COVID: DÉJÀ VU OR JAMAIS VU?

Uncertain Spaces

Leaders of all types and stature say, “we are going through unprecedented times”. A truism in words, written and spoken, actively propagated. But are we really? Or is it Déjà vu or jamais vu?

Our mind space has been so forcibly captured by covid that all our thoughts and actions are centred around it. This disruptive phenomenon, like one-never-before, has left nothing of our existence untouched. Socio-economic and politico-religious divides apart, wary of covid, everybody individually and collectively behaves differently. As debates about its geographical origins rage, attributing religious, political, military, strategic or economic intentions lead it to ‘us’ versus ‘you’. Oblivious to the likelihood of themselves becoming part of statistics, politicians and profiteers make a killing. That is where the whole world is.

Closer home, as hospitals are overwhelmed, people scurry for beds. Even as a few ‘lucky-unlucky’ succeed in managing oxygen and ventilators, everyone seems to have lost someone near or dear. Angry accusations of poor governance and insensitivity meet with silence or counter accusations. Pyres burn relentlessly across the country and few, once our fellow beings, bloat and flow down rivers unclaimed, abandoned on their final journey. Death, reported, rumoured and denied, is growing. Is dignity in death, becoming luxury? Uncertainty, no more spirituality, is certainty.

What Future Beholds

The question that haunts us in private is “What will happen to us?” while in public we ask “How can we rein in the pandemic?”.

To visualise what will become of us and predict how the pandemic would progress, needs understanding of the virus, its inter-species relationships, and affliction statistics, from an evolutionary perspective. Revisiting history can help us put in place mechanisms to combat the menace. Till then we shall merely be reacting to situations. It needs patience to understand and perseverance to overcome pandemics. (This article too needs a patient read).

Perspective?

To help us understand interspecies relationships let us attempt to answer an entirely unrelated question, important nevertheless.

Did we domesticate wheat?

or

Did wheat domesticate us?

Having been conditioned to believe that we reign supreme over all other species on the planet, most of us would laugh at this ridiculous question. But if philosophers[1] are to be believed, wheat is a smart grass. It enticed and enslaved human species to colonise the world and anchored the nomadic Homo sapiens to geographical limits. Even if one disagrees, accepting its likelihood is being objective!

The truth is, each species attempts to genetically adapt itself and even behaviourally modify other species to ensure survival and sustenance Corona is no different. It will do everything to survive, sustain and thrive. This natural phenomenon must guide us to the solution to the pandemic.

Mutation an Existential Need

‘Severe Acute Respiratory Syndrome Coronavirus -2[2]’ which causes ‘corona virus disease (Covid 19)’ needs live hosts. Within the dead, it dies. For the virus, human death is collateral damage. Thus, it needs to mutate till it becomes a strain that can hold humans alive and long. Therein lies our hope and despair. This statement seems unbelievable, only till we revisit the fate of pathogens that caused earlier pandemics.

While we host large number of microbes, without which we would be dead we also continually battle large number of pathogens. We don’t even realise the battles raging within, waged and won every day. Common cold is nothing but manifestation of an internal war against an intruding virus (Rhino virus, corona virus, respiratory syncytial virus, influenza etc). During cold, we are essentially dealing with a mutated viral load that uses us to help it replicate. Of the millions that contract common cold every year, most walk free after couple of days of misery. Very few die out of pneumonia. Virus, seldom sets out on suicidal missions. It needs living human hosts to be alive!

History Lessons

Bubonic plague of 1346 apart, the Spanish flu was the fiercest pandemic ever recorded. With more than 500 million afflictions and over 50 million dead, the Spanish flu, first detected in March 1918 came with the symptoms of fever, nausea, aches and diarrhoea. It came in three waves, the second being the deadliest. It drove down average life expectancy. Unmindful rulers and careless crowds ensured free passage helping it spread like wild fire. Gory descriptions of its impact apart, literature available on the subject, is silent about eradication of the virus. All it speaks about how the pandemic ended is “It killed till it could kill no more!”. All those who were not afflicted were already immune and those who survived became immune. The pandemic stopped when we and the virus found ways to coexist. Virus was never eradicated!

