Covid-19 Pandemic: IT Revolutionized Its Management!

The pandemic of loneliness and isolation, the nuance and power of that missing direct touch and connection, all that was highly frustrating. Or, should I say, bewildering. Indeed, wonder if I know the right word to describe the kind of absurd life that I led during the last two years. Constant fear of inhaling the virus from anywhere around, known or unknown… no matter whether it was a person or an object, the altered style of caring for even family and friends, … ha, what a traumatizing change!  

As I was thus lost in the labyrinth of these thoughts, the ring tone of my phone alerted me to a new message: “Dear …Murty you are eligible and may avail precaution dose on 19-01-2022 after medical advice. Please visit cowin.gov.in-CoWIN.”

Wow, what a surprise! A functional message from a functional government, “Isn’t it?”

This instantaneously reminded me of one of my childhood experiences. It was 1956. I was studying third form in Taluk High School. One winter evening, I was lazily walking back home from school. As I reached the stone house of the lawyer, suddenly somebody in a khaki short and white shirt stopped me in the middle of the road by holding my upper arm. I stared at him in bewilderment. “Bhayapadaku, ilaa raa! Don’t fear, come to this side” saying, he pulled me into the open yard of a house left to the road.

There were two tables placed side by side and a bench behind each table. A man sitting behind the first table enquiring me noted down my name, age, the class that I am studying, father’s name, and location of our house in a big register spread open on the table. He then explained the purpose of retaining me there thus: “You will be given BCG vaccine. It protects you from TB. No pain. Good for you. So, coolly take it.”

The khaki short fellow then took me to the other table. There on that table was placed a white box and a kerosene stove warming water in a vessel that was loaded with needles and syringes. Behind it stood a nurse in a white frock and cap with a syringe in her hand. There was a boy by her side with one of his arms held by an attendant. Making me stand behind that boy, the khaki short fellow took books from my other hand and placed them on the bench.

After a while, looking at me with a smile, the nurse enquiring my name, etc., and rubbing wet wool on my deltoid muscle gently, suddenly inserted the needle into the muscle and injected the vaccine by pressing the plunger… Then pulling it out, she applied slight pressure on the injection site with a wet ball of wool and then directed me to sit on the bench for 10 minutes holding the cotton at the site, and then to go home. Also told, “You may get slight pain tomorrow. Don’t fear. That’s OK! If you feel hardness at the site, ask your amma to massage there with warm water—not today, only tomorrow, (sareena?) OK?”

So, that was how I got vaccinated in 1956. For that day, that was a great feat! Indeed, the Government, laying down the organizational set-up required in each state to cover the total young population during a five to seven years period, started the BCG Vaccination mass campaign in 1951 and covered all the states by 1955-56. Perhaps, that laid the foundation for subsequent mass campaigns for vaccination in the country!

Of course, today IT has revolutionized the whole scene. It simply transformed governance even in countries of the Global South by enabling them to offer better public service. So, today, if I get a text message from government reminding me about my due date for a booster dose, there is absolutely no wonder. For, the radical changes in our daily lives that were ushered in by IT have by now become a taken for a granted lot!

Nevertheless, Covid-19 pandemic has further highlighted the importance of AI, machine learning, IoT, and digital technologies to public health security and pandemic preparedness by answering the call for enhanced agility, scale, and responsiveness more effectively. AI and high-performance computing have also come in handy in accelerating research into understanding the virus and developing vaccines, therapeutics to arrest and treat infections.

Even we in India experienced the benefits of our government leveraging IT to manage the pandemic. It is the government’s Cloud-based digital platform CoWIN, which, by facilitating easy and accurate registration for appointments, and recording the immunizations, helped the nation to cover around 87 crore people with two doses of the vaccine and over 100 crores of people with at least a single dose. Imagine how much time it would have taken if everyone were to be caught hold of by hand as I was then and inject vaccine and take a note of it in a register with a pen!  

You know as a student I was to run around Municipal offices for quite a number of times to get a vaccination certificate that was needed for attaching to the application form seeking admission to professional colleges such as medical college, agricultural college, etc. But today, sitting at the home I just downloaded my Covid-19 vaccination certificate straight from CoWIN platform—not once, but at the completion of first, second, and the booster dose. That’s the luxury IT is affording today!

Storing of such voluminous data pertaining to more than 100 crore of people and making it available for individuals to download as they desire with a click of mouse that too, quite accurately, has now become a child’s play with the availability of Cloud Computing. What a technological progress! And, another important gain to the ordinary citizen is the elimination of the erstwhile rent-seeking agents in the system. That’s a real comfort.

Thanks to IT, today, the government has even digitalized the vaccine supply chain network—Electronic Vaccine Intelligence Network (eVIN) developed with the support of Gavi, The Vaccine Alliance, and implemented under the UN Development Program through a smart-phone based app— through the use of cloud technology that keeps it posted with the latest information on vaccine stocks and temperatures across the network in the country. This ensures the maintenance of the efficiency of the national cold chain network.

Having said that, we cannot ignore the fact of weak links that the pandemic had exposed in an otherwise strong vaccine service delivery network that we have built over the years. For, the success of a sustainable vaccination program heavily relies on supportive infrastructure such as the uninterrupted supply of electricity that maintains the functionality of the cold chain network. But reports indicate wastage of vaccines due to failure to properly control storage temperatures. And such wastage has two implications: one, cost implication, and two, importantly delays the achievement of immunization targets.

Aside from the laurels for the good work so far done, we, taking a cue from these experiences, must pivot to newer mechanisms such as solar energy, etc., to build resilient cold chain systems across the country to be future-ready to handle newer pandemics, if any, more effectively. 

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Pandemic to Endemic: It Doesn’t Mean Exit of Virus

 

People are throwing away their masks. Government’s mandates are easing. Everyone is freely moving around. People are socializing happily. Crowds have swelled up all around. Even people played Holi in gay abandon. So, it’s no wonder watching this emerging merriness, if someone raises the obvious question: Where is Covid-19?

But the fact remains that the more contagious sub-variant of Omicron, BA.2 subvariant is circulating amidst the loosening restrictions/new-found freedom and cases are reported to be rising globally. China is reported to have locked down many of its big cities to contain its largest Covid-19 outbreak since the start of the pandemic.

