The Hindu Editorial Analysis
26 March 2020

1) A long road: On India’s 21-day coronavirus lockdown


  • CONTEXT:
  • India’s unprecedented 21-day national lockdown is an unparalleled effort at stopping the march of a fast-spreading scourge that has overwhelmed the health infrastructure of several nations.
  • Although the Centre seems to have thought of such a move in advance in a bid to flatten the curve of transmission of the novel coronavirus, the enforcement has left millions of people unprepared for the severe disruption.
  • The janata curfew, on March 22, ahead of the lockdown was obviously a drill for the three-week imposition, but the government failed to anticipate the complex issues involved in confining over a billion people to their homes.
  • LOCKDOWN:
  • Of course, as a public health measure, the full national lockdown announced by Prime Minister Narendra Modi is being welcomed by the medical community as a necessary measure to cut the transmission chain of the virus.
  • Fresh arrival of travellers from abroad has already been stopped, and three weeks is long enough to allow for symptomatic cases of COVID-19 disease to emerge.
  • This should give the government sufficient time to plan a treatment response. But for the lockdown to serve its purpose, it should lead to wider testing of all suspected cases.
  • LACK OF PLANNING:
  • Regrettably, the lack of planning on the lockdown resulted in another bout of crowding, with people rushing out to buy essential supplies and medicines.
  • There were instances of mindless police violence against workers performing routine jobs. The virtual curfew could have been made far less stressful through prior discussion with the States, and unambiguous communication to the public.
  • Clearly, State agencies did not follow the order issued by the Home Ministry under the Disaster Management Act, 2005, spelling out provisions on essential services.
  • If the prolonged lockdown is to be executed without too much trauma for the general public, there has to be a war room approach.
  • Chief among the measures needed is reliable access to food, water, medicines and emergency assistance.
  • Here, some States have moved early and announced cash relief and free rations. The challenge is to ensure effective implementation.
  • Again, if movement is to be restricted, essentials must be delivered virtually at the doorstep. This is enabled explicitly by the Home Ministry’s order.
  • Allowing delivery of medicines by pharmacies is important and essential personnel must be given passes that protect them from police harassment and ensure movement of goods.
  • There is also a deplorable trend of social discrimination against health workers handling COVID-19 cases, which must be sternly dealt with.
  • The onus is on the Central and State governments to provide for everyone during the lockdown, and they should be working round the clock.
  • Otherwise, people will be forced into a situation where breaking the curfew might seem the safer alternative to deprivation and suffering in isolation.
  • IMPACT OF THE LOCKDOWN:
  • The efficacy of a protracted three-week-long countrywide lockdown in the fight against the pandemic aside, what is very clear is that the shutdown is set to bring the approximately ₹200-lakh crore national economy close to a shuddering standstill.
  • The ramifications are already so wide-ranging that measuring the fallout merely in terms of lost economic output would be grossly inadequate.
  • The hardest hit are the millions of daily wage earners, the self-employed and small businesses, and the rural landless poor.
  • Vulnerable segments of the workforce face the immediate prospect of a lack of income as well as hunger.
  • On a larger scale, with public transport services now withdrawn and private vehicular movement severely restricted to the barest delivery of essential services, it is hard to see how people employed even in vital sectors of manufacturing or the utilities would be able to reach their workplaces.
  • RELIEF MEASURES:
  • The Finance Minister on Tuesday announced a welcome slew of tax and regulatory compliance-related deadline deferments as well as some credit-related relief to the MSME sector.
    • the combined steps will at best be of marginal help to tackle the unprecedented economic crisis.
  • Any package to address it therefore demands a set of mitigation and subsequent stimulus measures that would need to be of an exceptional scale and require implementation on a war footing.
  • For a start, the Centre must abandon its fiscal deficit goals at this moment of a worldwide healthcare and economic crisis that is set to tip the global economy into a recession, at the very least in the near term.
  • The Centre needs to immediately release sizeable cash grants to all persons with Jan-Dhan accounts and BPL ration cards and use its various social welfare schemes including PM-KISAN and MGNREGA to ensure that the reach of such financial aid is maximised countrywide.
  • The plan must also encompass a broad swathe of spending measures.
  • These should include:
    • substantial investments in public health infrastructure targeted at COVID-19 treatment — for which a beginning has been made with an allocation of ₹15,000 crore —
    • as well as provisions for free services to all financial aid recipients;
    • loan repayment holidays and a wage bill subsidy to all MSME businesses that retain their workforce at pre-crisis levels;
    • and once the lockdown is lifted, a huge public infrastructure creation backed spending push to generate jobs and restart economic activity.
  • A modest doubling of the budgeted fiscal deficit figure for 2020-21 could see about ₹16-lakh crore being freed up for the Centre to both spend directly and provide capital support in the form of grants and subsidies to State governments and banks.
  • WAY FORWARD:
  • The government would do well to use the crisis as a once-in-a-generation opportunity to address both the economy’s and the public’s well-being.
  • The lives and livelihoods lost to the pandemic should not be in vain.
  • The unprecedented lockdown can work only if governments help people stay homebound.