Déjà vu or Jamais vu?

The overwhelming scenes we witness today are mere replays of days, a century ago. Dependent on the viral load and dictated by one’s own immunity, people contract covid from known or unknown sources. Though symptoms manifest differently in each individual, these generally conform to symptoms of the earlier pandemic. Many, though infected remain asymptomatic and spread it. For those who become symptomatic, physiology dictates level of complications. Once, severely afflicted, survival depends on timeliness and quality of medical intervention. This must help us draw up action plan for isolation, immunisation and intervention. Isolation helps retard infection rate, reduce patient accumulation and stagger intervention requirements, preventing system overload and breakdown.   

Truth be Told

Covid 19 virus is here to stay. Cruel it may sound, each one of us, in all probability will face it. Most of us will host it, unknowingly and incident free. Many would suffer and overcome but few would succumb to it. It is the number of afflicted and needing medical intervention that would dictate the socio-political outcome.

The Magnitude

Doubts on recent socio-economic indices published by India notwithstanding, Government figures are considered authentic. India over the last three months have alarmingly moved up in numbers and may soon dislodge USA as the most afflicted. It is important to bear in mind that India started late and were amongst the first to announce victory, albeit prematurely.

Statistics:13 May 2021

COUNTRY	TOTAL CASES	AS % OF POPULATION	TOTAL DEATHS	AS % OF AFFLICTED
USA	3,35,86,136	10.10%	5,97,785	1.78%
FRANCE	58,21,668	8.90%	1,07,119	1.84%
BRAZIL	1,53,61,686	7.18%	4,28,256	2.79%
ITALY	41,31,078	6.84%	1,23,544	2.99%
UK	44,41,975	6.51%	1,27,640	2.87%
INDIA	2,37,03,665	1.70%	2,58,351	1.09%

Source: Worldometer

 

According to the figures above, Indian covid spreads slow and has low mortality. Widespread apprehensions about data fidelity, non-reporting and low testing notwithstanding, low rates could have led us to believe that we had put brakes on the spread. The line of thought, that Indians are generally immune also gained currency. Many quacks, alternative healers and even political outfits came up with practices beyond scientific logic. However, the second wave debunked immunity claims and deflated triumphalism. As covid rages, the naïve follow the ridiculous and bravado remains blind. 

Remember, scientists and doctors propagate home care to tide over covid issues for most, as according to them only a very miniscule percentage of those infected show distress and only a very low fraction of that need hospitalisation. At the currently recorded rate, even if ten percent (US rate) of the population gets afflicted, we could be looking at a cumulative infection of only about 13,91,64,220 (10% of 1,39,16,42,201- our population) and only 15,16,890 (1.09% of 1,39,64,220 – the current rate) deaths.

Even at the current low rate of affliction (1.7 %), our health system has floundered. Though administrations issue aggressive denials, getting beds in hospitals, ICU admissions, oxygen or ventilator remain a daunting task. At times it comes a little too late for the afflicted. Crematoriums across the country seems overwhelmed. Dumping the dead has been reported. Obviously, our infrastructure, is grossly inadequate even for the current load.

 

Hold Rates Not Numbers

It’s not the cumulative numbers that matter but the rate at which it grows that matters. Need of the hour is to decelerate rates of infection and fatality. Only if the government can decelerate the spread from the current figure of 2,37,03,665 infected and delay reaching 13,91,64,220, can it gain control of the situation. It must also put in place mechanisms to check mortality rates. The two areas of focus therefore are clearly defined, brakes on spread and cut mortality! Hold the rates, numbers will fall.

 

Prevention

Rate of infection depends on immunity of the population and the conditions that permit spread whereas mortality rate under the present conditions depend only on infrastructure.