True, the disease, that killed 6 million people according to official statistics globally, is not causing much concern today for those who are vaccinated and even boosted, but specialists warn that the virus is still dangerous for those who have had no access to jabs or those who had preferred not to get vaccinated.

Although cases, hospitalization and deaths due to the virus are stabilized affording a kind of respite that was very much missing during the Delta wave, specialists warn that declaring an end to the pandemic is very much an iffy proposition, given the proven ability of the Coronavirus to surprise us. Some virologists are even warning us about an inevitable emergence of new variants sooner or later that could be more lethal than Omicron.

Dr Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard TH Chan School of Public Health, said: “It is so tempting to just try to forget about [the Pandemic] and move on, but we can’t do that… We need to remain vigilant.”

Dr Bill Hang, Associate Professor of Epidemiology at the Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health states that “the end of the pandemic phase [is] defined as much by human behaviour as by the dynamics [of the virus]”.

So, what these experts mean is: that today, society is closer than ever to calling Covid an endemic, but endemic doesn’t mean the exit of the virus; it only means that the disease is regularly found and very common in a region or among a particular group. Therefore, we cannot throw caution to the wind. For, there are still many unknowns that have a direct impact on us, the public.

The first one is: the duration of the immunity. The current evidence indicates that the natural and as well as vaccine-induced immunity wanes over time—of course, more so against infection. Similarly, the extent of waning immunity against Omicron is yet not known fully, except to say that those who received booster doses of vaccine may enjoy medium-term protection. At the same time, the booster uptake is also not that significant in the country.

Secondly, it must also be realised that many characteristics of the virus such as its pathogenesis and epidemiology are still not known clearly. Equally unknown is the risk and impact of the long Covid. It is still not known if vaccinations protect people from long Covid. Same is the case with regard to intervention measures, if any, to mitigate the long Covid. Similarly, causes for long Covid in children and its effects on them are still not clear.

In the light of these realities, there is a need to strike a balance between public safety and personal liberty. However, as a first step in this direction, government must keep a system engaged in reading genetic code of virus variants continuously to serve as an early warning system for the health authorities to isolate such cases immediately so as to contain the spread of new variants. There is also a need to open virology laboratories in every State capital for speeding up of identification of the viruses/emergence of new variants of virus and to initiate arresting measures with no loss of time. The second step is speeding up of vaccinating all age groups to build up herd immunity soon in the country. Third, testing and surveillance shall be increased to the level needed to get a dependable data for scientists/policymakers to make decisions.

There are also countries that, adopting a zero-Covid policy, have constrained the development of herd immunity. It would therefore be a potentially fertile ground for incubating and releasing new variants. So, the free movement of people from such countries is likely to spread the new variants to the rest of the world.

Then turning to the public, it must be said that we have an equal responsibility, if not more, in containing the spread of the disease. But unfortunately, more and more people have given up their Covid-appropriate behaviour perhaps, presuming that health risks of Omicron are not significant enough to warrant avoiding crowds, maintaining safe distance and masking or because of their vaccine status, their youth, or desire to move on to old normal.

Though the optimism brought out by Omicron about the pandemic waning is understandable, the break in behavioral adjustments is certainly an undesirable development. For, the way the virus has so far mutated releasing four variants within a short span of two years, makes it suicidal to think of no new variant scenario in the future.

So, what is needed is to stay correctly informed, protect the vulnerable and be conscious of the hand-hygiene.

Wishing on this Ugadi day good health to you and yours ….

2022, the Year of ‘Uncertainty’

 

The year 2021 has come to an end as it had begun. It was a hard year that threw us all into an ‘uncertainty’ of unpredictability resulting in anxiety, depression, and sorrow. Amidst the fear that something is looming around the corner, which has almost become an inescapable presence, people all over the world faced similar plight—scrambling to find comfort, hope, and relief, however fleeting it might be.

Rapid vaccination drive in certain parts of the world did help avert the worst effects of Covid-19, but scientists expect it to assume endemic status soon causing cyclic and seasonal waves of disease. The hardest part of the emerging scenario will be that this disease is not a temporary phenomenon and hence calls for a paradigm shift in our business set-up and societal make-up—calling indeed for permanent behavioural changes.  

Amidst this persistent threat, businesses were challenged by the disruptive crisis: millions of workers have dropped out of the labour force—a ‘Great resignation’ momentum was set in motion in the western world. As the business leaders are grappling with this new problem, the very future of work has now become a hot topic of debate. Though much is being talked about ‘Hybrid work’, the fact remains that we do not know how working environment will evolve in 2022. Yet, one thing is for certain: management of people and talent has acquired a new importance.

The pandemic has, also accelerated the adoption of digital technologies by companies, for companies with digital edge were found racing ahead of the rest. ‘Cloud’ and IoT have become two very closely affiliated internet technologies of the day. But there is a challenge embedded in the digitalization of businesses: inclusive growth may be impaired. Indeed, digitalization is all set to trigger layoffs to save costs and realize growth in productivity. Simultaneously, it may lead to labour tensions in terms of skill-mismatches, rising unemployment and stagnant wages. The tech landscape thus sounds pretty complex and calls for a careful assessment of its scope for fuelling sustainable and inclusive growth. 

Rising inflation has become another challenge all over the globe—even the traditionally low inflation countries like the US and Germany are reporting inflation close to 6%, a three decadal high. The accommodative monetary policy of the RBI though served the economy well in the early phase of the pandemic, the delay in withdrawing the excess liquidity in the system by it has resulted in wholesale price inflation reaching 12.54%, the highest in five months, and it is only a matter of time before it gets translated to higher retail prices. The price increases and higher wages that are witnessed in many countries may throw the already disrupted global supply chains into further disarray. This means, inflation would not remain as a ‘transitory’ but soon will assume a permanent threat unless tackled immediately and that is what the US fed is aiming for now. Here, it is worth remembering that high inflation impacts the poor disproportionately, for they do not have staying power nor are there any social safety nets.

It is amidst this intense feeling of fear, helplessness, and desperation that the world looked forward to the dawn of the New Year, 2022 hoping it would reanimate the human heart. But with the dispiriting news of the emergence of a new variant of coronavirus, Omicron, the common man on the street is once again afraid of his economic fortunes.

