As cases started surfacing the central government started declaring hotspots and various coloured zones with very little back up public health initiative. The country failed to come up with with any plan for mass screening of the hotspots due to lack of serology kits and only had to depend on the costly and time-taking RT-PCR testing of those who are either quarantined because of foreign travel or for having a contact history with confirmed covid cases
How many more days, manyabar how many. ?
These were the oft-repeated words, when home minister Mr. Amit Shah was placing before the parliament his governments justification for scrapping Article 370, where he tried to describe Article 370 as a temporary arrangement in August 2019. It was the time of locking down Kashmir!
History has taken a queer turn ever since. In the wake of Covid 19 epidemic, it is time for the whole nation to go into a lockdown as if to justify the yearnings of a little Kashmiri girl, Nafissa Umar, homebound for months in Srinagar, who stopped a journalist to tell that she wanted a situation when the whole country faces a lock-down just for getting a feel of how the Kashmiris were suffering. The story has been recently published by the same journalist Arvind Mishra, working for Econonic Times, who was eventually part of the entourage comprising foreign and Indian journalists, who were taken by government of India to Kashmir, for showcasing to the world that Kashmir was under absolute Normalcy. The country is now having a tete-e-tete with a lockdown situation and we all now feel the torment that Kashmir had to endure out of one of the greatest blunders in the Indian political landscape.
To everyones surprise, two seemingly unconnected situations are converging to produce similar results! What would you call it? Poetic (in)justice or a retribution of history? I dont know for sure. Do you?
Now India is into the third phase of a Complete lockdown, for nearly 7 weeks with disastrous results. Putting aside the sufferings of the working people let us, for the time being, concentrate on technical issues alone, related to management of the Covid pandemic. It is time that we reflect upon the happenings of the past weeks and try to reason whether lock down was the best possible public health action for restraining the virus or were there better options? The corporate media and the pro-government scientific establishment in the country would make us believe that without this prolonged lockdown India would have had a virtual deluge of Covid-infections and deaths numbering in crore. Many in the scientific community, however, are talking about some natural advantages India and Indian people have in preventing the sweep and virulence of the virus. They are pointing out to our predominance of young age in the population, to better build-up of vitamin D in our body (due to habitual sun exposure), to the average high environmental heat in Indian summer (which would help to de-activate the virus to a large extent), to our mass BCG vaccination program, boosting our innate immunity (expected to have some role against the viral virulence) and to the possibility of developing herd immunity in our population (given our population density and habitat compulsions) etc. While most of these assertions are anecdotal in the main, the trend of the Indian epidemic as it unfurls itself, does suggest that there are definitely factors other than the lockdown to have some attenuating effect the epidemic. What they are and exactly how they operate are larger epidemiological questions and can be proved or disproved only with rigorous scientific probe, which is lacking at this moment.
To get to the heart of the matter, we may get back to the initial days of the epidemic. Though the virus originated in our neighbor country, it didnt travel to us through the Himalayas. It had to take aerial route and travel via Europe and more importantly America to reach India. India has very few direct flights to China, probably only 4 flights a day, which were easy to be closed down, without much economic effect. The difficult part of the job was to curb on European and American long hauls. By now we all know that there was inordinate delay in curbing and putting under vigilance the flights from Euro-America and in tracking the people travelling there-from, putting them on quarantine, testing and treating them. This is where we beat the first retreat and could never make up for that. By delaying this process, Modi government effectually invited the virus into the country and sat tight reticent with what belief they only know better. The delay actually got translated into an epidemiological blunder at the expense of the life people of the country, already made difficult by the regime. This criminal neglect is what Modi and his government will have to carry with them for long.
Looking at the fact sheet there is real reason to question the purpose of the lackadaisical response particularly when the government had enough time in hand. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 by WHO and on 11 February 2020, WHO announced a name for the new coronavirus disease - COVID-19. During that period Modi and his babudom were busy hosting a gala show with their global master, Trump and walling off poor neighborhood from the masters sight in Ahmedabad! It was as late as in 24th of February, 2020. And as if taking permission and blessings from the master, Modiji started thinking of doing something about the emerging danger. Let us also remind ourselves that another month elapsed in idleness and no one knows what the government was doing before 24th of March 2020, when Modiji declared a total lockdown in the country with four hours notice!! It is during this period when one of the Indian states, where first Covid case was detected was in full swing of action and was setting examples on how such an epidemic can be handled with positive intent and affirmative government actions taking people into confidence. Well, the state concerned has few unique features such as being ruled by a leftist government, high per capita income and much better public health infra-structure compared to Indian average. But the government leading the largest democracy on Earth didnt seem to take much from that experience other than the lockdown aspect it. And that is how a complete (in Modijis language, it was to be taken Carfew) without caring for the care aspect of it, which the Kerala government tried to do within their limited power.
