7
|
7
|
-
|
-
|
DELHI
|
576
|
547
|
20
|
9
|
DADRA AND NAGAR HAVELI
|
1
|
1
|
-
|
-
|
CHHATTISGARH
|
10
|
1
|
9
|
-
|
CHANDIGARH
|
18
|
11
|
7
|
-
|
BIHAR
|
38
|
22
|
15
|
1
|
ASSAM
|
28
|
28
|
-
|
-
|
ARUNACHAL PRADESH
|
1
|
1
|
-
|
-
|
ANDHRA PRADESH
|
314
|
306
|
5
|
3
|
ANDAMAN AND NICOBAR ISLANDS
|
10
|
10
|
-
|
-
|
TOTAL
|
5356
|
4728
|
468
|
160
|
Hot Spots . 20 hot spots and 22 likely hot spots have been identified
by the Government. These are increasing.
Outlier Events . There are a few outlier events which have occurred which
have an overall bearing on the overall situation.
The Tablighi Markaz event has turned out to be a pan India problem
with many infected members moving to and fro from many districts in the
country. As result infection must have transmitted much beyond; despite the
contact tracing efforts. They will surface after 15 Apr only when the incubation
period is done. It has a bearing on the lock down period.
The Migration fracas must
have taken infection into rural areas. Though there are reports that these
migrants have been traced to their villages and put in isolation camps. The efficacy of such action is suspect. This time bomb is an unknown quantity and will go into
fission mode only after 15 April.
It is very common that people
disregard common cold and cough in the lower income groups, specially in heart
land India. Hence many cases could go unreported. It has two facets. The young
population of India, and many of them are migrants, will be able to/might come
out of it without reporting. Simultaneously herd immunity is building. The
problem is that there is undetected transmission going on at fission rates which
will burst on us after two weeks when critical mass is achieved.
All these indicate that the Chinese
Virus must be pulled out of its hole like a cobra. Which means lock out has to continue.
Gearing
Up. The entire country
is gearing up for Phase 2 of the battle. We are now battle hardened.
Assessment. The Chinese Virus is still
in Stage 2 with limited community transmission in hotspots.
Harvest. Beyond 15 April is harvest
time. This has to be factored in all calculations. It is unthinkable that
harvest activities are curtailed.
Data Co-Relationship
Fatality Rates
and Case Discovery Rates.
Everyone says ‘Test, Test and Test’. The feeling is that we are not testing enough.
Hence, data from countries badly affected in the temperate zone, tropical zone
and an outlier (S/Korea) were analyzed. (base data from https://www.worldometers.info/coronavirus )The true indicator of prevalence of
disease in the country is death and hospitalization; if you cannot test
enough. Another indicator is - for the number of tests being conducted how many
cases are being discovered or are surfacing? This analysis was done for 05 and
08 Apr and has been tabulated. Focus on
the fatality rates, and the case discovery rates columns. View it from any parameter,
Indian rates and actual numbers are the least. An analysis of data from these tables
indicates the following: -
COUNTRY
08
Apr 2020
|
CASES
|
CASES/Million
|
DEATHS
|
DEATHS/M
|
TESTS
|
TESTS/M
|
FATALITY RATE /M
(%)
|
FATALITY RATE /M
(%)
(05 Apr)
|
CASE DISCOVERY
RATES
CASEs/TESTs (%)
|
CASE DISCOVERY RATES=
CASEs/TESTs (%)(05
Apr)
|
Temperate Zone
|
||||||||||
USA
|
400412
|
1210
|
12854
|
39
|
2075739
|
6271
|
3.22
|
2.76
|
19.29
|
18.8
|
SPAIN
|
141942
|
3036
|
14045
|
300
|
9.88
|
9.48
|
||||
ITALY
|
135586
|
2243
|
17127
|
283
|
755445
|
12495
|
12.61
|
12.32
|
17.9
|
18.9
|
GERMANY
|
107663
|
1285
|
2016
|
24
|
1.86
|
1.48
|
||||
FRANCE
|
109069
|
1671
|
10328
|
158
|
9.45
|
8.41
|
||||
IRAN
|
62589
|
745
|
3872
|
46
|
211136
|
2514
|
6.17
|
6.1
|
29.64
|
29.96
|
UK
|
55242
|
814
|
6159
|
91
|
266694
|
3929
|
11.17
|
10.3
|
20.71
|
22.8
|
NETHERLANDS
|
19580
|
1143
|
2101
|
123
|
86589
|
5053
|
7.96
|
9.89
|
22.61
|
22.04
|
Tropical Zone
|
||||||||||
INDIA
|
5351
|
4
|
160
|
0.1
|
140293
|
102
|
2.5
|
2.33
|
3.81
|
2.79
|
SAUDI
ARABIA
|
2795
|
80
|
41
|
1
|
1.25
|
1.176
|
||||
PAKISTAN
|
4035
|
18
|
57
|
0.3
|
39183
|
177
|
1.66
|
1.66
|
10.29
|
8.2
|
MEXICO
|
2785
|
22
|
141
|
1
|
25410
|
197
|
4.54
|
4
|
10.96
|
12.06
|
Outlier
|
||||||||||
S KOREA
|
10384
|
203
|
200
|
4
|
477304
|
8996
|
1.9
|
2
|
2.17
|
2.21
|
In
all parameters India is at almost the lowest levels.
