The ‘janata curfew’ of March 22 began as a pleasant surprise.
Despite being imposed for the people, without any punitive consequences, the streets were completely empty, and no cases of violation were reported. In a remarkable show of self-discipline, people stayed away from crowds and avoided stepping out of their homes, just as our Prime Minister had requested.
That is, until 5 pm.
As soon as the time to “thank” our health care workers came, a sea of people were recorded flooding the streets across different parts of the country, banging their utensils together, and dancing through the gullies as if it were a carnival.
The “thanks” were in no way limited to five minutes, and the scene was nothing short of a celebration. Clearly, they had completely missed the point.
Since confirmation of the first case of the coronavirus disease (COVID-19) in January this year (a student in Kerala who had returned from Wuhan), the country has moved rapidly on the epidemic curve. In a short span of seven weeks, India has crossed the dreaded 500-case mark, with the disease entering 25 states and Union Territories and killing 10 people at the time of writing this. The toll is now 17 and it is safe to say that India is looking down the barrel of the catastrophe.
At this point, it is simply foolish to take this pandemic lightly, or believe that gaumutra, the “naturally strong Indian immunity system”, or the 33 koti (the 33 types of Gods that exist according to the Vedas) will save us.
In the words of the renowned physicist Richard Feynman, “We must be careful not to believe things simply because we want them to be true. No one can fool you as easily as you can fool yourself.”
On the other hand, predictions provided by the scientific community on the future course of the COVID-19 epidemic in India are also varied. At least four models for this are available in India, developed by different sets of researchers – one led by Dr Ramanan Laxminarayan, the second by Dr Giridhar Babu from Public Health Foundation of India, the third by a team from Delhi School of Economics and John Hopkins University, and the fourth by the Indian Council for Medical Research.
To make matters more confusing, the total projected deaths according to these models vary from 5,000 to 500,000, as do the total number of cases. In this context, seeing the global scientist community arrive at a consensus on at least one matter brings some solace – that the novel coronavirus is a catastrophe of unparalleled proportion in modern human history, coming closest to the Spanish flu of 1918-19 and the black plague of late nineteenth century.
They also agree that the only possible intervention available at this point is to flatten the curve of the epidemic, that is, reduce the burden on the healthcare systems by mitigating the spread of the disease. The following graph depicts nicely how flattening of the curve would allow health systems to provide optimal care to the proportion of individuals falling severely sick. The overall deaths could thus be minimised, as the total number of cases will remain same.
The question facing most governments now is of how this could be done – with suppression and mitigation emerging as the leading strategies. India, fortunately or luckily, has an advantage here. It can learn from the experience of countries that saw the severity of this epidemic much before us – such as the success stories of South Korea, Singapore, Germany, China (outside Hubei province) and failures of Hubei province, Italy and now the US and UK.
Professor Neil Ferguson, a British epidemiologist, has clearly delineated the role of suppression versus mitigation in the trajectory of the novel coronavirus epidemic curves in the population. Suppression would entail more aggressive approach including complete lockdown of the country, and is based on presumption of keeping the disease transmission at very low level, till an effective cure in the form of drugs or vaccine is available.
Mitigation on the other hand is a more conservative approach entailing the isolation of those who are sick. This approach is based on the principle of immunity development amongst the exposed and the subsequent emergence of herd immunity in the general population. The model of post-suppression mitigation proposed by him, based on data from China, has raised some concern on its validity in a country like India.
To begin with, the government of India has done a commendable job so far, of proactively controlling the international entry of the virus. By closing down international borders, suspending mass public transport and constituting several high powered task forces, it has surely taken important steps, albeit four weeks too late. Now, as we are nearing the peak of the outbreak, the government seems to be adopting the suppression policy even more, the latest being through the national lockdown announced in the prime minister’s address to the nation on March 24.