 

2) Dressing a wounded economy


  • CONTEXT:
  • The impact of the coranavirus pandemic is now felt by almost every country.
  • First, there are the health effects of the virus, and second is the economic impact of the various actions that have to be taken to combat the virus.
  • The world is experiencing an additional slowdown on top of the contracting tendencies already present and India is no exception.
  • The economic impact on India can be traced through four channels: external demand; domestic demand; supply disruptions, and financial market disturbances.

  • EXTERNAL, DOMESTIC DEMAND:
  • As the economies of the developed countries slow down (some people are even talking of recession), their demand for imports of goods will go down and this will affect our exports which are even now not doing well.
  • In fact after six months of negative growth, it was only in January that Indian exports showed positive growth.
  • The extent of decline will depend on how severely the other economies are affected.
  • Not only merchandise exports but also service exports will suffer. Besides these, the IT industry, travel, transport and hotel industries will be affected.
  • The only redeeming feature in the external sector is the fall in oil prices. India’s oil import bill will come down substantially.
  • But this will affect adversely the oil exporting countries which absorb Indian labour. Remittances may slow down.
  • LOCKDOWN:
  • To ward off the spread of the coronavirus, the government has declared a lockdown of the country.
  • As passengers travel less, the transportation industry, road, rail and air, is cutting down schedules, sometimes drastically.
  • This will affect in turn several other sectors closely related to them. The laying off of non-permanent employees has already started.
  • As people in general buy less, shops stock less, which in turn affects production. Perhaps retail units will be first to be affected and they will in turn transmit this to the production units.
  • One is unable to make an estimate of the reduction in economic activity at this point.
  • If the situation is not reversed soon, there can be a serious decline in the growth rate during 2020-21.
  • Supply disruptions can occur because of the inability to import or procure inputs. The break in supply chains can be severe.
  • It is estimated that nearly 60% of our imports is in the category of ‘intermediate goods’.
  • Imports from countries which are affected by the virus can be a source of concern.
  • Domestic supply chain can also be affected as the inter-State movement of goods has also slowed down.
  • FINANCIAL MARKET ISSUES:
  • Financial markets are the ones which respond quickly and irrationally to a pandemic such as the coronavirus pandemic.
  • The entire reaction is based on fear. The stock market in India has collapsed.
  • The indices are at a three-year low. Foreign Portfolio Investors have shown great nervousness and the safe haven doctrine operates. In this process, the value of the rupee in terms of dollar has also fallen.
  • The stock market decline has a wealth affect and will have an impact on the behaviour of particularly high wealth holders.
  • How does the government deal with this sudden decline in economic activity which has come at a time when the economy is not doing well?
  • The two major tools that are available are monetary policy and fiscal actions.
  • Monetary policy in a situation like this can only act to stimulate demand by a greater push of liquidity and credit. The policy rate has already been brought down by 135 basis points over the last several months.
  • There is obviously scope for further reduction. But our own history as well as the experience of other countries clearly show that beyond a point, a reduction in interest rates does not work.
  • It is the environment of the overall economy that counts. Credit may be available. But there may not be takers. You can lead a horse to water but you cannot make it drink.
  • Any substantial reduction of policy rate can also affect savers. Interest is a double-edged sword.
  • The Reserve Bank of India (RBI) needs to go beyond cutting policy rate. A certain amount of regulatory forbearance is required to make the banks lend.
  • BANKS:
  • Even commercial banks on their own will have to think in terms of modifying norms they use for inventory holding by production units.
  • Repayments to banks can be delayed and the authorities must be willing to relax the rules.
