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A r e y o u im mu COVID-19 ne? ALL WE KNOW ALL WE DON’T

RNI NO. 7044/1961 ‹ N A V I G A T O R ›

EDITOR-IN-CHIEF Ruben Banerjee MANAGING EDITOR Sunil Menon EXECUTIVE EDITOR Satish Padmanabhan FOREIGN EDITOR Pranay Sharma COVID-19 POLITICAL EDITOR Bhavna Vij-Aurora SENIOR EDITOR Giridhar Jha (Mumbai) CHIEF ART DIRECTOR Deepak Sharma SPECIAL WRITERS Lola Nayar, Qaiser Mohammad Ali (Senior Associate Editors), G.C. Shekhar (Associate Editor), Jeevan Prakash Sharma (Senior Assistant Editor), Ajay Sukumaran, Puneet Nicholas Yadav, Jyotika Sood, Lachmi Deb Roy (Assistant Editors), Naseer Ganai (Senior Special Correspondent), Preetha Nair (Special Correspondent), Salik Ahmad (Senior Correspondent) COPY DESK Rituparna Kakoty (Senior Associate Editor), Anupam Bordoloi, Saikat Niyogi, Satyadeep (Associate Editors), Syed Saad Ahmed (Assistant Editor) PHOTOGRAPHERS S. Rakshit (Chief Photo Coordinator), Jitender Gupta (Photo Editor), Tribhuvan Tiwari (Deputy Photo Editor), Sandipan Chatterjee, Apoorva Salkade (Sr Photographers), Suresh Kumar Pandey (Staff Photographer) J.S. Adhikari (Sr Photo Researcher), U. Suresh Kumar (Digital Library) DESIGN Saji C.S. (Chief Designer), Leela (Senior Designer), Devi Prasad, Padam Gupta (Sr DTP Operators) DIGITAL Neha Mahajan (Associate Editor), Soumitra Mishra (Digital Consultant), Jayanta Oinam (Assistant Editor), Neelav Chakravarti (Senior Correspondent), Charupadma Pati (Trainee Journalist), Suraj Wadhwa (Chief Graphic Designer), Editorial Manager & Chief Librarian Alka Gupta

BUSINESS OFFICE CHIEF EXECUTIVE OFFICER Indranil Roy PUBLISHER Sandip Kumar Ghosh SR VICE PRESIDENT Meenakshi Akash VICE PRESIDENTS Shrutika Dewan, Diwan Singh Bisht SR GENERAL MANAGERS Kabir Khattar (Corp), Debabani Tagore, Shailender Vohra COVER STORY GENERAL MANAGERS Sasidharan Kollery, 18 Shashank Dixit COVID-19 has been around for at least six months CHIEF MANAGER Shekhar Kumar Pandey MANAGERS Shekhar Suvarana, Sudha Sharma now, surging across the globe. After all this time, are CIRCULATION & SUBSCRIPTION Anindya Banerjee, Gagan Kohli, G. Ramesh (South), Vinod Kumar (North), Arun Kumar Jha (East) we any closer to containing the pandemic? Are there DIGITAL Amit Mishra multiple strains, with the less virulent ones responsible HEAD OFFICE AB-10, S.J. Enclave, New Delhi - 110 029 for fewer deaths in India? Have lockdowns succeeded Tel: 011-71280400; Fax: 26191420 Customer care helpline: 011-71280433, 71280462, 71280307 in controlling the pandemic? Why have certain e-mail: [email protected] For editorial queries: [email protected] countries managed to contain the virus where others For subscription helpline: [email protected] have failed? And most importantly, what must we do OTHER OFFICES next? We explore the treatments under consideration, MUMBAI Tel: 022-50990990 CALCUTTA Tel: 033 46004506; Fax: 033 46004506 the latest research on the virus, the probability of a CHENNAI Tel: 42615224, 42615225; Fax: 42615095 BANGALORE Tel: 080-43715021 vaccine’s development and the way forward. Printed and published by Indranil Roy on behalf of Outlook Publishing (India) Pvt. Ltd. Editor: Ruben Banerjee. Printed at Kalajyothi Process Pvt. Ltd. Sy.No.185, Sai Pruthvi Enclave, Kondapur – 500 084, R.R.Dist. Telangana and published from AB-10, S.J. Enclave, Issue Editor: Sunil Menon New Delhi-110 029

Total no. of pages 100, Including Covers 8 POLIGLOT | 94 AUDI 5 | 98 LA DOLCE VITA | 100 DIARY Cover Design: Deepak Sharma

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2 OUTLOOK | JUNE 22, 2020 R.O.S. No 11225 L E T T E R S FEEDBACK › [email protected]

15/6/2020

The present flare-up cannot be ernment is not expected to dis- viewed in isolation—it is part of close all its plans for security China’s quest for hegemony. considerations, as an elected Similar incidents are occurring democratic government, it is in the South China Sea, obliged to tell the nation about Senkaku Islands and the the extent of incursions by the Taiwan Strait. China does not Chinese army. It is time to take hesitate to weaponise trade. It citizens and the Opposition plays by its own set of rules, into confidence. whether in the domain of trade practices or territorial disputes. CHENNAI Its message to neighbouring K.R. Narasimhan: India and nations: do not support USA in China should fight COVID-19 the US-China standoff. Many rather than indulge in brink- might consider its economic manship across the LAC. At a strength a positive, but the time when India is facing a sig- country’s rise as a global power nificant increase in cases and is not making it popular with its there are fears that a second neighbours. China should not wave could engulf China, bor- overlook the fact that in the der clashes are uncalled for. event of a cold or trade war But the timing of the border with USA, it will need support incidents comes on the heels from its Asian neighbours, of India’s decision to clamp including its major trading down on Chinese FDI invest- partner India. More alterca- ments and encourage Western tions are likely, but fortunately, and Japanese companies to communication channels shift their production bases between the two countries have away from China. India also The Tiger been and, hopefully, will supports Taiwan’s participa- remain open and strong. tion in the WHO as an Blows Fire observer. Despite the PLA’s NAVI MUMBAI incursions, India’s infrastruc-

DIGIMAG.OUTLOOKINDIA.COM NAINITAL C.K. Subramaniam: It is evi- ture upgradation close to the Vipul Pande: This refers to the cover story dent that China is not comfort- LAC will continue. This has Can India Become China 2.0? (June 15). The able with India’s strengthened irked China to no end. pandemic has disrupted the supply chains of infrastructure along the border. Softening its stand, Chinese many goods originating from China. This As a sovereign nation, India is ambassador Sun Weidong said has made countries realise that overdepend- within its rights to take aggres- that China and India pose no ence on China isn’t prudent. Moreover, sive steps. Unfortunately, the threat to each other. While there is Beijing’s opaque, stubborn and government has not thought it India has shown a willingness aggressive attitude to contend with. With fit to take the nation into confi- to confront China to safeguard YOUTUBE.COM/OUTLOOKMAGAZINE countries, especially those that do not toe its dence or share the ground real- its territorial interests, it line, wary of China’s increasing clout, oppor- ity. This may lead to spiralling should also try to diffuse the tunities have opened up for India. Its posi- misin format ion. While the gov- standoff through talks. tive image and vast market can draw big companies to its shores. However, this entails a lot of spadework to create an inves- politician branded a migrant? tor-friendly atmosphere. Cocooning Indian Hunger Games If so, the entire Bollywood fra- manufacturers in the name of self-depend- ternity and almost every politi- FACEBOOK.COM/OUTLOOKINDIA

ence isn’t the right way forward. Let them DEHRADUN cian and bureaucrat in Delhi compete on a level playing field. Rakesh Agrawal: This refers and state capitals would be a to What After Home? (June 8). migrant. We, the people of BANGALORE Terming the workers forced to India, the city-based, urbane H.N. Ramakrishna: India and China share return to their homes as mig middle-class professionals and one of the world’s longest land borders and rants is rubbing salt on their elites, have failed the workers there have been several conflicts. In 1962, bleeding wounds. Is any doctor, who built our dream worlds. China attacked India while ostensibly pro- engineer, software profes- We have remained as we are—

TWITTER.COM/OUTLOOKINDIA fessing the motto ‘Hindi Chini Bhai Bhai’. sional, poet, writer, actor or self-centred, inward-looking

00 OUTLOOK4| MAY OUTLOOK 4, 2020| JUNE 22, 2020 | PICTURE: GETTY IMAGES | NewsL / ESLUGGG/SUBSLUG T T E R S FEEDBACK › [email protected]

and insensitive—while millions have been passed to atone for its of poor people have been left at initial refusal to intervene to the mercy of a government that secure their welfare. The apex FROM THE Daak Room utterly lacks empathy and fore- court could have crowned itself sightedness, like most of us. with greater glory by taking the Dear Ruth, I have some more very bad news to desperate plight of migrant write. I guess if things keep on like this, by the MUMBAI end of the year, there will be nobody left in workers far more seriously at town. Harold Ashley died yesterday at Camp M.R. Jayanthi: The the beginning of the crisis its Wilton(?) and his body is to be brought to overnight declaration elf. The country’s top court Middleboro as soon as the government can get of lockdown to combat took an unforgivably long things straightened out. the spread of COVID- time to take note of their mis- As things are, I can give you no further infor- 19 has harmed people ery and ask the government mation about the funeral, only that in Massachusetts, no public funerals or any other and the economy. The to provide succour. Even gathering can be held. Schools, churches, lodges, country has not healed from the now, there seems to be no end to clubs, book rooms etc are closed down tight. All wounds of demonetisation, yet the suffering of migrant work- Red Cross workstations are suspended and they the government has pummelled ers. Tragic deaths due to hunger, have cut out some of the electric car trips as so it further. The Centre should heat, dehydration and exhaus- many men are sick. have been considerate and stra- tion continue to occur due to Just as soon as I hear any more about Harold’s funeral, I will let you know. I will also look out tegic; it should have scheduled the government’s ill-disguised for the flowers. I was intending to write on consultations with experts and apathy bordering on callous- Saturday, but Captain Doten told me that Harold stakeholders. The proverb ness. Of particular poignancy was improving, so I thought I would be able to ‘haste makes waste’ has come was the image of a child trying give you some good news... but about 8 pm today true with the sudden declara- to wake up his dead mother at a Harold Doten came up to the house on his motorcy- tion of the lockdown. railway station. Running of cle and told me the sad news. He also said that Mel Shurtleff died at Camp Devens yesterday at almost Brainstorming is vital for any Shramik Specials looks like tok the same time as Harold. decision to be effective and enism when it falls far short of Yesterday I worked around the yard all day, get- successful. the requirement to ferry lakhs ting things cleaned up so that I could… then rest of migrant workers. It is not that this morning, I filled one barrel with Baldwins MARUTHANCODE the Indian state is incapable of so that we might have a few in case we had a high G. David Milton: The Supreme ensuring the safe return of wind. On Friday we had seven funerals and Saturday about as many so you see what we are up Court’s belated order to provide workers to their native places, against. In Brockton, three days last week, there free food, water and transport to but it has been unwilling to rec- was one every hour. I am glad that you are having migrant workers appears to ognise the value of their lives. so good a time and that you can be on vacation even if I can’t get one as things are very rushing at present. MUMBAI for healthcare and should be Last Friday I went to work at 8 am and quit at 8:30 pm with just one half hour out for supper. For Ramani C.K. Jayanthi: This compensated with high salaries dinner, I had two sandwiches so you can imagine refers to Thank You, Nurse and more time-off. what we are up against. (May 4). Nurses from Kerala, I am sending you the OLD COLONY and the who form the MUMBAI Middleboro paper and also a card which came from backbone of Bholey Bhardwaj: This refers Abington. If I find it is all right for you to go almost every hos- to The Abusage Of Rhetoric to the funeral, I will telephone you, but do not go unless I do for at this time it doesn’t pay to take pital in Mumbai, (June 8). It’s not a coincidence any chances. have left in that Nepal woke up to redraw I hope you have written to Harry’s mother droves, crippling its map and claim Indian terri- explaining the circumstances, for I should feel operations at sev- tories—it’s a well-thought plan rather cheap if I should happen to meet any of eral major hospi- to upstage India at China’s them and not have them understand just how things tals. The contribution of Kerala behest. Nepal is culturally and were. Captain Doten was just in and told me to tell you not to think of coming as Harold will be in the medical field is com- geographically aligned with buried just as soon as his body arrives and there mendable. In Mumbai as well India. It could never have mus- will be no funeral. Dr. Jackson’s wife is very ill. as other parts of the world, tered the courage to make an Hoping you will not catch anything and that nurses from Kerala are a com- issue out of border roads with- you are still getting better with the… mon sight. Nurses are the most out China’s clandestine support. With Love, Chick….Plymouth, Massachusetts, important pillars of the medi- India will do well to placate September 30, 1918 cal fraternity—abroad, they are Nepal and increase it’s presence one rung below doctors, but in there, for ignoring it may push Bad News A letter written by a man in Plymouth, India, they are not accorded the Himalayan nation into USA, during the Spanish flu much respect. Nurses are vital China’s fold.

OUTLOOKINDIA.COM JUNEMAY 4, 22, 2020 2020 | OUTLOOK | OUTLOOK005 THENEWS

Heartland

Oil India Ltd firefighters—Durlav Gogoi, Heartburn a former state football team goal- keeper, and Tikheswar Gohain—were Runaway Covid, sulking killed trying to contain a massive fire loyals...MP BJP also has that broke out at an oil well blowout Scindia playing hardball site, barely 1.5 km from Dibru Saikho- PTI wa National Park in Assam’s Tinsukia Puneet Nicholas Yadav Return hug—Jyotiraditya Scindia and district on Tuesday. Many houses were Shivraj Singh Chouhan damaged. Villages were emptied out after the blowout a fortnight ago. ADHYA Pradesh health central leadership because several minister Narottam Mishra senior MLAs were unhappy after being is a busy man these days. informed that they may not find a MHis schedule, however, isn’t packed place in the cabinet because Scindia’s with matters linked to the steadily men have to be accommodated,” a BJP rising coronavirus infections in MP. leader says. Instead, it is the health of the BJP Senior BJP MLAs feel that Scindia’s government that has taken primacy men would be favoured above them for Mishra. While the state has been for cabinet berths and that party adding nearly 200 new COVID-19 veterans who lost the December 2018 cases daily, the health minister has assembly polls against these Indian and Chinese troops have been trying to pacify BJP veterans newcomers may be permanently “disengaged” and returned to their still sulking over the induction of elbowed out of electoral politics. BJP previous positions along the Line of Jyotiraditya Scindia’s loyalists into veteran and Chouhan’s former cabinet Actual Control (LAC) in Ladakh follow- the party in March. colleague, Gauri Shanker Shejwar ing military-level talks by both sides Mishra was among the five ministers says, “The BJP used to value its to defuse a faceoff since May 5 when inducted by Chouhan into his mini- karyakarta but now those who have soldiers clashed in Pangong Tso. cabinet on April 21, nearly a month fickle loyalties get rewarded.” after the BJP returned to power in the Chouhan’s five-member cabinet has state following a 15-month hiatus. two ministers who are Scindia Mishra’s efforts comes at a time when loyalists. Sources say Scindia wants at chief minister Shivraj Singh Chouhan least four more cabinet berths for his has been struggling to finalise his men in the upcoming cabinet cabinet expansion plan while also expansion. A section of BJP leaders, preparing for 24 assembly bypolls. The however, wants the induction of these bypolls—16 of them within the former MLAs made incumbent on Gwalior-Chambal region—have been their ability to win the bypolls. Reading the Communist Manifes- necessitated because of the defection Amid this confusion, rumours that to, Lenin’s works, Mao’s life, calling of former Congress MLAs loyal to Chouhan may go for another mini- friends ‘Comrade’ and greeting them Scindia who switched to the BJP, cabinet expansion instead of an with ‘Lal Salaam’ are among the making way for Chouhan’s return as extensive one have begun to gain reasons cited by the NIA for charg- CM by toppling the Congress-led currency in Bhopal. This, say BJP Kamal Nath government. insiders, would give Chouhan more ing farmer leader and social activist Sources say Chouhan had finalised a time to broker peace between old Akhil Gogoi of Assam under sedition blueprint for cabinet expansion warhorses and Scindia. Mishra, who and anti-terrorism laws. Gogoi and recently after discussions with state played a key role in the defection of three other Krishak Mukti Sangram BJP president V.D. Sharma, party Scindia and his loyalists, has been Samiti (KMSS) leaders were arrested leaders Vinay Sahasrabuddhe, Suhas tasked with playing peacemaker for protests against the Citizenship Bhagat and some ministerial hopefuls. between party veterans from the (Amendment) Act last December. The plan was “put on hold by the Gwalior region and Scindia. O

6 OUTLOOK | JUNE 22, 2020

PTI

Vendors are back— POLIGLOT Chikmagalur, after lockdown restrictions MIXED SHOTS were eased

SNAPSHOT PTI “Elephants travel hundreds of kilometers through fixed corridors for food. As railway lines, roads, canals, high-tension wires, and quarries disrupt these, what will the stressed animals do?” says WSO’s Biswajit Mohanty. They have little choice but to Efforts under way venture into villages and to retrieve the body raid farms, leading to of the pregnant man-animal conflicts. elephant which Elephants have killed died in Kerala’s over 2,300 humans Palakkad between 2014 and 2019. The destruction of elephant corridors is a chief reason leading to deaths. But who is to be blamed? The government, largely. The ministry of environment last year gave clearance for mining in 1,70,000 hectares of pris- tine Hasdeo Arand forests in Chhattis- garh. They include elephant corridors. The National Board of Wildlife recently allowed Coal India Limited to conduct open cast mining in an additional 41 hectares of the Dehing Patkai Elephant Reserve in Assam. The Trunk Call is an SOS While wild elephants (about 27,000) face disruptions, the lot of those in cap- Salik Ahmad over the death of a pregnant elephant tivity is worse. Captive elephants in in Kerala’s Palakkad is natural. Yet, in India number between 2,600 and WILDLIFE Its imposing bulk, the same week, two more elephants 3,000—used for temples, tourist rides, with its pendulous would have died a death as painful even for wedding processions. To sub- proboscis, is impos- somewhere else in India. According to due and train young elephants, mahouts ing; its capacity to wreak havoc in government data, an average of 102 subject them to great pain. The situa- ancient warfare or if it’s disturbed is elephants died unnatural deaths every tion of tuskers is no better in temples. terrifying too. But the elephant is an year between 2014 and 2019. How does this happen when the acutely sensitive and gentle animal Consider this: a train mowed down five Wildlife Protection Act, 1972, gives that follows rigidly atavistic social elephants in Assam’s Hojai in February elephants the highest protection? norms. The whole herd celebrates a 2018. That year, seven elephants were Ownership certificates, initially newborn calf; when a male reaches electrocuted by a high-tension wire in permitted by the Act for those already reproductive age, it is pushed away Odisha’s Dhenkanal. The Wildlife in possession of elephants, have from the herd by matriarchs to avoid Society of Odisha says about 100 continued, owing to poor enforcement inbreeding—elephant society is one of elephants were killed in accidents of the law. Oversight has led to a the most evolved in nature. Along with during 2018-19 in Odisha alone! trafficking of sorts. its majesticity, it is celebrated as such “At times, young elephants are caught too—in traditional tales in the Pan- in the Northeast and sent to temples in chatantra and the Jatakas it’s held up The Wildlife Protection Karnataka, Kerala, Tamil Nadu and as a creature imbued with wisdom; as a Gujarat. The owners claim they are rare animal which sheds tears, like us, Act 1972, which unable to take care of them and are giv- from emotional distress (elephants protects elephants too, ing them away. Something does not experience post-traumatic stress dis- seem right here,” says Suparna Ganguly, order like humans from trauma), it’s is poorly enforced. co-founder of Wildlife Research and perhaps a natural choice for ancient, Oversight has led to Rehabilitation Centre. and modern-day, anthropomorphism. India, certainly, is no country for Thus, the outpouring of national grief trafficking of sorts. elephants. O

8 OUTLOOK | JUNE 22, 2020 POLIGLOT

ODISHA Firing The Blank Mask

Sandeep Sahu in Bhubaneswar

HE ‘blank cheque’ is proving really costly for the Naveen Patnaik government. Speaking at Tthe daily government briefing on the coronavirus pandemic on April 28, PTI Hemant Sharma, principal secretary of 48 hours ago on April 15. As if that was the industries department and head of not enough, there were wide variances ‘Scam’ taints Naveen Patnaik’s stellar the “emergency procurement commit- in the procurement price of test kits, job in fighting the pandemic tee for COVID-19”, said chief minister which were procured from three differ- Patnaik had given a ‘blank cheque’ to ent firms at prices varying from Rs 980 In another firefighting measure later buy and stock on everything needed to to Rs 1, 125 within a short time— in the day, the government also divested fight the contagion. After two cases in between April 21 and May 10. RT-PCR nine senior IAS officials of their addi- the Orissa High Court, an FIR by RTI machines, which cost Rs 4 lakh to Rs 5 tional pandemic responsibilities. activists and removal of Sharma from lakh were bought at Rs 12.84 lakh. But the government’s hurried action the committee, the ‘blank cheque’ is With the Opposition turning on the has failed to douse the fires as the accu- haunting the government. Tell-tale heat and activists constantly breathing sations have only turned shrill in the signs of corruption in the purchase of down its neck every day, the state gov- days since then. The Nationalist PPE kits, masks and test kits keep ernment on June 5 removed Hemant Lawyers’ Forum filed a writ petition in tumbling out. Sharma as head of the “COVID-19 pur- the Orissa High Court seeking a CBI The crux of the allegations so far is chase committee”. inquiry into the scam. State Congress this: the state government ordered 30 unit chief Niranjan Patnaik said the lakh triple-layered masks priced at Rs 16 opposition party would move both the apiece from a Tamil Nadu-based firm on Odisha ordered masks central vigilance commission (CVC) and April 17 in what was a clear violation of priced at Rs 16 apiece the Lokayukta seeking high-level inves- the Centre’s guidelines, which pegged tigation into the “scam”. the maximum price at Rs 10 apiece. from Tamil Nadu firm, The financial scandal appears to have Curiously, the state placed orders for clearly above Centre’s taken the sheen out of the state govern- the same kind of masks to a Faridabad ment’s otherwise stellar record in fight- based company at Rs 9.90 apiece barely ceiling of Rs 10. ing and containing the coronavirus. O brevis

Javed Akhtar Ved Marwah, the Bollywood producer Former Santosh Kannada film actor became the first former governor of Anil Suri has died Trophy player, E Chiranjeevi Indian to receive the Mizoram, Manipur of COVID-19. He was Hamsakoya, has Sarja, who began Richard Dawkins and Jharkhand has 77. He produced died of COVID-19 in his career in 2009 Award—presented to died in Goa. He was films like Karmayogi Mumbai. The with Vayupatra and people who uphold 87. He was Delhi (1978) and the 61-year-old former acted in 22 movies, rationalism and police chief just 1984 multistarrer footballer was from died after a cardiac scientific truth. after the 1984 riots. Raaj Tilak. Malappuram, Kerala. arrest. He was 39.

