If you have a hammer as the only solution, everything before you will appear to be a nail.
Corona Epidemic threat in India has exposed the deep fault lines of “governance” in India, exemplified by the current RSS-BJP’s Modi Sarkar. This epidemic threatens lives of millions and to begin with, the precautionary steps urgently needed to involve these millions of helpless, deprived Indians in its management and control.
Some facts to start with:
- The first exposure with Corona came light in China’s Wuhan province on 17th November 2019. China did well to share the genome with the world in order to help all countries prepare for it testing and management.
- Corona spread to almost all of Europe and USA, also Japan, Iran and South Korea, but to few countries below the Tropic of Capricorn. The reasons will unravel in time to come. Close trade contact between Wuhan and EU and US were the main reasons for early spread there. This late and low spread in India, Africa, Latin America was certainly not due to better screening, better care of contacts, better health of the people, etc.
- China contained impact of Corona by sealing Wuhan town first and the province Hubei later and by mobilizing the country to make provisions. Closed factories were made to shift production and stitch masks, make sanitizers, respirators and other hospital equipments on a large scale for use. South Korea went for early wide based screening and testing, containing the infected and their contacts with other measures. Japan quarantined all suspected foreign arrivals on a massive scale ever since the first case was reported.
- For most of the first two months, till March 5, Modi govt. remained in denial, its ministers even making fun of the seriousness of the problem. It failed to ban tourists who were the only vehicles of transmission of this virus. It failed to screen and test arrivals from abroad. It failed to set up such facilities and to compulsorily quarantine persons arriving from abroad in all of its several international airports. It will be fair to believe the govt. knew well in advance the seriousness of this killer virus that spread only through international travel, majority who are upper class and high officials, who often frown on attempts at being disciplined. They may actually have been the reason for this casual attitude. WHO had warned of the seriousness in December itself.
- In India the govts’ active steps have only surfaced after tourists and VIPs were caught with the disease and they tested positive. Then the Govt immediately resorted to mass lockdown, curfew, creating mass hysteria through propaganda of the devastating nature this infection and blaming the common people for not following the strict instructions. The PM said it, since you are not following Janata curfew, so we will impose it. The police has been most vigorous in implementing measures to fight this ‘health’ scare, not the doctors, health and food department officials.
- Observe carefully, the more the number of VIPs that got caught violating precautionary measures, the stricter became the restrictions on common people, even when they are not to blame for the spread that has taken place so far. The Parliament was to be seen as working, it has worked till 24 March, VIP gatherings were on, big hotels continue to function, partying continued, President’s breakfasts were on, Madhya Pradesh swearing in continued and Ram Lala Puja was on till 25th, the CM participating – all without masks or physical distancing.
But for the common people there is complete lockdown, factories, shops, hospitals (almost completely closed), transport, trains, even coming out of the house with the police mercilessly baton charging, confiscating vehicles, lodging FIRs to drive people home. Trains were completely stopped, not increased when there was excessive rush of migrant workers to go back home.
- In the villages people are petrified due to lack of work, earning and no shops or facilities being open. The worst condition is in large metros where millions of migrant workers are trying to get out and return home to far off villages in order to beat the unemployment, unhygienic crowded living conditions, fear of an epidemic spread and sickness/ death looming over their heads in a foreign land. Their hutments are the most unsafe places for spread of Corona, the inhabitants being as oblivious of this as they are of the dangers of Corona. But yes, these are the biggest potential sources of the Corona infection getting into stage of Community spread and becoming endemic (high disease rate in a geographically bound area).
Then there are jails, for which the SC unfortunately gave just a casual order to decongest, without specifying any date for it and without stopping arrest people accused of small crimes. Such arrests continue. Infection in the crowded jails will after all enter from outside only. Immediate release of inmates in for minor crimes would have provided better safety for those released as well as those inside.
Airlines incidentally are the last to be locked down and private cars are still not in lock down.
- On paper emergency supplies of food, health are on and some paltry payments of Rs 1000 per worker has been promised for entire the month. The govt is to send supplies to homes, but there is no structure in place for that. With such a clampdown all backend supplies are bound to choke and short supply and panic is bound to intensify. As per a report in ET, 35% customers were unable to buy essential goods via e-commerce between March 20-22 and this shot up to 79% on March 23-24. Similarly from retal stores this shot up from 17% to 32% . Delhi Noida Border has already seen a road jam due to cars being stopped.