Inherent immunity, derivative of genetics and healthy living, remains beyond government’s intervention at this stage. However, inducing immunity and reducing spread is well within the realms of public administration, diligently approached both are possible even now.

Allegations of misdoings and mega moneys involved in the vaccine regime are plenty. It is also known that those already vaccinated have also contracted the virus and succumbed. The numbers are large enough to raise eyebrows. Though the rapidly mutating virus is known to bypass the vaccine antibodies, the scientific community has unequivocally supported the idea that vaccination either prevents or diminishes the effects of covid. It serves us well to accept this theory unless we find another way out. Till then vaccine is the only way to protect ourselves. That is why countries world over are racing to vaccinate its citizens.

Vaccination Conundrum

The ever-elastic gap between the two prescribed doses from the initial 28 days to eight weeks to twelve hasn’t helped the cause of vaccination. Authorities quote the National Expert Group on Vaccine Administration for Covid-19 (NEGVAC) which in turn used the data ‘particularly from UK” to support its claim that increasing the gap does a better job at shielding. Ironically UK it seems is reducing the gap to eight! Right or wrong, public associates this increasing elasticity to decreasing availability.

Poor planning and roll out of the vaccination programme have added to chaos and mistrust. It has truly promoted crowding all over the place. While only a few in the crowd can manage to get a jab, most can easily get the virus for free.

Pricing and sourcing strategy followed by the government added confusion and seeded allegations of corruption. Vaccine has become the latest stress in federal governance. The number of vaccines and sources prima facie looks a smart move but considering the logistics associated it can turn out to be a real challenge.

All these notwithstanding, we as a nation have adopted vaccination as a step in containing the pandemic and thus must go full steam ahead.

Programming Vaccination

The best way forward for us is universal vaccination. The government could consider: -

·     Eligibility.   Announcing centrally controlled, compulsory universal and free vaccination is the best way forward. However government may fix criteria to decide who should pay or get free.

·   Agency. Handing over the programme to an agency to monitor the scheme. If passport seva can be outsourced even this can be.

·       Equitable distribution of the short-supply vaccine is important. Government must publish the allocation methodology.

·      Seeing is believing. Make availability and allocation fully transparent visible and information made accessible.

·       Make state Governments and local body organisations stake holders and partners.

·       Incorporate local health centres and workers to administer vaccine, else at the current rate of vaccination we may never catch up with the virus.

·   The agency can schedule dozes and location and intimate the individual and the health worker. It’s a matter of rudimentary coding

·   Details of each individual who has taken the vaccine is already available and can be handed over to the agency.

·       Ban spot registration for any dose and prevent crowds.

·       Polio and earlier vaccination drives have reached homes with much lesser infrastructure and IT resources at command.

·       Take the vaccine to the door step or as near to the door as possible.

·       The entire programme can easily be choreographed depending on the availability of vaccine doses. Increase vaccine availability.

 Lockdown Compulsions

The most proven method of reining in the spread rate is lock down, keeping people away from each other. It drastically reduces spread in quick time and helps gain time to put in place combat procedures.

Reluctance of the central government to impose lockdown over the entire country can be linked to political expediency. But political mileage is possible only when body politic exists! Short sighted political decisions can in the long run become albatross around the neck. Hesitation now can haunt later. The hesitancy is intriguing especially when the government had claimed victory with the grip it took through the first lockdown. All the miseries and accusations associated with it had paled in comparison to the flat curve achieved. The government is well advised to declare central lockdown

With many states going in for lockdowns on their own, flattened curves and saved lives will be political victories for them to claim. It will also add to interstate tensions already evident in sharing of oxygen, vaccines and medicines.  Efficacy of patch work lockdowns at best remain temporary and questionable. Pussy footing adversities only worsens it. State wise lockdown is akin to few of the crew plugging the holes near them in a badly leaking boat, while others sit quiet hoping their efforts will save the boat. We may get ashore but with many dead, not because we did something great but virus chose to let us live. To bring the rates of infection (Test Positivity Rate) and with-it mortality, universal lockdown is inescapable.