Just as the previous address by the PM was renounced by the Progressive Medicos and Scientist Forum as a effort to abdicate the government’s responsibility and shift the onus on the poor and daily wage earners of India, the lockdown has also been criticised by renowned community medicine experts like professor Jacob Muliyil, who has expressed concern about the success of “suppression strategy” primarily on grounds of operationalisation and feasibility, and social economist Jean Dreze, who has also flagged the negative fall-out of a lockdown on the poor and daily wage labourers of India.
While the exponential increase in cases everyday clearly points to the need for suppression as the only option to flatten the curve, these harsh policy decisions must be supported by socialistic measures that can support the poor and vulnerable. We are set for tough times ahead. Only optimism and will to put in our collective best effort will minimise the human and economic losses from coronavirus.
We use this article now, to lay out a specific action plan to combat this disease.
1) Immediate response
A nationwide lockdown will help curb the spread of the disease while a war-level preparedness of our health system, including nationalisation of private health system, if required, will help respond to emerging cases. India’s healthcare systems are starkly deficient. Access to it is made worse by socio-economic inequity and high out-of-pocket charges.
The curve has to be flattened below the peak threshold capacity of the health system, and therefore India does not have any option but to continue the total lockdown, at least till the stage when our lethargic red-taped bureaucracy allows for preparedness of the health system. But the lockdown needs to be backed up by support to the poor. Provision of monetary and other support to the poor, the daily wagers and the vulnerable section of society will have to be made to ensure adherence to the lockdown, and also prevent other social and human catastrophes.
Whatever we have seen of the coronavirus till now and experience from different countries across the globe is showing that coronavirus is a socialistic virus.
It has forced governments of several countries to announce several packages for poor and vulnerable of the country. The term ‘social distancing’ promotes a self-centred attitude. Like any epidemic, coronavirus cannot be prevented without social bonding or initiative. Social distancing excludes it.
Therefore we must talk about physical distancing and social bonding to fight corona. The poor, underprivileged, and elderly, can be supported by this social bonding. Only physical distancing is not enough. Health is a right and a social responsibility, and while social distancing denies it, physical distancing and social bonding takes up that task.
We request you kindly take up this understanding and campaign in different fora so that doctors, health workers and people are aware of it and start using physical distancing and social bonding (PDSB) in place of social distancing while fighting the coronavirus.
2) Short term
COVID-19 task forces at both national and state levels must be headed by technocrats, and not bureaucrats, as they would be better positioned to understand and respond to the dynamic situation on the ground. They should also be given a mandate to advise on implementation of measures to control the spread of the disease. The ‘test, test, test’ strategy as suggested by the WHO, must be implemented for better monitoring and control. Apart from that, the law and order situation in the country must be maintained, as the last thing we need right now is more chaos.
3) Medium term
Detailed analysis of huge amounts of data being generated by hospitals and other institutions will help better understand and respond to the pandemic. We suggest linking the implementation strategy to the data being collated and analysed by experts.
4) Long term
Strengthen public sector health care system. Restore primacy of evidence based planning and decision making by technocrats. Fix responsibility for delay in instituting control measures. Review the human development model based on exploitation of nature and also look at climate-friendly sustainable models of development.
We sign out on a positive note. The science supported by humanistic policies will help us in overcoming this calamity with minimal loss to human life.
Nature has once again reminded us of our precarious situation in the overall universe and it is high time that we humans take note of it and correct the course before it’s too late.
“One health” is the theory of ensuring optimal harmony amongst all humans and animals of the world based on principle of “vasudhev kutumbkam“. Being respectful and mindful of all animate and inanimate beings of this planet, is the way forward for survival of the post-corona world.
Dr. Kapil Yadav is a public health expert currently working as faculty at All India Institute of Medical Sciences (AIIMS), New Delhi. Shivani Karmarkar is a social anthropologist, and works as the Executive Editor of Inter-Actions, the interdisciplinary digital quarterly published by LILA Foundation for Translocal Initiatives.