  • Any relaxation of rules regarding the recognition of non-performing assets has to be across the entire business sector.
  • The authorities must be ready to tighten the rules as soon as the situation improves.
  • This is a temporary relaxation and must be seen as such by banks and borrowers.
  • Fiscal actions have a major role to play. Once again, the ability to play a big role is constrained by the fact that the fiscal position of the government of India is already difficult.
  • Even without the pandemic, the fiscal deficit of the Central government will turn out to be higher than that indicated in the budgets for 2019-20 and 2020-21.
  • Revenues are likely to go down further because of the virus related slowdown in economic activity.
  • In this context, the ability to undertake big ticket expenditures is constrained. But there are some ‘musts’. The virus has to be fought and brought down.
  • PRIVATE HOSPITALS:
  • All expenditures to test (there is some concern that the extent of testing that we are doing now is low) and to take care of patients must be incurred.
  • Now that private hospitals are allowed to test, the cost of the people going to private hospitals must also be met by the government.
  • The involvement of private hospitals has become necessary. It is mentioned that a test costs ₹4,500.
  • The total cost can be substantial if the numbers to be tested run in the thousands and more.
  • This may sound exaggerated. But we must be prepared so that we avoid the tragedy of Italy.
  • Therefore, the first priority is to mobilise adequate resources to meet all health related expenditures which includes the supply of accessories such as masks, sanitisers and materials for tests. The challenge is not only fiscal but also organisational.
  • THE JOB SECTOR:
  • Serious concerns have been expressed about people who have been thrown out of employment. These are mostly daily-wage earners and non-permanent/temporary employees.
  • In fact some of the migrant labour have gone back to home States. We must appeal to the business units to keep even non-permanent workers on their rolls and provide them with a minimal income.
  • Some relief can be thought of by the government for such business units even though this can be misused.
  • However, in general, in the case of sectors such as hospitality and travel, the government can extend relief through deferment of payments of dues to the government.
  • There is also talk of providing cash transfer to individuals. There is already a programme for rural farmers with all the limitations. For a system of cash transfer to be workable, it has to be universal.
  • At this moment when all the energies of the government are required to combat the virus, to institute a system of universal cash transfer will be a diversion of efforts.
  • The burden on the government will depend upon the quantum of per capita cash transfer and the length of the period.
  • WAY FORWARD:
  • As mentioned earlier, the government should advise all business units not to retrench workers and provide some relief to them to maintain the workers.
  • A supplemental income scheme for all the poor can be thought of once the immediate problem is resolved.
  • Provision of food and other essentials must be made available to the affected as is done at the time of floods or drought. States must take the initiative.
  • The fiscal deficit is bound to go up substantially. The higher borrowing programme will need the support of the RBI if the interest rate is to be kept low.
  • Monetisation of deficit is inevitable. The strong injection of liquidity will store up problems for the next year. Inflation can flare up. The government needs to be mindful of this.
  • All the same, the government must not stint and go out in a massive way to combat the virus. This is the government’s first priority.

 

3) COVID-19 and the great Chinese puzzle


  • CONTEXT:
  • The pandemic is spreading like wildfire. What started surreptitiously sometime in late 2019 in Wuhan, China, has engulfed 172 countries and regions by March 25, 2020.
  • Globally over 4,35,000 have been reported as confirmed infected, over 19,500 have died, and around 1,11,000 have recovered.
  • The virus is SARS-CoV-2; the clinical illness is COVID-19. When not specified, reported numbers may pertain to either infection or disease or a mix, misleading decision-makers to conflate the two.

