April 20: India prepares to partially relax lockdown
Health Ministry: growth in total cases was slower & slowingpace of case doubling
WARNING: vastly different testing rates among States
Delhi has ramped up tests per million people and also reported a higher percentage of positive cases.
West Bengal and Madhya Pradesh which have done far fewer tests and yet find a higher share of positive cases.
Kerala has managed to test, trace, quarantine and treat effectively, preventing new infections.
April 18: 2,154newcases in a single day
UNCERTAINTIES: long-term effects of SARS-CoV-2 on people, including medical outcomes for those who have recovered from severe infection.
India’s COVID-19 strategy has to focus on testing, containmentandtreatment on the one hand, and distress alleviation for vulnerable sections on the other.
Testing data sharing – real time
Pandemics have the ability to quickly expose underlyinginequalities.
Flattening the curve will require clear messages on preventive health, and steps to help people maintain strict quarantine.
Economy in lockdown
‘Great Lockdown’ has forced the IMF to junk all its previous projections for economic output in 2020.
IMF: the current “crisis is like no other”
World output since the Great Depression of the 1930s, the IMF slashed its projection by 6.3 percentage points from its January forecast for 3.3% growth to a 3% decline.
In contrast, the recessionof2009 saw world output contract by a mere 0.1%.
On India, the IMF has cut its projection for growth in the fiscal year that started on April 1, from January’s 5.8%, to 1.9%.
Gita Gopinath, has advocated ramping up a broad-based and coordinatedstimulus once the disease has been contained.
India’s fiscal measurespale in terms of scale when compared with what several other nations have undertaken.
Given the size of the informal sector in India as well as the anticipated prolonged disruption in labour supply even in more formal parts of the economy, the Centre needs to proactively commit to a substantial stimulus package in order to ensure that once the economy reopens, it has the legs to run.
A shot of hope with a game changing vaccine
March 24 to April 14: India reported a 20-fold increase in confirmed SARS-CoV-2/COVID-19 cases and a 36-fold increase in deaths.
Testing is stillinadequate in India.
The case-fatality of 2% to 3% is indicative of the large number of deaths India can expect.
The failures in widespread testing for infection or for immunity imply that transmission-chains via asymptomatic, mildly-symptomatic and pre-symptomatic people remain undetected.
Union Health Minister, Harsh Vardhan, asserted that lockdowns and social distancing are the most effective “social vaccines” available to fight the pandemic.
SOCIAL VACCINE: It is a metaphor for a series of social and behavioural measures that governments can useto raise public consciousness about unhealthy situations through social mobilisation.
Social mobilisation can empower populations to resist unhealthy practices, increase resilience, and fosteradvocacy for change.
This can drive political will to take action in the interests of society and hold governments accountable to address the social determinants of health by adopting progressive socio-economic policies and regulatory mechanisms that promote health equity and reduce vulnerability to disease.
A social vaccine addresses barriers and facilitators of behaviour change, whether attitudinal, social, cultural, or economic, and supplementsinformation, education, and communication (IEC) with targeted social and behaviour change communication (SBCC) strategies.
UgandaandThailand used these strategies effectively during the HIV/AIDSpandemic to bring down the incidence of HIV infection, before highly active antiretroviral treatment (HAART) was introduced in 1995.
They demonstrated how an effective social vaccine helped “flatten the curve” till effective treatments were discovered that dramatically reduced mortality, viral loads and infection transmission.
Lessons from HIV pandemic
The human immunodeficiency virus (HIV) that causes the acquired immune deficiency syndrome (AIDS) is believed to have made the zoonoticjump from monkeys through chimpanzees to humans in Africa as early as the 1920s, but the HIV/AIDS epidemic was detected in 1981 and was a pandemic by 1985.
From 1981 till December 2018, around 74.9 (range: 58.3 to 98.1) million people worldwide were HIV-infected, and around 32.0 (range: 23.6 to 43.8) milliondied (43%, range: 41 to 45%) from AIDS-related illnesses.
The early years of the HIV/AIDS pandemic were also a time of globalpanic.
The cause was unknown (till1984) and diagnostic tests were unavailable (till1985).
Since there was no treatment, a diagnosis of HIV infection was a deathsentence.