Encouragingly, despite the resurgence in concerns about Omicron, Indian businesses are found to be pretty optimistic about 2022: they are very bullish on private investment and growth in the economy. And, this is not an ill-founded optimism, for India’s GDP during the second quarter of the current fiscal grew by 8.4%. Another noteworthy feature of this growth is that as against the contraction noticed in all sectors except agriculture and electricity during the Q2 of the previous fiscal, this time around, all the sectors did well: indeed, grown sequentially.

But the challenge posed by the Omicron to employers in terms of keeping their workforce safe while meeting their business needs, may derail the growth process. The only hope for the economy in such a scenario is for the government to focus on capex to boost growth. The National Infrastructure Pipeline, perhaps needs reassessment and in particular, realignment of its timelines. Also, its funding, for obvious reasons, needs to be delinked from asset monetization to strengthen the ongoing growth momentum, and achieve the aspired for double-digit growth in GDP. Startups emerged as a silver lining in the Indian scenario, which the government should support out and out as they are found generating employment, particularly in tier-2 and tier-3 cities. While prompt corrective measures are needed to keep inflation under check, fiscal consolidations would need to be calibrated carefully so as not to disrupt the ongoing growth process.

It is with our inherited indomitable spirit and resilience that we must face the threat posed by the coronavirus collectively and responsibly to help the economy wriggle out of its grip.

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Sail Forth ... O Brave Soul...

 

A new year dawned dispelling darkness and ushering in new hope. Braving the pandemic with an indomitable spirit and resilience that humans emerged out of 2021.

Amidst the death and disaster, it is the human spirit that ultimately won the battle. As always, it is the human spirit that flew on and soared high on fragile wings in search of new answers to the new threats. For, search is in itself blissful; aspiring itself is life.

Science and scientists gave a newfound hope against the pandemic. Doctors and nurses, transforming themselves as Covid-warriors, did their best in giving hope to the suffering lot.

Future unfolded from that silent explosion, asserting its might over the darkness. Sensuous pleasures of the known world reappeared before the dreaming eyes promising the forbidden delights of life in 2022.

But in that symphonic breathing of rekindled wisdom, you and I have a role of our own: Play it religiously as defined by the Scientists: Care for the other while caring for yourself. That is the Mantra to fight the ever-tormenting virus. 

Let us collectively fight the virus to win back our known normal!

Merry Christmas!

We, the humans, are a very frustrating lot”, said a writer. For, as a species, we are erratic, talented, magnificent, creative, arbitrary, snitty, loving, aggressive and what not!   

However erratic we might be, there is still value in our interactions with others. No doubt, every life has to end in death. But it doesn’t mean our life has no meaning. Its value and meaning squarely rest on the way in which we interact with people around us and how their lives have been affected by our interaction. And in that good effect which changed their lives for better, that we gain a sort of immortality!    

Think of the people who were affected by the Coronavirus pandemic: Globally 270 million people were said to have been affected by the coronavirus and more than 5 million—a figure said to be a “gross underestimate”— were dead. Think of your neighbours, friends, relatives, and others, and evaluate how your covid-appropriate or -inappropriate behaviour would affect their lives in the light of the emergence of a new variant of Coronavirus, Omicron.

Reports indicate that Omicron is advancing around the world at an astonishing rate. A study in the UK revealed that each infection of Omicron tends to produce at least three more. As against Delta’s doubling time of 11 days to two weeks, Omicron is reported to be needing hardly three days. This exponential growth, which is currently noticed in the UK, is certainly dizzying. Scientists fear that with a spread of this kind, Omicron is sure to replace Delta, the variant that is currently causing havoc globally, soon.        

Still worse is, that the risk of breakthrough infections—reinfections or infections among the vaccinated— appears to be three times higher with Omicron. Lab tests reveal a significant decrease in vaccine-derived antibodies’ ability to control Omicron, said Dr Fauci, the Chief Medical Advisor to the US President.  But within a month of a booster shot, antibody protection appeared to have significantly improved.   

The only good news, if any, is: evidence is building up towards omicron infections being less severe. Experiences in South Africa and the UK indicate fewer hospitalizations, comparatively, fewer days of stay in hospitals, and less need for supplemental Oxygen.  According to Dr Fauci, the data from the UK “very strongly suggestive of less severity compared to Delta”.

A similar phenomenon is reported from India too. According to a report of ICMR, of the 358 cases of the Omicron reported from India, nearly half were found to be fully vaccinated. None of those evaluated had severe disease symptoms. Nearly 73% of them were marked as ‘asymptomatic’. Of them, 60% were men.

Regarding booster shots, Indian vaccinologists are still examining the data on the efficacy of various vaccines and how persistent antibody levels were. It is hoped that once culturing of the Omicron variant, which is said to be harder vis-à-vis earlier variants, is mastered, its impact on the efficacy of Covaxin and Coveshield could be evaluated rightly and then a decision can perhaps, be taken on the booster shots.

As the matter stands, it is clear that the “virus is tough to control”, for a third of those infected are asymptomatic and 60% of infections are reported from those who are symptom-free. So, the way forward is complete vaccination of the people globally. This is a long-drawn process.

In the meanwhile, if we have to protect ourselves from Omicron what we need to do is: Adopt other mitigation methods such as wearing masks, hand hygiene, and maintaining appropriate distance from each other. It is here that ‘belief’ comes to play a significant role. For, belief is the essential component of the coping mechanism of humans with the world around them.

What then, is this ‘belief’, and what effect it has on our behaviour? Belief can perhaps be defined as “any set of perceptions which are sustained by a person as a consistent attitude or view and which extend beyond any factual information available, or even contrary to relevant factual information.”

On Thursday, Allahabad High Court, observing “…if there is life, election rallies and meetings can be held in future as well…” requested the Prime Minister and the Election Commission of India to immediately ban rallies and public meetings of political parties, and consider postponing the 2022 UP Assembly election due to rising cases of the Omicron variant. Example enough for belief-driven behaviour? 

Belief thus becomes central to our behaviour. So, think of your friends, relatives who, craving for oxygen in or outside hospitals, lost their lives during the second wave of the pandemic. And this thinking about your lost friends, relatives, neighbours is sure to ignite a question: “If we make a mess of our own world, who is there to come to our rescue?”

