Threat from COVID-19 needs no introduction. It is a pandemic now knocking at our doors. The sound is loud and clear. Incidence of discovery of Markaz at Nizamuddin, New Delhi on 31 March 2020 has made the situation even more alarming. Due to far reaching consequences of this Markaz we have now entered in unchartered waters so far as spread of COVID-19 is concerned. India is a democratic country and is considered a soft state. But this is not a time for vote bank politics. Neither this is a time to care for sentiments of law breakers. The District Administration and Police Force have enough powers to deal with the situation. Invoke provisions of additional powers if situation so warrants. These powers should be use hesitation. There is a reason why these powers have been vested with the administration and not with political class. The political class has to win elections whereas those in administration are free from such constraint. The worst that will happen is a transfer to some other place.
Having said that I must point out that we are lucky, in a way, that we had time to observe the spread of this virus to many countries across the world. During this period we were able to do some kind of advance preparation. But remember that pandemics do not recognize state borders inside India, nor does it recognize borders between countries. It is a highly contagious virus for which mankind does not have any vaccine or treatment, except symptomatic treatment. This viral transmission spreads easily through droplets caused due to sneezing and even by touching contaminated surfaces.
There is a saying in army that no plan survives contact with the enemy. Taking a cue from this well established fact the Central Government and State Governments have to prepare at two levels – Strategic Level and Tactical Level. In brief Strategic Level means overall planning to fight COVID-19 spread across the country and provisioning of all types of associated logistics (including medical logistics) and strong legal provisions. Tactical Level includes what the administration is required to do at district and sub division level to contain, treat and arrest the spread of COVID-19 at local level. There has to be continuous dialogue and feedback so that Strategic Level decisions support Tactical Level actions and vice versa. Having said this let us concentrate on following points of immediate concern:-
- Containing the spread – The Nizamuddin Markaz is shocking eye opener for all Indians. The horrific consequences of this mindless and criminal activity will unfold in coming days. This incidence has sent a loud and clear warning regarding arresting the spread of corona virus. Each state needs to identify current known hotspots along with future likely hotspots. The administration must focus on isolating these hotspots completely. There should be zero tolerance towards those who do not follow the laid down directions. Action should be taken against those who do not follow the lockdown. The action taken should be advertised to deter similarly inclined people. Privacy laws in this regard (if any) should take a backseat. These are not normal times.
- Limited Lockdown or complete shutdown? – Choice is ours. But I believe that a limited lockdown may not work. Corona virus is very contagious. It is easily transmitted too. A complete shutdown is required to stop or at least minimize the viral transmission. This will give time to state governments to be better prepared to deal with an outbreak, if it happens. We do not want to be caught with our pants down, in a manner of speaking.
- Provision of daily needs – After PM Modi’s appeal people have shown willingness to follow the lockdown. I anticipate that corona virus situation is not going to go away soon. So we should be prepared for a long haul. This calls for better logistics planning so that daily needs of food supply, medicines etc are smoothly catered for. Otherwise rumours will set in and people will break the lockdown to hunt for provisions.
- Limited essential manufacturing activities and transportation – Governments have to identify those industries which cater for daily needs of the population, including old people and children. These manufacturing units should remain open and raw material supplies to such units should also not be disrupted. The entire supply chain needs to be managed by a special cell. Transportation of these finished goods by rail and road should continue uninterrupted. This calls for closer look on how we can ease movement of trucks all over India, including last mile connectivity of supplies. Newspapers have reported long queue of trucks at state check points. In some instances truck drivers have abandoned their vehicles and left for home. So special attention needs to be paid to truck drivers who need quick clearance and food & rest along the long routes of supply. It should not be difficult to earmark places where the truckers can stop for food and rest. Such places should be established by State Governments and should be co-located with petrol pumps. Many such places already exist and only need to be reopened. The truckers association of each state can be called for their input in this regard. Take their opinion and come to a decision quickly. Implement the decision as soon as possible.
- Creation of additional hospital beds – We should hope for the best but should prepare for the worst. We must learn lesson from events in Italy. This country is supposed to have one of the best medical facilities. But very large numbers of corona patients have died. Why so? The prime reason is that the deluge of patients overwhelmed the existing medical support system. The Italian government failed to lockdown in time and didn’t anticipate that number of patients will be so large. Rest is history. We do not want to be in such unenviable situation. Cities like Noida, Delhi, Bangalore and Meerut etc should provision for at least 1500 beds in government hospitals. We should presume that 1000 patients will need isolation/quarantine and additional 500 patients will need ICU facilities. ICU facilities of private hospitals should also be utilized as they are of better quality. COVID-19 patients must not be mixed with regular patients, to avoid infection of regular patients.
- Doctors, Nurses and Paramedic staff – Planning for this is of utmost importance. In Italy a situation came when doctors could not attend to all the patients despite working very long hours. Lives can be saved if we use the time available to prepare well. We need two teams of medical professionals. One team will screen the patients and medical care during quarantine. Second team will be more specialized and will attend to patients who are more serious and are admitted in ICU. These critical patients (including old patients and very young) should be sent to private hospitals which have better ICU facilities for critical care. CMO is best person to decide about numbers. But my opinion is that we should start with 8 hours shift for medical staff. So for 1000 patients in hospital quarantine we will need around 80 Senior Resident doctors and 250 nursing staff. In addition we will need other support staff like anaesthetists, lab assistants, radiologists etc. These are not small numbers and hence require advanced planning. As per a news report there are 50000 doctors who have got medical degree from abroad which have not been recognized by the government. If these medical colleges are recognized in their respective countries then government should give one time relaxation to such doctors. Post Graduate medical students and Final Year Medical Students can also be roped in. We should tap into this available manpower and should use them as Resident Doctors.
- Shortage of other medical infrastructure – Full potential of doctors and medical staff can be utilised only if government provides all the facilities and equipment to them. We need large numbers of essential items like Test Kits, Ventilators, Suction & Compressed Oxygen Supply, Central Piped Oxygen System, Masks, Gloves, Hazmat Suits for doctors’ protection etc. There should be no excuse for shortage of funds at government level. We also need large numbers of ambulances with life support system and staff. We need to move fast in procuring these items from wherever they are available. We also need to give government approval for local manufacturing of these items. Private sector should be able to do it quickly if permission is given.
- Insurance of medical staff – All levels of medical staff should be immediately given medical insurance cover of suitable amount. They deserve this much.
We should assume for the worst and prepare accordingly. We are lucky to have learnt lessons from the mistakes made by other countries. Let us use this knowledge to efficiently handle the COVID-19 crisis. We have to be ready to fight this war on two fronts – first on flattening the curve (through lockdown, public awareness etc) and second (simultaneously) to prepare our hospitals for treating the cases in quarantine and ICU. Governments need to be sensitive to the needs of administration and police force. They need moral support and financial support. The local administration, police force and medical staff are the foot soldiers who will fight this war on behalf of all of us. Let the government and citizens support them to the fullest and unflinchingly. Show zero tolerance to incidences like Nizamuddin Markaz, no matter where it happens.
