The Corona Combat: A Third Review

An incisive review on the ongoing COVID-19 pandemic by former DG Artillery, Lt. Gen PR Shankar and current HOD Aerospace engineering, IIT-Madras.


11 min read

The Corona Combat: A Third Review

General


It is day 15 of the lock down. 3/4th of phase 1 done.  Phase 2 fast approaching. That stupid Chinese Virus has not made much head way in India. We are ahead of the curve. India battles bravely and resolutely. The world is starting to look at us and say – hey, what are these Indians doing right?

Even WHO has praised us. The PM has spoken to all the CMs, Cabinet, Past PMs, Past Presidents and the Opposition. That is good. There is no politics in Corona. All states are in full swing. We are in it together – all for one and one for all. All communities can sink or swim together – no choice baby.  

The Corona Virus has done some good also. Pollution levels are low. CO2 emissions are down by more than 25%. Climate change negotiations could not achieve this. Do not say this loudly. The Chinese will say it is because of their global leadership! Incidentally there were reports that people in Jalandhar were able to see Himalayas.  A few days more and all the Sardars there will start seeing rockies! Then you will have to wonder which Corona effect they were talking of? The Virus or the Beer?

The government has taken very stringent action as per the data put out by Oxford COVID-19 Government Response Tracker. That is clear from the map above and graphic below. It is indeed commendable. The worlds most populous democracy with such a high rate of success in implementation. Sure there have been blips. That is to be expected.

The economic stimulus response may seem low. However businesses can wait. The needy need to be attended to. That is being done. I am also sure that the Government has kept its powder dry and has some reserves left. In this battle, the reserves, their deployment and recreation will matter. Take it from a salty old Gunner. The least cost approach will do well ultimately. We must be proud of what we have achieved so far. We need to just do more.

The Enemy

The enemy has not mutated as yet but has clearly  revealed it’s a slow festering fuse which attains critical mass and erupts with a fission rate of 2.5 if left unchecked. It has not yet surfaced fully in India. It has started spreading through asymptomatic people also. Stealthy. In China, Singapore and Japan it is re-appearing in a second wave. Singapore has gone into a 30 day lockdown. Japan has declared Emergency.  

Overall Assessment

We have to kill it or it will hit us hard in multiple waves. Its either the Chinese virus or us. Take your pick. However till we get a vaccine we have to live with it. It will be an endemic disease till we attain herd immunity either naturally or by design.

Current Status

Climate.  The temparature are varying between 29-36 deg C with night time temps around 21-24 degs.
Cases . The current status state wise is as below (https://www.covid19india.org/)

State/UT Confirmed Active Recovered Deceased
West Bengal 91 75 13 3
Uttarakhand 31 27 4 0
Uttar Pradesh 332 308 21 3
Tripura 1 1 0 0
Telangana 404 348 45 11
Tamil Nadu 690 664 19 7
Rajasthan 348 321 25 2
Punjab 99 77 14 8
Puducherry 5 4 1 0
Odisha 42 39 2 1
Mizoram 1 1 0 0
Manipur 2 1 1 0
Maharashtra 1018 875 79 64
Madhya Pradesh 290 248 21 21
Ladakh 14 4 10 0
Kerala 336 263 71 2
Karnataka 175 146 25 4
Jharkhand 4 4 0 0
Jammu and Kashmir 125 118 4 3
Himachal Pradesh 27 24 1 2
Haryana 143 110 31 2
Gujarat 175 136 25 14
Goa 7 7 0 0
Delhi 576 547 20 9
Dadra and Nagar Haveli 1 1 0 0
Chattisgarh 10 1 9 0
Chandigarh 18 11 7 0
Bihar 38 22 15 1
Assam 28 28 0 0
Arunachal Pradesh 1 1 0 0
Andhra Pradesh 314 306 5 3
Andaman and Nicobar Islands 10 10 0 0
Total 5356 4728 468 160

Hot Spots

20 hot spots and 22 likely hot spots have been identified by the Government. These are increasing.

Outlier Events

There are a few outlier events which have occurred which have an overall bearing on the overall situation. The Tablighi Markaz event has turned out to be a pan India problem with many infected members moving to and fro from many districts in the country.

