RIDING THE THIRD COVID WAVE

Ant and The Grasshopper

The story of the ant and the grasshopper must have been narrated countless times in our childhood. The ant survived the famine and the famished grasshopper perished! Most of us, forced to by our kids or grandchildren would have re-narrated the story with all the sound and action to make it captivating. The last line is often about the moral of the story! They say all these childhood stories convey some profound message, which we conveniently forget as we grow up. 

Let us recall the story in another setting!! The 'covidian' setting!

Did it evolve naturally or was it synthesised for weaponisation? Even as debates rage, accusations denials and counters fly, covid continues to wreak havoc across the world. The second wave was deadlier than the first and everyone is now talking of a third. 

Will there be a third wave? Will it be deadlier? Then what do we do?

What Numbers Say

A distinct rise, a fall and the relative calm thereafter is referred to as a pandemic wave. Lethality dictating intensity of affliction and virulence dictating spread, differ from region to region. India weathered the first wave without much damage compared to others. Mistaking the calm before the storm as the end, we declared victory. But the storm struck again.

A comparison of figures available in public domain in respect of the top ten covid affected[1] countries throw light into the magnitude of affliction.

	Country	Total Population	Total Cases	Total Deaths
1	USA	33,27,70,250.00	3,40,43,068.00	6,09,544.00
2	India	1,39,23,45,967.00	2,80,47,534.00	3,29,127.00
3	Brazil	21,39,34,926.00	1,65,15,120.00	4,62,092.00
4	France	6,54,05,173.00	56,66,113.00	1,09,402.00
5	Turkey	8,51,64,357.00	52,42,911.00	47,405.00
6	Russia	14,59,91,530.00	50,71,917.00	1,21,501.00
7	UK	6,82,10,816.00	44,84,056.00	1,27,781.00
8	Italy	6,03,80,707.00	42,16,003.00	1,26,046.00
9	Argentina	4,55,73,096.00	37,53,609.00	77,456.00
10	Germany	8,40,28,088.00	36,87,715.00	89,051.00

 

In terms of infection rate, Andorra, a tiny European country with a population of 77,378 leads the table with infection rate of 17.74 % that translates to 13,727 in absolute terms. The USA, with 10.23%, at 13^th spot of rate of infection leads the list in absolute numbers with 3,40,43,068. India with infection rate of 2.01%, stands 105^th but comes second[2], in absolute numbers.

In absolute numbers of covid deaths, India stands third. However, with a fatality rate of 1.17% amongst the infected, it stands 139^th. Compared to many advanced countries, COVID has been kind to India. Percentages are dangerously innocuous. Increase in percentages impacts countries depending on the population size. For a large population base, even one point increase can mean colossal numbers. One percent for India, translates to a humongous 1,39,23,459 infections. At the current fatality rate of 1.17%, it means 1,62,904 people more dead. While the numbers are large by themselves, the economic and social cost of losing citizens especially young would be huge.

The second wave was characterised by increased fatality. How the third wave would impact whom remains a speculation. If bravado of the grasshopper about doing better than other countries in competitive covidian statistics consumes anyone, it may tempt them to let guards down. It can be a terrible mistake. Only ant-like single-mindedness can prepare countries adequately enough to face the third wave. With a huge population to take care of India has a lot to do.

Combat Strategy

A two-pronged strategy of ‘Prevention’ and ‘Intervention’ is required to tackle the third wave. Prevention is the best weapon against COVID. Quantum of beds, oxygen, doctors and medicine etc required will be inversely proportional to the success of the preventive measures. More successful the preventive measures, lesser required the medical intervention. With one new variant being called an “absolute beast”, it is wise to be the ant and be prepared for the worst.

Prevention The Remedy

The primary focus of the government and citizens in the war against covid, must be prevention. Prevention has many facets.