JUNE 22, 2020 | OUTLOOK 9 POLIGLOT MixedShots

AIRPORT TO HOTEL IN 74 DAYS T could have been like the Tom Hanks movie The Terminal. Or worse, Mehran Nassiri, the Iranian-origin refugee who lived in a Paris airport from 1988 to 2006. But Ghanaian footballer Randy Juan Muller’s residence FIRE THE FIRER Iat the Mumbai airport ended after a relatively short HE Maharashtra State stint—74 days—thanks to the timely intervention of the Reserve Police Force Sena youth wing. Rudy was scheduled to fly home on a Tshould be worried. One of Kenya Airways flight, but international flights were its jawans is so off the mark that suddenly suspended due to the pandemic. He bided during target practice, a bullet time in the airport’s fancy artificial garden and he fired crossed a “mountain bought food from the stalls there. Airport staff range” (sic) and wounded a helped him by recharging his phone and giving him woman in Sitepaar village, WiFi access. A post on Twitter bought the man’s Gondia district. The force has plight to the attention of Aaditya Thackeray, who now instituted a probe team to shifted him to a local hotel, mercifully avoiding a repeat find out how the bullet travelled of Mehran’s fate. O “accidentally” for 3 km! O

BEEP BEEP? PEE PEE FTER 25 years as a surgeon, Walliul Islam thought he had seen it all—until he saw a charging cord in a 30-year-old man’s bladder at a private hospital in Guwahati. The man came to him complain- Aing of stomach ache after eating a headphone cable “by mistake”. A surgery found nothing in his gastrointestinal tract, but an X-ray found a charging cord in his bladder. For those who were wondering how the cable entered his urinary tract, the doctor unequivocally spelled out the anatomical nitty-gritty in a Facebook post with a heartening conclusion: “Everything is possible on earth.” He also questioned the man’s mental health, though it seems more a case of misdirected pleasure-seeking. O

WORSHIP GOES VIRAL THE PRACTICAL MATHS TEACHER HITALA Mata, that divine healer of fevers, sores and F there is one thing India diseases, might lately see a drop in devotees thronging her doesn’t lack, it’s talent. temples for a cure. For there’s a new goddess in town— What that talent might SCorona Devi. To end the pandemic, women in several districts of Ibe used for is another matter Bihar are making offerings to the Devi at waterbodies—rituals altogether. Take Anamika of generally associated with the Chhatth festival and sun god. Mainpuri, Uttar Pradesh. Quite apt, we think, considering the sun has a corona too. A The enterprising pedagogue woman at Sarveshwarnath Temple in Brahmapura, Muzaffar- allegedly “worked” simulta- pur, says she realised that the disease could only be eradicated neously in 25 schools in with offerings of laddoos, sesame Baghpat, Aligarh, and Saharanpur among others, earning seeds and flowers after “watching a a neat sum of over Rs 1 crore in 13 months. This despite a video”. Another learnt of it in a digital database and “real-time attendance monitoring” dream. It’s too early to say what the in UP schools. All the more easier, we guess, with a name Devi thinks of her followers’ like Anamika, which means unnameable. Too bad. We oblations presented with adequate won’t be able to call her for a webinar to find out the social distancing, but COVID-19 cases details behind her stupendous heist because she who have been rising steadily in Bihar. O must not be named has gone incommunicado. O

10 OUTLOOK | JUNE 22, 2020 ILLUSTRATIONS: SAAHIL; TEXT BY SYED SAAD AHMED, ALKA GUPTA Masterspeak A Webinar Series-Episode 4

ManaGinG Cash in UnCeRtain tiMes with Ravi Gilani Founder and Managing Consultant, Goldratt India

In conversation with V KeshaVDeV Executive Editor, Outlook Business June 18, Thursday, 7:00, PM To register, visit: www.outlookbusiness.com

Presented by Co-Sponsored by VOTE/COVID Balloting a Pandemic Social distancing at booths, virtual or e-voting, postal votes— polls in Bihar may herald era of post-COVID electioneering. But is it possible?

Boats on the Ganga during the lockdown in Patna

Bhavna Vij-Aurora tain social distancing norms while ated that elections will be held on queuing up at polling booths. Virtual time,” says a senior government offi- voting may be tried in a few assembly cial, who has attended previous ECI OME minister Amit Shah spoke seats as a test case. Declining to give meetings—all held on video platforms. about Bihar’s journey from the details of the “baby steps” taken “The general view is that elections can “lantern to LED” as he towards digitisation of voting, chief be delayed only in a force majeure sit- Haddressed the people of the state at a election commissioner Sunil Arora uation, if pushed completely into the virtual rally on June 7. The BJP tried to says, “We are working on blockchain corner by the prevalent situation of make it look as real as possible by solutions to enable remote voting. The the pandemic.” creating a rally-like atmosphere at the Technical Experts Committee (TEC) Elections to Lok Sabha or state party headquarters in Delhi, giving a of the Election Commission of India assemblies can be postponed for six peek into what post-COVID-19 election- (ECI) is working to develop a block- months by the EC. However, in case of eering is going to be like. And Bihar is chain system that would allow voters an Emergency, the elections can be going to be the first big election following to exercise their votes when they are deferred for one year, plus six months the outbreak of the pandemic in India. physically away from their constitu- after the Emergency is lifted. Former Top government sources say postpone- ency.” The TEC comprises experts CEC S.Y. Quraishi says the state of ment of the Bihar elections is the last from IITs across the country. emergency can be declared only if thing they would want. The assembly The ECI is holding an exhaustive there is a threat to the security and elections, which must be concluded by meeting on June 15 to discuss the way sovereignty of the nation, not if there November 29, are likely to take place as forward. “CEC Arora has always reiter- is an epidemic or a pandemic. “Impos- per schedule in October-November and ing President’s rule in the state is will be the trendsetter for a new kind of another option, but its limits have electoral democracy. A hybrid model been repeatedly defined by the Though various options of virtual of e-election and Supreme Court,” he says. and e-voting are being discussed, they According to Quraishi, holding elec- are all in the nascent stage yet. Accord- regular voting could tions in Bihar may be a daunting task, ing to sources, the elections will by and be tried out in the but not impossible. “After all, South large see voting in the traditional man- Korea held its parliamentary polls ner, though people will have to main- Bihar elections. amid the coronavirus pandemic and

12 OUTLOOK | JUNE 22, 2020 VOTE/COVID

witnessed the highest ever turnout. The ECI is studying the South Korean model and I am sure India will do better than that,” he adds. Bihar’s population of 9.9 crore is, however, much bigger than South Korea’s 5.16 crore. The sheer logistics involved in holding elections in Bihar at such a time are intimidating, says an official. In the 2019 Lok Sabha elections, the total number of polling booths in Bihar was Rallies will be replaced 72,227. Each booth ideally caters to 1,200 to 1,500 voters, which can turn by virtual ones. Focus out to be a nightmare for social distanc- will be on digital ing. The ECI is in the process of figuring out the ideal number of voters per poll- canvassing, says BJP’s ing booth. “If we allow only 500 voters Bhupendra Yadav. per booth, we need 70,000 more officials to man the increased number of booths,” says the official. “And if we decide to have 800 voters per booth, we need 51,000 additional officials. We are working on all these issues.” Each booth needs at least six officials to man it— first polling officer, second polling officer, third polling officer, presiding officer, micro observer and digital camera person. The role of each is well-def ined and cannot be curtailed. There are no easy solutions. IIT-Bhilai director Prof Rajat Moona, who is part of PHOTOGRAPHS: PTI the ECI’s TEC, says they have been away the identity of the voter. come. Political leaders say their cam- working on the possibility of remote vot- Bhattacharya believes a hybrid model paign strategies will also see a big shift. ing for some time. Referring to a 2015 of e-election and regular voting could “Crowded rallies will be a thing of past, conference where this issue was dis- be tried out in the forthcoming elec- replaced by virtual ones. There will be an cussed, he says the electronically trans- tions in Bihar as the ECI is contemplat- increased focus on digital canvassing mitted postal ballot system was initiated ing. Quraishi agrees it can be tried out and more personalised micro ground- as an outcome—for people using postal in a few assemblies, but adds that these level contact with the voters. There will ballot, like those in the armed forces and should selected by the draw of lots. He also be a return of handbills and pam- other services. In this, the ballot paper is adds that it is important to demonstrate phlets,” says BJP general secretary Bhu- transmitted to the voters through an that the technology used is hack-proof. pendra Yadav. electronic mechanism. The PDF file is Bhattacharya says technology, when The parties are also taking a relook at then downloaded by them, a print taken deployed on a large scale, needs to be the issues they generally raise before and the vote cast. It is then mailed back tested out for both its technical robust- every election—those of caste and reli- through the normal postal system. There ness and its social acceptance, especially gious identity. They may not work any- is no system in place yet to send the bal- for sensitive applications like elections. more as delivery of welfare measures lot back electronically. “We should start moving towards e-elec- and livelihood issues are likely to take Centre for Digital Economy Policy tions as it would also reduce the cost of centre stage in the post-COVID-19 Research president Dr Jaijit Bhattacha- conducting polls,” he adds. The 2019 scenario. “The fear of disease has rya says holding e-elections with the Lok Sabha elections had cost the ECI united the people in broader terms. current infrastructure is extremely chal- Rs 6,500 crore—Rs 72 per voter. There is also anger among the lenging. “People need to have their While holding digital elections may migrants regarding their struggle to e-signs and it is far-fetched as of now. reduce the cost manifold, political par- reach their homes, and at the misman- Penetration of smart devices is still not ties are hoping there will be a major agement by the authorities. There will deep in India. Enormous amount of reduction in their campaigning costs in be a political fallout,” says political training and system build-up is needed the Bihar polls, and then in the elections analyst Manisha Priyam. Whether before we move towards e-elections,” he in West Bengal, Assam, Tamil Nadu and LED has replaced the lantern or not, says. There is also the need to devise a Kerala, due in the first half of 2021. They more important in the coming elec- way to maintain the secrecy of the ballot anticipate that social distancing norms tions would be whether the political as e-signs or digital signatures could give are here to stay for some elections to parties keep their promises. O

JUNE 22, 2020 | OUTLOOK 13 THE AUTHOR IS SECRETARY, OPINION/ Sanjay Agarwal AGRICULTURE MINISTRY

Seeds of a Revolution The government’s intervention in the agriculture sector is expected to help farmers take control of their destinies

promulgation of three ordi- farmer-friendly marketing ecosystem. THE nances, undertaken to push The Farmers’ Produce Trade & Commerce (Promotion and Facilitation) through holistic agriculture Ordinance provided for the creation of an ecosystem to promote efficient, reforms, will provide free- transparent and barrier-free inter-state and intra-state trade and commerce dom of choice to both farmers and buy- of farmers’ produce outside the physical premises. It also provides a facilita- ers to sell and buy across the country tive framework for electronic trading and transactions platform for trade. and that too without licensing barriers Trade and commerce ordinance does not require state authority as state gov- for better price realisation for the farm- ernments will continue to have control over APMC Acts and their efficacy ers. The Agricultural Produce Market has been protected except when it pertains to trade area. Committees (APMCs) Act has geograph- The Farmers’ (Empowerment and Protection) Agreement on Price Assur- ical restrictions as the farmers can sell ance & Farm Services Ordinance provide for framework for farmers to their scheduled market surplus only at engage with agri-business firms, processors, wholesalers, exporters or large fixed market places, which can be either retailers for farm services and sale of farmers produce. Opening of agriculture the markets operated by market com- markets will lead to greater choice and price competition, allowing farmers to mittees or private markets or warehous- seek the best price for their produce. This will ensure higher income to farming, cold storages, silos declared as ers, a part of which is expected to result in improved investment in better deemed markets or the notified places of agricultural practices resulting in higher direct marketing licensee. In these productivity. Marketing avenues will open places also the purchase is by licensed The reforms up and result in higher private sector trader. The licensed buyer on the other investment in supply chains. hand is free to sell to anyone anywhere. are expected to Another aspect of the new initiatives is These constraints hindering the devel- protect farmers that they will help in unfolding funding opment of “one nation one market” for facility, announced as part of Atmanirbhar agricultural produce shall be removed. as informal Bharat Abhiyan package, to the tune of Rs The new reforms will not only create agreements will 1 lakh crore for creating post-harvest man- competition but will also make the agement infrastructure, including e-mar- APMCs more efficient. The holistic shift to formal keting points with the active partnership approach to reforms will also encourage of states. As farmers get better prices and investment in developing value chain agreements. opportunities of employment grow in infrastructure by new investors in the rural areas due to investment in agricul- states due to a liberalised atmosphere. ture related infrastructure, the role of states will gain prominence. The pres- This will eventually lead to value addi- ent system of MSP for various agri produce shall continue. It is a support tion, reduction in post-harvest losses, price mechanism, announced before the cropping season. The farmers shall improvement in agriculture share in now have additional options apart from mandis and MSP centres. GDP leading to more rural employment, Substantial increase of area under farming agreements is expected. The thus ultimately motivating states to reforms are expected to protect farmers as informal agreements will shift to come on board to support the consoli- formal agreements. The farming agreements for sale of future farm produce dated measures. at predictable and remunerative price can be adopted at a large scale only if Thus, the ordinances will potentially there is a conducive and uniform policy framework in the country. enhance production and productivity Under the ordinance, the farmer is safeguarded against price volatility, as by facilitating competitive pricing for the purchase price of the farm produce is to be determined and mentioned in farmers’ produce due to more choice the farming agreement. In case price is subject to variation, the farming of buyers. The greater freedom and agreement will explicitly provide for guaranteed price to be paid and addi- choice to both farmers and buyers will tional amount as premium and bonus over and above the guaranteed price open up multiple channels of buy- based on the pre-determined price reference. ing-selling like physical trade and Farmers entering into farming agreements will be safeguarded as the ordi- e-trade under this ordinance, in addi- nance prohibits acquiring of land ownership by the sponsor and also not tion to options to sell in the market allowing the sponsor to construct any permanent structure on farmers’ land. yards notified under the APMC Act. Accessible, quick and cost-effective dispute mechanism have also been pro- Thus, in days to come, there will be a vided to safeguard the interest of the farmers. O (Views are personal)

14 OUTLOOK | JUNE 22, 2020 UK-IndIa joIn hands

At Kabirdham district, to cope with home to the Baiga tribe, women plough the land as men believe the climate change land to be their mother distress (Chhattisgarh)

It’s not seen as a source of primary climate science to district, block and bout two-thirds of India’s 1.3 income but certainly as an important village levels. So far, it has been billion population is engaged in source of supplementary income, implemented in 103 blocks across 22 agriculture. Out of those, more especially for women who can’t go out districts of Bihar, Chhattisgarh and thanA 85% come under the category of of the villages for work owing to a Odisha. The initiative has benefited small and marginalized farmers, or number of social reasons. With migrant approximately 1.8 million people in simply put, those with less than two labourers working in cities returning to these three states. hectares of land. This huge section of their villages due to covid-19 lockdown, Furthermore, ICRG helps farmers the village population finds itself in a the reliance on MGNREGA for succour make informed decisions about crop very volatile economy. The reasons are has risen steeply in villages. As per the choices in view of climate change. So their limited resources, dependence on latest figures, there are 120 million it’s providing knowhow on climate- erratic monsoons, and agriculture active workers under the scheme. resilient practices to not just being vulnerable to adverse effects of The ICRG has always been committed MGNREGA works but also farming. climate change. to making interventions at the very Awareness about rights is another focus In such a situation, protection of grassroots. In the same spirit, it tries to area of ICRG. That, teamed up with these small farmers is a pressing make the works under MGNREGA climate knowledge, empowers the challenge. That’s where an intervention more in line with climate-resilient village representatives to negotiate called the Infrastructure for Climate practices. The works in the with district administration on fund Resilient Growth (ICRG) comes in. It employment scheme are usually related disbursal, and channel it towards a emerged in 2016 from collaboration to irrigation, plantations, ground water more climate-conscious form of between the UK Government and the recharge, and soil conservation. A development. Ministry of Rural Development in driving idea behind ICRG is to take This joint UK-India initiative has not India. One of the central objectives of only helped rural development but also ICRG is to embed climate resilient made it more sustainable and enduring strategies in the implementation of vis-à-vis climate change. The initiative Mahatma Gandhi National Rural Grassroots-level has provided a way for vulnerable Employment Guarantee Act interventions communities to secure their livelihoods, (MGNERGA) – the world’s largest of iCrG has along with learning to guard themselves social protection scheme. helped it Give a from the onslaught of climate change. Any person in a village can seek work World Environment Day is the perfect under MGNREGA and has a guarantee Climate-resilient timing to acknowledge the importance of 100 days of work in a year. The work approaCh to of global cooperation and the power of involves light manual labour and the works under countries joining hands to act as a force daily wages are roughly around Rs 200. mGnreGa for good. O SANS FRONTIERS

WORLD TOUR

FOREIGN HAND NORTH KOREA The nation threat- ened to cut off all communication lines with South Korea, including the hot line between the two nations’ leaders. The North said this was the first in a series of actions against the “enemy”. The two nations are officially at war. But the current move is seen as North’s attempt to RAN and Venezuela, two adversaries of the US, both subject to American sanctions, came together in an act of defiance to violate get more concessions from the South. I the terms being set by the Donald Trump administration. The Islamic Republic leadership in Tehran undertook a risky mission when it decided to send five tankers carrying oil through some of the world’s most crucial maritime gateways to cash-strapped Venezuela, which suffers from acute shortage of refined oil, despite having the world’s largest oil reserves. Through its action Iran wanted to send a message to the US that Tehran was determined to challenge American policies aggressively. The mission was accomplished last weekend when the last of the five tankers reached their destination. Despite its large military presence LIBYA Turkey-US relations may enter a in the Caribbean waters, the US did not intervene; the revolutionary “new era” after an agreement on Libya socialist government of Nicolas Maduro got its much-needed cargo. As was reached between Recep Tayyip motorists lined up to fill their tanks, Maduro declared that he would Erdogan and Donald Trump. The two soon visit Tehran to sign more agreements and thank the people of spoke on the phone recently. Turkish Iran. US sanctions on Iran’s oil sales have throttled its crude exports. support for the UN-backed regime Anyone buying Iranian goods risks punitive measures from in Tripoli managed to marginalise Washington. Venezuela is also under US sanctions. “Our policy towards the US has changed from a defensive to an renegade general Khalifa Haftar’s force, offensive approach,” an Iranian regime insider toldFinancial backed by Russia. Moscow says it will Times. “The US sent us messages through two regional states that work for peace in Libya with Erdogan. ‘we will hit your tankers if you proceed’. Our answer was clear: If you hit us, we’ll hit back.” In the last stage of their journey, Venezuela, which had warned that any US efforts to stop the convoy would be an act of war, sent jets and the navy to escort the tankers. For Iranian leaders, given the risks and transport costs, the transaction made little economic sense. In total, they earned at most $50m, probably paid in gold to bypass sanctions. The five tankers carried 1.5m barrels. But, for the regime, the show of strength justified the risks. Iran has stood firm in its encounters with the US and Britain. When British marines seized an Iranian SPAIN A probe has been launched tanker in Gibraltar, Iran impounded a British-flagged ship in the against former Spanish King Juan Carlos Strait of Hormuz. The Iranian tanker was later released. It also shot by the Supreme Court for alleged kick- down a US drone last year. After the US killed Iran’s revered backs for a high-speed rail project in military commander, Qassem Soleimani, in Iraq in January, Iran Saudi Arabia. Carlos abdicated in 2014… launched missiles against a US base in Iraq. and lost immunity from the probe. A western diplomat observed that despite a huge rise in inflation and Spanish firms had won a contract worth unemployment, the republic was showing no desire to change course. 6.7 billion euros for the rail link between “The US knows its sanctions will not pay off,” said the diplomat. O Mecca to Medina. The probe also involved Swiss banks.

16 OUTLOOK | JUNE 22, 2020 Episode - 6

Role of opposition DuRing a panDemic

Shahnawaz Hussain Bhavna Vij-Aurora Former Union Minister and Political Editor, Outlook National Spokesperson, BJP manish Tewari Neerja Chowdhury Lok Sabha MP, Congress Political Commentator

join us on @outlookindia @outlookmagazine on June 13, Saturday, 6:00 pm COVID-19 SPECIAL

WHAT ARE VIRUSES? A glimpse into virosphere—that mysterious cusp between life and non-life—will tell us they are part of us, within us, and wrote us into being

18 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

ANIRBAN MITRA

MERS virus LBERT Szent-Gyorgyi was a giant of twentieth century science. His discoveries on Vitamin C, the Krebs A cycle and how our muscles function are part of text- books of biochemistry. He once wrote how, in his search for a picture of life, the torch-light slipped over the very edge of being: “I started with anatomy, then shifted to function, to physiology, and studied rabbits. But then I found rabbits too complicated and shifted to bacteriology...later I found bacteria too complicated and shifted to molecules and began to study chemistry.... I ended with electrons which have no life at all—molecules have no life—so life ran out between my fingers actually while I was studying it, trying to find it...” Szent-Gyorgyi was not alone in this. The boundary that separates the non-living from the living—that mysterious cusp—is a real one, but trying to put that knife-edge under a microscope can actually impede understanding life on this blue planet. Take the most abundant biological entities of nature—viruses. The sheer number and diversity of viruses easily dwarfs humans, our crops and domesticated cattle, the billions of insects teeming in the tropical forests, even the microscopic organisms abundant in any river. A litre of sea- the rest of the cell makes proteins. In turn, the proteins water may contain a hundred billion viruses of few thousand (like insulin, antibodies, enzymes and collagen) join hands different kinds! They occur in millions in the lungs and to do all the physiological work, finally leading to reproduc- intestines of healthy people. They are present deep below tion and thus ensuring that there are more copies of that the Antarctic surface, in the subterranean caves of Mexico, body and the DNA within. It’s teamwork between the cell’s on the scorched sand dunes of African deserts, and in almost DNA and protein-making apparatus. every living species scientists have studied. They control the Viruses do the same but they have found a shortcut. They growth of bacterial populations, play vital roles in the mega do carry DNA (or RNA, a related molecule), but, being so geochemical cycles that make up our environment and can, tiny, there’s no space for the protein-making apparatus. of course, evolve—jumping from one host species to another, There’s no need either: when a virus infects a cell, it hijacks as we now are only too keenly aware. It’s no wonder that Carl the latter’s protein-producing factories, captures the depots Zimmer referred to the Earth as “a planet of viruses”. The of nutrients and commands the cell to make only multiple present global crisis brought on by Covid-19—directly linked copies of viral proteins and viral DNA! Thus, although they to rampant deforestation and illegal animal trade—is a result carry only a part of the ingredients essential for life, viruses of our unbridled and greedy misadventures into virosphere. are intracellular parasites that evolve and flourish in the Yet, viruses are not exactly ‘alive’ in the sense cellular foggy zone that demarcates the living from the inanimate. organisms are. The latter are made up of one or many cells. How viruses evolved this ‘hijack strategy’ is an enduring Indeed, many of them, like ourselves, form large, organised mystery. The fact that prehistoric viruses have not left fos- cellular associations—a body. The bodies sils has not helped either. But today, move, eat, fight, take in resources to build “Stunning as it there’s a wealth of knowledge that take us their cells and, in time, mate with other to the very origins of life. Notably, even bodies to make more cellular entities like may seem, the DNA within present-day cells, some RNA mol- themselves—the next generation. The in our chromosomes ecules can store genetic information (like instructions for doing all this is encoded DNA does) as well as catalyse biochemi- in a long chain-like polymer(s), called is peppered with cal reactions (like proteins do). This is an DNA, present within the cells. The DNA sequences that indicator that at the very dawn of life, in is a manual, a blueprint; different links in the hot, anoxic oceans of the primordial the chain—genes—carry the information once belonged to world, simple chemicals formed bonds for making different proteins. Following resulting in complex molecules and some those commands embedded in the DNA, active viruses.” of them, in turn, gained the chemical

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 19 COVID-19 SPECIAL

Ecoli bacteria

ability to make copies of themselves. It was certainly not an Thus, no more only parasites, viruses now answer to that efficient process, more like a stenographer who makes mis- proverb—“an enemy’s enemy is a friend”! The utility of takes while typing several copies of a document, so soon viruses does not stop there. Rather, their perennial arms- there were variants of the parent molecule that were com- race with bacterial cells is the source of what are called peting with each other for better duplication. In time, small restriction enzymes and CRISPR-Cas, sets of bacterial pro- RNAs (or the more stable DNAs) might have joined to form teins without which many of the applications of modern larger chains of genes, and then a membrane of fats proba- biotechnology would be impossible. bly enclosed them to form a mobile, self-replicating unit. There are others who are less friendly, of course—for Alternatively, some proto-cells might have gained both example, the malignancy-inducing Papillomavirus and DNA and protein-making machines, but then lost the latter Hepatitis B viruses. But, humankind’s association with and learnt to enslave neighbours who had both. Probably viruses goes way beyond diseases and modern technology. both mechanisms gave rise to the vast repertoire that Stunning as it may seem, the DNA in our chromosomes is makes up virosphere today. Evolution by natural selection peppered with sequences that once belonged to active had found its way. viruses. Called Endogeneous Retroviruses, these relics of past encounters make up more than 8 per cent of our HAT is certain is that it’s this ancient lineage genomic space—a colossal number when you consider that that has made viruses so ubiquitous. Animals, our protein-encoding sequences take up hardly 1.5 per Wplants and bacteria—all are hosts to viruses in cent! None of them make active viruses any more, but some this timeless struggle for existence. The most abundant of have been recruited into our cellular circuits. One note- viruses are the bacteriophages, literally the ‘bacteria-eat- worthy retrogene is Arc, which is essential for long-term ers’. But, phages do not only devour bacteria. They con- memory storage in the human brain. Another is Syncytin. stantly shuttle fragments of bacterial DNA from one cell to Originally from an endogeneous retrovirus, it has got har- another, creating fresh combinations of genes and thus nessed to build up the placenta—a unique mammalian providing fodder for evolution. Science has put these organ without which none of us would have been born! phage-couriers to good use. During WWI, Felix d’Herelle These new findings, however, should not confound us. discovered that bacteriophages could be used to cure sol- After all, the present is a fleeting snapshot on the evolu- diers of dysentery. Popular in the 1930s, phage therapy lost tionary timescale and, like viruses, we are little more than to ‘non-living’ antibiotics. However today, when antibiot- carriers and mixers of genetic information. The rest—cul- ic-resistant bacteria have significantly blunted our ability ture, history, societies, politics—are facets of human collec- to stop infections, phage therapy is being studied with tive imagination. O

renewed enthusiasm. In addition, oncolytic viruses are ANIRBAN MITRA IS A TEACHER OF MOLECULAR BIOLOGY being harnessed to selectively target and kill cancer cells. AND BIOTECHNOLOGY, BASED IN CALCUTTA

20 OUTLOOK | JUNE 22, 2020 Learn from IIT Topper Live Online Classes Weekly Online Homework (Concept Videos + Pracce Problems) Weekly Tests Books & Workbooks Instant Doubt Clearing Register Std 7 to 12 Now! 96001 00090, 96001 00020

D.P.Sankaran S.Santhanam Paul Rajan BIOLOGY COVID-19 SPECIAL OUR LIVE-IN VIRUS Corona has settled over this landmass like a moving cryptic crossword. How do we read its clues?