Stigma, discriminationandviolence towards infected individuals, their families, social groups (sex-workers, gay men, drug users, truck drivers, migrants), and even health workers, were common.
Reducing HIV transmission centred on acknowledging that everybody was potentially infected — even those apparently healthy — and that infection occurred predominantly through sexual transmission and intravenous drug use.
The core preventive messages involved being faithful to one sexual partneror100% condom use during sexual intercourse outside stable relationships; resisting peer-pressure for risky behaviours, and harm reduction for intravenous drug use.
These measures conflicted with prevailing cultural, social, religious, behavioural and legalnorms.
IEC and SBCC activities targeted (and partnered) individuals, families, community leaders, peer-led community networks and social and health systems to change attitudes and behaviours. Religious and community leaders were key change agents.
For example, the CatholicChurch in Uganda did not initially support promoting condoms for safe sex since its use prevents life.
After large numbers of people died of AIDS, their tacit acknowledgment that their religion did not preclude the use of condoms to prevent death was an important turning point.
Thailand pioneered the effective use of social marketing ofcondomsfor safe sex and usedhumour to defuse social taboos about publicly discussing sex.
These strategies and advocacy against stigma and discrimination were successfully adapted in India.
These skills and experiences can be innovatively adapted for the current pandemic.
How it can work
The coreinfection-controlmessages are available from officialsources.
Maintaining physical distancing in social situations (unless impossible) and wearing cloth masks or facial coverings in public (especially where distancing is impossible) by 100% of people (and 100% of the time) is key to preventing infection along with regular disinfection of oneself and one’s surroundings.
People are more likely to practise these behaviours if all leaders (without exception) promote them publicly and consistently, the whole community believes in their importance, and if proper information, support, and materials are available and accessible.
A social vaccine also requires people to hold leaders accountable to invest in
Rapidly scaling-up testing
Meeting the basic and economic needs of vulnerable sections
Providing psychological support where needed
Not communalising or politicising the pandemic
Providing adequate personal protective equipment (PPE) to front-line workers in health, sanitation, transport and other essential services
Not compromising the privacy and dignity of infected individuals and their families in the interest of public health
Building trust is key if government-imposed mitigation strategies are to be embraced by the population.
United we will be saved
Covid-19 require a coordinated global response.
Sadly, US-Chinasquabble is growing
President Donlad Trump’s reported attempt to secure exclusive rights to Germanbiopharma major CureVac’s vaccine reflects a continuing preoccupation with his ‘America First’ approach.
China’sauthoritarianmodel and lack of transparency in handling the crisis have dented its global leadership credentials.
Fragmented national responses will not help us.
It is natural, even necessary, for governments to focus on enhancing national capacities andencouraging local production.
In India, the crisis has exposed vulnerabilities in key areas like protective equipment, diagnostics and criticalpharmaceutical inputs.
The dependence of Indian drug makers on Chinese APIs has raised concerns about disruptions in supply of essential medicines.
These vulnerabilities will need to be addressed through appropriate industrial policy tools.
At the same time, the importance of global supply chains in producing and distributing these products around the world must not be undermined.
There are three dimensions of the concerted global action required
The free movement of medical supplies and services around the world
The development of necessary medical interventions involving diagnostics, drugs and vaccines
Their mass production and distribution around the world at affordable prices.
On April 3, the WSJ, quoting German officials, reported that a shipment of face masks destined for Germany was seized at Bangkok airport and diverted to the US in an act of “modern piracy”.
Similar seizures and diversions were reported in other countries.
Work on the second dimension accelerated after Chinesescientists provided the sequence of the Covid-19genome.
More than 100 drug treatments and vaccines are in development worldwide, including at least 70 candidate vaccines, three of which are under clinical evaluation.
More than 250clinicaltrials, including the WHO led Solidarity trial, are underway.
Once medical treatments are developed and validated, the issue of their mass production and distribution will need to be addressed.
This will require action on twofronts, both of which require collaborative arrangements between governments, international organisations and private firms.
The first concerns the technology and resources required for scaling up production, for which organisations like GAVI, CEPI, and the Gates Foundation will need to work with WHO and governments.
