SARS-CoV-2 that causes COVID-19 is here to stay. Every single carrier is one too many. Even if by a miracle everyone is cured this instant, surfaces could still carry SARS-CoV-2 for days. How long before a single, stray virus finds its way into someone’s lungs and this global nightmare has a sequel?
As the PM and CMs of different states met over video conferencing and decided to extend lockdown for two more weeks, reactions varied. Richer Indians fluctuated between boredom and irritation, poorer Indians between worry about short term hunger and long term poverty and death.
The real question though is this: would we go back to normal on the 1st of May? And if we do, how long before another burst of infections emerge across the country like in China, which on 11th April saw 99 new cases, its highest increase since March 6? Do we go for another lockdown? If yes, how long?
Let’s take the immediate goal first; flattening the curve. Problem is we don’t know how tall and wide this curve can be, or how high its peak considering that we are a nation of 1.3 billion people?
Let’s find out the peak our medical infrastructure can handle. India only has around 40,000 ventilators with only a few thousand free during normal times. New York Governor Andrew Cuomo asked for 30,000 new ventilators just for New York alone whose population is as much as Mumbai’s. How many ventilators does Mumbai have? The answer – 600-800, and just over 1000 all over Maharashtra. Tamil Nadu and MP have 1,500 and 1,800 ventilators respectively
Add to that the fact that we only have 1 doctor per 1,457 citizens i.e we have a shortage of over 600,000 doctors and 2 million nurses. Right now is perhaps not the time to ask why even after 73 years of independence, India’s medical infrastructure is so woefully inadequate or laugh at the irony of doctor-shortage in a nation where every second middle-class family wants to make their child a doctor.
Thus without sounding alarmist, even 10,000 cases nationally which we are reaching right now, are too many for us. Add to that the many hospitals in Mumbai shut after over 100 staff tested positive and government authorities struggling to sanitize and open it, and you know you’re staring down the abyss of disaster.
Thus whatever be the actual peak of the COVID-19 infection curve, we might already have crossed our capacity to handle it even though the state governments are doing their best to increase it.
What the first 21 days of lockdown mainly ended up doing – besides preventing new spreads – is expose the extent of the spread of COVID-19 so far. The next lockdown, hopefully, would be the one that would do what epidemiologists were hoping the first one to do – flatten this first curve.
Problem is, what after we flatten it? How soon do we open the country? And how big, bad, ugly would the curve in the next wave be? What would we do then? Go under lockdown again? If we do, we might expose millions to the dangers of starvation. Is it even fair – this trade-off between COVID-19 vs starvation deaths?
The problem is COVID-19 is not going anywhere. Till we find a cure or develop a vaccine, we have to somehow ‘live’ with the virus. And it might be expensive and require extensive efforts, but it is neither impossible nor hopeless to do.
First the good news. After receiving convalescent plasma transfusion (plasma from recovered patients), all 10 severe COVID-19 patients in one of the first tests in China saw all symptoms i.e. fever, cough, shortness of breath, and chest pain, disappear or largely improve within one to three days. India has approved its use.
This, however, cannot be a permanent, long term cure. What about herd immunity? The problem is there’s no consensus whether people who get it once, develop long-term immunity. Hence - at this moment - we cannot take it into consideration.
How then do we tame this beast, especially in a nation like India?
We learn from nations – almost all Asian – who have succeeded. South Korea, Taiwan and Hong Kong have kept the virus under manageable levels without draconian lockdowns, and it now seems so has China.
What these places did is what the WHO had asked in the first place – the three magic words – ‘test, test, test’ and two more: ‘contact-tracing’. But these pose a special challenge for India.
Considering the state of India’s finances even before the pandemic, conducting millions of tests which are expensive currently, could cripple our economy. What we thus need is typical Indian ‘jugad’ (quick-fix) that can be scaled up i.e. tests so ridiculously cheap and fast - no more than Rs. 50 for one – that testing oneself is as easy and quick as getting vegetables from the nearest market. This will be a key breakthrough not just for India, but the world.
If anyone can develop such a cheap test, it is India – the nation that practically reinvented the space wheel when it created its own almost fully indigenous space program.
The day we are able to do a few million tests every day, followed by effective quarantine and contact-tracing, is the day we would be on our way to ‘living’ with the virus till we find a cure.
Hence, the most important government push right now, should be to help those trying to make these cheap, quick tests, a field in which we have indeed seen some promising developments like this, this and this.
A key problem in India is our horrendous communication skills. Millions still haven’t understood the gravity of the disease and continue to roam around needlessly despite the lockdown (excluding genuine cases like hunger-stricken migrants). Thus what we need most is effective community communication of the seriousness of the issue involving local leaders and workers. This will be key to any solution we come up with.
To repeat once again - COVID-19 is not going away in a hurry. The government should make decisions based upon this assumption, as also the knowledge that resultant poverty could kill hundreds of thousands in India. But it need not be so. With enough testing, we can restart life and economy in a phased, controlled manner. And together, over time, united as a nation, step by step, we can defeat this invisible enemy better than any other country in the world.
(Satyen K Bordoloi is a scriptwriter, journalist based in Mumbai. His written words have appeared in many Indian and foreign publications.)