By Glenn C. Kharkongor
The repetitious cycle of lockdowns and curfews is yielding diminishing returns. Meghalaya is a case in point. The government waged a good campaign to test and trace contacts from the Bethany epicentre, and found all primary contacts to have tested negative. So far so good.
Now is the time to act on the data gathered in Meghalaya and the fund of knowledge that has come from the labs of science and fieldwork of epidemiologists. We don’t have all the answers yet, but we know much more than when the pandemic started.
Overall in India, the doubling time has gone from 3 to 6 and is now 10 days. There are spikes here and there, but those places are tackled by the correct policy of containment zones. The first lockdown was based on the incubation period of the virus. That has been doubled and more, so the calculations for extensions of the lockdown are less sure-footed now.
Prolonged lockdown will soon be tantamount to lockup, which is not a nice word. It will lead to collateral economic, social and mental damage, about which much is being written up now. Here and there we are seeing protests against lockdowns. Fortunately these have not become widespread.
Pre-symptomatic and asymptomatic carriers
There is muchevidence for such carriers and the prevalence rate for these mostly innocent individuals ismounting by the day. Nothing much we can do about these individuals, who will take us towards herd immunity, because we can’t identify or quarantine all of them.
Unless we do wide testing with antibody tests, and use resource-saving ploys as pool testing, meaning thatblood samples from multiple individuals are tested together. This saves kits if the result is negative. If the test is positive, the technician will go back and test each of the samples individually.
This is a good strategy in resource-poor countries, in communities where prevalence is expected to be low. The ICMR has issued guidelines for pool testing of 5 individuals at a time. This is too conservative, especially for a country with a large population. Germany is testing 50 at a time.
But this mass surveillance is a toolonly for later use, when policy makers need to know prevalence rates so that budgets can be allotted and schemes created for control or eradication. This will come into play when a vaccine is available.
Though India is in the downslope of the curve, we need to wait for a certain equilibrium to be established, in which the numbers are countable and future trends are predictable. To get to that steady state point, a return to normalcy is required.
Decision-making not so easy now
In the early part of this crisis, administration was easy. Decision-making by state leaders merely followed the national directives, with some local tweaking. Every state called for shutdowns and police clampdowns, and those that were stricter were praised. On the technical side, compliance with the ICMR guidelines was the order of the day. Perhaps only Kerala forged their own strategies, honed by earlier experiences such as with the Nipah virus.
Local leaders now have to peruse new data, manage variations in the local situation, and deal with logistics and economic exigencies. They have to balance public demands, try to grasp the evolving science, and engage with their medical advisors, not all of whom are on the same page.
Cues from the national or other state governments are of diminishing importance and each state has to detail out its stepdown measures, minor calibrations of which may have unforeseen fallouts. Curfews in Shillong have had mixed success.The crowding evidenced by pictures in the Shillong Times on ‘open’ days quickly nullified the benefits of strict curfews. Perhaps no state had seen the need to have such stringent curfews.
Many states, including Meghalaya have faltered on public communication. We have heard mainly from the Chief Minister with the Deputy Chief Minister seen more now as spokesperson, and occasional statements from the Health Minister. This is not enough. There needs to be an articulate scientist who explains the rationale behind decisions and takes the technical questions. Even a stumbler like Donald Trump has a seasoned epidemiologist doctor standing one step to his side at all press conferences.
Politicians have varying levels of knowledge. When they falter inglib attempts at science, it is easily noticed by the public. The state should have had a technical spokesperson also. This is advisable in all disasters. In a major earthquake scenario, a geologist or a scientist from NESAC would have great credibility.
The editor of the Shillong Times wrote about “fear management”. Fear of the unknown is human nature. One may be less fearful of a fiery inferno because one can see it. But the virus is invisible and takes on ghostly proportions. Advising the public repeatedly not to panic carries little weight, when they see the unsure stances of the leaders.
Overlaps of power as seen in the Jhalupara and Nongpoh episodes could have been avoided by invoking the Shillong City Disaster Management Plan 2018, which clearly places the DC at the helm and provides against multiplicity of authorities. Incidentally, epidemics are included in Category 5 of the classification of disasters in the 2018 Plan. A reading of the 239 page plan indicates that there are many levels of preparedness which could have been put in place. Instead there was recourse to the outdated Epidemic Diseases Act of 1897, once the crisis was upon us.
New cases will be zero after May 16
The Niti Aayog key empowered committee for Covid has released their study on the future course of the epidemic in India which shows that the peak in new cases will be reached on May 3 and this will drop to zero on May 16. Imprecisions aside, this provides a tentative timetable for decision making.
It is important to unbolt the lockdown lockjamsoon.In getting back to normalcy, many sectors need to be properly reviewed. Karnataka has opened all neighbourhood shops, only large markets and malls are closed. Hardware, mobile, barber shops, bakeries are open in all cities, towns and villages. Farmers can take their produce to the cities. In this way family and small enterprises are back in business.
It has been reported in the Shillong Times, Apr 26, that 10288 Meghalaya citizens are stranded elsewhere in the country. Many are in dire straits. Bangalore police are issuing travel permits for people from other states to return home. There are not many takers because with no public transport, hiring a private vehicle to go by road is prohibitive. Even if someone reaches Byrnihat, will he/she be permitted to enter the home state? If not now, when? After reaching home, will quarantine be enforced? This should not be necessary.
Educational institutions need to be reopened, or the school year and examination schedules will be compromised. Furthermore unaided private schools must collect fees, otherwise they cannot pay the teachers and other staff. This is not a big worry for mainland India because of the buffer of summer holidays, but Meghalaya has a different academic calendar.
Declare EKH as Green Zone soon
Only Kashmir and NE states have this habit of enforcing curfews. Curfew is an ugly word, seemingly enforced because the public is at fault, and has colonial overtones. Civil restrictions could have been invoked through the Disaster Management Act 2005 or the Shillong City Disaster Management Plan 2018, which was given to us with great fanfare but forgotten thereafter. West Bengal has coined and imposed a “super lockdown” but not a curfew. The Supreme Court has repeatedly upheld that the right to live implies the right to live with dignity. This is transgressed repeatedly by police in this country, making citizens hold their ears, do push-ups or frog marches, or beating them with lathis.
The government managed the Bethany cluster in a timely manner. With the good news that all primary contacts have tested negative, it can soon be announced that there are no active cases in the state. Meanwhile a containment zone can be declared temporarily, either of the Bethany Hospital locality or the Greater Shillong Area, and the rest of EKH can revert to green status.