Ajay Sukumaran Let’s take a step back from a Covid- induced humidity, if such a thing is possible. And rewind to the mid-1980s when another scourge, a real ‘unknown unknown’ that had unnerved the West, was beginning to surface in India—HIV, or the human immunodeficiency virus. Veteran physician T. Jacob John has a vivid memory of a panic-stricken October evening in 1986 when Vellore’s Christian Medical College—where he headed the virology

22 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL VOX POP department—admitted one of its first HIV patients. An American, the patient was taken in by evening and at night his room was locked from the outside. The door was Pershing Square Professor of opened slightly, tremulously, for dinner—it Global Health and Wellcome was pushed towards him by a wardboy who Trust Principal Research scampered back to safety soon after. Vikram Fellow, Department of Global Health and Social Medicine, The HIV danger, by then, was real, clear Patel Harvard Medical School and present—in 1986, the first cases of AIDS in India had been discovered among Will this pandemic radically alter our sex-workers in remand homes in Tamil Nadu. How the infections first started was approach to public health? never tracked down, though it was clear it It’s hard to predict the long-term conse- had come in via foreign visitors and then spread. India’s HIV transmission was largely quences of our approach to public health due heterosexual—a later discovery—but the air to COVID-19; remember we had a similar major then was thick with irrational fear, stigma, misinformation. “In the morning,” recalls scare in the 1990s in relation to HIV/AIDS and John, “I had the blood sample and it was pos- while the public health response to that par- itive...full-blown AIDS.” He accompanied the duty doctor on his rounds, went and sat ticular disease was outstanding, most of the on the patient’s bed next to him, put an arm rest of the healthcare system has remained around his shoulder and spoke to him. “That’s the best lesson doctors got that day,” under-funded, under-performing, poorly gov- he says. The story of how India finally wres- erned and largely unaccountable. On this oc- tled AIDS down began that day—‘social vaccine’, as the term goes. “Public education casion, the threat is right at the doorstep of became one of the cardinal rules for its con- the rich and I hope there will be much greater tainment,” says John, who designed the sentinel surveillance for HIV/AIDS that impact in mobilising support across society continues even today. Think of all those con- for a much stronger public healthcare system. dom campaigns and the Red Ribbon Clubs in schools and colleges. The world is now gasping for clarity and a new chance against a new enemy—a highly contagious respira- curve saw no peaks or troughs as elsewhere, Those actually tory virus—but that social vaccine jab is no jagged edges; instead it has been arching what will work for COVID-19 too, he says, upwards smoothly, like a yogic asana, to infected could long before an actual vaccine comes along. break into the world top 10. With the US, After all, the coronavirus is, we’re told, Brazil and Russia taking the medals, India be 20-30 times something we have to live with. India’s head- has been in the playoffs with Spain and the the number of line numbers of March and April bucked the UK for positions 4-6 with a caseload up- worst predictions, but now, after four wards of 2.5 lakh, inching towards 3 lakh. confirmed cases. months of living with the virus, we are faced The original European hotspot, Italy, has with that experience common to trekkers: stanched its haemorrhaging wounds (for a So Infection the moment you scale a high promontory, a comparative Covid growth rate graph of all Fatality Ratio is bigger peak swims into view...and then ano four, with India in the clear lead, see ther. Judging by the altitudes of May and Lockdown story). always much early June, the real Everests may belong to The good news is that half of those patients July. “Now the inevitable is happening. Our have also recovered—so the count of active lower than Case goal is now to reduce mortality. Let the virus cases has just crossed 1.3 lakh, less than half play its game, but we should now protect all of the total 2,67,614 as on June 9. But could Fatality Ratio. the vulnerable people,” says John. That’s this be the actual figure of infected people? why he’s stressing on precaution—the ele- Not likely, say most experts. “We will have mentary symbols of which are the mask and some idea of that number once we have those physical distancing circles chalked out some serological data available from the first on the ground. The past few days, India has ICMR (Indian Council of Medical Research) been reporting a razor’s thin edge short of survey that is being rolled out,” says Prof 10,000 cases daily—the country’s Covid Gautam Menon of Ashoka University, who’s

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 23 COVID-19 SPECIAL

we know: about 30 districts account for 70 per cent of the total Covid cases in India— the western states of Maharashtra, Gujarat and Rajasthan coupled with Tamil Nadu and Delhi figure prominently there. But, officials warn that the eastern states—Bihar, West Bengal and Assam, to which the flood of migrant workers flowed—could potentially emerge as the next hotspots. The numbers are beginning to rear their hoods there. Add to this inclement weather—two cyclones in a span of one month and a monsoon season just setting in, bringing with it those familiar seasonal illnesses. The situation’s fluid, literally. Take Kerala, which had famously kept its infection count leashed down, but is now battling Round 2 with inter-state movement opening up (see Jeevan’s Sitrep story). Or take Delhi, where daily cases were around 400 in mid-May—now it clocks 1,400. “The cities with more infections may be peaking sooner. The other places, Tier 2 and Tier 3, will progress slowly,” says Dr S.K. Sarin, who heads the Delhi government’s Covid response panel. He foresees a plateau by end- July or mid-August for the capital. “We are in a relatively early stage, and the peak is still working on mathematical modelling initia- several weeks ahead of us. That could be one tives, including one by the Indian Scientists’ guess,” says Gautam Menon. “You would Response to Covid (ISRC). Think of serolog- really know you have crossed the peak when ical studies as a dipstick survey—testing lo- the number of daily cases begins to calised groups of people for antibodies in the decrease.” blood to know the average ratio of the popu- Case counts alone don’t offer much gran- lation that had a Covid infection. But until ular insight—the states differ on many Extrapolated that data is available, a probable yardstick to counts. For example, contact tracing. A go by would be 20-30 undetected infections recent ICMR study showed wide variations over Germany, for every detected case, Menon reckons. in ‘contacts tested per case’ during the early actual infections That range, he explains, is based on the num- phase across states—broadly, those with ber of deaths—just short of 7,500 so far in good public health systems did meticulous were pegged at India, which can be reasonably assumed to contact tracing, explains epidemiologist be closer to the real picture (barring a few Giridhara R. Babu, a co-author of that study. 1.8 million—a undiagnosed deaths). How is this done? That’s still easy to grasp, as a function of straight 10 times There’s something called the Infection administrative efficiency. But in many Fatality Ratio (IFR)—the number of people other ways, the epidemic settled over the more than its of- who die out of all those who actually get in- land like a giant cryptic crossword. What fected. This is always much smaller than the explains the fact that, for instance, while ficial figure of ratio of deaths among only the confirmed both Tamil Nadu and Delhi carried out a 1.8 lakh. cases. For COVID-19, the IFR was calculated high number of Covid tests over a span, at 0.37 per cent for a small German town. Delhi saw 7.8 per cent testing positive, Extrapolated over Germany by the while it was only 2 per cent in TN? University of Bonn, even that yielded 1.8 The ‘test positivity ratio’, as it is called, million actual infections—a straight 10 times could point to two things. The simpler expla- more than its official figure of 1.8 lakh. nation: Delhi could have genuinely had a Elsewhere, Covid IFRs range up to 0.7 per wider prevalence during that period. cent. At this point, therefore, we can only “Different states are indeed in different guess at the actual footprint a tiny virus is stages,” says Babu. “Or again, testing itself leaving over this vast landmass. could have been made more targeted and Zoom in on that map. So far, here’s what efficient, say by zeroing in on as many severe

24 OUTLOOK | JUNE 22, 2020 COVID-19 V X P P SPECIAL O O

respiratory cases as possible—a syndromic approach.” Sharp, constant surveillance is key. Not the easiest thing to manage during Gautam Professor ‘Unlockdown’. Railway stations are opening Physics and Biology, up, public places coming alive—eventually, Menon Ashoka University places of worship will draw out the devout from their confines, trying to dispel the What does data tell us about the pandemic— gloom. What can be done? its past and future trajectory? Mask-wearing, says John, needs to be enforced like a sacred commandment. “Viral It tells us that the lockdowns have worked in behaviour is as predictable as water going reducing the exponential growth of the epi- down a slope. So if you have a virus that spreads by droplets, it will infect people by demic. The doubling times have increased social contact,” he says. “Ultimately, people from around 3-5 days at the onset of the lock- have to take precautions for themselves and their families. Nobody has understood down to somewhere between 15 and 20 days that. Even now people shift from the ludi- at present. However, the effective reproductive crous to the sublime.” Across the world, lockdowns are tapering ratio remains above 1, indicating that the epi- off. But the coronavirus still places us in a demic is still in its growth phase and the num- peculiar spot: there’s a wealth of information about the virus itself, but some fundamental ber of new cases each day shows no questions haven’t been settled yet. For sustained decline. Thus, relaxing our guard instance, are asymptomatic patients infectious? Is reinfection possible? We haven’t now will inevitably lead to a faster spread of heard the last word on these yet. That’s the disease. Our models suggest that allowing another facet of the corona chronicle—a very conspicuous absence of scientific consensus people to return to work in a periodic but stag- on many fronts. Scientists are indeed work- gered manner—say with three days on and six ing at an unprecedented pace, crossing mile- stones in days and months instead of years. days off, with a third of the population at work But the deluge of research reports globally each time while being effectively locked down seethes like a stormy, troubled sea. Last otherwise—can reduce the rate at which dis- week’s retraction of a controversial study on Hydroxychloroquine in leading journals The ease spreads. Our models also point to the Lancet and The New England Journal of crucial importance of rapid, ramped up testing Medicine came by as a shocker amidst this turbulence. There was a controversial India and quarantining of positive cases as the only connection there too (see Data story). way to halt the progress of the epidemic. Since the pandemic broke out, scores of pre-print papers—not yet vetted by peers— are being put out every week and some of these hypotheses are hotly debated. “A significant fraction of that would never make sorted out over time.” it to peer-reviewed publications,” says The coronavirus isn’t likely to go away any- virologist Shahid Jameel, who heads the time soon. But why did it come? “This pan- DBT/Wellcome Trust India Alliance. demic was not a black swan event,” says “Nevertheless, it’s important for the rapid Sridhar Venkatapuram, associate professor evolution of knowledge. So whatever one of global health and philosophy at King’s reads in that space must be read with that College London. “Any good epidemiologist understanding.” Jay Bhattacharya of will tell you that pandemics were expected. Stanford University agrees: “We will need And more will come in the future.” But it has good ideas from everywhere to solve this created an important need to rethink how epidemic.” Some frictions are inevitable, he societies are connected, he says. Countries says. “People working in different disci- may have been flinching back from hyper- plines learn for the first time the different globalisation of late, going back into their ways in which other scientists approach protectionist shells…but here has come similar problems. This is typical of the sci- along a microbe, like a voice of the planet, to entific process and will undoubtedly be remind humanity that we are indeed one. O

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 25 COVID-19 SPECIAL

TRIBHUVAN TIWARI WHAT IS THE APOORVA SALKADE PEAK?

APOORVA SALKADE SANDIPAN CHATTERJEE COVID-19 SPECIAL

Jeevan Prakash Sharma

Whe the air is vacuum-cleaned of real information, what fills it is the elements of empty anticipation. Rumour, speculation, fear…all these form a suspended particulate matter that we then breathe in. The latest talk doing the rounds was that India would duck back into hi- bernation—into a strict lockdown—by the middle of June or so. Since Indians are familiar In big cities, ICU with the phenomenon of a late-evening broad- bed-to-patient cast fundamentally altering their realities, ap- ratio is alarm- pending a ‘could be’ or ‘maybe’ on that rumour ing, and hitherto healed regions is pointless. But the reason why the situation have plunged spawns such speculation is clear. anew into the Covid morass. India’s Covid graph has been curving up in good energy on dragging it out—it took 65 an unbroken geometric progression—re- days, till May 12, to reach the 1,000-case gardless of lockdown. Then, in phases mark. But that, alas, was when ‘Unlockdown since May 3, India has been also opening 1.0’ was already in motion. The next 1,000 up: ‘Unlockdowning’. For eyes long shut, cases took a mere 10 days; then eight days; the light outside was blinding. After our then three days; then four again. As of June first coronavirus case on January 30, India 10—another four days—it was on track to hit had taken 45 days to reach 100. Nine days 6,000 cases with over 3,000 active cases. later, as the lockdown started on March 24, Manipur had registered the Northeast’s first we were around 500. But six weeks later, case on March 24, but touched only 29 in the on May 6, just after we exited strict lock- next two months. Over the next fortnight, by down, we had zoomed to 50,000! The lo- June 10, it was aiming for 300, with only 61 calised surges consequent to opening up cured. Kerala, famously, took nearly two full bent that curve further upward, like surf months to reach 100 after inaugurating on the sea. In another four days, we India’s first case on January 30, then sloped reached a lakh. As we go to print, we’re just up gently to 800-plus over the next two 20,000 short of 3 lakh, with 1.3 lakh active months. That doggedness went waste when, cases. It has been messy and cheerless. in one day after domestic flights resumed on As we adjust our retinas, what do we see? May 25, it took a standing leap to 1,326—now COVID-19 as a radiating pain, a shifting, pul- it gloomily contemplates 2,000, out of which sating, intensifying migraine. Some parts of over 1,200 are still active patients. the body in extreme distress; the big cities But economic exigencies mean beginning to choke, with their available ICU Unlockdown is inevitable. The question is: bed-to-patient ratio looking alarming; new How to open up? What can be the mechan- areas of the hinterland in trauma; even hith- ics of doing it in modulated, calibrated erto healed regions plunged anew into a ways—where you can loosen the tourni- spreading gloom. Karnataka had had its first quets on our starving economy, while at the Covid +ve case on March 8, but expended same time lassoing down the rampaging

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 27 COVID-19 SPECIAL

virus. A bit like an ICU doctor handling a Delhi, witnessed a quick surge; others are critical patient with multiple points of con- catching up now. traindications. The layperson wants to To understand the peak in the context of know, even more anxiously, if COVID-19 India, the Department of Science & will get him or her sooner or later—the Technology (DST), under the guidance of chances of that happening now are in- the Jawaharlal Nehru Centre for Advanced finitely higher, especially if actual infec- Scientific Research (JNCASR) and IISc, tions out there are close to a million, as Bangalore, is trying to create a new model some estimates go. Epidemiologists and that integrates “the best features” of hun- data experts, on the other hand, are groping dreds of existing models sourced from gov- in the dark about the shape the epidemic ernment and private bodies (they’re calling graph will take. In what way, on which parts it, well, the ‘supermodel’). “The consultative Experts predict of the map, will it spread further? And what committee was formed last week, formal does the much-talked-about ‘peak’ look proceedings have just begun,” says A.N. different like? Most crucially, can we alter it? Jayachandra, secretary, JNCASR. The idea is Simply, the ‘peak’ stands for that point on to arrive at a predictive tool with the same months, the graph after which the number of in- prescience as meteorological tools that do from July to fected people starts declining. There’s, of weather forecasting. To get there, it’s map- course, no sign yet of that Mount Meru, the ping the pandemic across the globe, trying to November, for tip of the pagoda. At present, as the govern- understanding the factors that led to specific ment ramps up testing, India’s caseload is events, and weaving that into their grid. The the peak to arr only showing a daily upward trend. At the model should be ready in a few weeks. ive. But should peak, the ‘R0’ value tips over to less than 1 “Using the Susceptible-Infected-Exposed- (see Lockdown story)—this means an in- Recovered-Dead (SEIRD) model, the infec- we look out for fected person infects less than one person, tion rate in India at the end of May so you start descending to the valleys. Now, (averaged from May 18-31) was at around 8.5 varying peaks if 50 per cent of the population is infected, per cent, which is definitely better than what for individual the R0 automatically dips below 1 (see we started with, around 24 per cent, but also Muliyil interview). But many experts say far from the peak. This is a highly simplified states? India should not wait for that—a crucial part model; we are working on more hyperlocal of epidemiology policy relates to this. models to derive the ‘supermodel’ now,” says Depending on how policy affects the trajec- Ashwin Srivastava, co-founder and CEO, tory, experts have also predicted different Sapio Analytics. Sapio is part of the ongoing months, from July to November, for when exercise. the peak will arrive. But no one knows what it looks like: how many Indians being Why is predicting Covid+ve at one time. The concept of a peak throws open a whole lot of questions. Should the ‘peak’ a challenge? we not look for one peak—and see different Data scientists say it’s the quality of data— states as having different peaks? What about any presumptive model can only be as good rural and urban re- as the data that feeds it. Correct reporting gions within a state? of data—and enough tests to cover an ac- It’s important to cap- ceptable sample—is not exactly forthcom- ture the dynamics of ing from every part of India. Scientific a disease—that helps assumptions have to fill in the blanks. A us ensure we are as section of experts says the peak should be medically prepared as seen as happening state-wise, and should possible. It’s not a be calculated differently for rural and question of choosing urban regions within a state. “At this mo- one mathematical ment, it’s practically impossible to suggest model to calculate the a peak for India. Any model that does so is infection rate—there (deficient of) required parameters,” says are many—as the Srivastava. Positing a peak anywhere from most convincing and August to November, they also say this final. The real com- range can change significantly based on plexity is due to the policy decisions. Manoj V. Murhekar, direc- varying rates in each tor, National Institute of Epidemiology state. Some, like (NIE), also prefers caution. “I have no idea Maharashtra and what the peak will be like and how many in-

28 OUTLOOK | JUNE 22, 2020 TESTING TIMES ICMR ramps up capacity but controversies abound HE ICMR website shows that, as on June 9, the total number of samples that India has tested was 1,45,216. On May 20, it also claimed T that, in just 60 days, it made a 1,000 per cent progress in the country’s testing capacities. On January 30, when the first Covid-19 patient was found in Kerala, there was only one lab under ICMR: the National Institute of Virology, Pune. Even till mid-February, samples of COVID-19 patients were being air- lifted from various locations and brought to Pune for testing. Today, ICMR has approved 590 government labs and 233 private labs across India country for the three kinds of tests currently being done to test for the Covid: rRT PCR, TrueNat and CBNAAT. Initially, rRT PCR—or Real-Time Reverse Polymerase Chain Reaction—was the only confirmatory test for COVID-19. Out of the three tests it was seen as the most reliable, but it entails complex steps: a specially manufactured swab to collect throat or nasal secretion, a special fluid called viral transport medium (VTM) to transfer the swab to the lab, a viral extraction kit to tease out the virus from the swab, and then finally an rRT-PCR kit to test for viral presence. Even with all four elements present, if personal protective equip- ments (PPEs) were not available for those engaged in the process, testing could not be initiated. Everything needed to be there, at once. Naturally, that limited the scope of its applicability. Considering the urgency of the situation and the need to ramp up testing, ICMR then approved TrueNat (a test for drug-resistant tuberculosis) and CBNAAT (cartridge-based nucleic acid amplification test) as part of the testing arsenal. “While rRT-PCR is limited to well-equipped hospitals, TrueNat can be deployed at district hospitals across India, addressing the last mile barrier,” says Dr Rajni Kant, PRO, ICMR. fections will make the peak. Experts have Till date, 240 labs for TrueNat and 63 for CBNAAT has been given approval. The given various deadlines, none has come Council now says it has “developed and validated the completely indigenous true,” he says. IgG ELISA test for antibody detection for SARS-CoV-2.” It has transferred this Modelling the peak on the basis of, say, technology—which it calls ‘Covid Kavach’—to seven companies that are exp Italy or US, poses its own issues. “Many ected to get manufacturing licences from the Central Drugs Standard Control European countries contained the infection Organisation (CDSCO) in a month. within a geographical limit; in India, we have In April, the Council also faced flak for buying a China-manufactured rap- allowed it to travel the length and width of id-test kit that was supplied to all states. The kits had to be withdrawn after the country,” says Bhupesh Daheria, CEO, some states reported erroneous results. Though ICMR claims it incurred no fi- Aegis School of Data Science. State health of- nancial loss as no money was paid to the company, the lack of due diligence that led to the goof-up and the ambiguity in financial dealings raised ques- ficials admit the lockdown relaxation and re- tions. Not to mention the waste of precious time and manpower in the middle sumption of air-services, along with the of a pandemic. earlier displacement of migrant workers, took COVID to Tier II-III cities and beyond. Many districts in Bihar, Jharkhand, UP, Odisha have witnessed a sudden rise in cases quarantine centres to contain the infection. of late. The Northeast, barring Assam, But many smaller cities and state capitals Meghalaya, Manipur and Tripura was com- failed to track the incoming population due pletely COVID-free and in the green zone to the sheer numbers. Patna, for one, is at till May 25. Dadra Nagar Haveli didn’t have a serious risk. Containment is the initial single case. Not so anymore—these places strategy; if the infection explodes, one has have turned into red zones with cases being to resort to mitigation. reported from even remote districts. Mizoram initially had only one case, with a How to stop health system recovery, says the state’s Integrated Disease Surveillance Programme (IDSP) officer, P. from getting overwhelmed Lalmalsawma—“now we have 88”. One of the biggest advantages of the lock- Health experts point to the irony of open- down, claimed the government, is that it ing up after the lockdown itself forced mi- provided time to upgrade the health infra- grant abour back to their native places—bad structure to meet the demand (see box). economics, bad pandemic control. “We cre- Contrary to that claim, cities like Delhi, ated a huge shortage of workforce in our Mumbai, Ahmedabad and Indore have factories while allowing the infection to started facing an acute shortage of beds in travel all across India,” admits a senior epi- hospitals; patients saying they have to run demiologist. A lot of villages in, say, Bihar from one hospital to another is a common and UP converted government schools, scare-story—in many cases, even dying in banquet halls and community centres into transit for want of treatment. That suggests