Temperate region countries are very badly off
as compared to tropical countries. Hence it would be fair to say that we will
not be so badly affected.
Deaths and number of cases are low in India. There
is a similarity with Pakistan being in the same belt. This is crucial since
India went into a stiff lock down whereas Pakistan did not.
Very interestingly the number of cases
surfacing for the tests we have conducted is among the least. The testing
rates are akin to S Korea! Even if we increase the cases by 20 % and decrease the
tests by 20% , the case discovery rate stays below 6%. So what does this tell
you? It tells you quite a few divergent things as under: -
The disease is not prevalent or transmitting at
rates as seen elsewhere. It is far slower. The lock down is clearly working.
This could also be due to other factors like rising
temperature, BCG vaccination factor, natural immunization due to exposure of
Indians to multiple virus / Other endemic diseases.
Kerala was looked at separately since it is
one of the earliest affected states due to a high level of overseas traffic and
migrants. It has 275 cases and has tested 11232 persons. Its case discovery is
2.44%. it approximates to the national average (http://dhs.kerala.gov.in/wp-content/uploads/2020/04/Daily-Bulletin-HFWD-English-April-7-1.pdf).
We
might be testing the wrong persons. Possible. However the probability is low.
Cases are not being reported even for testing.
Hence transmission is taking place unchecked without our knowledge.
Even if there are a lot of unreported cases, hospitalization
and death would have spiked. That has not happened. However it would be prudent
to monitor deaths due to other diseases. If this is true, it might burst on us one
fine day in the next week or so.
It is also possible that unreported cases have
recovered or in self-recovery mode due to the youth factor. In which case two
things are happening. The youth dividend is paying off and herd immunity is
increasing.
The disease is increasing in spread in India. In
other countries it might have peaked. However for us, it is on the upswing. The
worst is ahead of us.
WE HAVE SLOWED DOWN THE FISSION RATE. WE HAVE BOUGHT
TIME. WE SHOULD UTILIZE IT. WE HAVE THE OPPORTUNITY TO LOCALIZE IT AND BOTTLE
IT.
Spatial
Distribution Granulation
The number of cases in the country
needs to be granulated to district level. The data for all districts of TN and
Punjab are given below. Data for the rest is also freely available. A look at
the granulated data tells you quite a few things: -
|
|
The spread is from urban areas to rural areas.
The rural areas are not yet affected as much as urban areas.
However we need to watch for outbreaks. We should
be able to free up the rural belt first.
The
number of hot spots in the country which need to be focused upon emerge very
clearly, if one sees all districts
Many districts have few cases. Districts/cities which need bottling,
and those which can be freed out comes out from this granulation. After all if a district has a few cases
only, it can be opened with precautions.
Districts
which are lowly affected are our reserve capacities.
A fatality rate and case discovery rate analysis
along with the demographics of the districts will tell us how to handle each
district individually and a state collectively.
This
Chinese virus needs to be handled at district level by district-based local systems.
Herd
Immunity.
A virus is defeated only if herd immunity is built. Herd immunity is built either
through vaccination or exposure. Vaccination is 18 -24 months away. Exposure means
huge amount of people infected and diseased. Limited experience suggests immediate
exposure means an overwhelming load on the health care system beyond India. Lock
down only postpones the problem to buy us time. Hence we need to go into a
controlled herd immunity program through staggered and planned exposure. Even that
is possible only if we know that a person who has been infected does not get back
the disease. We need to work on this very seriously since this is a long haul
enterprise as said by the PM. Moreover, many of our people may also be
acquiring herd immunity without our-knowing it. Trap this data and mainstream
it.
Key Lines of Operation
We are in it for the
long haul. The key lines of operation which started in Phase 1 have to be practiced
and reinforced all the way through. These are reiterated in point form below :-
Intensify testing, tracing, treatment, teamwork, and tracking and monitoring.. Break the transmission chain.
Increase
surveillance, vigilance and monitoring social, political and communal
disruption.
Continue
to build up capacities in medical and health care equipment.
Institute public
and private behavior norms of social distancing, isolation, mask wearing, spitting,
public urination. Make violations a punishable offence.
Carry out extensive door
to door surveys and build data.
