With Highest Positives And Deaths Per 24 Hours In The World, India Needs Urgent Re-thinking Of Its Strategy along-with Pooled Testing
It is six months since genome sequence of SARS-CoV-2 was published by Chinese scientists and was available to the world. What has India done since that January should find no excuse in otherwise legitimate accusation that China did not inform about the novel virus to the world in time or it kept WHO in dark. It is true that China erred and it is also true that there are reasons to scrutinize WHO. But what have we done since it indeed released the information about the virus? For instance, while some countries like Taiwan, South Korea, Japan had cases of probable infection long before China released the vital information, India registered its first case only in late January, long after China had published genome sequence of the virus and WHO had informed the world about such an outbreak. So unlike those countries, and they have it under control now and cases are breaking new records in India, we cannot blame the outbreak on Chinese malfeasance. Whatever situation we are in today is our own making. While this bit of truth is hard to digest, especially to large population that has personally attached their egos with present government, the refusal to acknowledge would move us into further abyss, further down the rabbit hole. In that regard, everyone must prepare a mental plan of things they would have done when they came to know of a novel virus on the horizon six months ago. Ravish Kumar of NDTV did a detailed show on coronavirus on February 18 where he asked, ‘Is India prepared to tackle Coronavirus?’. Kerala already had some plan-of-action in place even before India saw its first case. Given all this, what all things would you have done since January to save your nation and its citizens from this new virus? Would you have for instance organized a massive rally for Trump in February in Ahmedabad? Would you have waited for toppling of a opposition led government in Madhya Pradesh to announce a nationwide lockdown? A day after Shivraj Singh Chouhan government was sworn in, Modi announced a national lockdown on 24 March. Just go and look at the crowded images of politicians from Madhya Pradesh during that time. And just read what has come to happen to that state vis-a-vis coronavirus now. Chief Minister of Madhya Pradesh has himself tested positive. Cases in Ahmedabad have skyrocketed with its percentage of death highest in country at one point. And reports are just in about Home Minister Amit Shah testing positive. Karnataka CM BS Yediyurappa has also tested positive alongwith his daughter. A cabinet minister in UP has succumbed to virus. But Bhumi-Pujan celebration at Ayodhya in UP would go on as planned with none other than PM Modi as its chief guest. This isn’t about politics. The signals these events sent (and will send) still remain. What was (and is) govt saying through these events? That India is warm country and virus won’t affect us? It would get killed itself from the sunstroke? That our people do yoga, we use haldi (turmeric) in our foods which will fight the virus? I’m not making up these things. These were some of the things said on our news channels by panelists. Our people heard them over and over again. And they saw their politicians, most powerful people in their nation, hugging and waving hands in the middle of massive crowds — they had every reason to believe the bunkum coming from idiot box. The idiocy was legitimized by political maneuvering. They were then made to believe how mass thali-banging would get the virus killed, how mass diya-lighting would destroy the virus. Oh! that was to boost health and essential workers morale? Then why are we not banging thalis now? By July 13 around 123 healthcare staff including 108 doctors have succumbed to coronavirus. They need morale boosting more than ever now. Why is the big boss, erm Prime Minister Modi, not announcing such tasks now? Because, my friend, morale boosting is not the aim of such tasks. The aim was (and is) to create images, get you do things so as to make you feel something was being done, to calm your nerves and instill in you the idea that your government was doing something. Did that something get doctors and essential workers, their PPE kits and other safety equipment? No. Some did not even receive their salaries. Rajdeep Sardesai for many weeks continued his good fight to get stipends to Davangere junior doctors. In Gujarat, the state government inaugurated fake ventilators which were purchased and the state hospital that used them had its death rate close to (or more than) 50%. Pondicherry cancelled its order for the ventilators after news broke out. This did not stop Narendra Modi govt from procuring 5,000 ventilators from this Rajkot-based firm despite Ahmedabad’s largest COVID-19 hospital doctors, where initial batch of ‘ventilators’ were installed, saying that they were not up to the mark. You wonder why such blatant negligence from Modi govt in risking people’s lives. The reason lies in close connection of this firms current and former promoters being close to BJP, leading up to that controversial gift of an expensive suit to Prime Minister Modi. Gujarat government, in fact acted on and isolated the journalists that broke this news. In whose interest was the news and in whose interest was govt action? Not much hard to guess, isn’t it? Then our central government went on a ‘made in India’ march. This was again a distraction scheme. We need made in India, no doubt about it. But it won’t happen in a day or month or even a year. It takes thorough long-term plan. And ‘made in India’ does not translate into sub-standard goods. For instance, in Mumbai, the made-in-India ventilators turned out to be ‘fake’. PMCARES ventilator maker too built fake ventilators — they fudged their software to hide poor performance. So we are buying coffins from people’s donations. Take all offense you want, this is no time to sugarcoat words. Amit Shah or Yediyurappa’s life won’t be put on risk by these sub-standard ventilators, their life won’t be endangered this way, it is only the poor, aam-junta that will face the brunt of this murderous system.