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 29 COVID-19 SPECIAL

SURESH K. PANDEY to bear the costs. Karnataka too. “At present, all COVID hospitals here are government hospitals,” says Nandakumar Jairam, CEO, Columbia Asia Hospitals. The government “may involve private healthcare” if the numbers increase. Delhi initially had only three private hospitals roped in for COVID. “But of late, the state has asked all private hospitals to either completely get converted to COVID-19 hospitals or reserve 20 per cent beds for it,” says Mahipal Singh Bhanot, zonal director, Fortis Hospital. Mumbai has followed a different strategy. It has demar- cated some hospitals as quarantine centres for patients who are asymptomatic, mildly symptomatic and severely symptomatic/ high risk respectively. The state government has asked all private hospitals to ramp up capacity. It has also notified that 80 per cent of total operational beds (both COVID and non-COVID) will be regulated as per rates specified by the government. But hospitals have their worries: severe Crematorium, Lodi Road, the health system is already overwhelmed: shortage of staff, especially non-medical Delhi—Stacks of ash urns of not a good omen, with the peak still far staff like nurses, housekeeping, ward boys the dead during the lockdown from sight. State governments like Delhi etc. Many non-medical staff have got in- dismiss news reports and public claims fected, absenteeism is high, many are leaving about a shortage of beds, but all the signs due to fear of catching the infection— are that resources are drying up. For one, Maharashtra, the current hotspot, is grap- the various restrictions on treatment and pling with an exodus of sorts. “We need to testing; for another, the strange decision in understand that our frontline healthcare which the Delhi government prohibited workers are putting themselves at risk, sacri- people from the National Capital Region ficing their personal lives and working round from availing any hospital facility in Delhi. the clock. They need to be counselled, kept Available COVID-related (The order has been overruled by the LG.) motivated,” says Gautam Khanna, CEO of health infrastructure as The Delhi government claims it has a total Hinduja Hospital, Mumbai. of June 5, 2020 of 8,575 dedicated COVID beds right now— The treatment cost also becomes a bone • 957 dedicated COVID hospi- 4,413 occupied, 4,162 vacant—including of contention as soon as private healthcare tals with 1,66,460 isolation beds, 21,473 ICU beds and government and private. It has also devel- comes in: many patients complain of over- 72,497 oxygen-supported oped a mobile application in which anyone charging. Experientially, most Indians will beds. can check this availability. But patients say say that’s true, but it’s not always easy to • 2,362 dedicated COVID the app shows something, and the hospitals judge. “When an allegation of overcharging Health Centres with 1,32,593 something else when they reach there. is made, we need to have a standard or isolation beds, 10,903 ICU Black-marketing of beds is also being spo- mean to judge it by. In its absence, any rate beds and 45,562 oxygen-sup- ken of. One scary indication of the short- can well be called arbitrary,” says Nishant ported beds. age—present and/or imminent—came from Srivastava, managing partner, Actus Legal • 11,210 quarantine centres the deputy CM, where he said Delhi would Associates. The FICCI health services com- and 7,529 COVID Care Centres need 80,000 beds by July end, when the mittee recently proposed that treatment with 7,03,786 beds. state’s caseload is expected to touch 5.5 costs be fixed between Rs 17,000 to Rs • 128.48 lakh N95 masks and lakh. The Union health ministry said there 45,000 depending on the facilities. The gov- 104.74 lakh PPEs provided to were a total of 1,33,632 Covid +ve patients ernment hasn’t taken any call on it yet. states/ UTs/central in India as on June 10—an exact break-up “Various state governments have an- institutions of admitted patients is a matter of loose nounced separate policies for reimburse- reckoning, because mild/asymptomatic pa- ment of care given to COVID-19 cases,” tients are advised home quarantine. says Dr Harish Pillai, member of the FICCI Many states had initially kept private hos- committee. This is one end of the drama pitals out of the ambit of COVID-19 but are unfolding across India—private healthcare now rethinking their strategy. Uttar Pradesh in the midst of a very urban nightmare. didn’t allow a single private hospital to treat Other, less visible nightmares stalk the COVID-19 patients—not even those willing countryside. O

30 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL THE NEW HOTSPOTS DELHI Central Delhi: NA HARYANA West Delhi: NA Gurgaon: 2,546 North Delhi: NA Faridabad: 855 North West Delhi: NA Panipat: 86 Jind: 65 UTTARAKHAND BIHAR Nainital: 334 Katihar: 192 RAJASTHAN Tehri Garhwal: 223 Darbhanga: 135 Jaipur: 2,411 Haridwar: 154 Madhepura: 124 Jodhpur: 1985 UTTAR PRADESH Aurangabad: 95 Udaipur: 590 Jaunpur: 352 Dungarpur: 383 Etawah: 96 Nagaur: 520 Gorakhpur: 148 Bhadohi: 76

ASSAM Golaghat: 225 Nagaon: 198 WEST BENGAL Hojai: 266 Howrah: 1,524 Karimganj: 83 GUJARAT Calcutta: 3,128 Lakhimpur: 75 Ahmedabad: 15,305 North 24 Parganas: 1,258 Cachar: 90 Surat: 2,281 Vadodara: 1,395 MADHYA PRADESH ODISHA Ujjain: 745 Cuttack: 209 Burhanpur: 377 Kendrapara: 170 MAHARASHTRA Gwalior: 228 Puri: 115 Mumbai: 52,667 Sagar: 242 Balangir: 124 Thane: 14,720 Morena: 133 Nayagarh: 97 Pune: 10,406 Aurangabad: 2,173 TELANGANA Palghar: 1,738 Hyderabad: 2,514 Kolhapur: 671 Medchal Malkajgiri: 96 Solapur: 1,483 Ranga Reddy: 190 The latest mapping of India’s 38 most Adilabad: 30 affected zones presents one side of the picture: the top rankers where TAMIL NADU cases are exploding now. It does not Chennai: 25,937 KARNATAKA include states like Kerala and Manipur Chengalpattu: Yadgir: 669 2,328 Thiruvallur: that have seen a surge post-open- Udupi: 947 1,581 Cuddalore: ing up. Nor does it denote what may Chikkaballapur: 152 498 Ariyalur: become the future hotspots, with Chitradurga: 40 384 Kancheepuram: 600 transmission in dense urban/periur- Viluppuram: 392 ban zones in, say, Bihar and Bengal.

Map not scaled; Figures are in total COVID-19 cases (active+recovered) on June 9 GRAPHICS BY SAJI C.S. Source: Union health ministry data COVID-19 SPECIAL DID THE LOCKDOWN WORK? Ajay Sukumaran

This one executive decision was deemed at first to be a no-brainer. Perhaps a faint dread preceded it, blended with a resigned sense of inevitability—as if for an elemental event beyond our control, the way we may anticipate news of a solar eclipse sweeping the land that would offer no clear promise of when the sun would shine again. Still, for a country blessed with frighteningly fractious opin- analysis shows the curve indeed shifted, ions on everything, there had been with a smaller rate of growth. Had the epi- near-unanimity on this. No political party, demic continued at its initial rate of growth, no social segment, no corporate lobby, nor active cases would have crossed 2.5 million even any healthcare expert had offered a se- by May 17, the end of Lockdown Phase 3. rious objection. Stunningly simple at one And the number, as we know, was around level, it was also profound in the way it 55,878 that day. ‘Active cases’ is different straitened our primary conditions of living. from the total tally: it’s the total number of Poets, historians and sociologists will have positive cases minus recoveries and deaths. their say another day. But the immediate, Yes, it’s still exponential: with the chart practical question is: did it work? As Week 9, galloping at 10,000 cases a day, India will be 10 and 11 of the lockdown saw public trans- skimming 3 lakh by the time these words A collective of port and air travel thaw out messily from a reach you. If this pattern continues 600 scientists freeze—as India daily counts a new crest in through June-July, the figures will begin to numbers, and balks at counting the social look very scary. But there’s reason for some estimates that and economic costs of internal migration on grim comfort: cases will go up as long as the a never-before scale—one prediction can be Reproduction number of the infection (also 8,000 to 32,000 safely made. This question will be hotly de- called R0, pronounced ‘R nought’) is fatalities had bated even months from now, in ever-new greater than one—essentially, that means forms. Questions proper to governance in one affected person can infect more than been averted the socio-economic realm cannot really be one person on average. “It’s not a big sur- delinked from the growth path of an epi- prise that every day will bring a new record. till May 15, demic—they are connected inextricably. But The thing we need to really worry about is compared to a they are also subject to opinions beyond the whether the rate of growth has increased or scope of medicine proper. The original ques- not,” says Sinha. ‘do-nothing’ tion still stands: was the lockdown effective India’s R0 trajectory could offer some in controlling the India story of COVID-19? clues—Sinha’s analysis of national data att scenario. Contrary to scepticism, that the lockdown ributed a basic R of 1.83 at the start of the slowed the Covid rate of growth isn’t in contagion in March and a significantly lower much doubt. Consider a model evolved by 1.29 for the period April 13-May 14. It re- Prof Sitabhra Sinha of Chennai’s Institute of duced further to about 1.22 between May 29- Mathematical Sciences, whose projections June 4. Essentially, that means 10 COVID have closely resembled official statistics. patients can probably infect 12 others. So Sinha works on publicly available daily sta- while the overall numbers climb, that may tistics that the government puts out and his suggest a cooling of the pandemic’s inner fire

OUTLOOKINDIA.COM JUNE 15, 2020 | OUTLOOK 33 COVID-19 SPECIAL

as it scythes through the forest of people in the Niti Aayog’s range of 37,000 to 2,10,000 Should the India. What explains this decline, especially fatalities averted during lockdown—as the when lockdown relaxation saw freer move- ISRC pointed out, various models had been lockdown’s ment and higher caseloads? The most plau- cited but there was little explanation as to sible answer, Sinha suggests, is that the how those numbers were obtained. There efficacy be national R0 was so far skewed by the early are also lateral lines of questioning that can measured exponential growth in Maharashtra. In rec find no quantifiable answers. Should the ent weeks, Maharashtra’s R0 value has act lockdown’s effectiveness be really meas- against a ‘do ually decreased to even below the national ured against a “do-nothing” scenario? Or average, he says. against what could have been very decent, nothing’ “Now you are seeing a crossover. Because very plausible, perhaps better alternatives? situation? Or Maharashtra is tending to flatten out, other Say, having had our antennae and radars up states that are growing at a much faster rate earlier—a month and half earlier—putting against very are going to start influencing the India-wise in place elements of an early response, number,” says Sinha. But those states punch tracking and contact-tracing only the 15 plausible, better at a lower weight in number terms. Seen an- lakh or so international arrivals in that pe- alternatives? other way, Maharashtra’s R0 is now lower riod, creating containment zones only than some states far down the ranking list. around their hubs, and testing there aggres- “From a policy point of view, it’s very impor- sively? Instead, India was in vishram stance tant to keep an eye on states with a very high all through—even Parliament functioned R0 because that’s presumably where the till March 23…and the very next day it hotspots might move if you don’t take imme- was savdhaan. The whole country had to diate corrective action,” he adds. Overall, down shutters with a couple of hours’ no- there’s a mixed picture—in some states like tice. A discomfiting new reality that actu- Rajasthan, Gujarat and Madhya Pradesh, the ally created the movement of lakhs of curve of daily active cases is somewhat flat- people from urban hubs. As we said, in epi- lining. In others—like Karnataka and Bihar— demiological terms, difficult to quantify. it’s climbing. So too in Haryana, Assam and So what lies beyond a lockdown? The Uttarakhand, where the R0 (as of June 4) frank answer is that an accurate picture is too shows a sudden increase. elusive. From one end of the spectrum of Did the lockdown save lives? The Indian scenarios, epidemiologist Jayaprakash Scientists’ Response to COVID-19 (ISRC), Muliyil offers the unsettling figure of 2 mil- an independent collective of around 600 lion deaths and that, “in three months, we scientists, has estimated that 8,000 to develop herd immunity”. Muliyil argues 32,000 fatalities had been averted till May that herd immunity is the only way out 15, compared to a “do-nothing” scenario. (see ‘We have to count...it will stop’). What Their analysis had come as a response to that means is, when a substantial percent-

34 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL VOX POP age of the population has been infected and develops immunity, a virus finds it difficult to find a new host, or get from person to person. But, for that salutary stage to be reached, a reasonable guess is that 50 per cent of people will have to get infected, sometimes more. And even countries that Jay initially thought aloud about the idea, like Professor of Medicine, the UK, have balked at it. Even the US, with Bhattacharya Stanford University the world’s highest infection count, isn’t anywhere near herd immunity, according to Lockdowns have helped buy time. some experts. But what next? XPERTS concur that lockdowns Lockdowns delay, but do not prevent, the helped to buy time but the trade- onset of Covid-19 cases. They are not a tool offs started to get skewed the longer they were in force—the for disease eradication. The costs of the lock- Ehuman costs in India, given the fact that down—including the collapse of the global most of our workforce is in the informal sector with virtually no social security, economy and increased deaths and disease were far worse than those seen in wealthy among the poor throughout the world—are countries, says Vikram Patel, professor at the department of Global Health and already enormous and will have to be paid for Social Medicine at Harvard Medical years to come. School. “The lockdown definitely slowed down the epidemic. But beyond a point, it Some alternate policy proposals, such as is not helpful,” says Ramanan testing, contact tracing, and quarantining Laxminarayan, director of the US-based Center for Disease Dynamics, Economics & the infected population, cannot work given Policy. “You have to remember its purpose how widespread the epidemic already is and was not that the disease will die out. A lockdown was always to buy time to prepare.” the likelihood of spread by the asympto- The other crucial question vis-a-vis lock- matic population. We are going to have to downs was, of course, how to end them? For, it could be relatively easier to enter a lock- learn to live with the virus, just as we have down than exit it—the medical analogy to learned to live with a host of other deadly exiting a lockdown, as virologist Shahid Jameel puts it effectively, is that of a patient infectious diseases. on ventilator. “You decide in a few seconds whether to put somebody on a ventilator. But then you need to wean them off slowly.” Both polio and HIV, he points out, were The world over, these are the dilemmatic tackled on that very premise and the results waters being navigated currently. With the speak for themselves. “We showed we were exception of Sweden—an outlier of sorts, it the world leaders for polio when people didn’t opt for a lockdown, instead relying on said we couldn’t eradicate it. They also said social distancing. But Sweden’s Covid death that for HIV but they were wrong.” So, it all toll at 4,656 (as of June 7) is much higher boils down to how well we can track and than those of its Scandinavian neighbours trace: what they call man-to-man coverage and recently its state epidemiologist Anders in football. “The only thing we have to mon- Tegnell admitted that, with hindsight, things itor is the (virus) circulations going on and could have been done better. how we can prevent deaths. If we wait for Surveillance indeed is the way ahead, hospitals to report, it will be too late. The reckons epidemiologist Giridhara R. Babu. earlier we pick up, the better it is.” While But, as a subset of public health in India, testing has to follow a systematic strategy, the amount of resources or attention given it’s still possible to isolate people assuming to surveillance has been abysmal, he says. every case of pneumonia to be Covid unless “If we do not have surveillance systems otherwise proved, says Babu. strengthened and then open up, we are just For India, the implications of the COVID- pretending that nothing is going to happen.” 19 lockdown need to be seen also within the

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 35 COVID-19 SPECIAL

VOX POP

Reetika Development economist, Khera IIM Ahmedabad “One important rationale for a lockdown is so the administration could focus on the public health crisis. A stringent, sudden lockdown in India was a bad idea because it created an ad- frame of other diseases that too require ditional, humanitarian crisis. Rather than redu urgent attention. “You have to be worried cing administrative burden so that pressing about other collateral damages,” says Muliyil, pointing to appendicitis or cancer concerns like increasing laboratory/hospital patients who have not been able to get to bed capacities and creating a protocol for the hospital. “For India and other lower/ middle income countries, there are epi- testing could be addressed, the unplanned demics occurring among the poorest con- lockdown multiplied challenges. The new crisis tinually,” agrees Prof Sridhar stretched lim ited state capacities, which has Venkatapuram of King’s College London. Based on other epidemics like HIV and ma- not been directed at dealing with it. One rea- laria, most observers expect the COVID-19 son could be because the government was pandemic to ‘settle’ into LMICs while high-income countries will control it, he plugged into conversations in the developed says. “Some people have been arguing that world, with very different economic structure. we should just let it spread and let people get sick and become immune, and protect Only about 17 per cent of the workforce has those more vulnerable. What they don’t say salaried jobs here. One-third of the employed is that potentially hundreds of thousands or millions could also die over the two- work as casual labour, many as daily wagers. three years of waves it would take to create Nearly 50 per cent are self-employed, mostly immunity in the population.” So do we have a picture of the new way of small operators. The lockdown dried up their living, the tentative openness, we are head- earnings overnight. It seems our policymakers ing into? Vikram Patel of Harvard Medical School sums it up: “Let’s be clear about one did not realise how fragile their lives are, how thing: as lockdowns are lifted, it is inevita- numerous they are. A rerun of Ramayan was ble that new infections will occur.” Engaging public health assets, such as announced for the people; the rest don’t seem ASHA workers, with appropriate training to matter or is visible to the ruling political and personal protection, to identify cases, trace contacts, and help people self-isolate, class, at least not until news reports/viral vid- may well be the more effective weapon, he eos about their condition flooded our media says. “But, at the same time, I hope we must remember that social interaction is an es- sources. Much of rural India rely on the remit- sential component of our humanity and tances from migrant workers who are now without it we cease to have lives that are worth living.” The initial question, then, de- additional mouths to feed at home. For the volves into a web of interrelated questions rural poor, the lockdown is a double whammy.” that will remain with us for the foreseeable future—and the answer can only consist of precise detailing, care and empathetic micro-management. O

36 OUTLOOK | JUNE 22, 2020 #itstimefornature Planet Outlook Lecture SerieS

Living with Lecture by Dr. ViDya athreya Director-Conservation Science, WCS - India

In conversation with JoIn uS on Ananda Banerjee, Editor, Special Projects, on Outlook June 17th, Wed, 7:00 p.m. COVID-19 SPECIAL

We have to count up to 60 crore,that’s when it will stop

Jayaprakash Muliyil is the Over 80 per cent are chief contrarian in India’s sub-clinical cases. We call epidemic story—who them ‘case’. We keep count famously prophesies two mil- ing them, we have to count lion deaths post-lockdown. up to 60 crore, that’s when it Leading epidemiologist, will stop. I think fear is what former principal of Vellore troubling us. Fear causes Christian Medical College, stigma, stigma makes you chairman of the scientific unjust and unfair. But all this advisory committee of the is the natural trajectory of an National Institute of epidemic. We are mostly Epidemiology…he explains rural, so it will slow there, his theoretical preference then it will come down. Next for ‘herd immunity’ to year, this time, everybody Preetha Nair. would have forgotten Covid. We live with lots of viruses We are in Unlock 1.0 and alr anyway. Do we remember eady seeing almost 10,000 any of them any time? daily cases…. But Covid is different… Those are people who are It may seem so at the mom positive. It possibly doesn’t ent. When HIV and HINI mean they are sick. happened, people were Everybody gets viral infec frightened. HIV was there tion, all of them are not sick. for several years, torturing

38 OUTLOOK | JUNE 22, 2020 Mayan doomsday portrait—A mural from the Mexican state of Chiapas. Smallpox, measles, influenza, typhus, yellow fever... Did the lockdown But we have to open up? epidemics introduced by the European colonisers in the New You have to worry about the World decimated 90 per cent of Maya and Aztec who had never serve its purpose? collateral damages of a lock encountered these germs and lacked immunity against them. down too. Now people are They could have going around sealing hospi tals…tragic and ridiculous. us. Now nobody is worried. And 7.5 lakh deaths in the age given one week’s People with other diseases Only thing is, Covid is a pro group of above 60? time, instead of will be in danger. There’s a longed one. That’s the most dramatic number of Covid deaths we How do you come to the cal thing. The death rate is very taking people expect. We can’t help it. The culation that India will see disproportionate when you focus has to be on providing two million deaths with a take age. Above 80 is over for granted. New services. substantial opening up? nine per cent of our popula Zealand informed We have reached commu Based on the mortality expe tion. They will have over 80 nity transmission, nobody riences from UK and France, per cent share of the deaths. the public several admits it...it’s a dirty word their latest publications. I We have 36 crore below age for everyone. At one point, applied the age-specific cor 15. My calculations say they days in advance one can test, identify and ona death rate through our will have very few deaths. For about the coming isolate, like Kerala did. This population. India’s popula a 25-year-old, the risk of is a different phase. A major tion is 1.36 billion: one dying is still only 30 out of lockdown. We ity will get infected, most should see the two million in 1,00,000, a very small rate. will be fine. Only the ones that context. It comes to The equation changes as you just announced who get breathless are sick. about two per thousand, go up the age graph. For it and people got Adequate oxygen supply will much less than Europe. In those in the seventh decade save lives. There’s no point India, even small percent (in their 60s), the rate is 2 per caught on the road. testing asymptomatic people. ages give us large numbers. cent. In the eighth decade, Just treat every pneumonia One per cent of Indians is it’s 4 per cent. Ninth decade, Basically, by doing case as a Covid patient, with 13.6 million people. So the 8 per cent. In those groups, this, we supported out testing. number of deaths would be mortality is anyway high: How does herd immunity high but the rate of death will whether corona is killing the virus. work? be low. Some 1.358 billion them or another disease, it’s Let the young go out and will still be alive. not clear. work. In the bargain, they

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 39 COVID-19 V X P P SPECIAL O O

Epidemiologist, Giridhara Indian Institute of Public Health, will get infected...and be population, with a certain R. Babu PHFI, Bangalore immune forever. They will percentage who are immuno not die: infection is nothing, logically susceptible.) It hap Is herd immunity the solution? they just walk away from it. pens by itself. I say it with One of the largest surveys was When many people develop confidence because I have immunity, the virus finds it seen it with measles, Ebola, done in Spain recently and the re- difficult to get from person to chicken pox, rubella etc. sults show just 5 per cent of the person. I’m an optimist. For Are you hopeful of a vaccine? one death, there will be 400 I’m very confident a vaccine population was infected in terms people recovering and devel will come, a good one. All of immunoglobulins. Therefore, oping immunity. That beco studies on the virus show mes an immunity-building nice immunogenicity…the looking at 5 per cent and so many population. We expect cities ability to stimulate our deaths, imagine the number of to achieve herd immunity at immune system. So chances 60 per cent, villages around are the vaccine is also easy deaths if 60 per cent get infected. 40 per cent. Mumbai will to make. Whether it’s vac So, I’m not a believer that herd im- come to that phase very rap cine or virus, it’s our body idly because they have many that produces antibodies. munity through infection is going cases. Delhi too. The virus And this virus is not that to be the solution. Herd immunity doesn’t disappear…it goes highly mutant. into a phenomenal value of Will there be a second wave? has to come from a vaccine. R1, a quiet endemic phase That’s for people who are not where it can remain for immune, never for this virus. months or years. We hope My reading is, once you are immunity means R1: one that break will be enough for finished with corona, you are case leads to one case, no epi a vaccine to come. out of it. demic, just a lingering on in But protecting the elders What about the reports of the community. That’s what may be difficult in India… reinfection from China et al... WHO is referring to. Future You can’t just protect them Humbug, not a single report. outbreaks will happen when by issuing a government What happened is, they the susceptible population order. You have to tell them found the virus in the throat increases… after a year or how to protect themselves. of those who had ‘recovered’ two, when a large number of Physical distance, hand hyg even after 21 days. CDC children are born, Covid can iene, ironing newspapers etc. Atlanta did a careful study... again move around. Young Make sure even in the house, they took the lingering virus people will block it, but it can you wear a mask most of the and tried to culture it. They kill the uninfected elderly. By time. The numbers will come couldn’t! So NOT infectious. Would all of us get the time, we will have a vac down from 7.5 lakh. After the ninth day, nobody infected sooner or cine hopefully. Do we see evidence of herd had any of the infectious Experts predict a peak in July. immunity anywhere in the virus in their throat. Then later? Luckily, I’m not an expert! world? what was that PCR test pick Usually it takes three months, Herd immunity levels will be ing up? Fragments of the Yes, sooner or not over four months. A lock different in different areas... virus, not the whole thing. So later. We don’t down is a break, a temporary you need above 50 per cent first we thought it was a pec delay, so we are slightly bet level to reach herd. In a uliar disease that doesn’t go know yet, because ter off vis-à-vis the peak. But thickly populated place like away even after immunity. this epidemic will take away Dharavi, you need a higher Now we know. This is the 80 per cent is a few elderly. In the process, level, above 60 per cent, truth currently. But with new asymptomatic. we have to make sure we maybe even 80 per cent. evidences, it can change. don’t destroy our country. With Influenza A, H1NI, we That’s science. We can get unduly Why are some states so badly measured it at exactly 40 per Is corona here to stay? affected? cent. Then it died down. I saw The virus has found a bal afraid…. Even at 71, We are taking a snapshot in it in 2009, then the next year. ance between itself and us. I have 95 per cent between…. Everywhere the (New births occur, people R0 is the starting rate: every curve is starting. Wait for it move, so there’s always a new body is susceptible. Herd chances of living. to be over. O

40 OUTLOOK | JUNE 22, 2020 William Dalrymple Historian and author

Narrative History, Literature FestivaLs, & PartyiNg Post-Covid

In conversation with

Join us on @outlookindia @outlookmagazine on June 14, Sunday, 11:00 a.m. Satish Padmanabhan Executive Editor, Outlook COVID-19 SPECIAL

DOES INDIA (NOT) HAVE A MILDER EPIDEMIC?

