Post-lockdown expectations

There is lack of definite information, so strategies are based on conjecture: said T.M. Vijay Bhaskar, at the Synergia Foundation webinar.

As Karnataka inches towards lifting of the lockdown on May 3, the government has a variety of plans on the table for an exit. Owing to differing opinions by experts in both the medical and economic field, there has been an effort to balance them, in a phased manner. While all are focused on the pandemic from the medical standpoint, the government's biggest concern at this point is the economic challenges, said Karnataka's Chief Secretary T.M. Vijay Bhaskar, at the Synergia Foundation webinar on 'Coping Strategies for COVID-19' held on April 22.

The objective of the webinar was to develop a strategic vision to combat the contagion and work on a calibrated post-lockdown plan on the medical, social, and economic fronts.

The panellists comprised of T.M. Vijay Bhaskar (IAS-Chief Secretary, Government of Karnataka); Arvind Kasturi (Head Community Health Care, St. John's National Academy); Naresh Shetty (President, M.S. Ramaiah Memorial Hospital); and R. Balasubramaniam (Founder SVY.M & GRAAM, Mysuru), along with the team at Synergia.T.M. Veeraraghav (Independent journalist, former resident editor with The Hindu, Sr. Editor CNN-News18) was the moderator.

First to speak were the medical experts. Dr. Arvind Kasturi expressed caution moving forward and suggested a detailed step-by-step procedure.

* The uninfected should remain so by raising awareness on the benefits of following hygiene, avoiding gatherings, etc.

* Medical services for people with comorbidities and other illnesses should continue.

* Facilities should be set up for those who can't be isolated at home due to space restrictions.

* Put in place early-warning systems for treatment using social media and other forms of communications, to spread awareness on the steps to take if one falls sick.

* The pandemic should be tackled with a teacher-with-a-stick model. At the same time, we must remember that migrant workers are our people, and we have to be the ones to get the message across to them.

* Prepare ourselves for some amount of human cost.

Dr. Balasubramaniam, was on the same page, saying the more there is for people to learn about the virus, the better. His worry was over the ticking time bomb -- when migrant labourers stuck in urban India, go back to their native villages, where the spread of the disease has been minimal.

Mr. Vijay Bhaskar too said the immediate fallout of the post-lockdown would be migration of people to their homes. Further, people would want to move around. The main concern then is how we ensure that this doesn't cause movement of infection also.

Dr. Balasubramaniam envisaged that the Centre and the State could see a fourth sector arise that focuses on benefit-optimisation.

He offered his strategies:

* Set up a 'real-time response body' to allow for the “accumulative cross-pollination” of experiences from all over. This would give people a better idea on how to tackle the pandemic.

* Mobilise resources; ensure short-term liquidity for the poor and vulnerable; keep basic services running; find ways to buffer economies (MSMEs and others); and leverage global support in the short term.

Smaller lockdown?

Post-COVID will be a different way of living altogether, said Dr. Naresh Shetty, and there could be the possibility of a smaller lockdown after this one.He also wondered why we are so focused on COVID, when there are many other harmful diseases that still exist. Is it because it is affecting the rich?

His pointer to the government:

*Stagger the population on the day lockdown is lifted. Hospitals will have to cope with the possibility of spread of infection when patients, relatives, and non-COVID patients intermingle.

New normal

On the strategic front, Maj. Gen. Moni Chandi (retd.) felt that the post-lockdown could have three outcomes: a professional win, where the containment is successful, and we restore economic activities and get a vaccine. Or, the situation could spiral out of control and the pandemic would rage through. Herd immunity would set in, but at a great cost.The final outcome could result in living a new way of life altogether, where new measures are put in place, with no vaccine available.

He suggested a way-and-means path:

* Play for time and wait for either the virus to mutate until it dies, or delay the pandemic for as long as it is possible through social distancing, until we find a vaccine.

* To work towards a controlled infection, which would give rise to herd immunity, allowing the lockdown to be lifted slowly while the most vulnerable (children and elderly) stay at home.

* Control the time and place of when we expose people to the virus, and marshal our resources.

Maj. Gen. Ajay Sah (retd.),however, cautioned against inculcating immunity, as there were cases of re-infection in those who had recovered. He also highlighted the morbidity and mortality aspect of the disease. With the morbidity factor, it is important to keep in mind that COVID can be transmitted through a variety of ways. More importantly, he said we must be aware of ‘superspreaders’ -- the spreading of the infection to many more through one person who is highly infected.

Without a vaccine or a drug right now, there is only the option of herd immunity and controlled infection said Sambratha Shetty, Chief Operating Officer, Synergia Foundation, adding that there are different factors to consider here -- the density of a population (it would be harder to control in metro cities), and hospital-bed capacity in the cities. A good way to also ramp-up testing was through pool testing or antibody testing.

But on the matter of controlled infection, Mr. Vijay Bhaskar stressed that medicines for COVID could be found faster than the vaccine for it. Projections showed that it would happen within a few months.

Corroborating Dr. Naresh Shetty's view that the healthcare system has never been at its best in India, and if it had at least 5% of the defence budget, it would have been a completely different story, Dr. Arvind Kasturi pointed out that this pandemic is a good lesson to improve the medical system from the grassroots --- both institutional care and general public hygiene. He said the government spends just 1.4% to 1.5% of the GDP on healthcare, which is very low compared to other countries.

Here to stay

All the speakers felt that pandemics were here to stay and this would translate to a different way of living altogether. Looking forward, Dr. Balasubramaniam warned of increased polarisation, an increase in the rural-urban split, and a change in our interconnected economies. If we don't come up with a solution that addresses all of it, it would just be a band-aid and not a systemic solution, he said.

In conclusion, Tobby Simon, Founder and President, Synergia Foundation, said there was a need to look at overarching issues of eating habits, especially the wet markets in China. After SARS, people had established that the disease was coming from bats. It is important that this be controlled, else we would have more and more SARSs. After all, there are only two things that can end mankind -- nuclear war and pandemics.

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