By now cases had started to trickle in all over the country. And those who welcomed lock-down as a short term measure, anticipating affirmative public health action were utterly dismayed by the lack of preparedness writ large everywhere. What actually happened is a virtual paralysis of the whole health care infra-structure with an extremely panicked health care workers, whose primary aim being save their own skin (from administrative wrath) and their lung (from Covid). In the name of managing Covid the countrys health facilities have been rather incapacitated to treat the ailing, which includes Covid infected people.
Now, was it unfair to expect from a government who had more than six weeks time in hand, to harness its ability and confront the epidemic prepared, before locking down the whole country? As days passed, it was all very clear that the much hallowed scientific institutes and the government had no preparation for testing, which holds the crucial key link in managing any epidemic. As cases started surfacing the central government started declaring hotspots and various coloured zones with very little back up public health initiative. The country failed to come up with with any plan for mass screening of the hotspots due to lack of serology kits and only had to depend on the costly and time-taking RT-PCR testing of those who are either quarantined because of foreign travel or for having a contact history with confirmed covid cases. And here too, they were doing business. While one IISER faculty in Kolkata went on record claiming that his institute is able to do the testing at well below Rs. 1000, the award for RTPCR went to a company with questionable credentials with a cost of Rs. 4500 per test. The whole of private sector laboratories are now allowed to make profit by charging Rs. 4500 which is now ICMR approved rate! And much later, when some serology kits were available from various resources, they turned out to be sub-standard and hence unusable, leaving the whole nation back to square one.
Belated though, it is also coming to the fore that the government actually ignored recommendations from its top scientists who favored community and civil society led self-quarantine and self-monitoring instead of a coercive lockdown. While the very basic grain of such lockdown rests on the premise of buying time for unleashing a scientific plan, to the chagrin of the nation, any such scientific plan has still remained elusive.
Well into the lockdown for a week, in private conversation with one of my old friends, who works with ICMR at considerable high level, I asked about the utility of a lockdown without matching number of testing. All he could say is that, we have raised the question. Unfortunately, raising the question alone doesnt enable the country to develop her own test kits and procure adequate volume off PPEs and good quality masks, for which a fair percent of GDP spending is necessary. And also raising questions in meetings is hardly any match for the greed of the capitalist cronies whose unmistakable motif of profiteering in anything and everything which is also in evidence even in the realm of covid pandemic.
Recently Smt. Sujatha Rao, an ex-IAS officer, who worked as health secretary in the Ministry of Health for a long time and was also a key person in designing HIV control program, expressed her concern for not finding public health specialist of repute in the current ministrys decision making panel. She also has refuted need of such blanket lock-down in dealing with this pandemic. Many scientists and epidemiologists and commentators of Indian and foreign origin have been airing their concerns about inappropriateness of this lock-down. Indian epidemiologist of repute Dr. Jayprakash Muliyil and 2013 Nobel prize winner in chemistry currently working on data science, Michael Levitt have condemned such lock-down efforts as useless in containment. For them growing herd immunity is the mankinds only durable safeguard against covid and more so for India. The problem with herd immunity, however, is that it is a double aged sword. A very calculated risk needs to be taken to allow calibrated community mixing, based on a systematic, meticulous and phased planning. We do not know whether the one-track Modi government is at all considering this, at least not so far.