Ajay Sukumaran

This is a question that has mutated right in front of our eyes, almost as if to mock us. It was in the air, minus the ‘not’, all of spring and early summer, tremulously asked, and perhaps frequently (and prematurely) presumed to have an answer in the affirmative. A sense that the virus was somehow less virulent here; that if there was a specific India story to Covid, purely epidemiologically speaking, it was that we were speaking of a more modest dystopia. Merely a stronger version of a passing flu. The data curve was such that it could help foster that impression. It was around three months ago, in March, that the COVID-19 season properly began in India. Soon, the dizzying spiral in Italy had gripped the world’s att ention. Then, within days, that graph was replicating itself in the US. Naturally, the spectre of Covid effortlessly conquering new territories evoked fears.

42 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

But even by April, India’s statistics were negate the original question. nowhere near the worst-case scenario. The So no, it’s no longer milder in the ordi- question naturally arose: was there some- nary sense—we’ll have to wait for the final thing at work besides a stringent lockdown? count and look at percentages to make a Nearly every possibility was speculated weaker claim at ‘mildness’, if at all. And no, upon—perhaps the virus was behaving dif- the heat certainly didn’t kill the virus. ferently here, maybe it was a milder One way to navigate this warren of alleys ‘strain’. Maybe there were different ‘strains’ is to try and mark out the actual presence in India itself....one thing in Gujarat, ano of the virus, as opposed to official numbers. ther in Gurgaon. The questions were not “Based on the results of seroprevalence What explains surprising: we knew little of the novel studies conducted around the world, we coronavirus, except that it was beset by now understand that the epidemic has India’s low signs of seemingly inexplicable random- spread far more widely throughout the ness. So how do we begin to put the pieces (human) population than can be gleaned uptake initially? of the puzzle together? We put the ques- from case reports alone,” says Jay India’s population to various experts. Bhattacharya, professor of medicine at For a start, the actual spread of the disease Stanford University. By seroprevalence, tion structure across the world is itself an unravelling story. he’s referring to the blood tests that look Russia, where they were making music vid- for antibodies—the body’s natural method probably… eos celebrating the near-absence of COVID- of fighting an infection. It’s a useful tool other countries 19 in the initial days, is now a scare story (see for epidemiologists to estimate what frac- Is Socialism the Vaccine?). And this is a tion of a population has already been exp have a larger strange, moving earthquake, one that has osed to the coronavirus. Last month, a serially found new epicentres: from Italy in Spanish antibody study indicated that 5 representation spring, to Brazil now. The data dashboard per cent of Spain’s population has been of the elderly maps out the curve so far—over 66 lakh con- affected—a figure that held up in a subse- firmed cases globally by the first week of quent second round of survey. Sounds than we have. June, out of which about 3.9 lakh people modest? Well, that’s nearly 24 lakh people, have died. And India has crossed 2.87 lakh over a third of the official world total. That cases, still with relatively fewer dea may be the actual wingspan of the virus ths—8115—than in many other countries. flying under the radar. But the arc had begun to look ominous by And here? Well, the Indian Council for May, in such a way as to almost completely Medical Research (ICMR) too is currently

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 43 COVID-19 SPECIAL

have been widely disputed—even a paper Bhattacharya co-authored last month was criticised for its methodology (one of the early antibody surveys, it had looked at Santa Clara, California, as a case study). Then, the virus itself. Some pointers of how it spread around the world come from the genomic sequences various labs have decoded. About 40,000 sequences are currently available on the GSAID database, including some 400 from India, enabling researchers to piece together an evolution- ary history, or the phylogenetic tree. All viruses mutate over time—think of them as the typos they make as they replicate their RNA inside the host body’s cells, which then get to be a new accepted spelling. The coronavirus is no exception. Researchers broadly group these variations into genetic lineages or clades. Globally, at least 10 clades have been identified, the A2a clade being the most common—in India as well. But there’s no evidence to say if any clade carrying out a household-level antibody is less or more virulent than the other—it’s survey to estimate the prevalence of the precisely such a claim that had come up infection in the country—an ELISA test last month from Gujarat. has been developed by the National All talk about some mutations being Institute of Virology to look for deadlier—such as the allegedly more lethal Immunoglobulin G (IgG), a type of anti- D614G mutation—or references to varia- body. The survey across 69 districts in 21 ble infectivity between the so-called ‘S states could potentially give us a richer, strain’ and ‘L strain’ have now been given more finely-grained view of COVID-19’s a quiet burial. Columbia virologist Vincent passage through India. ICMR favours Racaniello summarised it with a headline In the initial repeated cross-sectional investigation to to his blog post, ‘There is one, and only one establish the actual trends in an evolving strain of SARS-CoV-2’. The more recent phase, India saw pandemic—a kind of live cartography that claim from Italy that COVID-19 was maps the progress (or regress) of infection “weakening” too has largely met the same the infection in specific districts which, when aggre- fate. No serious study anywhere has yet mostly in young gated, offers us a country picture. found a significant mutation—either her- alding more virulence, or a weakening. people. When it HE spurt seen in the official count in Epidemiologist Giridhara R. Babu of the recent weeks—6,000+ cases being Public Health Foundation of India sums it spreads to the docked each day in the last week of up thus: “What we definitely know is the elderly and more TMay, almost touching 8,000+ as we closed genetic make-up of the virus is nearly the off the month, then scaling 10,000 with a same all over the world.” Another scientist vulnerable, the kind of sherpa-like tenacity a week later— working on vaccines says virus mutations gives us a peek into the spread. But even don’t present a significant issue to research- picture will be that may be a fraction. Bhattacharya says ers like him—“the most important protein the same as various global studies indicate—depending on the virus is the Spike protein and there is on the locality—that, for every identified a mutation at a single position, but the rest anywhere in case, “somewhere between 10 and 500 peo- of the Spike is pretty well-conserved in all ple have been infected without being iden- the isolates that have been seen to date.” the world. tified by healthcare systems as having the That doesn’t mean science stops looking. virus”. By itself, the view that swab tests “We can’t say yet if a strain is more virulent alone may not yield a true picture isn’t new, or not,” says Rakesh Mishra, director, because these tests, being time-consuming Centre for Cellular and Molecular Biology and expensive, have not cast their net wide (CCMB), Hyderabad, offering a cautious enough, especially in India. But, on the margin note. “There are some mutations other side, antibody survey findings too that look unique to our isolates, which is

44 OUTLOOK | JUNE 22, 2020 COVID-19 V X P P SPECIAL O O

understandable.” Last week, Mishra’s cen- Associate Professor, tre—along with its sister labs, the Institute Global Health & of Genomics and Integrative Biology in Sridhar Delhi and the Chandigarh-based Institute Philosophy, of Microbial Technology—identified five Venkatapuram King’s College London clades that were circulating in India at the beginning of the outbreak. Among them Are we in an era of constant and regular viral was a new clade, which, the study claimed, attacks, since SARS? Is a bigger one lurking? hadn’t been classified as such before. This new clade—they named it A3i—was mostly This is an opportunity for India to really under- from the Telangana and Tamil Nadu stand that there have been outbreaks and region, and seen in some other South epidemics in India every year for decades. Asian countries, says Mishra. SARS, MERS, Ebola, COVID-19 are epidemics HEIR next step will be to see if you are aware of because they worried people there’s a link between the clades and patients’ clinical manifesta- in rich countries. Globally, HIV caught people Ttions. “We want to see if there is a medical by surprise because most public health peo- correlation,” says Mishra. Meanwhile, genomic studies too are being planned to ple in the 1970s believed infectious diseases try and tease out a better understanding were all under control in rich countries, and of the virus and disease progression. There are several questions here—why are such they were only a problem of poor countries. a large number of patients asymptomatic, What we now know is that there are out- for instance. But alas, good science needs to be allowed to mature. “This breaks around the world every year, and that patient-based gene study will take six some of them can become pandemics. This months to a year...data generation takes time,” says Mishra. COVID-19 pandemic was expected, and unfor- “We certainly know more about the tunately, it is not considered to be the worst disease than we did at the beginning,” says Gautam Menon of Ashoka University, pandemic that is possible. There are other, which is currently building a long-term even more dangerous pandemics that are simulation model for the COVID-19 spread in India. “Our earlier estimates of the infec- possible. Old infectious diseases can come tion fatality rate were probably excessive, back, and there are new ones coming more and we did not understand the importance of asymptomatic cases in driving transmis- frequently. In fact, the WHO has a category sion early enough.” Even now, the question called Disease X which stands for a new dis- of how infectious asymptomatic people can be is open-ended (see Asymptomatic box). ease that we have no ideas about regarding An ICMR study of testing data up to April its origin or make-up, and they have been pre- 30 had found 28 per cent of 40,184 positive cases to be asymptomatic—but these were paring for what to do with that. only those who had direct contact with lab-confirmed cases. Throughout the world, the Covid virus is asymptomatic or mildly symptomatic in lion people. In the initial phase of the about 80 per cent of infected people. So what epidemic, says Babu, we were seeing the explains India’s low uptake initially? “India’s infection mostly in young people. “The population structure probably offers clues,” moment it spreads to the elderly and more says virologist T. Jacob John. “Other coun- vulnerable, the picture will be the same as tries have a larger representation of senior anywhere in the world,” he had predicted in citizens than we have. We have a different mid-May. Three weeks later, as India takes population pyramid.” But even though the the fifth spot in the world, we’re already 65+ age group made up only 6.18 per cent of there in a gross sense—without the benefit India’s population in 2018 (as against over of an age-wise mapping. The real challenge 18 per cent in the UK and Italy), the sheer may be to stop this from becoming truly, numbers are still large—roughly over 83 mil- chillingly Malthusian. O

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 45 COVID-19 SPECIAL

Ajay Sukumaran toms, a quickly peaking/sub- siding transmissibility, and a lower viral load in the nose HE ‘silent and upper respiratory tracts. spreader’—a patient That’s why, “despite the without symptoms—is deployment of similar con- Tthe big mystery about Covid. trol interventions, the tra- That puzzle actually starts jectories of the two epidem- with the symptoms because ics have veered in dramati- there’s such a wide range of cally different directions. them, and many of them so Within eight months, SARS mild that you may not even was controlled after SARS- notice. On the US Centers for CoV-1 had infected approxi- Disease Control and ASYMPTOMATICS: mately 8,100 persons in lim- Prevention (CDC) website, ited geographic areas. there’s a list of 11 symptoms— Within five months, SARS- nearly half of these, like ‘new CoV-2 has infected more loss of taste or smell’, were Can They than 2.6 million people and added in April, weeks after continues to spread rapidly the global outbreak had around the world,” said the begun. These symptoms Infect? NEJM edit in April. could appear 2-14 days after Virologist Shahid Jameel exposure to the virus. elaborates on that. In the By now, there’s fair con- case of the SARS epidemic in sensus that a large portion of Covid patients could be ‘pau- 2003, he says, people were shedding the virus only when cisymptomatic’ or experiencing mild symptoms—again, they were symptomatic. “But this virus starts shedding falling into different categories. But how many of them before symptoms appear. And that is one of the reasons truly don’t give out any clues at all of having an infection why this outbreak has expanded so rapidly,” he says. while they have it? There’s no precise statistical answer at Pre-symptomatic patients being infectious isn’t new: mea- the moment—estimates range wildly, from 6 per cent 41 sles and chicken pox too behave that way. HIV too is a clas- per cent, globally. But the actual riddle researchers are try- sic example of that, says Jameel. “With HIV, you don’t ing to crack is: Can they infect others? Yes, warned a group show symptoms of disease up to 8-10 years after infection of Chinese scientists back in February. They described the but you are transmitting. So there are various examples.” results of a comparative study they had conducted to the And yet, doubts about that are also occasionally lobbed New England Journal of Medicine thus: “The viral load into the air—even if not always convincingly. WHO epide- detected in (an) asymptomatic patient was similar to that miologist Maria Van Kerkhove this week had to clarify her in symptomatic patients, which suggests transmission claim about it seeming rare for an asymptomatic person to potential.” An NEJM editorial reinforced this view two transmit the disease on to a second individual. There’s no months later, calling asymptomatic transmission “the answer yet to the complex question of asymptomatics Achilles’ heel of current strategies”. It cited a US study that spreading infection, she said a day later, explaining that she also confirmed high viral loads in the upper respiratory had referred to a subset of studies. “Comprehensive studies tracts of asymptomatics: “Quantitative SARS-CoV-2 viral on transmission from asymptomatic individuals are diffi- loads were similarly high in the four symptom groups” cult to conduct, but available evidence from contact tracing (those with typical symptoms, atypical ones, the presymp- reported by member states suggests asymptomatically-in- tomatics, and asymptomatics). fected individuals are much less likely to transmit the virus Using this as a benchmark would alter testing strategies than those who develop symptoms,” says a WHO docu- around the world. Currently, since there’s no doubt that ment. Even if this dovetails with the anxiety of govern- people with symptoms are indeed infectious, testing has ments to open up, there’s science behind it—and the sci- largely been centred on them and their contacts. But this ence on both sides is incomplete. The question, clearly, is follows a line of epidemic control that perhaps stems from far from settled. Do asymptomatics then hold out possible the SARS virus which, while genetically highly similar to clues—to immunity and even cure? Some think so. A silver Covid-19, behaved differently in terms of onset of symp- lining, perhaps. O

46 OUTLOOK | JUNE 22, 2020 Masterspeak A Webinar Series-Episode 3

Reset ideas foR business leadeRs with R. GopalakRishnan Author and Corporate Advisor Former Executive Director, Tata Sons

Watch the complete discussion between R Gopalakrishnan, and N Mahalakshmi, Editor, Outlook Business on the reset ideas for business leaders at the time of crisis.

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Presented by Co-Sponsored by COVID-19 SPECIAL

HE WHERE IS T DATA? COVID-19 SPECIAL

Jeevan Prakash Sharma, Siddharth Premkumar

So we have a bio-earthquake with shifting epicentres in Covid-19, still rum- bling unpredictably over our demographic plates. How do you measure it on a real- time basis, count the damages, predict the next building to fall, the next neighbour- hood to be hit, and evacuate everyone safely? Not easy at all, as it turns out. Our need to quantify has loosed on us a vast trove of unruly statistics—data itself gone viral, a tsunami in the wake of a quake. Its sheer scale and speed posed challenges. But there’s an additional qualification. The virus, for all the conspiracy theories around it, is an apolitical being— class-neutral and ideology-agnostic.

Data, on the contrary, is deeply political—and not merely at the level of nations or governments. As a unit of knowledge, it is in its very DNA to segue into power—and to bend to its whims. It is owned, it is withheld, it is manipulated. Knowledge, when shared, grows—or so goes an old Indian dictum. But deriving power by knowledge secretly is tradition too. Democracy enjoins upon its keepers an oath to transparency on anything that affects the public; opacity means you don’t even know what questions to ask—a handy thing during one of human history’s most momentous events. Data is also an infinitely plastic element—clay in the hands of the pot- ter. And that’s not a uniquely Indian affliction. Witness the Surgisphere scandal in the US. Or wait…it’s an Indian-founded analytics company at the heart of the story. It had a data registry said to include some 96,032 Covid patient records from nearly 671 hospitals on six continents. That lured a star Indian-origin cardiac surgeon, with all the requisite gravi- tas, to push through major observational studies into venerable journals, The Lancet and The New England Journal of Medicine. The Lancet study claimed anti-malarial drug Hydroxychloroquine (HCQ), touted by President Trump as a ‘wonder drug’, posed an increased death risk to Covid patients; the NEJM paper said certain blood pressure medica- tions did not. Both were retracted within an hour of each other after suspicions mounted about the data sets—which were never made available for peer review. In their apology statement, the authors said they no longer had “confidence in the origination and veracity of the data, nor the findings they have led to”. But by then, based on that research, the WHO had halted the HCQ arm of its global Solidarity trial. They have since resumed. SANDIPAN CHATTERGEE

JUNE 22, 2020 | OUTLOOK 49 APOORVA SALKADE HCQ, meanwhile, still receives bullish pletely when it comes to more nuanced in- endorsements from Indian advocates. But formation, such as the number of PPE kits India is yet to extricate itself fully from the available, or of patients on ventilators or heart of darkness when it comes to data. oxygen support in hospitals in the country. How many people tested? How many men, There’s no such thing as a set of, say, 10 basic how many women? What age-groups? Do data-points that all states religiously gener- we know their blood groups? Co- ate, so that medical professionals and res morbidities? Are there patterns of any earchers can rifle through them and arrive at sort? Why did we not test enough earlier? reasonable conclusions, so that they can The best way to hide data is, of course, to feed bureaucrats and policymakers, so that not even generate it. What value was there the layperson can both be illuminated and in saying India had only around 500 Covid forewarned. That would speak of a data cul- +ve cases on March 24 when we had tested ture that we just don’t seem to have; India as only a grand total of 12,872 people by a collective largely behaves as if it’s still a There is no basic then—not even a handful of apartment family—disease is a stigma that we love to blocks? We were logging 1,300-odd tests a hide from our neighbours. Sorry to disap- data that all day when we could have tested 12,000 a point you, we aren’t sick. states generate, day. The tsunami was born as a trickle. The ministry’s daily briefings dovetail Questions were posed before the Union perfectly with that information-shyness. so that health ministry and ICMR about their re- When they do happen—one hadn’t been luctance to release both raw data and its held for 10 days as this goes to print—they conclusions can sourcing: the answer was mostly omerta. divulge genuinely valuable details and be deduced from Not very conducive to analytics. analyses less readily than they dispense Over two months on, the ministry website homilies on the merits of physical distanc- them, policy still provides only basic data: the total num- ing and pronouncements of ‘faraway ber of active cases, recoveries, and fatalities, peaks’. And yet, government press releases framed and and their state-wise break-up. are the only official sources of information common people Asymptomatic? Mildly symptomatic? The on such pressing questions as the doubling number of beds they occupy? No. For more rate of positive cases, status of PPE kits or forewarned. geographical more granular details—for ins updated guidelines for testing protocols. tance, snapshots of district and taluka—state Other crucial elements remain elusive: till government websites are the only recourse date, we have been handed zero details on (though Delhi does not confer us with that testing kit production, capacity and imp honour either). Most cripplingly, there’s no ort status. Nor any break-up of the number uniformity in the approach to data collec- of tests conducted by private labs and gov- tion—hence no comparability. Some states ernment labs and the percentage of posi- occasionally release age/gender data, some tive cases in each. When it does update the are hazy on that detail. The taps shut com- total number of RT-PCR tests conducted,

50 OUTLOOK | JUNE 22, 2020 COVID-19 V X P P SPECIAL O O

it uses the ambiguously-worded ‘speci- John D. Kalbfleisch men’—an imprecise measure of the num- Collegiate Professor of ber of individuals tested, since all Covid Prof Bhramar Biostatistics, School of +ve cases involve multiple tests with as Public Health, many specimens. Mukherjee University of Michigan “So we don’t know how many individuals have been tested across India so far. If this “Investment in public health, biostatistics and basic information is not provided to com- epidemiology is minimal in India and I am sure mon people, what else one can expect?” says a senior government official, on condi- after this pandemic is over, the need for grow- tion of anonymity. A common request ing capacity in these domains will be forgot- made during Outlook’s information-gathering efforts, it mostly met with a wall of ten until the next public health crisis emerges. reluctance. Those who do speak from It is a medicine/treatment-focused culture within officialdom say that besides the lack of data transparency, the situation is fur- rather than one that invests in prevention/ ther aggravated by a dearth of the requisite public health. Maintaining a strong public levels of data savvy at both the crisis res ponse management and leadership levels. health infrastructure is a general broader need as there will be many other public health What’s crises aside from a pandemic in the future. I the SoP? hope this public health challenge gives us an There’s none, and that’s a major impedi- ment to data analysis, researchers say. The opportunity to advocate for public health, lack of uniformity across states in the way data and data scientists. Data transparency their data is compiled, analysed, reported and presented makes it difficult for those and modelling is key not just in this pandemic, outside the system to access... let alone but for information-driven policymaking in understand. Put that down to ICMR’s lack of interest in devising any standard operat- general. We need a well-funded CDC in India, ing procedure. “What we are working with staffed with qualified data scientists and is highly imperfect because different states, even different districts, have adopted differ- public health professionals.” ent reporting and testing strategies. It’s not an apples-to-apples comparison. When we put them all on the same graph, it’s almost This is very important to track in the future like committing a statistical sin,” says Prof as a departure from the historical curve Bhramar Mukherjee, a biostatistician at the could indicate an outbreak.” Covid19india. University of Michigan who heads the Cov- org is a crowd-sourced volunteer initiative Ind-19 Study Group—a collection of US aca- that aggregates data from state press bulle- demics tracking the pandemic in India. She tins, official social media handles and spoke those words at an online symposium media reports—the gap they fill is obviously organised on June 6 by the Indian left by a retreating officialdom. Scientists Response to Covid-19 (ISRC) col- Another speaker at the symposium, Dr T. lective, an initiative comprising about 600 Sundararaman, former executive director scientists attempting to provide independ- of the National Health Systems Resource ent, data-driven, evidence-based informa- Centre, had similar thoughts. “The ICMR tion about the pandemic to the public. protocol is very clear that ILI cases which Statistical and data reporting infrastruc- are symptomatic, outside hotspots and con- ture itself is an issue, says Prof Mukherjee, tainment zones will not be tested. There’s a speaking to Outlook. Owing to “gaps and phenomenal reluctance to test sympto- misalignments in daily reporting from matic patients. But a hotspot cannot be ICMR…we use covid19india.org. I have declared as such unless you test. So there’s been looking for daily admissions and this whole chicken or egg situation,” he said. death data related to Influenza-like illness And why had the Integrated Disease (ILI) and Severe Acute Respiratory Illness Surveillance Programme (IDSP) stopped (SARI) across India, both historically and its monthly reporting of ILI and SARI from now, but have not been able to locate it. February 24, since Covid-19 is “clinically