The counter would be that we had a national lock down and graduated opening up before and about an year to beef up our medical infrastructure and treatment protocols, we are yet woefully short. It will cause untold miseries to the daily wage earners and the old and sick staying alone. The answer is that we now have adequate experiences, good, bad and ugly of the last extended lockdown. It doesn’t need much effort to codify what and how it should be done. With resolve we can make the lockdown less painful and more rewarding. A national lockdown should get the curve well under control, save lives. The dead doesn’t make an economy, the living does.

Confronting Challenges

The inadequacies of our public health system lay bare in the open. Iron hands and curbs can keep the living down but the dead are under no such compulsions. They do speak.

The requirement is to create adequate infrastructure. Infra upgrade needs time and effort. It’s not that every country has everything it needs. It is about making things available where it is required. We have working urban and rural models of excellent administration. The way BMC rose to the challenge is now public. Casting away one-upmanship, if need be, it can be adapted and adopted for each district or local governing bodies.

We Shall Overcome

The beauty of nature is that it balances out sooner than later. But allowing nature to decide how fast or slow it must deal with us is accepting failure. We have tremendous resolve as a people. If we together pull, we can beat Corona. The sacrifices made by our health workers at least will not go in vain.

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[1] Harari, Yual Noah. Sapiens: A brief history of humankind

[2] International committee on taxonomy of viruses announced this new name on 11 February 2020

AMBULANCES – SHOULD IT RUN AMOK?

Outrunning Death

Sirens wailing, lights flashing, ambulances zip through traffic as if nothing else exists in their way. Mortals admire his ability to turn traffic chaotic and even negotiate through it. It seems that his heroics alone, in carting the afflicted to hospitals at lighting speeds, is enough to prevent ‘the end’ and ensure survival of the patient. To us the public, he our saviour can outrun death.

What happens in the hospital at the emergency room or casualty is something different. Lightning speeds and driver’s daredevilry notwithstanding, the patient becomes one amongst many medical emergencies and receives a very informed and calibrated response, often mistaken by the near and dear ones as heartless apathy and callous complacency.  

Hailing Ambulances

Ambulances are used to evacuate accident victims or patients in emergency. It is common belief that, if a patient is ‘somehow’ ferried to the intended hospital fastest, survival and recovery stand better chances.  Thus, it has become a norm for drivers to fly ambulances over omnipresent potholes, ricocheting over unmarked humps on a ‘surface’ called road, chock-a-block with unyielding traffic and unruly people poised to strike at the slightest provocation. Knowing how emergencies are managed in hospitals, it is time to consider the need for ambulances needlessly rocketing all over.

Evacuation Woes

The maximum damage inflicted upon a victim after an accident happens during extrication from the wreckage. Unfortunately, the first respondents are inevitably people who have no clue of handling trauma. While many happily film the event, others shamelessly slip away. The few who dare, in their exuberance to extricate, drag the victim out holding whichever limb or part thereof they can first reach. In most cases rescuers, ignorant of the injury already suffered by the victim, unintentionally aggravate the condition. The victim’s ordeal doesn’t end there. Whatever damage is left to be inflicted or can be inflicted occurs during the reckless ride to the hospital.

Other medical emergencies are no different.

Imagine the state of a patient being evacuated in a medical emergency involving heart attack or asphyxia.  The speed with which an ambulance covers crowded and winding roads negotiating heavy traffic worsens the patient’s condition.

Mistakenly, speed seems to be the ultimate response.

Speed or Care?

Speed seems to be necessitated because it is important to provide medical attention without loss of time. Ambulances without requisite medical expertise on board resort to speed. If the requisite quality of medical care can be provided on board the ambulance, speed becomes inconsequential. An ambulance should ideally be moving the fastest to reach a victim or patient. Having reached the patient, its movement to hospital must be deliberate and with medical attention on board. Ambulance must have trained doctor or paramedics, adequately equipped to manage such emergencies. Ambulances should transform from merely being carriages to mobile intensive care units capable of providing medical support to stabilise the patient so that required medical interventions can happen immediately on arrival.