We are living in an unprecedented situation and if the deprivation lasts, there may be very genuine outbursts from deprived people, whose need for food and treatment will have become more important than safeguarding from Corona or the fear of the ‘hammer’ of Modi’s police.
- It is important to note specific aspects and scientific advisory to prevent spread of Corona. It spreads by droplet infection, not as an airborne disease. That means it is important that droplets released by a patient or carrier reach a victim. These droplets travel up to maximum of 1 meter when a person sneezes and the virus remains alive in the air for only up to 2 to 3 hours. Open air is the best place to be in to fight the droplets, as they dissipate fast and virus concentration decrease rapidly in open spaces. These droplets may travel through the hand, mobile phones and other surfaces where the virus remains alive for longer periods of 1 to 2 days.
An important aspect is that people need not be scared that even one virus entering their body will cause the disease as disease is caused only when there is a sufficient dose of the infective agent which the body’s natural defense cannot fight back. This virus readily spreads in immune compromised patients and is more fatal in patients of heart disease, diabetes, hypertension and asthma and in old people.
Most important aspect is that in fighting viral infections, role of nutrition well being is most important in building natural defense of the body.
Prevention needs to include:
- a) Physical distancing up to 1 metre between common people and up to 2 metres from patients, suspected patients.
- b) Use of masks by all persons;
- c) Washing hands by all persons when they enter their homes and before they eat, with scrubbing for at least 20 seconds;
- d) Isolation of all patients prone to be attacked and all old people;
- e) Decongesting single room dwellings and jails;
- f) Nutritional care of the entire population; and
- g) Proper medical backup.
Planning for this epidemic needs to consider that:
- i) Measures may be needed for months;
- ii) Precautionary steps should have been planned not just for the haves, but to ensure that the entire society is able to accept and implement it;
iii) Most people live in congested colonies and very small houses; and
- iv) When shut total down is ordered even daily needs like food, shelter, water, medicare, deaths need to be provided as emergency measures.
Preventive steps should be:
- Foreseeing the international spread, there should have been a complete ban on foreign tourists with all non tourist arrivals being tested and quarantined at least since February, since the virus began spreading to Europe.
- Decongestion the slums and jails should be done. Allow people to travel back to villages in trains sparsely filled. Ensure enough trains run so that people don’t panic. Shift excess persons from congested slums to vacant and under construction buildings temporarily. Instruct all old and sick to be in houses. Rally the youth, with preventive gear, for the various tasks necessary for taking care of society. Provide transport for emergencies free of cost.
- Ensure high nutrition diet to all poor by providing them with extra protein diet foods like eggs, meats, pulses or with extra funds to buy these. Provide fuel and running water. Put in place collection structure from farms and godowns and the supply chains. This will also build their confidence in cooperating.
- Take emergency measures for production of masks, soaps, sanitizers in each block/ village by organizing the village committees. Send teams of village youth to each houses to distribute these, two masks for each person, soaps and sanitizers to each house and to educate and demonstrate to each household the value of this and of keeping physical distances. Develop production and supply on war footing with the motto of physical distancing and social bonding.
- If a community spread breaks out these measures will be required for months and several hospitals/ medical care will be required. So the govt should convert empty schools into make shift hospitals, establishing such set ups in villages and bastis, equipping and training personal for this.
- What should not have been done:
- Shut down as has been done is without preparing for the emerging crisis. It reflects the response of a nervous govt, unsure of what to do now after it has failed to act in time. It is already spreading panic due to fear of the ‘unknown’. Population already burdened with poor facilities and resources, now deprived of even their jobs and means to reach home are in greater panic. Even officials, including the police, apart from pushing people back in to their homes, are nervously rubbing alcohol on their hands and praying repeatedly. The officials and common people could have been and should be now inspired and rallied together to fight the menace.
- The govt. has given direction to its political planning by asking people to come together on March 22 at 5 pm to beat thalis and blow conch shells as a social drive, basically to drive people towards exorcism, of ‘driving away the virus’ghost. Baba Ramdev is advocating Surya Namashkar twice a day. Some RSS persons are advocating Gau Mutra and others vegetarianism. All these are being promoted to divert peoples’ attention away from the real cause i.e. failure of the govt to ensure steps that will take care of the prevention as well as the massive requirement of food and care, which the govt has no plan to implement. The more the crisis aggravates, the more it is likely to intensify this obscurantist drive as well as ‘nail’ the peoples’ protests with the police ‘hammer’.
Dr. Ashish Mital
GS, AIKMS and
Formerly Resident Doctor at Deptt. of Community Medicine, All India Institute of Medical Sciences, New Delhi.