  • TEST RESULTS:
  • The numbers of test results put out from China, the ‘index country’, have helped the world World Health Organization (WHO) and affected countries get a sense of the seriousness of COVID-19 and SARS-CoV-2 infection.
  • In China, about 81,600 had confirmed disease; there were about 3,100 deaths. The crude estimate of case fatality was 3.7%. All diseased are infected, the reverse is not true.
  • Not all infected are sick or tested. Hence, information from China is unhelpful to confidently project the probabilities/proportions that will get infected; get COVID-19 symptoms; develop pneumonia; die.
  • Virus spread in China reportedly stopped by the end of the third week of March, with no new SARS-CoV-2 infections arising locally since then.
  • China is now gearing up to prevent virus transmission from citizens returning from other countries.
  • If only 90,000 were infected among a 1.4 billion population, the proportion was only 0.0065%.
  • Here is the puzzle: for any epidemic, its downturn consequent to high herd immunity requires about 70% infected and immune.
  • Every second person in the community will then be a dead-end for virus spread. What proportion of the Chinese was actually infected?
  • The proportion of 0.0065% is unrealistically low for the visible shift in epidemiology.
  • If 70% were infected, there were 980 million infections. This extraordinary range is the puzzle.
  • THE BEGINNING:
  • The story began unfolding in December 2019 with cases of pneumonia without an identifiable cause. One astute physician saw this and alerted his colleagues.
  • He was reprimanded by the authorities for spreading fear, rather like ‘anti-national activity’ in contemporary Indian parlance. Soon they realised that the alarm was true.
  • Among the first 41 cases, most were workers in, or had direct contact with, the Hunan Seafood Wholesale Market, where several species of wild-caught animals were stocked and sold.
  • On December 31, health officials informed the WHO of the outbreak of a suspected zoonosis (vertebrate-to-human transmitted infectious disease).
  • That market and all other similar markets nationally were closed the next day. On January 7, WHO was notified that the pathogen was a novel coronavirus.
  • Soon Chinese scientists mapped its full genome sequence and gene sequence for primers needed for diagnostic tests and made these data publicly available.
  • The International Committee on Taxonomy of Viruses re-named it SARS-CoV-2 because of its close genetic similarity to the SARS coronavirus that had caused the SARS epidemic in 2002-03. Also the new disease was clinically SARS-like.
  • By mid-January, several countries (Thailand, Japan, Taiwan, South Korea, Viet Nam, USA, France, Australia, Singapore, Malaysia and Nepal) reported COVID-19.