So far, in terms of preparation and performance Indias position has been at rock bottom. Take the testing figure as one parameter. As on 5th of May, 2020, in testing per 1 million population, Indias performance is still less than a thousand and is only higher than Bangladesh, Indonesia and Mexico and is around 17% of the world average even when we are into the 7th week of lockdown and 15th week into the pandemic. For obvious reasons this level of testing doesnt enable us to measure the status of the epidemic. By all other indications however, there are reasons to believe that we are already into Stage 3, i.e., community transmission level. Better picture would have emerged once we were able to do mass serological screening in the hot-spots/red zones. But that is not to be. We have to be content with bogus futile administrative oeuvres such as spraying hypochlorite solution in the neighborhood, where the cases are coming from and further locking them down and without being able to go for mass testing in those areas! And given that quarantine centers are nearly no better that the detention centers in Assam, it is a great dis-incentive for people to come forward for self testing even in the hot-spots. Thus the only fate that awaits us in coming days is to wait for chance detections and wait for herd immunity to develop. I hope none of us is naïve enough to dream of a vaccine as a rescuer!
If the people are actually consigned to fate, what can be the rationale to continue the lockdown, which means calculable suffering for the poor and the working people any further, particularly when there is no clear-cut goal of Covid pandemic efforts undertaken by the government? It is time that the question is raised now. We must start to appreciate that whatever damage we could imagine has already happened and the new cases that are coming up need proper treatment, which is becoming impossible in the lock-down situation. We must also clearly appreciate that the hospitals have been actually de-activated in treating other illnesses in the name of managing covid epidemic. They should be returned to normalcy, however, with adequate protection for health care workers. Some reports are also coming upsuggesting sluggishness in existing public health program such as TB control. According to some estimates, TB case detection in last two months has seriously plummeted in comparison to previous months, which means a serious disruption in the much touted End TB Program, to which India has also subscribed.
The lock down has turned out to be not only maximum chaos with minimum planning, it is time to assert that it is a sinister planning. If there is no planning in the technical front, it is nothing less than a sinister planning in the social-political realm. How many macabre deaths happening not due to Covid, would it take for us to appreciate this reality? 15-20 crore migrant labors and about as many poor people are in perpetual hunger and are drenched in pessimism. Many of them have already died and many more will die if this sinister design is allowed to continue. Is Covid casualty slated to be anywhere near this?
In his commentaries on the epidemic, many people have been talking about the shared trajectory of Covid 19 epidemic and economic globalization. Let us also note that the virus thrives on the material signifiers of civilization, viz., plastic, steel and cardboard in descending order of duration. And it also thrives on air-conditioned cold chain, a metonymy of modernity and development under neo-liberal dispensations! Add to this the fact that activation and generation of newer strains of viruses are emerging and will continue to emerge to keep us busy with many more. This is the larger picture which cant afford to lose sight of. The likes of Noam Chomsky has taken a very sharp dig at Trump administration for allowing the epidemic to build up with callous neglect and also urged to look at the larger picture of capitalism, viz. nuclear armaments and global warming. He also views covid pandemic as a colossal market failure and strongly advocates return to government led public health system. It is time for us to thoroughly expose the neo-liberal health care design which thrives on privatization and insurance based health security, being assiduously pursued in India ever since the neo-lib juggernaut has been set in motion in the early 1990s. Many people tend to view this as capitalist/imperialist conspiracy. But conspiracy or otherwise the design is sinister design for humanity and is but an inevitable outcome of heaped up injustice, capitalism has done on the working people and the nature.
Another lesson we must learn, narrowing down a bit from the larger picture is that, each time lock-down cant be the answer to the health disasters that come our way. Fascists and dictators would be happy with such arm-twisting measures. But people have to condemn such design steadfastly and in perpetuity. It is time to point out that measures such as lock down have to be taken in extremely exceptional and short term perspective. With minimal health action support, the government, it seems, is bent on continuing the spate indefinitely, if not for anything, because they are yet to frame any exit plan. Though sermons such we have to learn to live with Covid have started coming from the health ministry level, they hardly seem to be having measurable indicator based on which it can be lifted. Even if they do it, they will do it in arbitrariness and that is where, perhaps more misery awaits us. However, the chakra byuha they have entered without knowing exit route, seems to be bearing upon the people too hard. Now is the time to demand a plan for phased withdrawal of the lock-down by the central government and a more active public health plan.
Do we remember the phrase the home minister used to begin the first spate of lock down in India? Let us voice in unison the same phrase to put an end to the country-wide second spate and ask him, AUR KITNA DIN MANYAVAR? KITNA ..
Commentator is a doctor with substantial public health experience, who is also a radical political activist.