This belief-driven behaviour is sure to make the lives of all those about whom you care safe and secure. If we all collectively behave, Omicron’s impact can be put in check. So, let us believe in Covid-appropriate behaviour and interact with society accordingly to make our lives meaningful.       

Reopening of Schools: How Prepared We Are to Deal with Unintended Consequences?

Irrespective of the epidemiology of Covid-19 that varies from one place to the other, our education system consisting of schools, colleges and universities was shut across the nation under a uniform policy, since March 2020 to almost August of 2021. This has no doubt created a sort of educational emergency in the country. 

During the closure, some schools have, of course, offered on-line teaching. There are also reports indicating significant number of on-line “learning-sessions” (3-17 bn) and “learning-minutes” (37.85 bn) during the closure.  But as the studies carried out by private organizations/NGOs reveal that most of the teachers are unprepared for remote teaching, one is forced to wonder if these metrics really mean anything.

Over it, the youngest and the poorest students were to struggle a lot to catch up with the online classes owing to lack of devices or lack of knowledge-support from the family to handle these gadgets to learn the lessons, to submit the homework and to write the tests. In the process, no wonder, if many children from such families had given up learning.

The woes of these children, if examined dispassionately, are not just limited to availability/ non-availability of gadgets alone. With the pandemic-induced lockdown causing job-losses or the death of the breadwinner caused by the novel coronavirus made many children from lower strata either ending up in caring for the sick/younger siblings or work for pay.  The net result of the loss of formal learning for more than a year is: further widening up of educational inequalities in the society.

Tragically, this is not the end of the list of difficulties faced by millions of children hailing from the poorer sections. Due to this lengthy closure of schools, these children were to forego their midday meals. This had resulted in malnutrition which is sure to impair their cognitive abilities. And this is bound to reflect on their future learning prospects. 

Against this backdrop, a group of 56 experts—academicians and doctors and intellectuals from other professions—requested the government to consider reopening of schools and resume in-person classes for, “younger children are least at risk.” Their contention is that vaccination of children should not be considered as a prerequisite for reopening schools, since children are at a relatively low risk of severe or fatal Covid-19. And that is after all what the vaccination too is affording: prevent severe illness and death. So, they urge the governments to strike a balance of risks, which in their opinion, indeed favors opening of schools.        

Thus, governments have finally started reopening schools, colleges and universities. In a way it sounds pretty encouraging. Simultaneously, it also rings alarm bells for, there are multiple challenges—known and unknown—likely to emerge that call for effective management.

First things first:  observing Covid-19 appropriate behavior in the schools. Each school must prepare and be ready with a support plan to ensure safety of children. Testing temperature of children at the time of entering the school, enforcing wearing of mask, maintaining distance and proper ventilation in the classrooms, disinfecting school environment, particularly areas that are frequently touched and ensuring availability of hand hygiene facilities are the minimum requirements that schools, particularly government schools must cater to.  

As a uniform policy, students were promoted to next grade, though syllabus was not fully covered, merely based on their class-tests, etc., and hence there arises a need  for offering a kind of ‘bridge-courses’ to students to cover-up the learning losses. In the same vein, schools that offered on-line teaching  may have to offer a sort of ‘remedial-courses’ to such students who could not avail the on-line offerings owing to lack of infrastructural support.  How geared up our schools are first to identify the gap,  then structure bridge-courses with appropriate syllabus and offer support coaching to impart learning is a big question mark.  But the danger of pushing up students through to the next grade without offering such learning being obvious, this gap needs to be addressed with due diligence.

Finally, let us take a look at the health support system available for the students. Although children are said to be less prone for severe or fatal Covid-19, should contrary happen, its broader impacts on society as a whole will be catastrophic.  The experience of the US that had opened schools recently, particularly with Delta variant, appears to be different from common expectations. Also, we do not know the long-term effects of the disease on children, particularly children with malnutrition and other comorbidities. Another threat that the school-going children pose is that they can become ‘super-spreaders’ of the disease.

In the light of these threats, public health support system must gear-up to ensure that students—children, adolescents and young people—have easy and quick access to Covid-19 testing, quarantine and treatment facilities. Specially equipped hospitals with appropriately trained medical staff for treating young patients—isolated from parents—of Covid-19 are to be created and schools/parents to be kept informed of such centers to avail their facilities, should a need arise without loss of time in running from hospital to hospital.

But the big question is: Have we made these arrangements adequately? The answer is anybody’s guess!

Covid-19 & Religious Tourism Won’t Go Together

Pilgrimages to holy sites have no doubt immensely contributed to the development of geographic, cultural and civilizational horizons of nations in all religions of the world (Singh, 2004). They are the oldest form of tourism. India and her religions are no exception to this phenomenon. The good part of them is that they are changeable: interactions of religious, social and natural factors occurring within the geographic space of pilgrimages do result in such changes (Cohen, 1992; Coleman & Eade 2004; Digance 2003). Covid-19 is one such natural factor that has radically changed the traditional regular pilgrimage movement world-wide.

Against this backdrop, it is in good order to congratulate Mr Pushkar Dhami, the new Chief Minister of Uttarakhand, for his bold and rational decision of banning this year’s kaanwar yaatra due to the ongoing Covid-19 pandemic. Thanks to his foresightedness that other states like UP, Bihar, Jharkhand, Odisha, and Delhi immediately followed him by banning Kanwar yatra. His was a wise decision of significant bearing for reasons galore.

First things first: millions of religious-minded people undertake Kaanwar yaatra to fetch sacred water from the Ganga at pilgrimage centres such as Haridwar, Gaumukh, and Gangotri in Uttarakhand and Sultanganj in Bihar. These Yatris (pilgrims) could obviously become the potential super-spreaders of the coronavirus across the country.

At least that’s what the past incidents warn us: at the beginning of the first wave in early March 2020, of about 4400 covid-19 positive cases in India, nearly a third were said to be related to the religious gathering at the Markaz, the Jammat headquarters in Delhi. Government reports indicate that more than 8000 people from across the country—including people from foreign countries that were known to be hotspot nations for Covid-19—visited the Markaz.