Carry out public hygiene activities scrupulously including disinfectant sprays, garbage disposal anti malaria
spray
Put out norms for protection of the aged above 60 years. Separate
queues, entry, counters etc.
Put in place crowd sourced apps for local resourcing and amenities.
Institute population control measures. Reverse migration
should be expected.
Plan for de-congestion of overcrowded facilities through railways so that patients are moved from overwhelmed
hospitals into neighboring ones even if out of the city/ district/ state. Inter
state / inter district coordination must be instituted.
Security of health care workers is still
a concern, mobilize local help and provide security to them. This is of
paramount importance.
MLAs, MLC, MPs and all-party leaders must move
into their constituencies and mobilize local resources to fight the Chinese
Virus. They should provide leadership. They cannot appear only at elections to
ask for votes. Mobilise community leaders, celebrities, local thinkers to assist and guide the overall effort.
Testing. Testing capability and execution in the
country has been ramped up. Additionally the Rapid Antibody Based Blood Test
has been approved for use and will go into effect any time now. The strategy
for this is in the graphic below. Taking into consideration the way the virus
is panning out in India; the testing capability is presently ok. The only
danger is that there could be a sudden explosion of the Chinese Virus due to
the outlier events that could put things totally out of gear.
Containment and Hotspot
Management
Going forward it is important that all
Governments, center as well as state, have a robust containment and hotspot management
capability. This will be needed well into the future till such time a vaccine comes
up. Already 20 hotspots are being tackled and 22 are under surveillance. We have
had experience at state and district levels. These need to be built upon. Some important
issues are highlighted in succeeding paras.
Kerala
and Bhilwara Models.
Kerala
was one of the states hit early and had lot of cases since many Keralites have
extensive foreign contact. However despite the spurt in cases things are under
control. They are a model as to how a state has put things under control.
Bhilwara
in Rajasthan was an early hotspot put under lock down on 20 Mar, even before
the nation went into lockdown. They have undertaken steps to ruthlessly contain
the Chinese Virus. Today there are no new cases in the district. This model has been adopted as the base model
for the national containment plan.
An
amalgamation of these two successful models and suitable adoption in various states,
districts and cities as per local conditions will pave way for eradication of
this disease.
Government Policy. The government has quickly put together
policies and procedures for various issues. The website https://www.mohfw.gov.in/ is very useful. Visit
it once a day. Latest policies include Containment for large out breaks( https://www.mohfw.gov.in/pdf/3ContainmentPlanforLargeOutbreaksofCOVID19Final.pdf),
Guidelines for quarantining ( https://www.mohfw.gov.in/pdf/90542653311584546120quartineguidelines.pdf),
various training schemes for medical staff and Strategy for use of Rapid
Antibody Blood Test for detection of cases.
Decentralization. This
battle must be fought in villages, cities, townships, districts, municipal
corporations and states. It can and must be enabled, facilitated and
coordinated at the center. It cannot be fought from the PMO or the CAB SECs
office. Decentralization is the order of the day. Very significantly, that is
being done.
Lock
Down Options
Many options are available for lifting
the lock down. Kerala Government has come out with a three-stage plan. In the
previous review a five-stage plan was outlined. Whichever way one looks at it. The
lockdown must be lifted in a staggered manner as per local conditions. The response
must be flexible, differentiated and reversible. Whatever the option chosen –
prepare the people for it. Give some time for preparation – mental and physical.
For example summer is approaching. Water security and provisioning is an issue
especially in water scarce areas and cities. local administration needs
physical response time to act. Similarly
harvest activities must commence and norms must be put in place. Think through and anticipate. Each one of us has to put his/her hand up and make it count.
WE HAVE A LONG HAUL AHEAD
NEED TO STAY PATIENT , DETERMINED AND RESOLUTE
SO FAR ALL INDIANS HAVE HEAVED TOGETHER
THERE IS NO REASON TO FEEL PESSIMISTIC
IN FACT THERE IS LOT OF OPTIMISM
WE HAVE EVERYTHING TO GAIN
IF
WE ARE TOGETHER
WE WILL KICK THIS CHINESE VIRUS BACK TO WHERE IT CAME FROM
Success is definate as effarts are directed very intelligently without any dely after well planned.
ReplyDeleteVery Good Article covering all aspects and statistics.
ReplyDeleteWell written update. Life won't be same hereon. Wild horses need reining in and measured moves welcomed. Patience and social discipline would only help
ReplyDeleteVery well articulated, researched,analysed and presented. The very last sentence was a dampner though!
ReplyDeleteIndeed a long haul ahead.Is there a co relation between malaria tuberculosis and the present low numbers in India?Something to be studied.There is something which is helping us.Finding the answer to this may be t solution
ReplyDeleteExcellent
ReplyDelete