Covid, Public health, State of affairs, Caution – Thoughts interlaced with that of @AshishKJha @harvardgh

Dr. Ashish K Jha, Physician, researcher, and advocate for the notion that an ounce of data is worth a thousand pounds of opinion. Director @harvardgh. The Harvard Global Health Institute. Soon, Dean @Brown_SPH

I came across this significantly insightful tweet by Dr Ashish K Jha about happenings in the United States, but found resonating with me and very relevant for India now, when the graph is taking off dramatically. Hence I blogged it with my own takes, that is relevant to India. Thanks Dr. Ashish.

My 4 key public health messages I’ve tried to adhere to:

1. Never downplay horrible costs of being shut down

[But the leadership needs to know when the shutdown has to be enforced and when to be opened. In Indian context, it has been a decision, taken in haste, when hardly any infections were visible, the early days. Two months of lockdown and the people struggles without livelihood, hunger and penury. Then the mass desire to save themselves from the hunger and to reach their safety net of village homes, the following protests to be released, finding ways to reach homes, even at the cost of borrowing huge amounts of money at any costs. The silent long walks, by those that cannot afford to borrow….. a few dead due to thirst and hunger, with fear and exhaustion… what have we done to the humanity, the nation]

2 Focus on what needs doing: an effective government response to the pandemic. We still lack adequate testing/tracing so we can suppress virus, get our lives back

[Abysmally low levels of testing in India. With such mass numbers, too little testing. Here is the one of the latest articles on testing https://indianexpress.com/article/opinion/coronavirus-testing-india-numbers-6434215/]

3. As we open up, we should avoid things that are truly discretionary (pool parties, large indoor gatherings)

[In Indian context the opening has been as knee-jerk as the announcement of close-down. Since every one is shouting after the two months of knee-jerk shutdown – The industrialists to common man, fed up of being locked inside, wanted to fly. With the infection numbers rearing now, the unlocking has happened when actually it should have been time for close-down. Look at the graph above. We as a nation are at the brink of explosive growth. Need to be more careful in these months of June / July. Many of the virologists have been warning about this situation two months ago, early April.]

4. We should never begrudge folks angry about lost livelihoods, businesses, being unable to grieve for lost loved ones.

[With 85% of the working population being in unorganized sector, that is most hit by the lockdown. The SMEs that depend on every day production, sales to sustain, are going to be in dire straights. About 40% of these SMEs with mounting interests and debts, without any production and sales during the closedown of two months, with the hungry and unattended workforce moving to the hinterland to survive, are staring down the barrel. Their recovery is next to ziltch.

In their desire to reach home, the mass exodus of the 40% of the workforce from the industrialized cities and towns, to survive, to reach home, the humanity has gone through travails in their own nation, many losing their loved young ones, elderly on their long trudge to home, hundreds of kilometers away, due to shutdown of the transportation too. It looks worse than the stories of 1947 partition migration, I have heard and seen on the screen.]

3 personal views that are my values (yours might differ):

1. I support the protesters

[I do too, for the vast migrants that have been in dire straits. No one to take care of them. Samaritans did during the early days, but how long will one do? their resources are limited too. The govts efforts are left much to be desired. No one knows, and are prevented from knowing, about the utilization of funds from much touted @PMCares that has been collecting funds in the name of COVID. Estimates of collection go beyond 10000Crore rupees.

Protests in India have not yet erupted. I am very worried and concerned. Even when these migrants reach homes, without anything to carry, the villages and blocks will have unemployed youth and their families to be fed. When economy is in shambles, no demand, no markets how will they earn for themselves and for the family members who have landed back home devoid of any savings, rather with huge debts, after borrowing money to reach home.

I am afraid, we are going to see eruptions of anger soon. Is the nation ready?]

2. I am deeply worried protests will fuel outbreaks

[The movement of the migrant working population, had it been facilitated in late march when lockdown was announced, with hardly exposure to COVID virus then, that actually has arrived through various flights from the world, I feel we would have been able to curtail. With huge migrant working crowds now exposed to virus that has arrived by flights, mass protests that followed with no social-distancing and then packed sardine like trains, must have carried huge number of infected population into the country side. This will surely fuel mass outbreaks in the country side, devoid of proper health infrastructure. That could be a disaster. We need to over estimate the problem and states need to act. But it is going to be a herculean task]

3. I am angry we are in a position where there is tension between racial justice, fighting COVID because we didn’t suppress the virus

[In India context it is no better. The mass migration, with little care given to the affected marginalized skilled sections of the society that is rendered jobless with economic activities coming to a standstill and none to care about their welfare, the COVID numbers increasing. Now the ruling party goes on the election drive in Bihar with over 27 thousand LED screens across the state with election rallies when the state is struggling to handle the returning migrant workers from across the country. The priorities are skewed. There is going to be strife around the corner, with unemployment – COVID – Elections. I wish I am proved wrong.

2 takeaways:

1. If we had built up a strong testing/tracing infrastructure, we could have been in a very different position.

2. That would let us protest more safely. Go back to work more safely. Get kids back to school more safely.

Final point: I don’t want to fight about which kind of death is worse: death from a destroyed economy, death from racism [or migrants hunger pangs], or death from COVID. I really don’t.

We can make a different choice. It requires pushing our government to deal with pandemic by making testing widely available. Yes, tracing harder with protests but still absolutely essential And yes, we need to address issues of racism, policing and do so now.

[keep elections, the horsetrading in the backburner. Take care of people now, not the power].

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