Physical Distancing. It is proven that physical proximity greatly curtails spread. Physical distancing (NOT Social distancing) between people can drastically cut infection. This can be enforced by lawfully restricting movements of people and preventing congregation and maintaining stipulated interse distances between themselves. This can be successful only if citizens participate voluntarily and wholeheartedly. Such participation can come about only through building awareness. If physical distancing can be truly enforced, the third wave can definitely be defanged.

Masking. It is now confirmed that the disease spreads mostly through air. Though there are conflicting reports on the efficacy of masks in reducing spread of infection, it is widely believed that probability of infection can be greatly reduced if citizens use masks correctly. Pulling up a mask over one’s mouth and nose only to escape law enforcement doesn’t actually help. Use of mask must come voluntarily and correctly.

Vaccine Protection

The accepted practice to curb spread of a pandemic is universal vaccination. The probability of spread of epidemics considerably reduces in an immunised population. This should have been easy for India, the vaccine hub for the world. Analysis, of how we have done so far, done purely for administrative purposes and devoid of political aims, can help evolve strategy for future. 

                   https://dashboard.cowin.gov.in

The Numbers. As on 03 Jun, 21,98,43,531, doses have been administered through 33,996 (32878 Government & 1118 Private) centres. 17,56,89,202 were first doses and 4,41,54,329 second doses. 21,98,28,465 doses (19,48,14,503 Covishield & 2,50,13,962 Covaxin) have officially been given to 21,98,43,531 people, saving 15,066 precious doses through careful handling. 3.17 % of the population have been inoculated and 9.40% partially vaccinated. 

Citizens can legally receive vaccines only after registration on the government portal. As on 03, Jun only 25,73,76,403 citizens (only 18.49% of the 1,39,23,45,967 population) have registered for receiving vaccination. This low figure could be attributed to any one or more of contributing factors like vaccine hesitancy, access to portal or lack of awareness. This calls for serious policy thoughts and introducing incentives or penalties for registering.

The highest single day vaccination was 2,47,46,875 on 03 Apr. If the government pushes to maintain this figure it will take only 102 days more to immunize the country. But even those who have registered find getting slots for vaccination a challenge. This has come about due to vaccine shortage and the current policy.

Capacities.  According to available data, India has a total installed capacity of 8.2 billion doses per year. This includes capacities of “SII, Bharat Biotech, panacea Biotech, Sanofi’s Shanta Biotech, Biological E, Hester Biosciences, and Zydus Cadila”[1]. In addition, different vaccines are expected to be imported. Prima facie the entire population can be vaccinated twice over in one year. Unfortunately, things haven’t worked out this way. What then is holding India back?

Complexities. Underutilised capacities, pricing fiascos, and confusion over sourcing have added to the complexities. Introducing different types of vaccines to overcome shortages or provide flexibility have only added to the complexities. However, these can be surmounted even now. Three factors have to be ensured; vaccine willing people and the bridge between them. Here lies the visible challenge!

Medical Intervention

Despite the best of intentions and implementations virus will slip through and there would be infections. Since the infrastructure seemingly got overwhelmed, patients were advised to stay home till they developed serious complications. Left to non-medics and a combination of ignorance, aggravated by asymptomatic infection, high incidences of happy hypoxia and lack of access to emergency support, many succumbed. The high fatality rate of the second wave could have been different if all patients irrespective of their conditions were placed under medical supervision. That is the real challenge!

Covid has very serious and unpredictable pattern of attack. It needs medics and medicines. Faster the response better the treatment. Facilities have to me made as close to the population centres as possible to elicit credible results. A chain of treatment facilities, akin to evacuation and management of causalities in army, that takes cases depending on severity should be designed.

Kerala Model. Kerala steals a march over others in this regard. Rather than creating and operating unwieldy mega facilities it continues to micro managing. The primary health centres in each village or panchayat is the first line of defence against the attack. It is these facilities that continue to play stellar roles in curtailing fatalities. If the state had mandated even patients with mild symptoms to PHC care, Kerala could have seen very few fatalities.