The second concerns intellectual property rights, which could involve different approaches: issuance of compulsory licences by governments; the voluntary waiver of exclusive rights, either individually, or by joining a pool of rights; and international arrangements for purchase from manufacturers for distribution and supply around the world at affordable prices.
The world now needs determined political leadership to pull all these strands together into a comprehensive global programme of action.
The 73rd World Health Assembly, scheduled for next month, provides an opportunity for finalising a comprehensive programme.
But the existential threat the pandemic poses is too serious to be left to WHO alone.
The entire UN system and other international bodies like WTO and WIPO must be mobilised to act in concert. The G20 will need to demonstrate that it is more than a talk shop of noble intentions.
Goa on Sunday became the first zero COVID-19 State in the country with the last seven positive cases also turning negative.
This makes Goa the first green State in the country with no case of coronavirus being reported since April 3.
The State had a total of seven cases, of whom six had travel history and one was the brother of a positive patient.
Centre stops flight bookings
The government on Sunday directed airlines to discontinue advance bookings for travel from May 4. “No decision to commence the operation of domestic/international flights with effect from May 4 has been taken yet. All airlines are hereby directed to refrain from booking tickets,” the Civil Aviation Ministry told domestic and foreign airlines.
Confusion over mismatch in Health Ministry, ICMR figures
A day ahead of a possible relaxation in lockdown curbs, confusion reigned on the actual number of COVID-19 cases in the country registered on Saturday.
The Indian Council of Medical Research (ICMR), which coordinates testing and is the central node of data regarding the daily infections, reported that 16,365 individuals had been confirmed positive.
Of these 2,154 were confirmed on Saturday alone — the first time the daily case load breached the 2,000 mark.
However, the Health Ministry, the point-Ministry for all information regarding COVID-19, reported only 14,792 cases and 957 new cases.
Pharma units still not able to operate freely
A week after the Department of Pharmaceuticals warned of an impending shortage of drugs if pharmaceutical units are not able to operate freely during the lockdown, there has only been a marginal improvement in their functioning, with employee movement, transport and raw material supplies still hampered, and courier services remaining non-functional.
Most domestic pharmaceutical producers are operating at 30%-50% of capacity, while larger research-driven players say they have hit 40%-50%.
PM-CARES donations cut from govt. staff salaries
While the donations, meant for COVID-19 relief, were said to be “voluntary”, government circulars show that the deductions were made directly from salaries. Those unwilling to donate were asked to submit their refusal in writing.
No relaxation in lockdown, says Kejriwal
A spike in the number of asymptomatic COVID-19 cases detected in the Capital is due to the community sampling exercise being conducted in 77 containment zones, a State government official said on Sunday.
Earlier in the day, Chief Minister Arvind Kejriwal justified his decision to continue the lockdown in the Capital, pointing to the fact that all 186 patients who tested positive on Sunday were asymptomatic.
This, he said, was 25% of the total test results (736) that came in on Saturday.
PM calls for unity in COVID-19 response
Prime Minister Narendra Modi on Sunday took to networking site LinkedIn to speak to young professionals that adapting to new technology in the times of COVID-19 can help create new business models and lead to the engagement of a large segment of Indians, including the poor, with technical solutions.
“It is technology that diminishes bureaucratic hierarchies, eliminated middlemen and accelerated welfare measures,” he said giving the example of his own government’s push, since 2014, of Jan Dhan Yojana, Direct Benefit Transfer (DBT) and Aadhar linkage.
Islamophobia is rising in India: OIC
Calling on the Indian government to take steps to protect Muslim minorities who are being “negatively profiled,” facing “discrimination and violence” amidst the COVID-19 crisis, the 57-member Organisation of Islamic Cooperation (OIC) has criticised what it called “growing Islamophobia” in India.
“[We] urge the Indian Govt to take urgent steps to stop the growing tide of Islamophobia in India and protect the rights of its persecuted Muslim minority as per its obligations under international Human Rights law,” said a tweet issued by OIC’s Independent Permanent Human Rights Commission (OIC-IPHRC) on Sunday.
The statement came on the same day Prime Minister Narendra Modi had clearly said that “unity and brotherhood” must be the response to the coronavirus, which does not see “race, religion, colour, caste, creed, language or borders before striking.”