Covid19 : India Unlocked

A very unique experimentation for minimal adverse human and economic impact of Covid19 has been taken up in India. The initial total lock down provided the requisite time for the Healthcare oriented infrastructures and the services to be built-up. This was very intelligently worked out through the Covid Task Force directly under the PMO. Two groups were made. One group duly supported by ICMR and AIIMS looked after the augmenting the hospital infrastructures and Covid related entire R&D. The other group guided the science & Technology based R&D. While the continued lockdown from 25 March onwards limited the spread of the infection and this crucial time provided opportunity for the Covid Task Force to undertake the following measures: -

• Build-up of Corona Care Centres in all cities.
• Augmenting the numbers of Healthcare workers, integrating various NGOs (like ASHA) in it.
• Prioritising the Corona testing for the individuals at risk. Augmenting the number of Corona testing centres from 2 at that time in the country to >500 by May 20 and >2000 by now all across the nation.
• Augment the numbers of Covid Beds at various hospitals in all states affected with Covid.
• Augmenting production of the drugs useful among Covid cases that included HydroxyChloroquin, general usage anti-viral drugs and the hand sanitisers.
• Development of indigenous Corona testing lab kits…for both antigen and antibodies.
• Development of vaccines against Corona.
• Clinical trials of supplementary measures against Covid19 therapy incl serum therapy, Ayurvedic/Ayush supportive therapy, trials of newer drugs and so on.
• Facilitate indigenous production of Ventilators, Oxygen Concentrators, Commercial medical grade Oxygen separation facilities, Pulse Oximeter, Digital Infrared Thermometers, Personal Protective Ensembles (PPEs), N95 equivalent masks, surgical gloves and eye/face shields. Additional ambulances, beds, mattresses, sheets, blankets, were made available for all temporary Covid care centres be it through DRDO, Paramilitary, States levels and so on. In brief, the efforts of the task force during lockdown have been highly successful. India for its huge population, was able to turn table from being a huge importer to exporter for all above Covid care provisions & equipment.

The world has come to acknowledge that Corona virus will continue in the times to come and most if not all, will have to face it. Many medical research agencies (incl ICMR) believe that herd immunity can come only after vaccination but there are professionals who believe otherwise too. Sporadic reports of ‘Herd Immunity’ developing in the Indian (or even World) communities are coming as a result of possibly sub-clinical infections or sub-optimal viral loads not causing infection. Numerous candidate vaccines are under phase-3 human trials and the best optimistic views suggest the vaccines to be made available to the population the world over. Till now, the SARS nCoV2 Virus has not shown evidence of changing strain/antigenicity but the viruses are famous for it. This gives hope that a vaccine developed in one part of world will be useful in the other parts too. Hence, the world has to keep their fingers crossed that by the time the vaccines come, the culprit virus does not change its strain lest all these painful efforts of developing vaccine may go in vain.

Unlocks of Indian cities are going on in phases. After the unlock 1, 2, 3, there was frightening initial rise in the infection rate to almost 10-15% per day with the numbers of new infections reading as high as almost 1 lakh. This was due to two reasons…firstly very high number of testing (>10 lakh per day) and secondly rise in infection due to the unlock of the economic activities. However, with near 80% cases asymptomatic, there was no reason for the govt to go in panic. The rise in infection were handled well. At no time the Covid bed occupancy has gone over 50%. Covid precaution of mask, social distancing and hand/body hygiene have been kept in place. By now, the infection rate has fallen to around 5-7% per day that was also during the lockdown periods. The recovery rate from Covid19 has been improving gradually…from ~55% in the initial days to almost 91% while writing this article. It is due to the greater monitoring and therapeutic care in the hospitals. There also appears to be some role of the increased testing (nearly

10 lakh plus tests in a day) that helped in detecting and isolating the positive cases. Wide availability of the pulse oximeter for monitoring also helped esp the mild cases under home isolation (HI) to be shifted to hospital before it was too late. There may also be some positive impact of the Indian system of household prophylactic measures…of drinking ‘Kaadhaa’ made out of some herbs and few specific condiments, expected to help in boosting immunity against the virus. Covid cases on higher risks (CALL score >9) were advised specialised hospital care. Although India too lost many valuable lives due to Corona (numbering ~1.2 lakh) while writing the article, that makes the case fatality rate just about 1.5%...far below many other populous and advanced countries having far developed hospital set-up.

It must be mentioned here that the worst may not be over yet. A fresh wave of Covid has already started in Europe. Fresh restraints in the form of lockdowns are underway in many nations. Some feel that this new wave is even more serious than the previous one. WHO has become a Chinese mouthpiece. For some reason, Dr Tedros the DG WHO and Dr Harshvardhan, Chairman of WHO Executive Board…are all reluctant to investigate the Chinese Culpability. So, the culprit for causing the world Covid19 devastation has been mouthpiece? let to escape for the reason unknown. India, by virtue of being the most densely populous country is on its way to being the worst affected. Our PM Modi also must be aware of the Chinese culpability, but is silent on the millions of Covid19 victims of the world for them being compensated by the nation culpable for it. Corona vaccine is yet to come but no one could predict whether or not the virus will change its strain to make the vaccine ineffective. With the healthcare facilities in place, lockdown for Corona is no longer the answer. China has given the gift to the entire mankind to live with Corona and suffer the consequences. It is our destiny now, not yet aware of its long-time consequences, to the next generation.

There are reasons to believe that the gradual unlocks of the Indian cities & metros, and for that reason the entire world, to gradually increase the economic activities are actually justified. Otherwise, some are dying now with Corona but if lockdown continues, more will start dying of hunger. Some of the political parties in India yelling of unprecedented unemployment must understand that the jobs available prior to the lockdown are not lost, they are only held in abeyance pending restarting of those sectors. The moment the country is unlocked, those jobs will be back except some in the unorganised sectors which might have packed-up totally. Union govt has infused significant money to boost the local generation of the employment esp in the rural belt of India. However, inabilities of the State Govts in generating jobs have to be rectified.