Timely medical support is of essence, not speed.

Role of First Respondents

Modern automobiles provide high degree of survivability and protection to occupants if safety instructions, like fastened seat belts or well secured helmet, are adhered to. With most of the impact absorbed by inbuilt crumble zones, many occupants escape from crashes with minor injuries. However, with the scant regard we have for safety norms, most individuals involved in accidents sustain grievous injuries. In such cases people who arrive first at the site become rescuers. Unaware of how crash victims should be rescued and prepared for evacuation, first respondents in their eagerness unwittingly aggravate injuries causing irrevocable damage to the victims. This can be avoided.

Enablers

NGOs, governmental bodies and organisations involved in social work must launch awareness programs to educate people on how to respond to medical emergencies and accidents. Various audio visual and print mediums of mass communication, including social media tools and street meetings must be employed to prepare the society to handle emergencies individually and collectively.  Simultaneously, ambulance services be mandated to upgrade on-board capabilities. Government must create a medical emergency response grid and all hospitals must be mandated to be part of the grid.

KASHMIR – URGENCY TO RE-IMAGINE THE PROCESS

access the article also at onmanorama 

https://english.manoramaonline.com/news/columns/straight-talk/2018/05/28/kashmir-solution-is-in-re-imagining-the-peace-process-.html

An unusual conversation between a Kashmiri father and son, recently hogged prime time. The father was heard encouraging his son, trapped in a firefight with Army, to die fighting and not surrender. The father, despite his act lives a free man, a law-abiding citizen, while the son, a dead terrorist, now, is statistics and a locally celebrated martyr.

Dissected frame-by-frame and discussed ad nauseam, most “experts”, advocated military retributions, while a minuscule few sounded genuinely concerned. Panellists, irrespective of individual socio-political compulsions, agreed that glorification and ground swell for “home-grown terror” is luring local youth to terrorism like never before and that one man’s “terror” could well be another man’s “movement of resistance”.

The peace process in Kashmir, should have ideally moved forward, with the current political tie up being at the helm. Increasing incidence of confrontation between security forces and “terrorists”, and its expanding geographical spread with active participation of the local populace, indicate that the current policies have failed or are hopelessly irrelevant. What should worry policy makers at this stage beyond the increasing frequency and spread, is the readiness with which the local population is being recruited and the manner in which educational institutions are turning into sourcing bases. When parents become facilitators, respected professionals and highly educated youth join ranks, “terrorism” in Kashmir is no more a refuge of the unemployed. Treating it as a mere law and order problem can be catastrophic.

The hawkish, often recommend implementation of policies and practices pursued by successive Israeli governments, little realising that despite all strong-arm interventions, peace is still an elusive dream on the Jewish soil. While military may be successful in temporarily containing “visible violence”, it can’t be the means to the end. In fact, such operations are classic “David-Goliath” confrontations where the underdog grabs, sympathetic glory, breeding a new wave of suicidal volunteers. Whatever be the policy of the current ruling administration, it is a proven failure. Activities undertaken in the valley to "win hearts and minds" (WHAM) of people have yielded no credible results.

Like all multi-player socio-political issues, where over time, positions have hardened, concessions or agreements made by one side can be interpreted as victory or defeat, solutions lie far beyond the normal. Unless all parties concerned, engage each other with the sole aim of finding a solution, there can be no end in sight to the problem. Macho rhetoric and short-term political expediency can only worsen the situation. Absurd panel discussions and chest thumping that stem from ignorance couched in loud patriotism can at best bring down issues of strategic importance to street level thuggery and make solutions that much harder to find. Unfortunately, the trajectory of activities currently visible to the naked eye, points to escalation and spread of conflict.

Kashmir is not a problem that can eternally be contained by military, to be solved politically, at leisure. Any further delay can only carry the situation to the point of no return. It is time to re-visit and reimagine the Kashmir peace process.