Corona Virus: The Action Plans

The Novel Corona Virus (COVID 19) emerged from Wuhan, Hubei province, China, end 2019, & as per Worldometer has since spread to infect over 3.16 lakh people resulting in 0.13 lakh deaths (Fatality rate 4.3%). As per the Centre for Disease Control & Prevention (CDC), United States, the virus causes serious illness to 16% of patients while 84% are only mildly effected; furthermore, fatality is high for people across ages with chronic medical conditions – heart, lung diseases or diabetes - & for those aged over 65 years. World health Organization (WHO), perhaps belatedly, has termed it a pandemic only on March 11^th. 

German Chancellor, Angela Merkel, has opined that about 70% of Germans shall be infected by the virus & it is reasonable to assume a similar spread rate in other countries too with the fatality rate linked to the strength of the country’s healthcare infrastructure. Italy, despite having one of the best healthcare infrastructure, is an outlier with a fatality rate of 9% while South Korea is at 0.1%. As per the Financial Times, 23% of Italian workforce is aged above 65 years, the largest in the European Union, & that explains its high fatality rates - 35% of deaths reported in Italy were in the 70-79 age group & 43% in the 80-89 segment. The corresponding percentage of Indians, aged above 65 years, as per the 2011 census, is 5.3% but that is no consolation since the absolute numbers are humongous.- higher than the entire population of Italy - & that makes India extremely susceptible. Likewise, Indians, like Italians largely live with their parents, under the same roof & that could increase chances of infection; as per the same Financial Times article 66% of Italians, aged 18-34 live with their parents unlike 48% for EU.

South Korea, with a population under 6 crores, has avoided massive lockdowns, & conducts about 20,000 COVID-19 tests daily, that helped identify clusters with the highest risk of transmission, to have more focused, targeted action - a different protocol that elicited WHO praise; they rationed weekly face mask sales from pharmacies to contain the pandemic & launched an app that helped identify patients violating home quarantine protocols. As per Business Insider, India with a population of 1.3 billion conducts 90 tests per day, perhaps, to avoid spreading panic & to keep healthcare costs low, buts risks downplaying the extent of the pandemic.

India should learn from the experience of other countries;following is the suggested response:

(1)Protect the Healthcare professionals: Indian Parliament was informed on July 2^nd 2019, that India has a doctor to population ratio of 1:1457 & Nurse to population ratio of 1:675 against the WHO norm of 1:1000 & 3:1000 respectively & hence inadequate. They form the first line of defense & if they crumble we shall, inadvertently, invite a disaster. In the current context - where this pandemic is wreaking havoc worldwide - healthcare professionals from friendly countries stepping in to fill the gap is unlikely, unlike 2014-16, when the world stepped in to help the Ebola struck West African states of Liberia, Guinea & Sierra Leone. Hence the need to provide more than adequate protective gear like - hazmat suits - to doctors & nurses; reports of shortage of N95 masks, if true, is thus disconcerting.

India too was ravaged by the Spanish Flu, in 1918, & as per the BBC killed 17-18 million citizens –about 6% of the population while a third of the world’s population was affected claiming 50-100 million lives. While the flu slowed its advance during summer, it emerged in a more virulent form later & India needs to be prepared for a similar trajectory, as a worst case scenario.

(2)Flatten the curve of pandemic spread: With no vaccine available yet, non-pharmaceutical interventions – like lock-downs & social distancing- are the obvious choices along with a nudge towards a ‘behavioural change” of incorporating basic hygiene of “hand wash” to prevent the spread of the virus. Doctors are now using a mix of anti flu, malaria, anti retroviral, anti HIV drugs - class of drugs known as "Protease inhibitors" - which block a key enzyme that helps viruses replicate, that was used for treating SARS (Severe Acute Respiratory Syndrome) earlier; they could have unintended side effects though. It might take about 18 months for an antidote to emerge & hence the need to flatten the curve to buy time for our epidemiologists to discover a vaccine.