None of them were screened for the disease till the lockdown was announced on March 25. It was a chance encounter of Tamilanadu officials with the Thailand national at Coimbatore airport that triggered a search for people who visited Markaz and their contacts to screen for coronavirus. Being alerted by this incident, the panic-gripped States launched a massive search to identify all those who had visited Markaz and their contacts to quarantine them across as many as 15 Indian states so that at least further spreading could be arrested.

The whole episode raised serious questions about lack of alertness and transparency on the part of Central Government. It is worth recalling here what a silent observer of the whole episode said: “The governments have to demonstrate greater rationality than religious people”, for it commends that government cannot afford to satisfy religious demands at the cost of rationality and the overall safety of people.

Then came the second wave like a wild fire, overwhelming the health care system in the country. It was the Kumbhamela gatherings and the massive election rallies in five states besides, of course, peoples’ indifference towards covid-19 appropriate behaviour that were identified as the underlying causes for the deadly second wave. Bad policy decisions, poor surveillance and ignoring early warnings are also cited by experts as other reasons. There were frantic calls for hospital beds, medicines, oxygen, essential drugs and tests. The mayhem caused by the second wave is well summarised in the words of a surgeon of an effected district in Maharashtra “… What is worrying is that entire families are getting infected. This is a completely new trend”.

There appears to be yet another reason for emergence of deadly second wave: the report authored by Abhishek Anand, Justin Sandefur and Aravind Subramanian (former Economic Adviser to Government of India) states that the first wave “was also more lethal than is widely believed” and it is India’s inability to perceive the “scale of tragedy in real time” during the first wave that might have caused “the collective complacency that led to the horrors of the second wave”. Based on extrapolation of state-level civic registration from seven states, the report also opines that the Covid- related deaths in India might exceed the official figure by 3.4 mn. Although estimating Covid-deaths with statistical confidence may sound elusive, they need to be factored into future programmes that are meant for handling the pandemic.

Experts now opine that at the national level, the second wave is waning. But the heterogeneity at the local level, makes one wonder if India-wide trend of a sharp decline in active cases is now sustainable or not. Because of these variations, some experts are wondering if states like Kerala, Maharashtra and Delhi with R number hovering around 1 serve as a bellwether for the third wave.

That aside, the recent sero-survey report of ICMR reveals that one out of three Indians are vulnerable for Covid-19 attack, which means the overall vulnerability for the nation still remains very high. The important takeaway from these surveys are: Covid-appropriate behaviour is still the key defence against the pandemic, non-essential travel should be avoided, third-wave cannot be ruled-out, there being no difference between sero-prevalence in urban and rural areas, villages and cities are equally at risk, and there is no evidence to rule out reinfections and breakthrough infections.

Over it, as long as the virus circulates, it has the opportunity to further evolve—spinning off more transmissible variants. The IMA President, Dr Jayesh Lele, wrote a letter to government stating that “It is painful to note that in this crucial time [when] everyone needs to work for the mitigation of the third wave, in many parts of the country both government and public are complacent and engaged in mass gatherings without following Covid protocols”. It is this kind of human behaviour that aids virus circulation and even emergence of deadly variants.

All this cumulatively vindicates the significance of the banning Kanwar Yatra by the Chief Minister of Uttarakhand. This being the reality, we the citizens must understand: The Pandemic is not over. Let us not become part of the spread of coronavirus by wearing a mask indoors in public places, especially crowded places, and physical distancing. This commitment to public health adherence is all the more important in India, for 40% of our population is below the age of 17 which is not eligible for vaccination.

Simultaneously, government agencies are required to revitalise their genomic surveillance program so that we may have a better understanding about the properties of the variants, their clinical manifestations, diagnostic tests needed and treatment—simply put to better our containment measures. To conclude, let me quote what Dr C Lahariya advised: “…[if] people don’t follow Covid safety protocols, we only help virus spread faster”, which “will largely determine the fate of next wave”.  

 

Covid-19: Let’s Learn to Behave Responsibly!

It’s almost 15 months since we have been surreal. And, it became much worse in India with the disastrous second wave that left behind much agony and trauma—lack of beds in hospitals, lack of oxygen supply, lack of medicines, high financial strain on middle class families by way of mind-blowing hospitalisation charges, innumerable deaths, orphaned children and what not—among the victims’ families. And no one knows when we will get back to normal or even a new normal, for everything is fluid, nothing is certain, everyday something new is emerging challenging the wit of mankind. 

As the lockdowns were announced when the pandemic spread across the world, cardiologists feared that the people who are known to “eat too much, drink too much, exercise too little and fail to go for regular checkups” if confined to houses for a year or more with such behaviours which are the known drivers of cardiovascular diseases, would become more vulnerable for cardiovascular diseases and death in the days to come. Indeed, the risk of eating disorders across the age-groups skyrocketed during the pandemic. But there is of course, a way out: Cultivation of healthier lifestyle/habits can mitigate heart disease risks. Then the question is: how willing are we to practice it?

Then with the advent of the deadly second wave, doctors have diagnosed a rash of Mucormycosis, also known as ‘black fungus’, infection among recovering and recovered Covid-19 patients. Mucormycosis is a very rare infection. It is caused by exposure to mucor mould which is found in soil, plants, manure and decaying fruits and vegetables. Indeed, it is universal, found even in the nose and mucus of healthy people.

Doctors believe that it is the usage of steroids, a life-saving treatment for severe and critically ill Covid-19 patients, which might have triggered mucormycosis infection. No doubt steroids reduce inflammation in the lungs of covid-19 patients and may also stop some of the damages that can happen when the body’s immune system goes into overdrive to fight off coronavirus. But over-usage of steroids also reduces body’s immunity, besides pushing up blood sugar levels in both diabetics and non-diabetic covid-19 patients. And this drop in immunity is what is considered as triggering the black fungus infection.

People suffering from Black fungus infection typically experience stuffy and bleeding nose; swelling of and pain in the eye; drooping eyelids; and blurred vision and finally even loss of vision. Black patches may appear on skin around the nose. It affects even the brain and the lungs. It can be life-threatening in diabetic and severely immune-compromised persons such as cancer patients.

Doctors complain that most of the people infected by black fungus arrive late, mostly when they are losing their vision. And this forces doctors to surgically remove their eye to stop the infection from reaching the brain.