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 51 COVID-19 SPECIAL

ever, call it a “legacy problem” involving previous governments—yet, the manner of, and motivation for, data collection does change with each change of the guard. And the poverty of the data culture transmits downward. A government data expert says the problem is more individual than institutional. “If a person is not data-savvy, it leads to a lot of data collection in non-standard formats, leading to confusion. There have been multiple changes in the way data was recorded over the last two months even in the country’s most significant city…so public data cannot be considered accurate,” he says. Dr Raman Sharma, an expert on infectious diseases at Jaipur’s indistinguishable from the flu”? The only Sawai Man Singh Hospital, too says the plausible answer is, so that we don’t know. Union health ministry is not entirely at “There’s a mountain of data being churned fault because a lot of data contamination out from various sources, including IDSP occurs from the ground up. “Sometimes and health management information sys- the patient’s age is missing, often the gen- tems, among others. But there’s almost no der is not marked. If data transmission inter-operability; these data don’t talk to from the field is not correct, its analysis is each other despite a high degree of overlaps,” bound to give errors. The Centre is dep Dr Sundararaman noted. endent on state governments and hospitals Some data anomalies happen even within for all such data,” he says. one system: on May 14, the Delhi govern- Dr Sundararaman, though, isn’t inclined Experts blame a ment put out two sets of figures—one man- to blame doctors or auxiliary nurse mid- top-down lack of dated by the high court, another in its daily wives (ANMs) for falsifying whole sets of health bulletin. In response to a court order, data. “There’s no stake for them to do so. If expertise for it said 1,807 cases were reported that day the numbers upstairs are unreliable, there from various government labs, of which are complex processes responsible for this... data for poor 472—that is, 26 per cent—were positive. the whole way in which this data manage- quality of Meanwhile, the daily bulletin stated that ment is done, with senior IAS officers at the the total testing done till May 14 was top making pronouncements with raw ground-level 1,19,736—that was 6,391 more than on May numbers without any sense of the denomi- 13, hence 4,504 more than the number nators, is problematic,” he said at the sym- collection. The given to the court. Numbers from private posium. Concerns about the denominator poverty of data labs, which report only to ICMR, could have have been raised in a number of indicators accounted for the difference, except for the and metrics—including cases/deaths/tests colection trans- curious fact that the number of positive per million, as also test positivity and case cases (472) was the same in both reports. So fatality rates (TPR and CFR). “In India, mits downward. private labs tested 4,504 people—earning TPRs have been staying at 4-5 per cent. It’s eighteen million rupees—and found zero? been argued that this shows there’s no com- “How is this possible? That too when 1,807 munity transmission, but it’s undeniable public lab tests gave 472 positive cases? The that there’s wide variation in TPR across state government is either unable to explain states. It’s important to monitor such it properly or manipulating the data,” says a trends at the granular level,” Prof Delhi government official. “If this is hap- Mukherjee notes. Her Cov-Ind-19 group pening in the national capital, can you ima published a preprint on medRxiv last gine the situation in other states?” month that illustrated the wider problem of national data masking state-level variations Human by using metrics that don’t reflect their het- erogeneity, thereby hampering nuanced errors? analyses and informed policy interventions. Several data experts blame a top-down lack As for the case fatality ratio, Ashwin of expertise and appreciation for data for a Srivastava, CEO, Sapio Analytics, a data an- host of ills, including the poor quality of alytics firm working with various govern- ground-level data collection. Some, how- ment agencies, told Outlook, “The

52 OUTLOOK | JUNE 22, 2020 COVID-19 INTERVIEW SPECIAL Forming public policy

government has adopted a wrong method with missing data is to calculate CFR. It counts all cases together and then finds the death rate. That like flying blind shows a low mortality rate because the denominator consists of cases that should not be included in the pool.” That is, also Steve H. Hanke, a Professor of Applied Economics at the Johns Hopkins University the closed cases—the dead and recovered— in Baltimore (USA) and a member of the Charter Council of the Society of Economic Measurement, spoke to Outlook on why India doesn’t have a good data. along with the active cases. A patient adm itted today may die in 10-15 days—that’s What could be the reason for poor data generation and management in India? the relevant time-period. In the sympo- India has a poor track record of maintaining a reliable labour market and other eco- sium, Dr Sundararaman too flagged the nomic statistics. One important reason for this is that almost half of India’s econ- issue of time-lags being neglected. “If we omy is considered to be in the “shadow economy.” use the right denominator accounting for Do you think it is due to poor data culture or a deliberate attempt to hide the real the 10-15 days, the CFR would be 4.5-6 per picture? cent. This is internationally comparable. It The problem is a mix of poor data culture and a bloated, corrupt bureaucracy. This shouldn’t be surprising to learn that the is confirmed in a report by the Carnegie Endowment for International Peace (CEIP). virus behaves in India exactly as it does According to CEIP, the Indian Administrative Service “is hamstrung by political elsewhere in the world,” he noted. interference and outdated personnel procedures.” Others like Dr Sanjay Mehendale, direc- Is it due to bad data that India is not able to predict the pressure on its health tor (research) at Pune’s Hinduja hospital, infrastructure? And will it cause an acute crisis in the near future? maintain that data has to be validated bef Missing or low-quality data are always a major problem when attempting to form public policy in the health--or any other--field. It’s equivalent to the pilot of an air- ore being released. “In my 30 years of craft flying blind. working with ICMR, I can assure you data will become available in public domains Coronavirus Deaths per Million only once it is clearly validated and its (population): The Rotten Apples quality ensured. It’s easy to criticise that the correct data is not available, but you Vietnam No Data Reported have to agree that if non-validated data is India Government Reporting Highly Suspect Data put in the public domain, it will lead to Venezuela Government Reporting Highly Suspect Data much higher criticism.” Egypt Government Reporting Highly Suspect Data

Syria Government Reporting Highly Suspect Data The teaching Yemen Government Reporting Highly Suspect Data hospital Turkey Government Reporting Highly Suspect Data Many experts feel government bodies are China Government Reporting Highly Suspect Data so stuck in fire-fighting mode that they for- Noted: Updated as of June 9, 2020. get to plan for the medium- and long-term. Source: worldometers.info, prepared by Prof. Steve H. Harke, The Johns Hopkins University. “It’s one of the main reasons why our situation is so critical right now. Instilling a culture of data appreciation is much needed,” least ICMR’s nation-wide serological sur- says Srivastava. Generating lateral data, vey (see D-G’s Interview) analyses samples going beyond the immediate focus of test- for genotyping. “It will help prioritise risk ing someone positive or negative, could be stratification, help public health planning. of immense value. Studies published in If an association is found between certain Europe and China, for instance, have also genetic variants and severe outcomes...fut looked at possible statistical links between ure patients carrying that mutation can be Covid and genetic variations—such as in screened in a targeted way. Identifying the gene that determines blood types. The pathways, predicting treatment response research papers, while preliminary, sug- and drug targets…it will aid all of that,” says gest that people with blood type A might be Prof Mukherjee. Data, like time, is folded more vulnerable to coronavirus infection into three—there’s the past that needs to while people with blood type O—which a be understood, there’s the present emer- 2014 study found to be the most common gency that needs to be solved, and most of in India—might be resistant to more severe all, there’s the orientation to the future symptoms. How do we know if there’s a that the other two must feed. This pan- potential correlation unless someone has demic, and the next one. India as a civilisa- taken the trouble—over the lakhs of sam- tion cannot just be a hospital, it needs to be ples tested—to also do a simple blood a research hospital that sows and reaps its group test? Researchers now hope that at knowledge for tomorrow. O

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 53 COVID-19 SPECIAL

WHO DECIDES COVID POLICY?

Preetha Nair The pandemic has not been kind to Delhi. The state government, no stranger to pugilist moves in politics, is locked in a grim battle. Even since the lockdown was eased, horror stories have been escaping out of city hospitals like ghouls out to torment the populace. The city’s Covid graph is soaring; over- loaded hospitals are turning away patients, letting them die without proper medical care. But what’s a crisis if not an opportunity for some extra lashings of mayhem?

54 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

We were not disappointed: two contentious calls for national collaboration to solve it, a Tale of two windows Bengal decisions came along from chief minister measure of uniformity in policy. But how CM Mamata Banerjee does an Arvind Kejriwal to set off a right royal row. much uniformity? And who examines the aerial survey of the damage from Cyclone Amphan with PM One was on barring admission to patients content of that policy for its soundness? Narendra Modi from outside Delhi to state-run hospitals. Whose perspectives would feed it? Does it The order was sent back to the pavilion by reflect India’s multiple experiential reali- the lieutenant-governor, Anil Baijal, before ties? Is it consultative enough? A restric- you could pronounce N95. The other was a tion on autonomy at state level, essentially, revised testing strategy—that asympto- creates the spectre of a monopoly in policy- matic people will be restricted from testing. making. In short, it seems to have fallen Again, the L-G scalped it, directing the state upon a tiny virus you cannot see to invoke to adhere to guidelines set by ICMR. The another thing you cannot see much in India The real issue soundness of the decisions—or the lack of these days: a federal spirit. about Kejriwal’s it—in terms of ethics or effective epidemic In a glance, India’s COVID-19 policy is policy is one thing. But the episode framed overwhelmingly within the remit of a cen- U-turn—from a central conflict at the heart of India’s tral body, ICMR. (How did it get that job? Covid-19 battle—central being an acciden- See ICMR story.) States have to kowtow to aggressive tal word there. The key question is: who its decisions, even if those often seem owns an epidemic? short on logic or transparency. There’s testing to a Kejriwal’s U-turn—from being a votary of another entity in play—the COVID-19 subdued line—is aggressive testing to a subdued line—baf- National Task Force. It has representa- fled all, and gave enough ammunition to the tives from all states—an ideal candidate, if a state could Centre to train its guns on the state. Not then, to help set a well-rounded, multi- only because this was flip-flop—a pandemic voiced policy. But last heard, its own voice adopt its own is a dynamic flux, and policy needs to be was not being heard. Not that too many strategy that alive rather than rigid. The real issue was policymakers across the spectrum knew whether a state could adopt its own strategy, what to do with a pandemic. In terms of varies with in tune with its needs, but at variance with the quality of actors who filled out the the broad national template. There are roles, all sides come up short—Centre and a national competing formal frameworks at play here. states, with stray exceptions. That’s why template. Health is a state subject under the health economist and epidemiologist Dr V. Constitution. At the same time, a pandemic Raman Kutty can ask, “How much can is a national event—indeed, global. Rich they test? States have limited resources.” migrants courier in infection from abroad, That’s not a constraint unique to states— poor migrants connect it to the last mile. It “our health expenditure is very low nation-

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 55 COVID-19 SPECIAL

policy too. “The Centre is completely at odds with the federal spirit,” says Moitra. “Everyone works together in a pandemic. That’s not the case here.” Mithilesh Kumar Thakur, a minister in opposition-ruled Jharkhand, echoes the sentiments. Asking Ranchi before deciding on a lockdown? No such luck, he confirms. “We were never consulted, but it is we who get the huge influx of migrants. Our CM conveyed his reservations about opening up also, that too wasn’t taken into consideration. Now all states are opening up, we too will have to play along,” says Thakur. One of India’s poorer states, Jharkhand’s demand for fin ancial assistance, especially pending GST dues, have often fallen on deaf ears. Nothing better to exacerbate a tragedy. Legally Bound What’s the ideal scenario? Of course, the ally also,” he rues. Centre acting as a facilitator, say most exp Despite being at the forefront of pan- erts. Supporting states with financial sup- demic control, taking decisions that could port, guiding the laggards with a policy save lakhs of lives, most states, at least in grid detailing best practices, becoming a the initial months, were in the dark about network of shared knowledge, enabling key decisions: testing strategies, lockdown, research collaboration, distributing its suspension of travel, zone classification, fruits, becoming a nodal point for learning almost everything. The nationwide lock- and teaching at once. But what one saw down on March 24, with a four-hour ad- was the Centre draw on its legal powers to vance notice, caught many states by monopolise decision-making on key asp surprise. The resultant migrant exodus ects: testing strategy, drug protocols, sus- While states also hit them the hardest—states were left pension of international travel, were kept in the bereft, and states had to cope with the del- procurement of emergency supplies, local uge—that too with nary a talk of central production of diagnostic kits—things that dark, the Centre aid. On top of all that, an older virus was affected everyone, without anyone being infecting the air too—curiously, in selected on board. India has invoked the Disaster drew on its legal states. West Bengal, for instance, where Management Act (NDMA) 2005 and powers to elections are due next year. Trinamool Epidemic Diseases Act 1897 to do all this, Congress spokesperson and Lok Sabha MP and questions are being asked about the monopolise Mahua Moitra says states weren’t con- adequacy and validity of the two laws, esp sulted on anything—lockdown or the ecially their conflicting provisions. Under decision-making schedule of Shramik trains. “We requested Section 2 of the Epidemic Diseases Act— the Centre to shut airports and not to run which came into being after the Bombay on key aspects: Parliament in end February-early March. plague—state governments can adopt exc testing strategy, They didn’t listen. Now that the situation eptional measures to contain a disease. is out of control, they want us to handle However, under the NDMA Act, the Union drug protocol, the situation,” she says. health secretary is entrusted with those The contestation between the Centre powers. Says M.R. Madhavan, president, travel, kits, and states over federal rights is nothing PRS Legislative Research, “NDMA allows emergency new. Every regime in New Delhi has tried centralisation of power, which may not be to curtail the rights of states through dubi- a good thing during an epidemic. That bat- supplies.... ous constitutional means: indeed, the tle has to be as local as possible.” Congress has authored some of those Legal expert Prashant Reddy concurs, means. However, the last six years have saying the century-old Epidemic Diseases seen increasing centralisation of power. Act badly needs an update. “The govern- The continuous tussles one sees over West ment shut down the entire country using Bengal, Kerala, now Maharashtra…that some flimsy provisions of the NDMA,” he has tragically cast a shadow over pandemic says. Constitutional expert Subhash

56 OUTLOOK | JUNE 22, 2020 COVID-19 V X P P SPECIAL O O

Kashyap defends the resort to NDMA. “Nobody anticipated such a situation. Legal science tells us existing laws have to be M R read in context, and interpreted so that President, PRS the present situation is covered till the law Madhavan Legislative Research is amended,” says Kashyap. Whatever the legal opinion may be, Maharashtra, the “The Centre has invoked the Disaster current hotspot, feels aggrieved. “Under Management Act, 2005, which was not de- NDMA, the Centre possesses the power to decide on international travel. It delayed signed to handle epidemics. It repurposed the suspension despite our demand. That’s this Act to impose the lockdown across the the reason for the exponential surge in Mumbai,” says NCP leader and state cabi- country as it had no other legislation which net minister Nawab Malik. The lack of aut gives the power to do so. Parliament was in onomy further hamstrung them. States are in a better position to devise strategies session till March 23 and they could have to suit their requirements, he says. brought a new Act to tackle the pandemic. “Private labs here were not allowed to get into production of drugs or testing kits, The PM announced the lockdown on March while the Centre erred in buying faulty 24. From early March, the government has kits from China,” he says. been imposing restrictions and they had handful of states managed amidst enough time to plan it. We also had some this straitened space—Kerala, flights cancelled and the PM and other minis- A Rajasthan and Karnataka, for ins tance. A non- centralised approach bene- ters had cancelled Holi celebrations in March. fited Kerala internally too, points out Dr Kutty. “This happened 25 years back. They could have passed a broadly-worded Panchayats have been trained in disaster emergency Act to manage the crisis. That management. So when emergency measures were announced, they were ready. It’s would have been a better way to do it.” one of the good things that came out of the legislation process,” he says. Legislating, as it were, to delegate. But up the chain, it’s still a picture of conflict. Kerala was Dr Ekbal. “States have different sets of keen on conducting rapid antibody tests to problems, so should be free to develop check community transmission in March, their own strategies. If Kerala is spending but never got a nod from ICMR. And anti- money and testing people, why should body kits developed by Kerala’s Rajiv ICMR object to it? It’s a desire to control,” Gandhi Centre for Biotechnology (RGCB), says Dr Kutty. Karnataka and Delhi too sent for approval in April, are yet to be had been keen in April to conduct random green-signalled. Says Dr M. Radhakrishna antibody tests, but a kind of denialism Pillai, director, RGCB, “ICMR told us our about community transmission seems to product didn’t have a high sensitivity, alt have guided policy. ICMR’s ongoing sero- hough it had a perfect specificity. They ha- surveys are expected to throw some light ven’t said what is required. If we are on the topic now. Dr M.C. Mishra, ex- supposed to re-engineer the kits, we need AIIMS chief, says it’s too late to deny com- to know. There’s lack of clarity,” says Pillai. munity spread now—“all of us felt it was Lack of transparency is especially prob- there, but on a minimal scale. I’d say there lematic, says Dr B. Ekbal, head of the exp was a delay in conducting antibody tests.” ert panel advising Kerala on tackling Not all are critical of ICMR. Despite COVID-19, because ICMR is neither a stat- being a non-BJP state, the Centre “always utory body nor a regulatory one. “ICMR cooperated” with Rajasthan, says Rohit works in a bureaucratic set-up. It should Kumar Singh, the state’s additional chief act as a dynamic body in this hour. Some secretary (health). “We have the flexibility standards should be set. Then research to decide our strategy, and never faced any institutes should be free enough to market shortage of kits,” says Singh. That’s a their products based on that. Beyond that, model of the dynamic, flexible equilibrium ICMR should not act as a roadblock,” says federalism should mean. O

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 57 COVID-19 SPECIAL ‘Kerala is not easier to manage than New York’

With low mortality and high Preparedness and pre-plan- recovery rates, there has been ning is the key. We devised a ‘Kerala model’ in pandemic protocols and SoPs...for ins control too. But post-opening tance, hospitals are not to fill up, the coronavirus again their beds to capacity. If a stalks the coastal state. State hospital has 500 beds, and health minister K.K. gets 500 patients, they Shailaja—aka ‘Shailaja should transfer half the pa- Teacher’—explains how tients to the next Covid hos- they’re refocusing their strat- pital. Half the beds are always egy. Excepts from an interview set aside for critical cases. In with Preetha Nair case of a huge surge, we plan to convert private hospitals, Kerala’s curve is rising again.... institutions and hotels into We were expecting it after COVID-19 hospitals. the (post-lockdown) influx— What can India do better to till now, 1,87,619 people have contain the contagion? reached from outside. The Every state is doing its best. I majority of new cases are would say India should invest among them. We are not wor- the airport since January; other states. We are testing more on health. Kerala’s ried…the situation is not out positive cases were immedi- 67 times more than our case- strength lies in the strong of control. We have surveil- ately transferred to hospitals; load, Maharashtra only 25 foundation of the public lance at airports, ports and ambulances were sent if any- times. Our daily testing has health system, laid in 1957. state borders. But with lakhs one developed symptoms. gone up to around 3,200 sam- This helped a lot during the coming in, institutional quar- Every patient was given extra ples. We conduct sentinel corona crisis...even in district antine is difficult. People who care, that’s how we could save surveillance (random tests). hospitals, we could afford to come by road or air can go for even a 93-year-old patient We have conducted 20,000 set aside 200-350 beds for a 14-day home quarantine if with a heart condition and rapid antibody tests and de- corona ward. they don’t have any symp- his 88-year-old wife. Such tected only 25 positive cases; Is Kerala easier to manage, toms. Only symptomatic pa- care was possible because we all had a history of contacts. being a small state? tients are shifted to hospitals. stopped the spread from the Are you prepared for a surge, It’s not scientific to say What about contact tracing? beginning…we may not have the predicted ‘peak’ in Kerala has a low mortality It’s an arduous task now, but managed if 10,000 patients July-August? rate because of its size. With we are still following it. We turned up at once. We are facing difficulties— a population of 34 million have strict panchayat-level Is there a threat of commu- people have been entering and density of 860/sq km, the monitoring. People are fol- nity transmission? from hotspots, so the curve proneness to a spread is in lowing the principles of I can say community trans- we flattened in April is rising fact way more, so it’s more home quarantine. But with mission hasn’t happened so again—but we are confident challenging. Kerala reported lockdown relaxations, they far. Out of the total cases so we will manage. The positive its first case on January 30. sometimes behave as if they far, only 10-11 per cent got it cases may go up to 25,000… New York, with an 8 million got freedom! via contacts. The rest is all we are trying our level best population, reported its first Still only 17 deaths…. How? imported cases. not to reach that. We are get- case in March. Now New Most of them had come from Is Kerala testing enough? ting prepared with more hos- York’s toll has crossed 20,000. outside, already in a bad con- We have adopted strategic pital beds and Covid care Are you on course to address dition…like a leukaemia pat testing. Instead of calculating centres. It will be difficult to monsoon-related diseases? ient back from the Gulf. Our testing rates per million pop- handle if we face a situation We are extra vigilant and fatality rate is low mainly ulation (TPM), we should like Maharashtra. Right now, have already taken steps to because we took special care view it against cases per mil- we are in a good space. tackle dengue, malaria, viral of the elderly, adopting reve lion (CPM)…relative to the What are the lessons you fever etc…in the past two rse quarantine. We had a size of the outbreak. That way, learnt in disease years, we have brought down strong screening system at we are much ahead of many management? infection-related fatalities.. O

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ICMR, Ajay Sukumaran WHO? Not many would know that India’s top health sciences body, the Indian Council of Medical Research (ICMR), actually predates the UK’s Medical Research Council by a couple of years. That story goes back to the early 1900s, an era of big discoveries in tropical diseases—it was at the cusp of the 20th century that India-born British scientist Ronald Ross identified the Anopheles mosquito as a carrier of malaria in Secunderabad. In the years that followed, many med- Virus Research Centre—what’s now the ical institutes for communicable dis- National Institute of Virology. Again, as eases came up—like the Plague veteran scientists recall, an era of stal- Research Laboratory at Bombay, and wart science leaders. King Institute at Madras. Then in 1911, COVID-19 now again puts ICMR in an Indian Research Fund Association the driver’s seat, getting both bouquets was founded: that was to become ICMR and brickbats as it guides India’s epi- after Independence. demic response. In early March, when It led research into every pestilence our case count was less than 100, re- the country saw in the early years— searchers at ICMR had successfully iso- plague, kala-azar, cholera, small pox. lated the novel coronavirus, thereby And, post-Independence, its family of placing India among the handful of institutes began to grow. Among the countries to have done so. That first step first were the National Institute of was critical to developing home-grown Nutrition in Hyderabad and Pune’s diagnostic kits and a vaccine. The res

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earch body last month also came up with its own Meanwhile, the NCDC comes under the depart- ELISA test for antibodies, given the unreliability ment of health services. of imported kits. More recently, it stood its The NCDC too has a long history. Its origin ground with the World Health Organisation was the Central Malaria Bureau set up in (WHO) when the latter suspended ongoing Kasauli in 1909, which became the Malaria Hydroxychloroquine trials based on a controver- Survey of India in 1927 and later shifted to sial paper—ICMR cited its experience to say there Delhi as the Malaria Institute of India. In 1963, was no reason to suspend trials (globally, trials it was renamed the National Institute of have resumed after the paper was retracted). No Communicable Diseases. The Surat plague of surprise then that a former ICMR scientist tells 1994 proved to be a wake-up call. Seeing the Outlook the council’s response to Covid has so far need for better surveillance and preparedness, has been ‘impressive’. the government invested money and training But India’s top medical research body has also to transform the institute into the NCDC. battled charges of being tight-fisted—especially For a rough comparison, think of ICMR as the when it came to data about tests or while picking Indian counterpart of the US National Institutes laboratories with expertise to join the battle of Health, and the NCDC on the lines of the US sooner. It also took flak for India’s low rate of test- Centers for Disease Control and Prevention. ing in the early part of the outbreak. Noted immu- The NCDC uses a countrywide network called nologist Prof Indira Nath, however, says she the Integrated Disease Surveillance would not single out ICMR or India when it came Programme—a key outcome of the Surat to specifics like data. “I would say many countries plague—to keep track of outbreaks. “I can are not giving clear data on numbers of positive say IDSP is a robust surveillance system, cases.” A more widespread affliction, then, a mis- better than in many countries,” Udaiveer placed nationalism that countries display which Singh Rana, a retired joint director of does not flow from the province of science. NCDC, tells Outlook. But then, as an And yet, any institution begins to breathe a agency, NCDC hasn’t been as visible as its kind of power when invested with it, perhaps to research counterpart ICMR, plausibly bec an excess. That’s why Prof Nath, for instance, ause the health ministry, which it reports feels ICMR initially displayed a governmental to, conducts the daily Covid briefings. Also, attitude by only turning to its own institutes as UMich biostatistician Prof Bhramar when it came to testing. “The RT-PCR test is Mukherjee says, the usual IDSP data flow done by many accredited labs and researchers, on severe respiratory cases in India curi- it’s a very easy technique. So what you needed ously dried up during the pandemic (see was clear-cut SoP and included a lot more insti- Where is the Data?). Beyond Covid, ICMR’s tutions from the beginning. I think initially sphere of research activity spans a vast ter- there was a worry that only ICMR-based, or gov- ritory. There have been hits and misses— ernment institutes, could do it best.” some experts point to how the setting up of That possibly reflects a larger malaise affecting regional institutes of expertise grew into many scientific institutions in India—a bureau- an unwieldy set-up over the years, putting cratic attitude seeping in over the years. “ICMR the social relevance of many programmes into has a lot of bureaucracy, so does CSIR (Council of question. Last year, answering a Lok Sabha ques- Scientific and Industrial Research). What hap- tion, the government said the number of insti- pens, it seems to me over the years as I’m watch- tutes under ICMR have been brought down ing all these organisations, is the scientists from 32 to 26 in a bid to streamline things. themselves become bureaucratic,” says Prof Nath, Tackling diseases by creating an array of pro- who was on a committee reviewing ICMR’s programmes as separate verticals—tuberculosis or grammes back in 2013. There’s no mistaking the malaria, for instance—too has been counter-pro- scientific expertise, she points out. But she reck- ductive in the long-run, say some experts. “The ons that scientists, as they work with bureaucrats one-disease approach is a chronic disease of at the top, also tend to emulate them. India,” is how noted virologist T. Jacob John Of course, India’s Covid response involves puts it. This tendency, he explains, is aimed several agencies. Here’s how the tasks are div more at international obligations and less at ided: testing, diagnostics and vaccine research public health. “Without universal primary are ICMR’s forte; disease surveillance, which healthcare, TB cannot be controlled,” says John. includes generating and compiling data on the The Covid experience, says Prof Nath, may give spread, is the job of the National Centre for us insights into the structural changes required Disease Control (NCDC). The ICMR is an aut in terms of funding—India spends less than 1 per onomous body whose director general is also cent of its GDP on research and development— secretary, department of health research. and the working of institutions. O

