In Covid 19 season, I am daring to pick two truisms. One, tomorrow never comes. Two, as economist John Keynes said: In the long run, we are all dead. Today, India seems to be in a dark place as things are rapidly going from bad to worse in Unlock 1:0. Raising a moot fight: Are we losing the Covid 19 fight?
Stories abound of people dying due to unavailability of beds in hospitals, three patients to a mattress, crowed corridors reeking of infection, corpses lying on beds waiting to be shifted to the mortuary. Underscored, by the heart-wrenching tale of an 80-year old running from hospital to hospital for admission and each time he is shunted to another. Till, he dies in a car waiting for a hospital bed.
More. Doctors and nurses are being forced to wear discarded, defected or rejected PPE, never mind if they get infected and die. There is shortage of masks, gloves and medical equipments with 70% machines out of order including oxygen. A study by the Global Antibiotic Resistance Partnership-India Working Group found infections rate of hospitals wards and intensive care units is five times more than globally.
Alas, two-and-a-half months since lockdown nothing seems to have changed. Already, the surge of cases has crossed 10,000 cases per day and counting whereby, we cannot cope with the flood. Worse, it looks like we have no clue how to go forward or a strategy.
Questionably, what was the purpose of the lockdown? Has it been successful? What is the measure of its success? Sure, it slowed the Covid-19 spread and bought us time to ramp up our ill-equipped and ramshackled health facilities along-with sensitizing people about the pandemic dangers and how personal hygiene and social distancing alone could help stop the contagion.
However, as Unlock 1.0 unfolds it showcases that we have been unable to flatten the rising pandemic curve of infected people despite low testing and fudging figures. Appallingly, India’s testing remains one of the lowest in the world at 4.5% — 2,198 tests per million people. In fact, the country is now among the top 10 worldwide vis-a-vis total reported infections, and among the top five in the number of new cases.
Sadly, the only curvature that has been crushed and gone under is the GDP. This has been accompanied by a lot of pain — from migrant workers, daily wage workers, businesses, police and health personnel, salaried people and housewives! The Centre for Monitoring Indian Economy estimates that unemployment has already spiked to 36%, with 26 crores people already having lost their jobs.
True, Modi is no magician who would waive his magic wand and the ills that have plagued us for over 70 years and beyond would evaporate. That he is trying his best cannot be doubted. Certainly all his decisions might not be correct in hindsight, but whether good, bad or impulsive time alone will tell. But at least he acted decisively.
The bungled lockdown triggered an exodus of millions of informal workers who lost their jobs in the cities and began returning home in droves, resulting in spread of infection from the cities to the villages. And with the messy easing of the lockdown there are growing fears of infections spreading further in the cities.
Alongside, our health infrastructure plagued by a heartless attitude, lethargy, corruption and bereft of cure and consolation accounts for less than 1% of the GDP spend, is crippled by a shortage of over 600,000 doctors and two million nurses. Only 58% of those who call themselves doctors in cities have a medical degree; in rural areas the proportion is just 19% and a third of ‘doctors’ have only secondary school education.
Abysmally, nurses and doctors in district hospitals do not have the required skill sets to deal with the crisis. They do not even know how to operate ventilators. When the lack of the required skill sets and unsophisticated ventilators come together, it is a lethal combination.
Take Delhi. Even as Chief Minister Kejriwal avers ‘all is well,’ as he reels out figures of the measures he is taking to curb the spread and how effective his Government has been in containing it, the State is in the ICU. Hospitals are overwhelmed by cases, patients are running from quarantine centres as toilets are overflowing with garbage strewn all over and personal hygiene is lacking due to water shortage in many areas. The babus stock reply: Toh kya karein?
What next? As the WHO has repeatedly stated there is no alternative to “testing, testing, testing.” The Government would do well to take this advice on a war footing and scale-up testing rapidly. For, a country of 1.3 billion, we should have already been testing at least 3 lakh people per day. Consequently, in absence of a comprehensive strategy of extensive testing the virus seems to be winning.
Certainly, India will not be able to pull off a Chinese miracle and build a hospital in 10 days. But it can prioritise hospital readiness by reducing red tape, speed up expenditure and upgrade facilities. What is needed is a national task force and clear targets regarding testing kits, hospital beds, and lead funding the biotech industry to work collectively for a vaccine and not inconsistent messaging.
Clearly, this is just the start of the war with the situation threatening to get worse over the next few weeks, India need to be well prepared. Asserted a senior doctor, “If the infection rate continues to grow, things are going to get pretty grim in a few weeks time. A critical-care bed needs an oxygen line, a ventilator, doctors, nursing staff. It’s a tactical nightmare”
“The infection is not spreading uniformly. India will see staggered waves,” added a leading virologist. Stating, a one-size-fits-all strategy to contain the pandemic by unlocking the country will not work as different States will see infection peaks at different times. For example in Maharashtra the reported infection rate, the number of infections for every 100 tests, is three times the national average.
One way, some experts suggest, is to plan ‘multiple, small, controlled, explosions’ rather than allowing the disease to have a single massive explosion. Another thought is by allowing activity based on age so that more and more young people get infected and build immunity, the virus would just go into hiding (herd immunity). Towards that end open schools and colleges sooner than later. We would have thus reduced the overall mortality.
Granting the inevitability of people having to return to near-normal even under ‘new normal’ conditions, the Government needs to have a Plan-B, Plan-C and whatever more it might take to contain and reverse the trend from now on. It needs to build a functional Government health infrastructure large enough to meet the needs of 1.3 billion people and plans to effectively control the virus, else we risk losing what we have gained.
Even as our leaders exhort people to exercise Sainyam and Sankalp, this alone is not enough. The Government needs to remain focused and turn this crisis into an oppurtunity. It cannot afford to waste the valuable lead time it gained during lockdown which has prepared us for a new tomorrow with a new normal! As American singer Kenny Rogers sang: “If you’re gonna play the game, boy, You gotta learn to play it right.” All India needs to do is play it right.