First Review: https://palepurshankar.blogspot.com/2020/03/the-corona-combat-review-of-situation.html
Second Review : https://palepurshankar.blogspot.com/2020/04/the-corona-combat-second-review-by-lt.html
Please pass it on to your fiends. They will feel proud to be
Indians.
Others will wake up to India. We are ahead of the curve. We will
stay that way.
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.
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.
Own Forces
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
|
STATE/UT
|
CONFIRMED
|
ACTIVE
|
RECOVERED
|
DECEASED
|
|
WEST BENGAL
|
91
|
75
|
13
|
3
|
|
UTTARAKHAND
|
31
|
27
|
4
|
-
|
|
UTTAR PRADESH
|
332
|
308
|
21
|
3
|
|
TRIPURA
|
1
|
1
|
-
|
-
|
|
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
|
-
|
|
ODISHA
|
42
|
39
|
2
|
1
|
|
MIZORAM
|
1
|
1
|
-
|
-
|
|
MANIPUR
|
2
|
1
|
1
|
-
|
|
MAHARASHTRA
|
1018
|
875
|
79
|
64
|
|
MADHYA PRADESH
|
290
|
248
|
21
|
21
|
|
LADAKH
|
14
|
4
|
10
|
-
|
|
KERALA
|
336
|
263
|
71
|
2
|
|
KARNATAKA
|
175
|
146
|
25
|
4
|
|
JHARKHAND
|
4
|
4
|
-
|
-
|
|
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
|
-
|
-
|
|
DELHI
|
576
|
547
|
20
|
9
|
|
DADRA AND NAGAR HAVELI
|
1
|
1
|
-
|
-
|
|
CHHATTISGARH
|
10
|
1
|
9
|
-
|
|
CHANDIGARH
|
18
|
11
|
7
|
-
|
|
BIHAR
|
38
|
22
|
15
|
1
|
|
ASSAM
|
28
|
28
|
-
|
-
|
|
ARUNACHAL PRADESH
|
1
|
1
|
-
|
-
|
|
ANDHRA PRADESH
|
314
|
306
|
5
|
3
|
|
ANDAMAN AND NICOBAR ISLANDS
|
10
|
10
|
-
|
-
|
|
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.
Data Co-Relationship
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. (base data from https://www.worldometers.info/coronavirus
)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/M
|
TESTS
|
TESTS/M
|
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 UTILIZE IT. WE HAVE THE OPPORTUNITY TO LOCALIZE 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: -
|
|
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.
Districts/cities which need bottling, and 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 and 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. Think through and anticipate. Each one
of us has to put his/her hand up and make it count.
WE HAVE A LONG HAUL AHEAD
NEED TO STAY PATIENT , DETERMINED AND RESOLUTE
SO FAR ALL INDIANS HAVE HEAVED TOGETHER
THERE IS NO REASON TO FEEL PESSIMISTIC
IN FACT THERE IS LOT OF OPTIMISM
WE HAVE EVERYTHING TO GAIN
IF
WE ARE TOGETHER
WE WILL KICK THIS CHINESE VIRUS BACK TO WHERE IT CAME FROM
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