Too much gloomy news. Is there anything we can do now?
It is quite late now. Today, while India stands third in total number of corona cases, number of positives and deaths in 24 hours are highest in India. Six crucial months have just gone by and we still don’t have a promising system in place through which we can see a timeline when we would be out of this danger like many countries have. According to official figures, 39,000 have already lost their life due to coronavirus in India. But there still remains a large population which is still breathing and until that is the case, there would still be room for improvement and hope.
There are some things that we can still do to be in better shape next month than we would be with our current approach and pace. But first, we need to understand when virus infects a person and when they test positive. Both of these events do not occur on the same day. You don’t start coughing and feeling breathless on day one of your infection. In fact, lot of those who get infected don’t even show symptoms of infection. So you might right now be sitting with someone who is not coughing but might still have coronavirus in their system. Or you might yourself be infected and yet look healthy from outside. Then there’s the question of proportion of viral material. I might have viral material inside of me but my test might still turn negative. According to one report, it takes nearly five days since getting infected to accumulate enough viral material for one’s test to come positive. But during these five days, the said person is capable of infecting others; which means two things. First, the testing numbers we get everyday are not today’s. They don’t show who were infected today or even yesterday. Those numbers are of people infected at least five days ago. Second, and this is important to be understood, those who were found positive today have been spreading infection since at least last five days. Also, we are assuming here that we test individuals as soon as their viral material reaches required levels for their tests to be effective which is far far away from the reality. All of this means one thing and one thing only, it is most important to identify the infected as soon as possible, isolate them and treat them. A day later and we risk infecting more people. If you assume one person can infect minimum five people a day then that’s not just five infected people. These five people will in turn infect others before enough viral material accumulates inside of them for effectively getting tested. That is assuming they will get tested positive on day five. In India, unlike say South Korea or US, we don’t have voluntary testing booths where you can walk in and get yourself tested. Our testing is still centrally managed — a govt body decides who should be tested and who should not. This needs to change to begin with. And then we have to test more and more. Currently, India doesn’t even appear in the top ten countries in terms of tests per million. And no, this is not because of resource crunch because we are testing far less than our own daily capacity. In essense, we are letting infected persons roam and spread the disease until it becomes impossible to ignore and be forced to test and isolate them, and when we start doing it, the numbers in area would already be swelled so much that nearest Covid hospital would run out of its capacity. This isn’t pulp fiction but our reality. And this is continuing because we aren’t asking better from our representatives.
How can we change this and change it fast?
I get the “We cannot test everyone because India has such large population” excuse. Yes, it is excuse now because it has been six months since virus arrived on our shores. And our population has been this large like forever. It is not something that happened while we were under lockdown. Anyways, all said and done, what can we do now? First, there is absolutely no need to test everyone. You have to test a certain minimal percentage of population in each pockets. Each village, each society, chawl, each by-lane — take your pick. Pick random persons in market and test them on a random day, of course, with their informed consent. Otherwise, do what Maharashtra CM Uddhav Thackeray suggested — test one person each in every household. What would happen with this information is, we would get a real picture of where virus is and where it has not yet reached. This will help us with better monitoring. The current, red zone — green zone strategy is (and was) completely flawed. Not just because it is done at district level which Kerala Chief Minister Pinarayi Vijayani rightly criticized but many were declared green zone where not a single person was tested positive. For example, when my district was declared green zone (meaning there existed not a single person infected with coronavirus), not a single person in my city was tested. If zero tests were done in India until today, whole of India would be green zone. That doesn’t mean non-existence of the virus but abundance of collective stupidity. So, we need to take testing to all parts of India. This strategy should be combined with pooled testing. Now, what is pooled testing?