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 61 COVID-19 SPECIAL ‘No underreporting, all the missing links will be answered’

The Indian Council of Medical Research (ICMR) has been at the centre of pandemic control in India. Under the aegis of the COVID-19 National Task Force, it has set the overarch- ing policy on testing and treatment strategies, yet its role has faced flak for lack of data tra nsparency, among other issues. Here, ICMR director general Prof Balram Bhargava dismisses the allegation of under-reporting and says all the here. ICMR has conducted a Are there different strains of lent. The SARS-CoV-2 virus missing links would be soon nation-wide sero-survey in the virus in India? being an RNA virus has a explained. Excerpts from an 69 districts, covering a popu- To understand the progres- comparatively higher muta- e-mail interview with Jeevan lation of 24,000 people. This sion of the virus in India, we tion rate. Prakash Sharma. has recently been completed require a phylogeographic Any tests on India-specific and its results will indicate analysis with samples from strains? On their infectivity, Do you still deny that com- the exposure due to COVID- each state. Current sequenc- lethality, ability to survive on munity transmission has 19 in the community. ing data gives us over 220 various surfaces? started in cities like Delhi, Health experts feel the mon- (isolates) from India; the As the different strains for Mumbai, Ahmedabad etc? soon will aggravate the situa- majority belong to the A2a the SARS-CoV-2 are con- A majority of cases are being tion—there’s speculation on genotype. The GISAID’s huge served (they have a similarity reported from a limited num- reaching the peak around database has not revealed of ~99.7%), the same tests are ber of cities. And within the July-August…. When can we much beyond the mutation being used to identify the cities, there are specific pock- see a flattening of the curve? recorded in different coun- virus. Experiments need to ets. Hence, it would be better The reproduction number of tries; their role still needs be performed in order to ass to use the phrase high con- the virus determines its research. ess infectivity, lethality. Some tainment zones. Many of the transmission, hence the Is COVID-19 behaving differ- studies are there on its ability states and cities do not have spike. There is no concrete ently in India? to survive on different that much infection: hence, it evidence that the virus multi- The virus’s behaviour is de- surfaces*. cannot be generalised. plies higher in the monsoon pendent on its host and can Is India under-reporting? Prevention in containment season…how the rainy season have a varied effect based on We have crossed one lakh zones and in clusters will be will affect the transmission the host immune status. tests per day. If we compare decisive in stopping future needs to be seen. Since this Experiments need to be per- to any other country, we are spread. Local governments is a novel virus, it is difficult formed in order to assess doing better from the begin- and individual citizens need to predict its future course whether the strain circulat- ning, ratio wise. Rather than to play a responsible role of spread. ing in India is milder or viru- doubting, we must appreciate

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What explains the better and continuous monitoring recovery rates in Kerala? and testing. Now, as a task Nutrition? Immunity? force, we are undertaking the holistic efforts made by Better treatment? many projects and following prophylaxis in healthcare every sector of the country to It’s not correct to say Kerala lines of research…all the workers. ICMR has also initi- enhance diagnostic capacity has shown a faster recovery missing links will be soon ated plasma therapy trials and pool testing, especially rate than states like answered. And data regard- and published a special Covid ICMR and VRDLs. Maharashtra and Gujarat. ing different variables and its supplement to its scientific Do we know why some dis- There could be possibly many correlation with COVID-19 journal—the Indian Journal tricts are badly affected, oth- confounding reasons. The will be explained. of Medical Research (IJMR)— ers aren’t? What explains, for Nipah outbreak awakened Most of our decisions seem which includes 24 editorials, instance, why Dharavi in the populace, so social based on western research. perspectives, policy pieces, Mumbai, where social dis- acceptance of emergency What have been ICMR’s protocols, short commentar- tancing is not possible, moves being implemented major research ies, review articles and origi- initially witnessed helped. achievements? nal research papers from low transmission… There’s sharp criticism about Major research studies car- ICMR and non-ICMR Some districts are badly aff data being withheld or not ried out by ICMR recently researchers. ected—Mumbai, Navi even being generated? Won’t include the isolation of the How close are we to an indig- Mumbai, Thane, Pune, a more holistic and open ap- virus, with India becoming enous vaccine? Ahmedabad etc—because of proach to comparable data the fifth country to do so. We ICMR has transferred the high movement, being cities. help everyone? also did the whole genome virus strain to its partner, And it’s not true that Dharavi Initially, the priority during sequencing, which helped in Bharat Biotech International showed lower transmission. Ltd (BBIL), for developing It has seen a surge; strict con- the indigenous vaccine. It has tainment has reduced the also initiated work with the incidence. Serum Institute of India (SII) Some experts still hold that and Oxford University to Indians are more immune fast-track phase I/II clinical compared to the West… trials of the live attenuated There is no study or research recombinant vaccine for which has proven that COVID-19 developed by the Indians are more immune Oxford Group. We have also compared to Western coun- partnered with DBT/ICGEB tries. There is also no conclu- for development of monoclo- sive data—either nal antibodies for the treat- epidemiological, age-specific, ment of COVID-19 patients. gender-specific, vis-à-vis We have evaluated over 30 socio-environmental condi- drug candidates/repurposed tions, or serological drugs for identifying promis- evidence—to prove this ing treatment options. hypothesis. Opening up has led to a surge. What’s your strategy? Is there any The first and foremost prior- correlation ity should be to contain the infection through social dis- between BCG any outbreak is containment. the development of ELISA tancing, following adequate So, more focus was but natu- for antibody tests—and bec advisories like using a mask, vaccination and rally given to that, to increas- ame the first step towards an washing hands properly and immunity? ing the robustness of indigenous vaccine, being de- avoiding crowded places. diagnosis, and increasing veloped in partnership with Besides, the elderly and the BCG’s positive testing capacity. Secondly, it Bharat Biotech. ICMR is also comorbid population must was important to become participating in the WHO be taken care of, as they are at correlation in self-sufficient by developing Solidarity Trial which will higher risk. protecting against indigenous testing and diag- look at the beneficial effects *(Reference- Ren SY, Wang WB, nostic kits for different kinds of Hydroxychloroquine, the Hao YG, et al. Stability and in- COVID-19 is still of research related to Lopinavir-Ritonavir combi- fectivity of coronaviruses in COVID-19. In comparison to nation therapy, Interferon inanimate environments. not proven by any other countries, children beta-1a and Remdesivir. The World J Clin Cases. clinical trials. have been less infected; all study also seeks to under- 2020;8(8):1391‐1399. credit goes to the lockdown stand the benefits of HCQ as doi:10.12998/wjcc.v8.i8.139).

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 63 INTERVIEW

process of scientific river rejuvenation for the first time in India. The two basic requirements to rejuvenate the river are, first the Nirmal Dhara which means unpolluted river and second Aviral Dhara which means maintaining a continuous rajiv ranjan mishra flow. Besides that, we have also looked at Director General, NMCG, the complete ecology such as aquatic life, flora and fauna, sediments etc so as to rejuvenate it in all aspects. So far as achieving the goal is concerned, out of 313 projects taken at a cost of Rs 28,966 cr, 122 projects have been completed and the remaining are at various stages of execution. These projects are related to pollution abetment (sewerage infrastructure, solid waste management, Industrial pollution abetment, rural sanitation and water quality monitoring); development of riverfront, ghats and crematoria; afforestation, biodiversity conservation, research just to name a few. Several major drains falling into Ganga have been intercepted and diverted to STPs –new and old. Almost 80 major drains in five states have been tapped and stooped There is a marked waste water directly falling into the river. The Sisamau Nala in Kanpur, infamous improvemenT in GanGa's Kasawan Nala in Haridwar and Chandreshwarnagar nala at Rishikesh are waTer qualiTy other notable examples of such tapping. Along with short term goals, we have tried to achieve long term sustainability through A clean Ganga river is the dream of every Indian. The National Mission for Clean Ganga Hybrid Annuity Mode (HAM) projects and (NMCG), aims to achieve this through Namami Gange. Though efforts were made since “One city One operator” approach. the late 80s to keep the river in its original state, the desired result remained off the Q Now when 37% project is already mark till May 2014 when the Modi government came to power. A year later, the new complete, can we perceive these government made an integrated and comprehensive approach to restore its piousness changes on the ground? and glory by making several vital additions to the previous schemes. Of course, we can see the water quality Rajiv Ranjan Mishra, Director General, NMCG, who has been entrusted with the improvement along the entire stretch of gigantic task of achieving the dream of the nation, says that the new initiatives have river starting from Gangotri till the West already started showing the perceptible change in the quality of water. Bengal. One of the indicators is the amount An IAS officer of 1987 batch from the Telangana cadre, Mishra has achieved of dissolved oxygen which should be 5 mg many targets ahead of deadlines with his dynamic and inspiring approach. In an per litre. In the entire stretch of Ganga, it interview with Outlook, he reveals how soon a clean Ganga will be a reality. has gone beyond that. Another indicator is BOD (biochemical oxygen demand) which should be less than 3 mg/litre. 351 polluted Excerpts -: stretches of rivers in the country identified in 2018 by CPCB were prioritized on basis Q How is Namami Gange different which is much beyond cleaning, a of BOD from category I to V, with category from its previous version and how well comprehensive approach to tackle and find I being most polluted or critical. At it is progressing to achieve its goal? solutions to the challenges posed to Ganga present, not even one stretch of Ganga is in It is a unique initiative in many ways. We in several sectors such as wastewater and priority I to IV. There are only two stretches have been talking about Ganga cleaning for solid waste management, industrial left now, that too in priority V. a very long time and several schemes and pollution abatement, river front For the first time, notification for actions plans were made earlier. However, development, Biodiversity conservation, ecological flow was issued for River Ganga what really differentiates Namami Gange Afforestation, River management Planning, in October 2018, formally establishing the when it was announced in 2014 and wetland conservation etc. Under this right of river over its own water which has formally launched in 2015 is its integrated mission, the approach has been changed far reaching implications for ensuring river and comprehensive approach based upon from only pollution abatement to health in long term. long scientific research by a group of a integrated mission for conservation of Because of the improvement in water consortium of seven IITs. Ganga and its tributaries. It is like restoring quality the sighting of aquatic life of the Earlier the focus was on cleaning only. the wholesomeness of river to the extent river especially Ganges Dolphin has also Now it is on the rejuvenation of the river possible. We have embarked upon a increased. So there has been a marked condition of existing STPs and their The nationwide lockdown imposed in the improvement in water quality in the last capacities. Out of 50 STPs, some were wake of COVID – 19, has resulted in few years and I think compared to many defunct and some under-utilized. So overall ecological improvement due to other rivers in the country, Ganga is in besides rectifying the defunct ones, we curb on several human activities. There much better condition. improved the capacity and constructed has also been improvement in quality of new one keeping in mind the demand in air and water. The improvement has Q How has been the response of the 2035. For smooth operation and better come but we cannot have these kind of various state governments towards governance, we introduced a concept of situations normally and we cannot the river rejuvenation schemes? “one city one operator” which means one depend upon such crisis to improve our Every state has naturally shown interest agency has been given the responsibility to river. Keeping river healthy must be our and enthusiasm as the cause of restoring construct new STPs, rehabilitate old STPs responsibility and we have to have long health of mother Ganga is unifying and as required and maintain and operate all term perspective. There are many factors with universal appeal. The difference in STPs-new and old for 15 years. which combinedly resulted in the approach often comes due to capacity Further, to improve performance, we improvement of the Ganga river water constraints, lack of scientific data and introduced Hybrid Annuity Mode (HAM). quality during this period like increased planning. We do a lot of capacity building Here, we pay to the concessionaire only flow in the river due to intermittent rains exercise among urban local bodies of all 40% of its cost initially. The remaining 60% and lack of requirement of water for the states. They need a lot of hand-holding will be disbursed in 15 years with interest. agriculture during this period, improved for preparing detailed project report or sewerage infrastructure in cities along decisions during tender process. Q In the past, crores of rupees were the Ganga, reduction in industrial All projects in Haridwar, Rishikesh, spent on cleaning up the river with effluent discharge in the river, negligible Muni ki Reti –the main cities in no noticeable impact. How well is human interaction with the river in Uttarakhand on Ganga, have been the money spent being monitored terms of religious/ bathing activities, commissioned and most other STPs in and how different are the outcomes mining activities, motorboats activities, state on Ganga towns are also complete. It this time around? tourists. is a big achievement as the river meets the The prior programmes for clean Ganga had Out of several sources of pollution, large population and hence pollution load a total allocation of less than Rs 4000 from municipal sewage remained almost at same from Haridwar and Rishikesh. 1985 to 2014. Under this government, it level as before lockdown, while other Almost entire Prayagraj now has has been significantly scaled up through a sources were reduced to minimal level sewerage network and STPs. Varanasi saw dedicated outlay of Rs 20,000 cr for the during lockdown. If we talk about the completion of 140 MLD STP at Dinapur period 2015-2020 with 100% central improved sewerage infrastructure and and 120 MLD at Goitha. One city one funding. A total of 152 sewerage curbing pollution along ganga towns, operator approach HAM projects have infrastructure projects has been sanctioned several landmark projects have been been started for Kanpur, Prayagraj, to create 4856 MLD treatment capacity in completed intercepting several major Mathura etc. Mathura project has the Ganga basin. In 2014, only 28 projects drains falling into Ganga and diverting pioneered reuse of 20 MLD treated waste existed for only 462.85 MLD. Projects have them to STPs – new and old. water in Mathura refinery with IOC been taken up as per a comprehensive plan One of the important steps towards sharing cost. In Bihar, Namami Gange for all the 97 cities/towns along Ganga. sustaining the river quality is creating projects are increasing treatment capacity Subsequently, projects for tributaries have awareness among people. Sustainability by 10 times from existing functional also been started. Prior to Namami Gange, can be achieved by focusing on involving capacity of about 60 MLD to 650 MLD. In there was no effective mechanism for people living on the banks of the river. Jharkhand, Sahibganj STP is already linking the payment of operation and Everyone should be actively involving functioning and the only other STP on maintenance with the STP performance. themselves in Swachhata & water Ganga at Rajmahal will be completed in conservation activities. Behavioural few months. Several projects in West Q How soon a clean Ganga change is not only needed for keeping the Bengal too are making progress. become a reality? river clean and achieve Nirmalta, it is Cleaning of a river is like cleaning your also required for demand side Q Give us a brief detail of the cities house. It is a continuous process and management of water and improve water identified along the river for cannot be said that once done will not be use efficiency to reduce abstraction pollution control and how do you repeated. The cleanliness needs to be which is very important for improving plan to implement various schemes? maintained. We have to keep river clean flow in the river to achieve the objectives As I said earlier, we are looking at the river and flowing. Ownership has to be taken by of Aviralta. in continuity, so right from the beginning people. It cannot be the aim that any It has been again clearly demonstrated till the end, we have got mapping of 97 government-local or federal can clean up during lockdown that rivers do not pollute towns done on the bank of the river. There the river or rejuvenate the river. River themselves, but those who live on its banks are over 4600 villages in these 97 towns. cannot be cleaned in one day, it has to be and run industries, business etc are to take Then we also identified villages and towns kept clean & rejuvenated and that is why responsibility. on the tributaries of Ganga because Ganga our mission also very strongly works for People’s connect with river and their cannot be cleaned unless tributaries are improving people- river-connect and awareness is very important to rejuvenate pollution-free. Out of 313 projects, 152 are several things are being done to improve the river. We have to learn the lesson from sewerage projects costing roughly over Rs the condition of banks. ecological resurgence during lock down 23000 cr. 39 out of those 152 are on that, even if we go to the river which we tributaries. These tributaries help maintain Q How has lockdown improved revere so much, we love so much, we have a good flow. the quality of water and what is the to change our behaviour, we have to So after identifying cities, we lessons learnt and plan of action control ourselves, we have to regulate conducted intensive work to find out the for future ourselves. n COVID-19 SPECIAL ARE YOU IMMUNE? Jeevan Prakash Sharma

Short stories can afford to come with a twist in the end. But epics are fated to contain twists at every turn, at every level of the laby- rinth of nested stories. COVID-19 is proving to be one such gigantic and perplexing hall of mirrors: the logic unfolding in a sub-plot at Level 5 can alter the main narrative frame… COVID-19 SPECIAL

and then twist again. Immunity is a word that’s been lurking around like a minor character with a walk-on part in the story from the beginning. There was at first that partly naïve opti- mism in the idea that Indians, on account of exposure to a rich bouquet of pathogens, have a kind of all-purpose ‘native immunity’—a Teflon coating against Covid. As the new coronavirus plugged into India as a collective host, that was soon quietly replaced with a more modest, and perhaps illusorily durable, hyp othesis. That if the virus strains were the same as were lacerating Italy, the UK and US, Indians looked at least more immune than the West. Could it have something to do with blood

groups and variable vulnerability thereof? everything in the COVID 101 handbook The coronavirus Was it the wall-to-wall coverage of BCG about the elderly being at higher risk. By vaccination? now, this randomness is a leitmotif of the has shown an The questions seemed valid enough. COVID story: you as a patient may have After all, through Season 1, the India graph merely experienced an unpleasant fortnight extremely had moved at a gentle canter, with a low (with your “pizza tasting like cardboard,” as varying (official) fatality rate to boot. But as those writer Karan Mahajan told The Atlantic), ominous hoofbeats picked up in May, even but your neighbour goes to the ICU, perhaps potential to that was discarded for a more fragmented thence to the mortuary. Why? Two axioms picture. Some regions within India looked stay with us: the new coronavirus has shown infect and a less (or more) at risk. Over 30 districts an extremely varying propensity and poten- puzzling unpre- witnessed a wide spread, others experi- tial to infect, and an equally puzzling unpre- enced slower transmission. And seemingly dictability about who recovers and who does dictability about inexplicable variations within that defied a not. And perhaps neither has to do with the universalising story. It still looks deadliest virus per se. Some variation in recovery who recovers and in Maharashtra, as the state exacts the rates could owe to differing healthcare prac- who does not. highest toll. In Delhi, it looks more infec- tices and treatment protocols (at state/hos- tious but not as fatal as in Maharashtra pital/country level). But the lens surely and Gujarat. Kerala has a tremendous rec needed to be adjusted to another level of overy rate; no other state has that. magnification—because one key act in this But soon it became clear that one key play- grim drama unfolds inside the individual. field of variations existed at a still more This is where immunity comes in. micro level: not country, not region or eth- All other things being equal—age, health, nicity, but individual. Young Keralites in exposure to virus—why does Person A get their 30s were dying in the Gulf, but back infected and Person B go unaffected? That’s home in hilly Ranni, 93-year-old Thomas simply hard-wired innate immunity: a and his 88-year-old wife Mariyamma tested healthy body’s first line of defence against positive, even got critical and stayed so for pathogens, an in-built fortification. This days, then happily recovered—defying invisible armoury of the body is by nature

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 67 Safety in numbers The possibility of herd immunity is a vexed question in India

capable of warding offnew enemies—so the This is where the critical twist in the plot fact of this being a novel virus wouldn’t comes. It’s a cataclysmic breakdown of matter. The innate system has non-specific these normal immunity processes—this barriers that work regardless of who the complex wartime communication machin- enemy is—the body-castle’s moat, draw- ery—that’s now looming forth frighteningly bridge and mortar-fire repel Viking and as a final act. A sudden, little understood Mongol alike. By contrast, adaptive (or acq crumbling of the fortress. A gasping, shud- uired) immunity is like an active database of dering death. The key episode, called a cyt prior infections: it invests the body with a okine storm, is now linked to many a Covid pathogen-specific immunological memory. fatality. “It’s a centerpiece of COVID-19 An 85-year-old person’s body thus carries pathology,” writes Tufts University immu- the memory of a childhood measles infec- nologist Alexander Poltorak. “The killer is tion, but is too slow to produce antibodies not the virus but the immune response.” against a new enemy—hence, more at risk. Essentially, an excessive reaction or dys- “This is why children are more protected: regulation of the host’s immune system, their immune systems are simply stronger. akin to what happens with autoimmune That wanes as you age,” says Calcutta pae- disorders. The system goes into hyperac- The breakdown diatrician Dr Aniruddha Maitra. A point of tive mode, then goes berserk and launches mystery: COVID-19 initially seemed to a stunning mutiny against the body itself— of immunity spare children altogether. Thus the famous till the whole zeppelin comes flaming through a ‘double peak’ seen in other infections—older down. This happens when immunological people and children being most vulnerable, agents fail in one key function—recognis- cytokine storm healthy adults of median age being the har- ing self-substances, and exempting them diest—was markedly absent here. But as the from attack, while it goes for those nasty triggers a dys- pandemic spread, even children are seen to “non-self” macromolecules (the foreign regulation of the be not entirely out of its sway. But regard- pathogens). less of age variation, think of a first layer of The realisation that there’s a consistent host’s immune armour. pattern of Covid fatalities being linked to Now, say the enemy penetrates that arm this inner suicidal drama has led to a reori- system, similar our, via a Trojan horse, and you do get inf entation of efforts across the world. That’s to autoimmune ected. Why only a mild flu for X, and ICU why proposed/ongoing studies posted on for Y? Well, post-infection, innate immu- the US National Library of Health’s disorders. nity continues to work, now in collabora- ClinicalTrials.gov bear titles that refer to tion with its brother-in-arms, adaptive therapeutic strategies targeted at critically immunity: it smells out the foreign inva- ill patients who’ve suffered or are close to sion, and enlists its ally to produce the an immunological burnout—by modulat- ammunition…the antibodies. Infla ing or suppressing their immunity pro- mmation happens, like sirens going off, sig- cesses. A Lancet study called nalling for reinforcements to rush to the immunosuppression “a double-edged infected site. Usually, this is when you get sword” because the body may be still vul- fever with any flu, before the body recovers. nerable to any infection, and leaving it

68 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

V X P P bereft of its armour is risky too. As a focus O O area, though, it has dawned. But first the macro-level, before we descend the steps.