As result infection must have transmitted much beyond; despite the contact tracing efforts. They will surface after 15 Apr only when the incubation period is done. It has a bearing on the lock down period.

The Migration fracas must have taken infection into rural areas. Though there are reports that these migrants have been traced to their villages and put in isolation camps. The efficacy of such action is suspect. This time bomb is an unknown quantity and will go into fission mode only after 15 April. It is very common that people disregard common cold and cough in the lower income groups, specially in heart land India. Hence many cases could go unreported. It has two facets.

The young population of India, and many of them are migrants, will be able to/might come out of it without reporting. Simultaneously herd immunity is building. The problem is that there is undetected transmission going on at fission rates which will burst on us after two weeks when critical mass is achieved.  All these indicate that the Chinese Virus must be pulled out of its hole like a cobra. Which means lock out has to continue.

Gearing Up

The entire country is gearing up for Phase 2 of the battle. We are now battle hardened.  

Assessment

The Chinese Virus is still in Stage 2 with limited community transmission in hotspots.

Harvest

Beyond 15 April is harvest time. This has to be factored in all calculations. It is unthinkable that harvest activities are curtailed.

Fatality Rates and Case Discovery Rates

Everyone says ‘Test, Test and Test’. The feeling is that we are not testing enough. Hence, data from countries badly affected in the temperate zone, tropical zone and an outlier (S/Korea) were analyzed. The true indicator of prevalence of disease in the country is death and hospitalization; if you cannot test enough.

Another indicator is - for the number of tests being conducted how many cases are being discovered or are surfacing? This analysis was done for 05 and 08 Apr and has been tabulated.  Focus on the fatality rates, and the case discovery rates columns. View it from any parameter, Indian rates and actual numbers are the least.

An analysis of data from these tables indicates the following:

COUNTRY (08 Apr 2020) CASES CASES/Million DEATHS DEATHS/Million TESTS TESTS/Million FATALITY RATE /M (%) FATALITY RATE /M (%) (05 Apr) CASE DISCOVERY RATES (CASEs/TESTs (%)) CASE DISCOVERY RATES (CASEs/TESTs (%)(05 Apr))
Temperate Zone
USA 400412 1210 12854 39 2075739 6271 3.22 2.76 19.29 18.8
SPAIN 141942 3036 14045 300 9.88 9.48
ITALY 135586 2243 17127 283 755445 12495 12.61 12.32 17.9 18.9
GERMANY 107663 1285 2016 24 1.86 1.48
FRANCE 109069 1671 10328 158 9.45 8.41
IRAN 62589 745 3872 46 211136 2514 6.17 6.1 29.64 29.96
UK 55242 814 6159 91 266694 3929 11.17 10.3 20.71 22.8
NETHERLANDS 19580 1143 2101 123 86589 5053 7.96 9.89 22.61 22.04
Tropical Zone
INDIA 5351 4 160 0.1 140293 102 2.5 2.33 3.81 2.79
SAUDI ARABIA 2795 80 41 1 1.25 1.176
PAKISTAN 4035 18 57 0.3 39183 177 1.66 1.66 10.29 8.2
MEXICO 2785 22 141 1 25410 197 4.54 4 10.96 12.06
Outlier
S KOREA 10384 203 200 4 477304 8996 1.9 2 2.17 2.21

In all parameters India is at almost the lowest levels. Temperate region countries are very badly off as compared to tropical countries. Hence it would be fair to say that we will not be so badly affected. Deaths and number of cases are low in India. There is a similarity with Pakistan being in the same belt. This is crucial since India went into a stiff lock down whereas Pakistan did not.

Very interestingly the number of cases surfacing for the tests we have conducted is among the least. The testing rates are akin to S Korea! Even if we increase the cases by 20 % and decrease the tests by 20%, the case discovery rate stays below 6%. So what does this tell you? It tells you quite a few divergent things as under:
The disease is not prevalent or transmitting at rates as seen elsewhere. It is far slower. The lock down is clearly working. This could also be due to other factors like rising temperature, BCG vaccination factor, natural immunization due to exposure of Indians to multiple virus / Other endemic diseases. Kerala was looked at separately since it is one of the earliest affected states due to a high level of overseas traffic and migrants.