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  • GLOBALISING DISEASE:
  • This was a globalising disease, no longer China’s problem alone.
  • It was no longer zoonosis but had become anthroponosis (person-to-person transmitted infectious disease).
  • But when did this epidemic actually start in Wuhan? How long did it remain unrecognised? The number of cases at a given time could reflect the duration of the outbreak.
  • Since amplification of infection is a function of time, the higher the number of cases at a time when laboratory testing was in full swing, the longer the virus had circulated in China as anthroponosis.
  • The necessary numbers are just not available, which is a problem.
  • Only on January 11 did China record the first death from COVID-19.
  • Considering that the test had just become available, any earlier death would not have been attributed to SARS-CoV-2 infection. More than a week later China counted 26 deaths among 830 diagnosed with COVID-19.
  • By January 20, Wuhan was placed under lockout; Hubei province followed shortly. China alerted the world by end-January, it alerted the world that COVID-19 was widely prevalent in all 31 provinces.
  • The WHO declared the disease a ‘public health emergency of international concern’ on January 30.
  • The very next day Philippines, India, Russia, Spain, Sweden and the U.K. documented virus importation through infected travellers.
  • A pandemic (global epidemic) is declared by the WHO ‘when the world’s population would likely be exposed to a new infection with potential to make a proportion sick’.
  • By February 2, the infection had already spread to 24 countries outside China-Hong Kong-Macau.
  • Given time this contagious anthroponosis was more than likely to expose the whole world and was already a pandemic by definition.
  • PANDEMICS AND EPIDEMIC ACT:
  • But WHO declared a pandemic only on March 11: 38 precious days were lost. Did WHO get misled by the 0.0065% risk?
  • Countries like India that depend heavily on WHO guidance for public health action had apparently mistaken the non-declaration as a signal that it was short-lived or non-serious.
  • Was not the likelihood of universal spread low if it was not pandemic?
  • On March 12, fear gripped India as it had not done homework to face the pandemic and invoked the Epidemic Diseases Act giving the state extraordinary powers.
  • On June 11, 2009, WHO had declared influenza H1N1 as a pandemic. It was relatively mild with a case-fatality of about 0.1%.
  • The low fatality rate was probably, partly, because it was not an entirely new virus. The 1918 Spanish flu pandemic was H1N1 virus, replaced by the 1957 Asian flu pandemic of H2N2.
  • People aged 53 and above in 2009 had a high probability of having some immune memory for H1N1. In addition, the 2009 H1N1 strain had lower virulence than earlier pandemics.
  • The pandemic alert was clearly warranted based on defined virological and epidemiological criteria.
  • Yet there were allegations that WHO had declared a ‘false pandemic’ as a pandemic on account of pharmaceutical industry pressure to sell more pharmacological products.
  • Might WHO have delayed the declaration of COVID-19 as a pandemic until it was too obvious to avoid criticism?
  • GROWTH PATTERN:
  • This infection shows an exponential growth pattern typical of contagious anthroponosis. Epidemiologists have estimated the transmissibility of SARS-CoV-2.
  • The term basic reproduction number (R0) denotes the number of new infections that an infected person could seed, during the infective period, if all contacts exposed were non-immune and susceptible.
  • For this infection, R0 has been estimated to be between 1.5 and 3.5.
    • If we accept conservatively R0=2, one infected person will, on an average, infect two other people; next generation will be 4, then 8, 16, 32 and so on. When a large proportion is infected, hence immune, the scene changes.
  • An infected person will encounter a majority of immune and a minority of non-immune among contacts, and virus transmission will slow down.
  • Experts outside China are projecting infection to reach 30-70% of the world’s population in the coming months.
  • Data from China indicate that 80% of the infected are likely to be not very ill, and hence require little or no medical attention.
  • Around 14% would develop severe disease, and around 6% would require critical care.
  • Consider these figures against a total of 90,000 reported infected in all of China and extrapolate to a probable 980 million infected.
  • If countries use these estimates to plan resource demand in terms of hospital beds, personnel, ICU beds, ventilators, equipment and trained personnel, no country in the world can claim to be prepared to meet these requirements.
  • This is why the Chinese puzzle needs exploration. If only <1 % will be infected when the numbers begin to fall, countries like India have reason for optimism.
  • Or does this puzzle indicate that although 70% of Chinese were actually infected with SARS-COV-2 by the third week of March, only about 90,000 of the 980 million infected (0.0092%) developed COVID-19?
  • This could also provide reason for optimism, but is highly speculative without necessary information.
  • DATA:
  • Why are the data missing? Has the world at large and WHO particularly missed a massive elephant in China?
  • For infection rate to decline, the proportion of immune, hence non-susceptible people among the whole population should be fairly high.
  • We define herd immunity as the proportion immune in the population and herd effect as the reduction of infection incidence in the non-immune segment of the population on account of the high herd immunity slowing down the circulation of the virus.
  • To determine how large the COVID-19 epidemic was in China is information that we need urgently. The only way to get it is by careful antibody prevalence surveys, which we hope WHO will be demanding from China.
  • China claimed success in interrupting transmission because Hubei province was under lockdown fairly early in the course of the epidemic, and China also imposed travel restrictions on other provinces. Is its claim credible?
  • What if the epidemic had actually started, say, in August?
  • CONCLUSION:
  • Since the lockdown occurred later than it should have, travellers attending the Chinese Lunar New Year celebrations transmitted the infection wherever they went.
  • Most countries have focussed on identifying infections brought by travellers from such high-risk countries but the majority with COVID-19 infections now are showing increasing rates of local transmission.
  • The signal from the Chinese puzzle could be that widespread infection is not inevitable and with stringent public health measures infection rate could be brought down to zero.
  • That scenario does not make epidemiological sense.
  • We have to conclude that China does not know, or is not revealing, the magnitude of infection in all of China.
  • All countries that expected very small numbers to be at risk of infection based on the China puzzle must anticipate about 70% to be infected in the first wave of the epidemic.
  • If summer heat dampens transmission, we may not reach 70% until autumn or winter. After that, the infection may stay on as endemic and seasonal.
  • WAY FORWARD:
  • We are better off to learn lessons from other countries. We must also learn our own lessons real-time, as and when events happen.
  • We have to catch up for lost time because of our optimistic reading of data that were not verified or even checked for plausibility.

