In the last
couple of months or so, there have been number of posts on the Chinese flu and
its consequent impact on socio-economic life in India and across the world. One
of the recent posts
talked about the Indian strategy in Unlock 2.0. Throughout the lockdown and
unlock versions, there have been debates on the feasibility of the same or the
alternative solutions to thereof. Many of the previous posts have captured
these debates at good length. One post
talked about the importance of the
understanding the rate limiting step of the corona virus so that it might
enable a mitigating strategy. Similarly, this post
discussed the merits or the lack of it about the debate on herd immunity. This post
talked about the possible strategy that needs to be factored in while exiting
the lockdown. Also this post
discusses the disruption in the healthcare equilibrium and how it needs to be
tackled as the country faced the pandemic. The economic impact of the same
among others is captured in some of these posts here,
here
and here.
There is of course a strong debate as mentioned before between economy first or
health first. The post
captures some motivations of the economy
first crowd. There is also a discussion here
the importance of data in mitigation and future strategies to cope with the flu
from Wuhan. The current post seeks to
add on to the matter discussed before in the current time-space context as
India continues to grapple the pandemic.
The lockdowns
are on and off and most of it is at the state level. UP is on a lockdown, quite
a number of cities and towns in Maharashtra too are under a lockdown. There was
a lockdown in Chennai, Madurai among other places in Tamil Nadu. Assam too
imposed a lockdown in metropolitan Guwahati while Kerala has imposed what it
terms a triple lockdown in Thiruvananthapuram among other cities. Karnataka
imposed a lockdown in Bengaluru among other districts for a week to ten days.
Apparently at this moment, across the world, aside of a lockdown very little
alternatives are available. These measures are not just in India but visible in
cities in US, Australia and Japan too. Yet these lockdowns too create their own
diminishing returns with passage of time. The current juncture is at a stage
where in absence of a vaccine, the only way that the chain can be broken is
social distancing with masks and hand hygiene. This has to be accompanies by
what they call test, trace and isolate. There seems to be little options
available. There are of course some optimistic voices suggesting an early
vaccine perhaps as early as August or September but perhaps it is too much to
depend on these given the natural life cycle of vaccine development. Therefore,
one needs to understand the options and decode them in order to plan the future
strategies.
In March/April,
the ICMR had suggested the use of hydroxychlorquinine (HCQ) as prophylaxis for
the high risk groups. Yet in the two months or so have passed since then but
barring a couple of anecdotal data, there is no data or information on the
efficacy of these treatment line as prophylaxis. If there were to evidence of
its success, then it could be expanded into other vulnerable groups thus
reducing the possibility of the spread. There are anecdotes emerging from
multiple places about its utility as tool of treatment but no information on
the original plan of its being a preventive medicine. It is time that ICMR
release the data.
Secondly, ICMR
is still silent on the links between the viral load and disease severity and
viral load with reproduction ratio. It is time to come out with the findings on
these important aspects. These findings are likely to go a big way in
addressing the apprehensions in the common man or woman as also in the decisions
of the policy makers. If there is evidence of low viral load translating into
low reproduction ratio, then it would have significant impact in disease planning
and mitigation strategy. There must be something lead indicator or coincident
indicator that could point out towards a possible superspreaders. Each patient
then can be addressed uniquely whether they are potential superspreaders or are
low spreaders. The isolation would be more emphasized on the superspreaders. Further,
low viral load if it translates into lower disease severity would also link to
the healthcare planning and isolation of patients.
The waiting game
for vaccine and towards that frequent lockdowns might not be everybody’s best
interest. The testing too has not increased. The current rate of testing is not
even in arithmetic proportion when the testing needs to be in exponential
proportion at this moment. At this stage, the ICMR must seek to experiment with
new prophylaxis tools just as it is experimenting with various lines of
treatment like remdesvir, plasma treatment, HCQ, azithromycin plus zinc among
many others. There is of course a recourse towards building immunity through
intake of Ayurvedic products. These too could have been experimented, data
collected and findings disseminated. If Ayurveda or other India medical herbs
could generate certain preventive steps within the human body, it could go a
long way in building immunity while slowly opening up the economy.
At this stage,
lockdowns could only be useful if they facilitate increasing testing. Since
people would be at home, it would be easier to test in higher numbers and thus
follow up with quick isolation and treatment. Further, this would prevent the
spread of the disease into the hinterland as the travel eases in the next few
weeks or so. But, this does not come out in strategy of either states or the
ICMR at the central level. The increase in antigen tests or the serosurvey
tests on a large scale to detect the rate of prevalence too have not taken off
in the way they should. India still has not reached one percent of the
population being tested when the current infection rates entail testing of
15-20% at the least. This is where ICMR has to emphasize along with the release
of the data about the patients and the spread patterns so far.
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