First Line Treatment Centres (FTC)

The most effective way forward to handle the third wave is to open as many small centres, twenty to thirty bed capacity, as near to the people as possible. Every case reporting must be attended to and tested for covid.  In fact, it will do the community good to encourage people to report to the FTC at the slightest doubt. With antigen tests and such other tests becoming more available, covid can be detected early on.

Those confirmed positive must be taken in and kept under medical care. It will separate the patient from others, minimise community spread and ensure better survival rates. Those needing more support can be send up the chain for treatment.

Many railway coaches were ceremoniously converted into wards. How they have been utilised a cross the country is not known. Every railway station has space to park these coaches. Wherever there is scarcity of infrastructure local administration must be assigned a coach.  These, assigned with doctors and nurses and equipped with adequate medical equipment can become the first line facilities. Thousand bedded mega centres can grab eyeballs and headlines but smaller establishments give outstanding results. It also provides locals to contribute and even provides that many more opportunities to those hungry for media glare to satiate their desire

Medical Hands. The most cited reason for poor rural medical care is lack of doctors and nurses in the front-line treatment centres. Even in this sphere Kerala is a beacon for other states to follow. India has a huge bank of medical practitioners at the house surgency level. These qualified individuals under the guidance of a qualified doctor can handle the point of contact. They can evaluate the patient and send them up to the higher facility if the need so arises. Similarly, we also have a large number of nursing students across the country. They too under the guidance of qualified nurses can augment the fight against covid.

Costs

Covid is an extremely destructive phenomenon and once in a life time experience. It inflicts uncalculatable economic and social costs. Combating it also demands tremendous costs. Preventive measures essentially are disruptive and directly or indirectly impact many economic activities. Restructuring or reorienting existing processes involve costs. Many social functions, part of our culture, would be impaired or altered and they too have serious impact on micro economy. But all these combined could be minuscule compared to the cumulative costs of treating infection post infection activities and deaths.

Preventive measures disrupt life, citizens are used to, and therefore could evoke poor voluntary compliance. Making people see reason is a painfully slow process. It needs concerted efforts to create favourable awareness. It would also need coercive implementation and that could hold political costs. That is where strong and visionary leadership stands apart.

To-do List

Aware of the difficulties of implementing even the most well-intentioned programmes, a list of implementable steps is suggested.

·       Legally enforce physical distancing.

·       Enact and enforce a national policy restricting types of congregations and stipulating numbers needs to be. It may be good to remember that virus doesn’t differentiate or make concessions based on type of congregation.

·       Incentivise production and businesses centres to devise means to stagger staff presence and self-regulate.

·       Adopt and implement concept of micro containment zones where lockdowns are complete in all aspects.

·       Make wearing of masks compulsory by law. Impose hefty fines on anyone breaking masking law.

·       Allow manufacture, distribution and sale of only correct pattern of masks.

·       Regulate price and prevent profiteering.

·       Open at least one micro treatment centres in every village panchayat.

·       Use out of service railway coaches, if need be, to create infrastructure. Allocate them to panchayats/ villages / local governing bodies to manage.

·       Equip these with medical equipment to function as primary covid treatment wards

·       Deploy house surgeons and final year medical students to man these facilities.

·       Similarly deploy final year trainee nurses to meet the need for nurses.

·       All district headquarters to operationalise a control centre operating on common platform to bring about transparency and asset sharing.

 ·       Ensure truthful reporting.

Wisdom in Caution

When initially cautioned about the tenacity of the virus to stretch the human species beyond 2020, many were scorned those who sounded alarms. Declaring the ‘song and dance’ for new year 2021, many ridiculed those advising caution as alarmists and worse, driven by personal agendas. The bravado vanished and those who scorned slithered behind the shadows. The virus continues to test. To beat the virus, whether it was an evolutionary curse or the folly of careless weaponisation only fortitude of the ant can help. Others can be allowed the freedom of the grasshopper. 

[1] https://www.worldometers.info/coronavirus/#countries

[2] Contrary to the prevailing tendency of covid competition, comparison made here is purely with the aim of gauging how covid has impacted the population.

[3] Business Today 14 Apr 2021