 

4) Test, test, test for the virus


​​​​​​​

  • CONTEXT:
  • The novel coronavirus differs from other pandemics because of its exponential speed of transmission. ​​​​​​​
  • CORONAVIRUS:
  • The coronavirus is a novel virus because the genetic RNA has undergone mutation recently to infect humans from an animal source, thus converting a zoonotic disease to an anthroponotic one.
  • Coronavirus RNA is new to the human immunological system.
  • Therefore, there are a lot of unanswered questions with regard to immunity, recurrence, carrier state, treatment and vaccines.
  • The incubation period is 2-14 days. However, research has revealed that the virus can remain in circulation for much longer in affected individuals.
  • ECONOMIC STATUS:
  • The economic status of a country influences implementation of its policies.
  • As India is a lower-middle-income country with a healthcare expenditure that is consistently below 1.5% of the GDP, it needs to be prudent and pragmatic in its approach to withstand it in the event of community spread.
  • Therefore, the government must focus on continued surveillance, prompt diagnosis and adopt robust treatment modalities to reduce morbidity and mortality.
  • INCREASE IN TESTING:
  • An increase in testing will identify the actual number of cases that would require quarantine and prompt treatment.
  • The Indian Council of Medical Research has to increase random sampling and screening of the high-risk population.
  • Nationwide, the government has identified 75 government hospitals for testing and has allowed private labs with NABL accreditation to conduct real-time PCR assay of the RNA virus.
  • The National Task Force has recommended that the maximum cost for testing sample should not exceed ₹4,500.
  • The country’s per capita annual income for 2019-20 is ₹1,35,048 and the average middle-class annual income is ₹10-15 lakh.
  • Out-of-pocket expenses in healthcare is what pushes a lot of low-income Indians below the poverty line.
  • COVID-19 is a national emergency. Therefore, the government should include the test under the ambit of all private and government health insurance schemes.
  • The primary goal of the government is to ensure availability and accessibility to diagnostic tests free of cost. Setting up diagnostic centres in every district general hospital should be the top-most priority.
  • Travel bans and quarantines are imperative measures, but testing alone can reveal the extent of the disease in the community.
  • FIGHTING MISINFORMATION:
  • Misinformation, especially on the use of facial masks, alternative medicine, and availability of a cure, should be avoided.
  • With limited resources, India requires protection gear such as three-layered facial masks for its healthcare workers and for those in service industries.
  • INDIA's POSITION:
  • There is no vaccine to fight the virus yet. Randomised controlled trials for antiviral treatment are difficult to execute during pandemics.
  • Researchers need to make tough choices during clinical trials, while ensuring the safety of the patients.
  • Medication was elusive in the past for H1N1, HIV and many other viral illnesses but the human mind proved invincible. Anti-COVID-19 drugs may be available sooner than later.
  • The true incidence of the disease is still unknown.
  • Evidence from the identified cases worldwide suaggest that 80% of the infections will be mild with people having flu-like symptoms, about 15% will be severe requiring hospitalisation due to breathlessness or pneumonia, 3-5% will require ventilatory support, and about 1% will succumb to the virus.
  • CONCLUSION:
  • Every individual at risk, and not just those in power, should be tested on request.
  • There are authentic reports that several individuals have been denied diagnostic tests despite a contact history.
  • The WHO categorised India as having local transmission.
  • If so, lessons can be learnt from South Korea which is taking 6,388 tests per million of the population compared to India’s 11.6. Every life is equally invaluable.