It has 275 cases and has tested 11232 persons. Its case discovery is 2.44%. it approximates to the national average (http://dhs.kerala.gov.in/wp-content/uploads/2020/04/Daily-Bulletin-HFWD-English-April-7-1.pdf).
We might be testing the wrong persons. Possible. However the probability is low.Cases are not being reported even for testing.

Hence transmission is taking place unchecked without our knowledge. Even if there are a lot of unreported cases, hospitalization and death would have spiked. That has not happened. However it would be prudent to monitor deaths due to other diseases.

If this is true, it might burst on us one fine day in the next week or so.It is also possible that unreported cases have recovered or in self-recovery mode due to the youth factor. In which case two things are happening. The youth dividend is paying off and herd immunity is increasing. The disease is increasing in spread in India. In other countries it might have peaked. However for us, it is on the upswing. The worst is ahead of us.We have slowed down the fission rate. We have bought time. We should utilise it. We have the Opportunity  to localise it and bottle it.

Spatial Distribution Granulation

The number of cases in the country needs to be granulated to district level. The data for all districts of TN and Punjab are given below. Data for the rest is also freely available.

A look at the granulated data tells you quite a few things:

TAMIL NADU 690
ARIYALUR 1
PERAMBALUR 1
KALLAKURICHI 2
RAMANATHAPURAM 2
THE NILGIRIS 4
SIVAGANGA 5
TIRUVANNAMALAI 5
KANNIYAKUMARI 6
VELLORE 6
KANCHEEPURAM 7
NAGAPATTINAM 11
THANJAVUR 11
TIRUPATHUR 11
VIRUDHUNAGAR 11
SALEM 12
THIRUVALLUR 12
THIRUVARUR 12
CUDDALORE 13
THOOTHUKKUDI 17
CHENGALPATTU 20
TIRUPPUR 20
VILUPPURAM 20
KARUR 22
MADURAI 24
THENI 24
RANIPET 26
ERODE 27
NAMAKKAL 28
TIRUCHIRAPPALLI 31
TIRUNELVELI 38
DINDIGUL 45
COIMBATORE 64
CHENNAI 152

PUNJAB 99
BARNALA 1
FARIDKOT 1
KAPURTHALA 1
PATIALA 1
RUPNAGAR 3
MOGA 4
MANSA 5
JALANDHAR 6
LUDHIANA 6
HOSHIARPUR 7
PATHANKOT 7
AMRITSAR 10
SHAHID BHAGAT SINGH NAGAR 19
S.A.S. NAGAR 26
FATEHGARH SAHIB 2

The spread is from urban areas to rural areas. The rural areas are not yet affected as much as urban areas. However we need to watch for outbreaks. We should be able to free up the rural belt first. The number of hot spots in the country which need to be focused upon emerge very clearly.

If one sees all districts Many districts have few cases. Which are the districts/cities which need bottling, and which are those which can be freed out comes out from this granulation.

After all if a district has a few cases only, it can be opened with precautions. Districts which are lowly affected are our reserve capacities. A fatality rate and case discovery rate analysis along with the demographics of the districts will tell us how to handle each district individually and a state collectively. This Chinese virus needs to be handled at district level by district-based local systems.  

Herd Immunity

A virus is defeated only if herd immunity is built. Herd immunity is built either through vaccination or exposure. Vaccination is 18 -24 months away. Exposure means huge amount of people infected and diseased. Limited experience suggests immediate exposure means an overwhelming load on the health care system beyond India. Lock down only postpones the problem to buy us time.

Hence we need to go into a controlled herd immunity program through staggered and planned exposure. Even that is possible only if we know that a person who has been infected does not get back the disease. We need to work on this very seriously since this is a long haul enterprise as said by the PM. Moreover, many of our people may also be acquiring herd immunity without our-knowing it. Trap this data and mainstream it.

Key Lines of Operation

We are in it for the long haul. The key lines of operation which started in Phase 1 have to be practiced and reinforced all the way through.