While avoiding fairs, festivals, theatres, schools, public lecture halls & entertainment spaces is a valid ask, the natural propensity of citizens to visit places of worship, during such distressing times, needs to be curbed.

(3)Succor through Public Distribution System (PDS) or Income transfer: 94% of Indian workforce is in the informal sector – many without social security benefits - & the lock-down could eliminate their meagre savings in under a month or two. For basic sustenance, they need to have access to the either of the following

(a)Public distribution system (PDS): Supply basic cereals & pulses, if need be free of cost for 3 months (say). There is a possibility, though of such large congregations of people standing in a line, that violates the principle of "social distancing", accelerating the spread of the pandemic; expecting shortages, if crowds violate queue protocols, deaths vide stampede possible; police force deployed, for maintaining law & order at those locations, too could get infected with the virus, creating fresh law & order challenges.

(b)Income Transfer: Income transfers to the people could lead to a better alternative of maintaining social distancing vide lesser no. of people at each of the mom & pop store across the country to buy food essentials, thereby sustaining the retail trade too. Since India spends about 2 lakh crores on food subsidy - to aid 66% of population, as per the Food Act - & 75000 crores under PM Kisan each year, a quarterly transfer of these moneys, vide Direct Benefit Transfer (DBT), suggested. Handling a pandemic, such as this, is akin to war & if situation worsens, fiscal deficit targets, too, can be loosened. States too should pre-pone DBT of pensions & other welfare program benefits.

The above suggestion, however, assumes that essential supplies – cereals, pulses, milk, vegetables & fruits – can reach each town/village. But it is possible that despite Indian Railways & State Road Transport organizations doing the heavy lifting, the last mile connectivity to each store could still breakdown. Effectiveness of Income transfers is thus contingent on reducing, to the barest minimum, supply chain shocks & the consequent spurt in inflation resulting in increased prices of essential commodities. Furthermore, the 2nd trance of PM Kisan was delayed due to data issues; the problem, if still, unaddressed, makes DBT prone to errors. There still exists a segment of population without bank accounts  & beggars whom the state needs to provide succour directly.

Considering the above constraints, each of the Indian states might have to take an informed call on using a judicious mix of the above two options.

(4)Keep Essential services Going: IT infra to keep healthcare infra & online banking network going is critical. If schools remain closed, beyond the customary summer break, Telecom & the network backbone to run EdTech modules should remain robust. A Business continuity planning (BCP) for organizations in the field of IT, Telecom, banking, utilities etc. is thus critical.

Alternatively, since people above 60 years & under 10 years of age & those with a history of diabetes & cardiovascular diseases are most vulnerable, keeping such people quarantined at home & releasing the rest for duty with an emphasis on “social distancing” & “health hygiene” could be an arguable option. Else, we need to follow the South Korean model of no enforced lockdowns but increasing testing even if it means higher healthcare costs.

Conclusion:

Diseases such as these are now a periodic occurrence: Nipah 1999, SARS (Severe Acute Respiratory Syndrome) in 2003, MERS (Middle East Respiratory Syndrome) in 2012. While India has 1 doctor for 1457 people, averages hide the huge divergence across states; if this virus spreads to the BIMARU states, we are in irretrievable trouble. Investment in healthcare thus becomes a priority.

That the virus is part of a US-China war for supremacy is a conspiracy theory that is as widely circulated as is COVID-19 as nature’s reaction against its tormentors - performing its function of “natural selection” as it did to dinosaurs earlier. Ironically, humans are caged due to a lock-down & animals are moving freely out on the streets & that should prod the human race towards sustainable development. History, perhaps, shall still continue to be defined by the acronyms BC & AD but with a different connotation: “Before Corona Virus” & “After death of Corona virus”; death is an exaggeration here since the virus can always resurrect in a new form later.  A reduction in world population, from the current figure of 7.8 billion & a worldwide recession with consequent job losses, with a potential to head into social chaos, if badly managed, are chilling likely consequences. Optimistically, we shall live, to fight another day; together, we can!!