Then came the reports about white fungus infection. Doctors say that “fungus or any other infection is all around us; it is there in the environment. Indeed, we co-live with them. But when a man’s immune system becomes weak, they invade the body. White fungus infection can spread to any part of the body— skin, tongue, brain, digestive system, kidney—and the symptoms depend on which part of the body is infected. If the infection reaches digestive system, patient can face difficulty in eating and swallowing food; if it reaches head, one may experience headache, and nausea. However, the commonest symptoms are: white patches on skin, white tongue, diarrhoea, hypoxia even after recovering from Covid-19.

Now the latest is: Cytomegalovirus-related rectal bleeding is reported in five covid-19 recovered patients from a private hospital, Sir Ganga Ram Hospital, in Delhi. Doctors say that CMV is usually present in the body but developed into a disease after a person’s immunity is lowered by covid-19 infection. Now doctors advise that any person after recovering from covid-19, if experiences abdominal pain or blood in their stool must immediately go to a hospital.

To protect oneself from all these secondary infections—infections that become virulent once our immune system become weak—patients recovered from Covid-19 must eat healthy food to build one’s immunity. Importantly, we should shun junk food from the street.

In spite of such life-threatening developments, what is more painful to notice is: we have still not learnt how to behave in order to keep ourselves safe. We continue to behave more irresponsibly towards ourselves, our families and our fellow citizens. People merrily roam around with mask under their chin.

It’s not uncommon to see people move around even in closed spaces such as inbetween the rows of racks of a Supermarket with masks hanging under chin! The other day I saw a young man enquiring the store girl—bindas standing in close quarters—“Where is Suzi?” And that poor girl, perhaps, fearing for her safety, pulling herself a little away, answered, “there in the next rack”.   “Aren’t there ½ kg packets?” “No Sir, over”, replied she. And till all this was over, I had to simply wait at a distance for the man to give me way. Of course, that was not what bothered me—rather about that poor girl, don’t know, in a day, how many such visitors threaten her safety and god only knows how she manages to be safe.

Wait, there was yet another bizarre scene that I encountered at the vegetable racks. A young men in his track suit standing in front of Bhendi tray fished out his smart phone and enquiring, perhaps, with his wife, whether he should pick Bhendi or brinjal, mind you with the mask under chin… … and this goes on merrily for a while… all around the vegetable trays. He even sent a pic of some tray. Talking and moving around those trays merrily sprayed all the vegetable trays with his exhaled virus [?] aerosols. It was only after he left with tomato, I could move nearer to the rack to pick Bhendi and Brinjal from those very trays and if I am lucky, I may not carry virus home.

As I talk of such indifferent behaviour of buyers in shops, suddenly an incident that happened back in our flats came to mind. One day our watch man stopping the Swiggy delivery boy from going inside directed him to call the bidder to come and pick the pocket. At it the resident-buyer yelled at the watchman: “Why don’t you allow him to come to my flat? Where is Corona? Govt had freed everything. Everyone got vaccinated. Why worry corona now?”

Interestingly, this yelling raises a very pertinent question: What the covid-19 vaccines actually do? As per the present knowledge, vaccines do not prevent infections with the virus, they only protect people from getting dangerously sick due to its infection.

Vaccine efficacy refers to how well a vaccine works against the disease. For instance, if a Covid-19 vaccine is said to be of 74% efficacy, it only means: a vaccinated man has a 74% lower risk of developing the serious illness caused by the infection vis-à-vis a man who is not vaccinated. It is still not clear as to “the extent to which it keeps one from being infected and passing virus on to others”.

Over it, with the arrival of new variants—Alpha (first found in the UK), Beta (first identified in South Africa), Gama (discovered in Brazil), and Delta (identified in India), Delta plus—the very efficacy of these vaccines became a question mark. According to UK data, Delta variant, also known as B.1.617.2, has assumed the status of concern on two factors: it has about 40% higher transmission rate over alpha, which already had a 50% higher transmissibility than the original strain of the virus.

So, as Dr Anthony Fauci said, vaccine is only “an additional tool for fighting Covid-19, but we don’t have a tool to replace everything we do just yet”. It means, we cannot give off sanitisation, wearing a mask, maintaining social distance and avoiding mass gatherings, if we want to remain free from infection.

Let us therefore, own up the responsibility to remain safe by religiously practicing Covid-19 appropriate behaviour till things become clear and a settled norm returns to our lives. This shall automatically take care of the safety of our fellow beings too.

**

Ex-Gratia to the Families of Covid-19 Victims Makes Political Sense!

Two separate pleas seeking directions to the Centre and States to provide Rs 4 lakh ex-gratia to the families of which the bread-winner died of Covid-19 as provisioned under the Disaster Management Act of 2005 and a uniform policy for issuing death certificates to those succumbing to the Corona virus have recently come up for hearing before the Supreme Court.  

Presenting his plea, the advocate said that since Covid-19 has been declared as a disaster, every family whose member dies due to disaster is entitled for ex-gratia of Rs 4 lakh under Sec12 (iii) of the Disaster Management Act of 2005. He further pleaded that hundreds of persons who were engaged in such services as health care dept., police dept. municipal sanitary dept., etc., died while attending Covid-19 relief works and in many cases they were the “sole bread earner” for the whole family.

Hearing the pleas, the Supreme Court made three observations: One, terming the present process of issuing death certificate as “prima facie more complicated”, asked the Solicitor General to do the needful to ensure that families of those who died of covid-19 get proper death certificate so that they can avail benefits of the welfare schemes; two, enquired whether the National Disaster Management Authority headed by the Prime Minister has taken a decision not to pay Rs 4 lakh ex gratia to the families of victims of covid-19; and three, whether uniform guidelines on compensation can be framed under the Act “otherwise there will be heartburn. Somebody will get some money and others will get more”.

The centre, in an affidavit filed before the Supreme Court on June 21 said that as the finances of State and Central governments are under severe strain owing to poor tax revenues and increased expenditure on healthcare due to the pandemic, payment of ex-gratia to all diseased persons due to COVID-19 is beyond the fiscal affordability of the government. It also said, “It is an unfortunate but important fact that the resources of the government have limits and any additional burden through ex-gratia will reduce the funds available for other health and welfare schemes”. The Court has however reserved its judgement on these petitions.