These are reiterated in point form below:-

Intensify testing, tracing, treatment, teamwork, and tracking and monitoring.. Break the transmission chain. Increase surveillance, vigilance and monitoring social, political and communal disruption. Continue to build up capacities in medical and health care equipment. Institute public and private behavior norms of social distancing, isolation, mask wearing, spitting, public urination. Make violations a punishable offence. Carry out extensive door to door surveys and build data.

Carry out public hygiene activities scrupulously including disinfectant sprays, garbage disposal anti malaria spray, put out norms for protection of the aged above 60 years. Separate queues, entry, counters etc. Put in place crowd sourced apps for local resourcing and amenities. Institute population control measures. Reverse migration should be expected.

Plan for de-congestion of overcrowded facilities through railways so that patients are moved from overwhelmed hospitals into neighboring ones even if out of the city/ district/ state. Inter state / inter district coordination must be instituted. Security of health care workers is still a concern, mobilize local help and provide security to them. This is of paramount importance.

MLAs, MLC, MPs and all-party leaders must move into their constituencies and mobilize local resources to fight the Chinese Virus. They should provide leadership. They cannot appear only at elections to ask for votes. Mobilise community leaders, celebrities, local thinkers to assist and guide the overall effort.

Testing

Testing capability and execution in the country has been ramped up. Additionally the Rapid Antibody Based Blood Test has been approved for use and will go into effect any time now. The strategy for this is in the graphic below. Taking into consideration the way the virus is panning out in India; the testing capability is presently ok. The only danger is that there could be a sudden explosion of the Chinese Virus due to the outlier events that could put things totally out of gear.  

Containment & Hotspot Management

Going forward it is important that all Governments, center as well as state, have a robust containment and hotspot management capability. This will be needed well into the future till such time a vaccine comes up. Already 20 hotspots are being tackled and 22 are under surveillance. We have had experience at state and district levels. These need to be built upon. Some important issues are highlighted in succeeding paras.

Kerala and Bhilwara Models

Kerala was one of the states hit early and had lot of cases since many Keralites have extensive foreign contact. However despite the spurt in cases things are under control. They are a model as to how a state has put things under control.

Bhilwara in Rajasthan was an early hotspot put under lock down on 20 Mar, even before the nation went into lockdown. They have undertaken steps to ruthlessly contain the Chinese Virus. Today there are no new cases in the district. This model has been adopted as the base model for the national containment plan.

An amalgamation of these two successful models and suitable adoption in various states, districts and cities as per local conditions will pave way for eradication of this disease. Government Policy. The government has quickly put together policies and procedures for various issues. The website https://www.mohfw.gov.in/is very useful. Visit it once a day.

Latest policies include Containment for large out breaks

(https://www.mohfw.gov.in/pdf/3ContainmentPlanforLargeOutbreaksofCOVID19Final.pdf),

Guidelines for quarantining

(https://www.mohfw.gov.in/pdf/90542653311584546120quartineguidelines.pdf) , various training schemes for medical staff and Strategy for use of Rapid Antibody Blood Test for detection of cases.

Decentralization

This battle must be fought in villages, cities, townships, districts, municipal corporations and states. It can and must be enabled, facilitated and coordinated at the center. It cannot be fought from the PMO or the CAB SECs office. Decentralization is the order of the day. Very significantly, that is being done.

Lock Down Options

Many options are available for lifting the lock down. Kerala Government has come out with a three-stage plan. In the previous review a five-stage plan was outlined. Whichever way one looks at it. The lockdown must be lifted in a staggered manner as per local conditions. The response must be flexible, differentiated and reversible.

Whatever the option chosen – prepare the people for it. Give some time for preparation – mental and physical. For example summer is approaching. Water security and provisioning is an issue especially in water scarce areas and cities. local administration needs physical response time to act. Similarly harvest activities must commence and norms must be put in place.

Related Articles

Ferry of Rafale
1 min read
"Make Thy Gold Multiply"
4 min read
The Truth About Safoora, Sans Propaganda
8 min read

GO TOP

🎉 You've successfully subscribed to The Watchdog News!
OK