The three-week coronavirus lockdown has worked. But an overdose of it could kill through long-lasting side-effects. It should be systematically loosened or de-escalated.
It’s unlikely that Jair Bolsonaro knew how well-timed his letter to Narendra Modi was when he used the Ramayana legend of Lord Hanuman bringing the Sanjivani Booti to save Lakshman’s life while seeking hydroxychloroquine and paracetamol from India.
It will be something if his staff has such a pucca Hanuman bhakt that only would he know the legend, but also the fact that the letter would arrive pretty much coinciding with Hanuman Jayanti earlier this week.
Nevertheless, it makes us reflect on the same God, and story a little bit as we debate the prospects of the three-week lockdown being extended (we hope not) or lifted (we bet, and pray not), or gradually, systematically loosened or de-escalated. That third option we prefer, and we are arguing why. With a little help, of course, from Bajrangbali. Our Gods, after all, aren’t just benevolent, they are also forgiving, and have a sense of humour—especially the one that Bolsonaro invoked.
Go back to that legend of Hanuman, with Lakshman lying unconscious, struck by Ravan’s warrior son Meghnad (also known as Indrajit) with what might be the equivalent of a smart, guided weapon today. Lanka’s finest doctor Sushen said only a magical herb from the distant Himalayas, Sanjivani Booti (Life-giving herb), could save him. And Jambwant, the bear-king said only Hanuman had the strength to get it.
We know what happened next. Unable to identify the herb, Hanuman brought the entire Dronagiri mountain. That’s the most familiar and popular picture in the Hanuman iconography. And no worries, as Vaidya Sushen identified the herb in a jiffy.
Now, see how this applies to our current situation. The ICMR started monitoring the rise of coronavirus infections in India in mid-February. Initially, only symptomatic suspects, foreign returnees or their contacts were tested, a very small number. In fact, on a tests per-million basis, the smallest for any major country in the world. The experts at ICMR leaned on an old, tried, tested and robust method in Indian epidemiology, sentinel surveillance.
This entailed picking up a sample of patients with SARI (Severe Acute Respiratory Infection), or severe pneumonia in ICUs of about 50 major hospitals. The first 826 samples in two weeks showed up no COVID-19 infection. It was seen as evidence that the disease was still more or less in stage one (imported) and partly in two (contact infection).
In the following few days, however, as more tests took place, by March 19, two positive cases emerged. These were just two in 965, but the first two. Nobody has told me this, but I am guessing, having known and covered the system closely in the past, that this was an alarm bell. The same day, sampling was extended to all SARI patients in hospitals across the country. Therefore, while only 965 were tested in the first five weeks, another 4,946 were tested in the next two, until April 2.
This has now been reported in a solid ICMR study published Thursday in the Indian Journal of Medical Research (IJMR), showing 104 coronavirus-positives out of 5,911 SARI patients. It is still only 1.8 per cent of a much larger base. But it isn’t negligible. These indications, we can safely presume, were becoming evident by March 21-23, which explains the timing, urgency and the extent of the lockdown.
This was no time for half-measures or searching for a precise, targeted solution. In short, this wasn’t the time to search for the Sanjivani Booti, but to haul the mountain. That done, can you then sit in front of the mountain and hope for the best another three weeks after that?
You could, but then you risk Lakshman, which is the economy and the poorest of India, dying in the meantime. You need that somebody wise now to find that one herb, or a bunch of herbs to move forward.
Much global assessment has emerged, listing India’s lockdown as the severest response to the pandemic. Most notable is a graphic used by The Economist based on the Stringency Index developed by Overseas Development Institute, Oxford. India tops this, at 100 per cent, with even Italy at 90. But the same index also shows us our limitations. On fiscal stimulus as a percentage of the GDP, India is the lowest on these charts.
It is not counter-intuitive or inexplicable. Of all the countries listed and ranked here, India is the poorest. The next ‘poorest’ isn’t quite poor with both China and Malaysia at about five times India’s per capita GDP. India, therefore, had a triple challenge. It is crowded, has a crumbling health system and is poor. Given this situation, a drastic lockdown like this was called for.
Results show that it has worked. The numbers of fresh infections are going up, especially with expanding testing, as you would expect. But the graph isn’t rising even geometrically, not to talk of exponentially. This despite one Tablighi ‘super-spreader’ cluster bringing in almost a third of all infections at this point.
Something has worked. And whatever be the other theories, from BCG vaccines to chloroquine in our blood or guesswork genetics, this lockdown has been the biggest contributor. The instinctive call would then be to extend it simply. Why change what is working. Many state governments have already demanded this. A couple have already extended till the end of the month on their own.
We need to assess, however, if it is sustainable. Or is it like an overdose of a medicine that saves your life in the short run but kills you through long-lasting side-effects? You can also see in the context of the Hanuman legend. You found the mountain; it brought a sense of relief, wouldn’t it be better now to look for the right herb. Or maybe a bunch of them?
There were pointers in the excellent ‘Containment Plan’ made public by the Union Ministry of Health earlier this week. Looking at it closely, you might think that the magic ‘herb’ was Rajasthan’s Bhilwara Model, but spread over much larger geographies and customised for different local and regional conditions and realities.
This could see, instead of the entire country remaining—and frankly throttling itself—in suspended animation forever, waking up carefully. At the same time, a number of Bhilwaras are identified and Lakshman Rekhas, drawn around them right away. We have seen some of that happen already with the declaration of ‘hotspots’ and ‘containment zones’ in some states, including Delhi.
That is the model to go for. It is enormously more cumbersome than a simple, total lockdown with one whistle. But taken beyond three weeks, it will be counter-productive. Too many of our fellow Indians live on daily wages, from meal-to-meal. Rabi is waiting for harvest and storage and fields have to be readied for kharif. Factories—even the globally vaunted pharma units—have to begin working again. And wherever there’s a threat, you have this fine containment model.
The idea of buying more ventilators is much in fashion the world over as there is a paucity. But cruel as it is, we need to understand what life on a ventilator means. At his usual White House press briefing earlier this week, Donald Trump answered the clamour for more ventilators by asking, ominously, do you want me to tell you how many people who go on the ventilator survive? You wouldn’t want to know.
But, a day earlier, New York governor Andrew Cuomo had given that answer in a weak moment. Just 20 per cent, he said. So, the best thing is to save the patient before he goes on the ventilator.
Here, we have put the entire nation of 138 crores, a nearly US $3-trillion economy on the ventilator. The time to think of letting the patient breathe, at least partly, on her own, is now.