This submission of the Centre rather sounds baffling. For, as per the latest statistics, total deaths owing to covid-19 stand at 3 90 691 and if all these families are to be compensated, the required financial outlay would be Rs 15 627 crore, which hardly comes to 0.44% of the estimated expenditure of the Centre’s budget for fiscal 2022.

Intriguingly, this financial outlay of Rs 15 627 crore is even less than the loss of Rs 19780 crore that Nirav Modi (Rs 12700 crore) and Mehul Choksi (Rs 7080 crore) together said to have caused to Punjab National Bank by their fraudulent acts.  

The recently approved takeover of Videocon Industries ltd by Vedanta group company in India’s first group insolvency resolution is said to result in a recovery of Rs 3000 crore against claims of around Rs 62 000 crore. These incidents clearly show how banks are being bled by the defaulting corporates floated by the rich entrepreneurs of the nation.

As per the latest data, Indian banks have written off loans worth around Rs 8 83 168 crore in the last ten years, of which PSBs alone have written off Rs 6 67 345 crore—a neat 76% of the total loans written off in the decade. And what is more important to be noted here is: a major chunk of these loans was availed by the companies floated by the top 1% of the wealthiest population of the country. 

Over it, to augment the capital of these loss-making PSBs, government has cumulatively infused Rs 3.16 lakh crore over the past five years (2015-16 to 2019-20) through budget. Compared to these losses that the Centre— the majority shareholder of PSBs—suffered, the financial outlay under the ex gratia payment to Covid-victim’s families simply pales. 

When looked at from a perspective that payment of ex gratia evades the likely contraction in consumer demand that might otherwise result due to the death of the sole bread-earner of such victim’s families, it turns out to be a stimulus to the economy. 

Imagine what would be the woeful plight of those families which are on the poverty-line/in the lower middle-income group  and eking out their lives through daily wages/meagre monthly salaries, should the bread-earner die due to Covid-19! They will not only fall below poverty line but also remain chronically poor for years to come. And such families would likely to be many. They need all the support—not only ex gratia but also long term support to come out of poverty—from the sane society and that is what the government indeed is for. Such benevolence makes a great political sense too!  

Cumulatively, payment of ex gratia merits government’s consideration. Of course, while framing uniform guidelines for such payment, Centre, in consultation with States, can limit such benefit to families within a certain income level. Such a gesture portrays the government with a human face. And that is what poor families look for in the hour of catastrophe.

 

Political Parties & Adam Smith’s ‘Invisible Hand’

 

The other day a reader of my blog post on Covid-19, with quite an analytical mind, remarked: “I am glad the blogger has appropriately paid compliments to the Mumbai commissioner Mr Chahal for his commendable handling of the wave… He could have dealt in more detail the two main causes for the surge of second wave one is Kumbh mela and the second reason… the lack of attention of … The US has paid advance amount to Pfizer and booked large number of Vaccine doses even in the 1^st wave itself anticipating 2^nd wave. The blogger should have emphasized on these two super spreading events.” 

True, I should have also dwelt on these missing links, but as I was more concerned about drawing the attention of readers to the excellent work done by Mr Chahal and his dedicated team in addressing the challenge posed by the 2^nd wave so effectively, and kindle a question in their minds: “How is it no other city thought of at least emulating BMC?” I made only passing remark about the issues raised by the reader.

Nevertheless, ever since I read my esteemed reader’s remark, particularly about the US paying Pfizer and BioNTech $1.95 bn as advance to produce and deliver 100 million doses of their Covid-19 vaccine if it proves to be safe and effective and on receiving regulatory approval for emergency use, I have been wondering at this offbeat act of President Donald Trump as early as in July 2020. 

Indeed, the US government had made an attempt to assemble a portfolio of vaccines under its ‘Operation Warp Speed’ programme by entering into such financial agreements with vaccine developers such as Novavax, Johnson & Johnson, Moderna and AstraZeneca involving a financial outlay of about $3.70 bn.

I call this move of Mr Trump offbeat, because, a study carried out by Harvard TH Chan School of Public Health found that “errors were committed in the pandemic’s earliest stages.” The report further observed that the Trump’s administration’s initial US travel ban of January 31 was applied only to non-US travellers coming from China though the virus was “already known to be present in Italy, Iran, Spain, Germany and the UK”. It went on to say that “The evidence suggests that ineffective national policies and responses, especially as compared to those of other wealthy nations … have been driving the terrible toll of covid-19 … in the US”.

Nor did President Trump worried of the pandemic: While Dr Robert Kadlee, the top disaster response official at the Health and Human Services Department, was busy in convening the White House corona virus task force as early as on February 21 with an urgent agenda to arrest the spread of virus, President Trump was predicting that by April, “when it gets a little warmer, it [virus] miraculously goes away”. 

Noticing the disregard of the US President to corona virus, Prof. Tim Naftali, clinical associate professor of history at NYU, wrote on January 19, 2021 in The Atlantic: “in the face of a devastating pandemic, he [Trump] was grossly derelict, unable or unwilling to marshal the requisite resources to save lives while encouraging behaviour that spread the disease”. 

But this very President, surprisingly took a very right decision of paying advances to vaccine manufacturers to make the vaccines available—once they have proven their safety and efficacy and regulators have approved them—to vaccinate the citizens with no further loss of time. What a bold decision! 

Intriguingly, this timely and rightful decision of President Trump reminds us of what a Scottish philosopher and economist, Adam Smith said in his famous book, An Inquiry into the Nature and Causes of the Wealth of Nations, some 240 years back: “It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own self-interest. We address ourselves not to their humanity but to their self-love, and never talk to them of our own necessities, but of their advantages.” 

Of course, Adam smith, introducing this as an economic thought that highlights how surprisingly “… an individual by pursuing his own interest, he frequently promotes that of the society more effectually than when he really intends to promote it”, set out the mechanism by which he felt economic society operated.  

Now my wonder is: Are political parties and their leaders any way differently operating from this principle? Take for instance our own political climate, we often hear every political party and its leaders talking about their intent to serve people, particularly the interests of the marginalised, those oppressed and the suppressed lot of the society. Leaders establish new parties to serve dalits, minorities and the downtrodden better. Even leaders change parties—yes, even quite frequently—all in their anxiety to serve people better. But the underlying intent is obvious: winning the elections, isn't it?  