The gold standard for diagnosing infection is a sample obtained by a nasopharyngeal swab followed by the identification of viral RNA through a polymerase chain reaction (or P.C.R.) test. The swab is uncomfortable, the test is slow, and the supplies to perform it are in short supply. In pooled testing, laboratories combine samples taken from several people and test the multiple specimens together for the presence of genetic material from the novel coronavirus. If a batch tests negative for COVID-19, all those patients are cleared. If a batch tests positive, the specimens must be retested individually or in smaller groups. Such tests could be used to quickly clear groups of people who are not likely carriers, such as students returning to school, or individuals in areas with relatively low active COVID-19 infection levels. This can hugely improvise our testing rates. Until vaccine arrives, testing, tracing and isolating remains the master strategy to deal with the pandemic. In case we decide to adopt pool testing we also need to be cautious of its limits. If the disease is prevalent in a community — more than around 10 percent, according to the AACC — pooled testing stops being useful because so many follow-up tests are likely to be required. Pooled tests may also result in an increase in false negatives because combined samples are diluted, making it more difficult to pick up the virus material, according to the FDA. Quest, however, says that in clinical data it presented to regulators for its method of pooled testing, it would not have found a false negative in more than 3,000 total specimens. So all in all, pooled testing would help us identify infected faster and with lesser resources.
Pooled testing isn’t the only way forward. Some companies are even making rapid antigen tests that can easily be done outside a lab. These tests look for certain proteins in the virus instead of genetic material. The problem is that they can miss more infections than a P.C.R. test. But they take only about 15 minutes to get a result, and if you run them in batch mode, you could most likely do more than 50 an hour. It’s not hard to imagine settings, like schools or sports teams, where such tests might be incredibly useful.
That’s not all.
This is not war and healthcare workers are not front-line soldiers. Their deaths shouldn’t go unnoticed like deaths in wars go. All of this was avoidable. In six months we should have gathered so much information that by now we should have been able to predict the pockets where cases could come and where they were highly unlikely. This would have helped us better and would have made lockdowns unnecessary thereby saving huge economical wealth that is lost now. But we don’t have that crucial information. In fact, if we don’t test aggressively, we would never reach at that point of intelligence. So far, we are following the virus. We wait until it infects someone and that someone infects some others. We are not proactive enough. Our strategies are ad-hoc. We don’t have any long-term plan of action. There is no collaboration with center and states or states to states. States are fighting battles alone and their resources are drying up. Forget releasing funds, central govt has refused to dispatch the GST dues it owes to the states. All this information should reach general public. They should know what is happening. In the battle of perceptions, Modi has so far managed his upper hand thanks to the disposal of TV media at his command. He can any day decide to address the public and TV will make sure his message is amplified. Will he ever tell you he has not released the money he owes to the state governments? Never. So how can you make informed decision in such a scenario. You can’t until you put efforts to equip yourself with more diverse information. And that is required. What would you do when hospitals refuse your infected kin, what would you do when hospital refuses to discharge the dead body of your relative because you can’t pay Rs. 5 lakh (treatment cost)? These things have happened in Delhi, in the national capital. Do you know that according to a serological survey, one in four persons in Delhi is infected by the virus? No, they did not made it to the statistics of 19 lakh which is current Covid count in India. They never will. If that’s the number for Delhi, what do you think is that number for entire India? We would never know in the absence of testing.
You know there is one easy solution to keeping our numbers below 25 lakh. Stop testing anyone right away. We will anyhow get the test results of people tested so far and that will get us close to 25–25 but not above that mark. How good is that solution? Let everyone infect everyone. Let’s control the count. That’s what is more important right? That is what we have been doing so far.
This is a fight between two races. It’s anyone’s evolutionary instinct to replicate and infect as many as it could. Coronavirus is no exception to the rule. And in this race to survival, we need to equip ourselves with more and more information so as to know and fight better. India needs to study countries like Taiwan, South Korea, Vietnam, Singapore, Norway etc who have found success in controlling and containing the virus on how to not just fight the virus but also about how to support its economy and the most vulnerable population. All this should have happened long ago but better late than never.
That’s all for now.
All said and done, we all still need to rely on social distancing, hand washing and ubiquitous masking. With testing, just as with masks, more is sometimes better than perfect.