Isn’t that in their endeavour for winning the elections, political parties/leaders also do good things for the society without even knowing how much good one is doing? In other words, a leader is often “led by an 'invisible hand' (the desire for winning the next election) to promote an end which was no part of his intention”. 

That’s precisely the motive behind Mr Trump's paying advances to vaccine manufacturers for developing and supplying vaccines quickely—just three months ahead of Presidential elections. It is because of the invisibility of such underlying reasons behind leader;s action,often times we fail to understand easily why political parties and their leaders do what they do, why do and do not take certain decisions and the timing of such decisions, etc.   Sometimes their acts, of course, also prove futile to their own interests! 

In the same vein, some of their decisions go against the interests of the ruled. Hence, it is essential for leaders to always remember what Adam Smith said: “The learned [leader?] ignore the evidence of their senses to preserve the coherence of the ideas of their imagination". Indeed, it is expected of a leader to tolerate multifaceted truths and divergent points of view rather than "Subjection to his Empire tyrannous". And that's what commoners aspired for, since ages.  

Any way that is the game of politics, but what India needs in these Covid-days is  not quarrelling on who did what wrong and when, rather it is time for political parties of all hues to bury their differences, at least temporarily, and to come together as a monolith to focus on annihilating the corona virus from India sooner!

India Needs a Relook at Its Vaccination Programme

 

Press reports indicate that a group of 116 retired civil servants from All India and Central Services that included former Cabinet Secretary K M Chandrasekhar, former Health Secretary K Sujatha Rao, former Foreign Secretary and ex-National Security Adviser Shivashankar Menon, former Adviser to the Prime Minister T K A Nair, et al. wrote an open letter to Prime Minister Narendra Modi urging him to provide: one, free, universal vaccination to all citizens of India; two, to ramp up RT-PCR testing in both rural and urban areas; three, to make adequate funds available to states for provision of medical facilities; and four, provide a monthly income support for the current financial year to the needy from the marginalised and deprived sections. 

The group has also raised certain other issues pertaining to governance and shortcomings thereof, but what I am concerned more about is their request for “free, universal vaccination to all citizens of India”. It is often observed by the epidemiologists that, there are only two policy instruments that could help any nation in controlling the pandemic: vaccination and lockdowns. But lockdowns have an adverse impact on the economy. It hits marginalised lot very badly, for their daily earnings are lost under lockdown. Thus, vaccination becomes critical in controlling the pandemic with minimal economic costs vis-à-vis lockdowns.

Over it, as Dr. Louise Ivers, executive director of the Massachusetts General Hospital for Global Health commented, the new variant, which appears to be more transmissible—might be as much as two times more transmissible as other variants—emerged as the predominant agent behind the ongoing catastrophic second wave in India that witnessed 350,000 to 400,000 people getting infected every day for almost a fortnight. Also, the social context that prevailed in the country during April had certainly played its own role in spreading the microbe wildly.

This sudden burst in cases has obviously hit our healthcare system which, according to Dr. Ivers, “is known to offer the best possible medical care in some centres”, while in others “even the most basic treatment for a diarrheal disease” is not accessible. That aside, the real challenge is of having no knowledge of a treatment to save lives of the infested except for the basic support of oxygen, triaging and some amount of steroids. And even that basic support of oxygen turned out to be something not that easy to get even in the best hospitals of the metros either. So, one can imagine the plight of lesser mortals in the semi-urban towns and villages. Under these circumstances, the only available means for the nation to fight out the pandemic is: vaccination.

As against this, let us first take stock of the ongoing vaccination programme. To begin with, we made a sincere effort to first vaccinate all the front-end healthcare and sanitary staff and police personnel. Then we addressed the needs of vulnerable section of the society by offering vaccination to all those above the age of 65 years as well as those above 45 with comorbidities. This exercise went on well for some time, till at least the Central Government announced that those above 18 could also join the queue for vaccination. But then, its announcement about different pricing mechanism for Central, State and private purchases turned the vaccination programme topsy-turvy overnight. All this clearly shows that in our anxiety to vaccinate the whole nation quickly, we have not done our maths correctly to match the production capacity of the two known vaccine producers in the country—SII and Bharat Biotech—with the number of people to be vaccinated. The result is: chaos and loss of valuable time as many states have paused the programme in want of supplies.

A report of E&Y shows that for vaccinating India’s population of about 108.5 crore that is above 12 years old, we need 217 crore doses of vaccine. Interestingly, the report also states that if the purchase of such a huge quantity is centralised, government can “reap economies of scale and have more bargaining power”—a commonsensical observation. Secondly, “Vaccines”, as Dr. Kizzmekia Corbett of Chan School of Public Health observed, “are the great equalizer when it comes to addressing health disparities, especially around infectious diseases”, such as Covid-19.  

It thus becomes evident that the Centre should take the whole exercise into its hands and procure jabs from all sources and put a transparent policy of distribution to States making them accountable for ensuring no wastage and vaccinating its populace. Else, each State, as is happening, will take its own time to call for global tenders, evaluation of tenders, negotiation for price, and finally by the time it places the order the whole programme of vaccinations gets inordinately delayed. It means, we would be quite ill-prepared to face the predicted third wave.

There is also a clear need for a well-tuned coordination between the Centre and the States to ensure a better harmony in their communication about managing the pandemic. It is in order here to recall what Dr. K Viswanath, Director, Harvard Chan India Research Centre said: whether it is in developing policies to handle the pandemic and their implementation, or enforcing issues of handling oxygen distribution and medicines in a very unified way across the nation, there is a strong need for coordination between Centre and States.

Looking to the production capacity of the existing manufacturers and not bothering about digging out faults of the past, we need to focus on future and organize ourselves as a monolith to vaccinate the population in an orderly fashion:

• Prioritize vaccination of super spreaders, i.e., auto and cab drivers, bus drivers and conductors, e-commerce agents, food delivery boys, workforce in the shops supplying essential goods and services
• Divide the population into different slabs of age, of course, matching with the supply of vaccines and proceed step by step to reach the lowest age group in an orderly fashion. 

And to carry out the programme in such an orderly fashion, centre has to take reins into its hands without minding who is footing the bill, for it is anyway public money, and chalk out a well-thought-out plan and execute it with finesse. Else, we may not win the war against the Covid-19!