Are Indians immune? Director, Center for ‘Native immunity’ is actually just a synonym Dr Ramanan Disease Dynamics, Economics and Policy, for innate immunity, but let’s twist it to fit us Washington ‘natives’. Have Indians been conferred with Laxminarayan an ability to take on all comers of the microscopic variety? Have we acquired a greater Are we more immune? Does BCG, immunity by way of familiarity with viruses heat…any of that matter? Does having in general? Would that suffice to thwart a novel and tenacious one like Covid? The a younger population? idea that prior exposure to other infections Younger population, yes. Not the others, of can create an all-purpose shield isn’t entirely erroneous. There is such a thing as ‘cross- course. There is no difference in immunity, resistance’, which can work by altering the I think the only difference is that we got the way receptor sites behave. But India’s climbing numbers do not seem to offer any blan- epidemic later—India, Pakistan, Bangladesh ket comfort there. Why? all got it later. Remember, at one point in the One reason could be that low nutrition levels enfeeble the delicate web acquired global curve of number of cases, we were at weaves in conjunction with innate. It’s the number 39. Today, we’ve caught up…. So latter’s signalling apparatus—a complex, there’s no question of us being more immune, multi-function communication grid involving constantly patrolling sentinel called neu- it is just how countries managed their lock- trophils, our most abundant White Blood down. There is no escaping the virus. Cells, and proteins called cytokines—that recruit the good guys with the Bofors gun, the B-cells and T-cells. (Roughly, the first produces antibodies that lock onto antigens pattern recognition receptors in such a way on the surface of pathogens, and calls upon that they pick up similar antigens on even phagocytes that eat them up; the latter kills new enemies (antigens are surface struc- infected cells). Micronutrient deficiency tures on microbial bodies). But it begs fur- leaves this double-barrelled defence fortifi- ther study…. “As of now, there is only cation starving at all levels. The internet is correlation,” admits Dr Maitra. And as awash with preprints of studies linking, for Lancet warned in another context, “correla- instance, Covid morbidity with low Vitamin tion does not equal causation”. D levels (severe among the old in Italy, Spain Despite India’s recent surge in cases, some et al). Elina Hypponen, an Australian nutri- researchers are willing to give a chance to tional and genetic epidemiology professor, BCG, a mandatory booster for children in offers preliminary support “in theory” for India to protect them against meningitis and the link, writing: “Nearly all immune cells disseminated TB. “While COVID-19 caused have Vitamin D receptors (showing the in- a lot of deaths in Spain, its neighbour, teraction). The active Vitamin D hormone, Portugal, witnessed a very low fatality. And calcitrol, helps regulate both innate and Portugal is the only European country adaptive immunity. And deficiency is associ- where BCG vaccination is still prevalent,” ated with immunity dysregulation.” So, on says Dr Sudhir Bhandari, senior professor of that front, India fundamentally represents a medicine at Sawai Man Singh Medical vulnerable mass of humanity—and it goes College, Jaipur. “The BCG association, like beyond vitamin deficiency. (see https://bit. that of hydroxychloroquine, arose because ly/379uA2z). the early spread of Covid was a reverse What about BCG? Can vaccination against image of these two, but there are multiple bacterial infections even conceivably work possible explanations for it without ascrib- against a virus? Well, there’s a new line of ing a causal link,” says Ranchi-based radiolo- theory on ‘trained immunity’—the idea that, gist Dr Manish Kumar. say, a vaccine can modify our innate system’s Many medical professionals anyway dis-

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 69 COVID-19 SPECIAL

miss the notion of India (or any other coun- a ChemRxiv preprint by two Chinese schol- try) collectively having a higher immunity, ars and then reiterated by Italian pharmacol- citing the interplay of several factors that inf ogist Annalisa Chiusolo that the Covid virus luence transmission and fatality. Dr Yadu manages to plug on to red blood cells, crack Singh, Sydney-based cardiologist, for ins open the haemoglobin and release the en- tance, attributes Australia’s “spectacular” closed iron. This was then linked to all the flattening of the curve (a mere 7,227 cases as observed chain of catastrophic effects: anae- of June 4, some 6,640 recovered, 102 deaths) mia, excess iron choking the kidney; silent hy- to simply “good policies…and civic sense”, poxia (from a hindered exchange of oxygen adding it has nothing to do with high immu- and carbon dioxide) starving all organs, inc nity among Australians. But even if coun- luding the brain; thrombosis, with all its usual try-wise variations are possible, we’re still in effects (heart attack, stroke) et al. Blood was the grip of a story that evokes fear and awe: also a putative candidate to explain Covid’s the perennially unravelling mysteries of rainbow effect: the all-pervasive nature of its Covid, and how your body can itself unravel, attack on the body. The theory is hotly dis- a deadly denouement where immunity is the puted, even if Ebola too famously wrought tragic protagonist. havoc on blood systems in unexplained ways. Amidst India’s The idea that the virus cracks open haemo- Covid surge, An evolving globin molecules (haemolysis) may or may not endure. Then where do we take all that some are willing death stunning variety of symptoms? Well, recent The Covid infection was initially thought to understanding inserts a vital first step: immu- to give a chance be a merely respiratory phenomenon, aff nity-gone-awry. Once that happens, your to BCG, which ecting only the alveoli in the lungs—and body-castle turns into a house of cards and bringing on pneumonia. That’s still the pri- caves in. That’s cause; haemolysis, thrombo- protects chil- mary effect: the lung’s ACE2 receptors are sis et al are effect (https://bit.ly/3cGOKli). the most abundant, most strategically So the real twist in the plot is when your dren against TB placed, most amenable to hosting the virus. body starts eating itself. An uncontrolled and meningitis. But it’s becoming clear that it often causes a immunological self-immolation. And it’s “multi-system disorder”, says Dr Maitra—an cytokines that do the arson. “Small pro- But this begs all-pervasive attack on several fronts. Heart, teins important in immunological pro- guts, liver, kidney, brain...all cells can get cesses” and produced by white blood cells further study. infected because most organs have ACE2 are called macrophages, their job is to receptors. A captured heart can go into “trigger inflammation” and “recruit” other myocarditis, an inflamed liver produces an immunological elements to fight infection. enzyme glut. Most benignly, the gut lining; Why they dysfunction is because Covid an altered gut flora equilibrium leads to the manages to “silence” this inflammatory loss of appetite and/or diarrhoea common response, and grows in the body in what an to many diseases. The UK officially added Atlantic article called “stealth mode”. the loss of taste and smell as part of Covid When the body realises belatedly that it symptoms on May 18—either as a present- has been totally besieged, the immune sys- ing symptom, signalling an early onset stage, tem goes into overdrive: cytokine storm. A or independently, without other symptoms. mass attack ensues on infected cells. The Indeed, isolated anosmia and ageusia are lungs fill with a sea of dead cells, a kind of now seen as a tool to screen potential biological sludge that leads to organ failure. spreaders, for these are often associated The blood clots all over, blood vessels leak, with a milder form of the virus—patients BP plummets because of vasodilation, “10 times less likely” to go on to be critical. anaemia occurs. Somewhere along this dis- The reasons for anosmia/ageusia are not astrous slope, they start turning on even understood yet. One view is that ACE2 is healthy body cells. Just like any other auto- also present in cortical neurons, making immune disorder, it’s an aberrant overre- them potential targets. Another is that it’s action that some people have. Including, likely to be a secondary effect—the nervous it’s now known, a subset of the children system, for instance, is dependent on blood who get infected. Why only they have it is oxygen to function properly—rather than a one of the mysteries of science. Thus, from direct infection of the nerves, as in, say, a struggling country down to a self-immo- forms of meningitis or encephalitis. lating cell, the view is different at each step This brings us to another potentially crucial down the baoli. And the last step promises site: blood. It was controversially proposed in a pool of water with no clear reflections. O

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COVID-19 SPECIAL WHAT IS THE TREATMENT?

There is no cure or vaccine for coronavirus. So far, there is no con- of the proteins, have shown promise in the treatment sensus on a treatment protocol either. Once infected, the treatment of hospitalised patients in Wuhan, China. is largely supportive, based on managing symptoms. Many propos- Ulinastatin, which is used to treat acute pancreatitis als are in the air or the lab—in the exploratory stage, trial stage or and septic shock real-time in-vivo experiments on patients. Some proposed medi- Acalabrutinib, a medicine used to treat mantle cell lymphoma cines, such as hydroxychloroquine, have been highly controversial. (a kind of blood cancer) Here are the treatments being tried out across the globe—many are Antibiotic treatments are being used for bacterial co-infections not backed by scientific evidence while others are downright harm- in patients with pneumonia ful. The list, therefore is descriptive rather than prescriptive. For critical cases For the uninfected Respiratory supportive strategies: Oxygen therapy, high-flow nasal Vaccines are in the trial stage. There is speculation that existing cannula and non-invasive ventilation might prevent the requirement vaccines like BCG and flu shots could protect against coronavirus. for endotracheal intubation. Extracorporeal membrane oxygenation Vitamin and zinc supplements. While a balanced diet helps you (a machine that pumps blood outside the body to an artificial lung stay healthy, there is no evidence that supplements boost immu- for oxygenation) is an important life-support strategy. nity. Biomodulina T, a thymic peptide obtained from bovine sources, Plasma derived from the blood of patients after recovery contains is being used in Cuba to stimulate the immune system antibodies against COVID-19. Convalescent plasma therapy is an old Immunity boosters from alternative systems of medicine—ayurvedic technique that appears to be clinically effective and reduce mortal- products such as Shadang paniya powder, Agastya harityaki and ity in initial studies. camphor; and homeopathy products such as a mix of Arsenic Circulatory support and fluid management through measures such album 6/ Eupatorium perf 30/ Lycopodium 30). Doctors have as fluid administration termed these medicines quackery and cautioned against their use. Monitoring and management of the functioning of vital organs such The most effective preventive measures are wearing a mask, wash- as heart, kidney, liver etc to prevent organ failure. ing hands, maintaining hygiene and practising social distancing Nutritional strategies such as gastric feeding to ensure that critically ill patients are not malnourished For mild cases Symptomatic treatment with over-the-counter medicines such as In cases of cytokine storm paracetamol to relieve symptoms. Hydration and rest A hyperactive immune system response where the body attacks its own cells while fighting the virus. As lung tissues die due to the For mild to severe cases cytokine storm, the air sacs fill with fluid, causing shortness of Anti-viral drugs like fabiravir, ribavirin, lopinavir/ritonavir etc. breath. In such cases, immunomodulation (modifying the immune Russia has approved anti-viral drug Avifavir to treat COVID-19. system’s response) is done through A combination of anti-malarial drug hydroxychloroquine with the —corticosteroids (improves clinical outcomes and reduces antibiotic azithromycin has been proposed, though there are indi- mortality in cases of severe sepsis) cations that it might have adverse effects in certain patient —cyclosporine A (immunosuppressant used in autoimmune Cuban product Interferon alfa-2b. Interferons are proteins that the disorders) body’s cells produce in response to infections to signal nearby cells —tocilizumab (used in the treatment of rheumatoid arthritis) to heighten anti-viral defences. Interferon drugs, lab-made versions

JUNE 22, 2020 | OUTLOOK 71 COVID-19 SPECIAL The C-Company

Don C: The Coronavirus Family’s new don—a cousin of SARS of 2003. Codenamed SARS-CoV-2, he began small in Wuhan in December 2019 and quickly became the world leader (like most Chinese products). With a diameter of 75 to 160 nanometers (a good face mask can hold him off) and a continuous linear single-stranded RNA (genetic material of viruses), he is lightweight—around 0.85 attograms, or about one millionth of a trillion gram (70 billion of him makes a person sick, which is about 0.0000005 gram). But he packs a killer punch. Like all things underworld, he is a parasite; needs a host to survive and procreate (the abundant human species plays perfect surrogate mother and wet nurse). Known weakness is soapwater/disinfectant that breaks down his biological suit: the fatty shell protecting his protein/RNA (imagine a hen’s egg). His primary murder weapon is COVID-19. Relies on stealth; a cough, sneeze or touch makes the fleet-footed killer change location instantly, constantly—“ Don ko pakadna mushkil hi nahi, namumkin hai !”

Protein Shake: Like any wily criminal enlisting a hardworking but unacknowledged insider for clandestine access into a protected setup, Don C uses a cell protein called angiotensin-converting enzyme II, or ACE-2, which sits next to human cells and whose task is to regulate blood pressure of various organs, head to toe. He latches onto this protein and uses it as a gateway into the cell, where he rapidly makes a bunch of little progeny, and the host cell dies. Other proteins play a role too. Like the transmembrane serine protease 2 (TMPRSS2), a receptor-class gene that encodes a protein and whose biological function is yet unknown. The job becomes easier for Don C if both receptors are present in the same cell.

How COVID-19 kills? Frankly, we know little. The cunning, stubborn Go For A Nosedive: Don C enters the oral airway through virus acts like no pathogen the nose—behind your beautiful face sits the mucous modern science has ever seen. membranes, nasal passages, sinuses. Say, if you touched Although the lungs are ground a contaminated surface and ran your hands over your nose, or if an infected, ‘unmasked’ person talks to you zero, doctors and scientists are up-close. Oral fluids contain about seven million realising that it is attacking its SARS-CoV-2 copies per ml, and one minute of loud human host with devastating speaking generates more than 1,000 virus-containing ferocity—from the brain to the droplets that remain airborne for eight minutes or longer, toes, and the heart and blood especially in enclosed environments. Well, Don C rides vessels, kidneys, gut in between. those projectiles and finds a welcome home in the inner lining of the nose (mucus- Here’s a snapshot of what we producing goblet cells and ciliated cells) that contains ACE-2 and TMPRSS2. He reproduces know so far, based on publicly rapidly. The hijacked cells release interferons, a signaling protein that activates anti-viral available data and studies/ defence of nearby cells, which in turn sets off the immune system alarm. Stormtroopers, reports, some published at warp the body’s soldiers, are scrambled and if they don’t beat back the gangster here, he slides speed and not yet peer reviewed down the trachea to the lungs and the oesophagus to the gut. Invisibly, of course! at the time of publication. Wait for research to sharpen the picture.

DESIGN BY LEELA 72 OUTLOOK | JUNE 22, 2020 TEXT CURATED BY RITUPARNA KAKOTY COVID-19 SPECIAL Kill Dill: Your heart has abundant ACE-2 and the don loves it. Low oxygen Liquid+Oxygen=Lungs: Don C does to the lungs what Ajit became can collapse your heart famous for—“Isko liquid oxygen me daal do. Liquid ise jeene nahi from a cardiac arrest and dega aur oxygen ise marne nahi dega.” The lungs have microscopic clots from arteries block it, air pockets, called alveoli, like holes in sponges, for the gas especially the left ventricle— exchange: inhale oxygen, exhale CO2. They have two types of cells, powerhouse chamber of our or pneumocytes. Type I helps in the gas swap. Type II produces a blood pump. Or a cytokine layer of goo—surfactant—that keeps the alveoli from sticking when storm could ravage the heart it collapses/expands, like a bellow. Don C targets Type II that has the ACE-2 receptor, and as it does other organs. triggers an inflammatory response and the body sends out Stormtroopers. But the troops go berserk. The body suffers an auto-immune disorder: a “cytokine storm”. Cytokines are chemical signaling molecules that guide an immune response. In a storm, cytokine levels soar beyond what’s needed, and immune cells start to attack healthy tissues. Blood vessels leak, blood pressure drops, clots form, and catastrophic organ failure can ensue. Your alveoli starts filling up with fluid—pus and debris from the fighting. Fluid accumulates in the interstitial space too, the gap between your cells. Your lungs are drowning to death. You are intubated to a ventilator for oxygen support. That’s pneumonia, acute respiratory distress syndrome et al.

Kidney Binned: Devoid of fresh oxygenated blood, the kidneys will fail. They will need dialysis because the body’s filters, abundantly endowed with ACE-2 receptors, present another Don C target. Ventilators boost the risk of kidney damage, as do antiviral The Plumbing Leaks: The don medicines. Cytokine storms can dramatically reduce blood flow goes into Dharmendra mode— to the kidney, causing renal failure. And pre-existing diseases like “Main tera khoon pee jaunga”. In diabetes can increase the chances of kidney injury. the lungs, oxygen transfers from the alveoli to the capillaries (tiny blood vessels that lie beside the air sacs). But a cytokine storm Stomach This: Don C slides down triggers blood clots, which break the foodpipe to the stomach, also apart and land in the lungs, a rich source of ACE-2. The classic blocking vital arteries. Don C COVID-19 symptoms—diarrhoea, vomiting, may directly attack the lining of abdominal pain—are believed to be the blood vessels, which are rich in don’s misdoings in the gastrointestinal ACE-2 receptors. Lack tract. Similarly, ACE-2’s presence in the of oxygen, from the liver and bile ducts makes these organs chaos in the lungs, vulnerable too. Plus, lack of oxygen will can damage blood inflame the liver. Other events in a failing vessels/alter oxygen body, like drugs or an immune system in uptake. Some overdrive, can damage the liver. COVID-19 patients record extremely low blood-oxygen levels and yet not gasp Bheja Fry: Don C can infiltrate the brain’s neurons/the central for breath. The blood vessels nervous system, much like his cousin SARS from 2003 could. He become inflamed throughout may cause meningitis and encephalitis, while blood clots can the body, causing vasculitis—a trigger strokes. A cytokine storm can provoke brain swelling. It’s form of which, seen in kids, is not clear how Don C enters the brain. ACE-2 plays handyman, the Kawasaki disease. Patients perhaps. Our top floor is endowed with this enzyme. Some with pre-existing damage to believe he travels up the nose through the olfactory bulb—which those vessels (from diabetes explains a loss of smell that Don C’s victims experience. and high blood pressure) face higher risk of serious disease.

Eyes, Toes In The Ballroom: Don C may cause conjunctivitis—red, watery eyes—though it’s not clear if he directly invades the eye. Besides, blood vessel constriction can cause ischemia in the fingers and toes—a reduction in blood flow that can lead to swollen, painful digits and tissue death. Reports also suggest a man’s testes are loaded with ACE-2 receptors, which raises the possibility of the don giving a kick in the groin. Does he really like to hang out down there? Picture abhi baki hain!

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VACCINE RACE— THE CANDIDATES Siddharth Premkumar in Thiruvananthapuram

The starting gun was sounded as far back as the weekend of January 11-12, when Chinese aut horities released the full sequence of the COVID- 19 genome. The ‘vaccine race’ has now grown to field some 118 potential candidates and seen unprecedentedly short projected completion windows—most experts endorse a 12-18 month ‘best-case scenario’. Traditionally, a vaccine’s clinic-to-market cycle can take upwards of a decade. Though the global health emergency brought on by COVID-19 has looked like catalys- ing that marathon into a sprint, the race has regulatory, scientific and market hurdles to overcome: the transitionfrom proof-of-principle to commercial development will be plagued by bottlenecks. And attrition too will play its part:

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industry benchmarks peg the failure rate at the pandemic-induced new normal in vac- greater than 90 per cent. No wonder the cine development: novel (read unproven) European Medicines Agency dismisses technologies and approaches, fast-track claims of a ‘cure by Christmas’. tags, political interests—and record levels All this unfolds against a backdrop of geo- of international collaboration...and compe- political tensions and ‘vaccine nationalism’— tition. The accelerated development path- faultlines that grew wider still at the WHO’s ways were mapped out in a March 30 73rd (but first ‘virtual’) World Health article published in The New England Assembly on May 18-19. Just days later, Journal of Medicine by the Coalition for Donald Trump was to announce that Epidemic Preparedness Innovations America would be “terminating its relation- (CEPI), the influential Norway-based mul- ship” with WHO. But at the Assembly, US- tilateral non-profit that’s bankrolling mul- based biotech firm Moderna was making a tiple COVID-19 vaccine projects (including pitch for Olympic gold. One of around eight Moderna’s). Its outlined “pandemic para- Having over a candidates in clinical trials, Moderna cited digm” is instructive: inter alia, a call for par- 100 vaccine early, non-peer reviewed data from Phase I allel testing of animal and Phase I (of three) human trials that began in March to ann human clinical tests and scaling up manu- candidates ounce that its mRNA-1273 vaccine had facturing capacity even before safety and “elicited an immune response of the magni- efficacy data are available! sounds good. tude caused by natural infection”. That is, With the exigencies being what they are, We will be after the trial vaccine was administered, a how do you even advocate scepticism? Well, small group of volunteers had shown levels actual efficacy is a good enough reason, and lucky if just a of antibodies comparable to or better than only one. “While having over a 100 vaccine those in recovered COVID-19 patients. candidates sounds good, it’s important to handful of the Levels claimed to be capable of stopping the remember we will be phenomenally lucky if SARS-CoV-2 virus from replicating, suggest- just a handful of the approaches...make it approaches... ing—but not proving—a degree of immunity. through to licensure,” CEPI vice-chair Dr make it through Only days before, one of Moderna’s directors, Gagandeep Kang has been quoted as saying. Moncef Slaoui, had been named chief scien- This caution against an assumption of to licensure. tist for ‘Operation Warp Speed’, a White ‘imminence’ or inevitability is a refrain House initiative to accelerate vaccine devel- taken up by scientists and public health of- opment. Unsurprisingly, the FDA is ficials—they liken the odds of success to “fast-tracking” regulatory reviews for its vac- playing Russian Roulette. WHO health cine. All said, Moderna looks on pace to del emergencies programme executive director iver on its “early 2021” timeline. Dr Michael Ryan labels the prospect of On a macro scale, this is a case study of finding a vaccine a “massive moonshot”.

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President Trump has been bullish about a SARS-CoV-2 is,” said Dr David Salisbury, vaccine to ‘keep America great’ in an elec- ex-director of immunisation at the UK tion year, but the (since sidelined) head of health department, during a webinar at his Coronavirus Task Force, Dr Anthony London think-tank Chatham House. “Like Fauci, says there is “no guarantee” a poten- any horse race, you pick your horse without tial vaccine is going to be effective. What’s the benefit of knowing whether it would worse, he cautions, in trading safety and ef- win.” The reference to the SARS virus is apt ficacy for speed, a vaccine might actually since the genome sequencing of SARS- “backfire” andstrengthen the virus. CoV-2 is said to exhibit over 79 per cent of What about India? There’s frenetic action genetic material identical to the virus beh in the worlds of science and pharma here— ind the 2002 epidemic (and 50 per cent of the promised speed with which the silver the MERS virus). Both viruses are com- bullet may arrive depending on who’s prised of RNA strips surrounded by a fatty speaking, whether it’s a repurposed version sheath through which its spike (S-) proof an old vaccine or a novel technology, and teins latch onto the same receptors on the whether it’s emanating from pure research host—the ACE-2 enzyme attached to the or is prodded along by industry linkages human lung’s surface cells, for instance— (including global collaborations). We also and go on to extend and infect the cells. have official word. Union health minister But the key Dr Harsh Vardhan says four of 14 vaccine What Kind candidates might begin clinical trials scientific deter- within five months. Dr Vardhan, appointed of Vaccine? the other day to the WHO executive board Past failures have not deterred big (and minant will be: rotational chairman’s post, is of the (rela- small) pharma from attempting to unlock what kind of tively) conservative opinion that a vaccine the virus’s secrets. Moderna and some 20 is at least a year away. It’s a call-to-arms to other candidates (per the WHO) are taking vaccine is it? the Indian scientific community from the advantage of a revolution in sequencing and government, so financial support/regula- genomics to create messenger RNA (mRNA) What does it tory clearance should be a cinch. The story vaccines that instruct human cells to create is running along several tracks, both inde- a protein specific to SARS-CoV-2 in order to do, how does it pendent of and tied to events elsewhere. So trigger a defensive immune response. propose to stop a quick scan of the world story must There’s also a plethora of alternative app precede the India one. But the key scien- roaches. Nipping at Moderna’s heels is this infinitely tific determinant here, as in China or the China-based CanSino Biologics whose Ad5- West, will be: what kind of vaccine is it? nCoV vaccine has emerged as a dark horse plastic enemy? What does it do, how does it propose to stop after becoming the first candidate to both this infinitely plastic enemy? move into Phase II clinical trials and release Dr Shahid Jameel, noted virologist and peer-reviewed data. It’s a recombinant ade- CEO of Wellcome Trust-DBT India novirus-based vaccine—that is, its base is Alliance (a leading research funding char- one of the common cold viruses, manipu- ity), speaking to Outlook, offers a prelimi- lated and weakened in the lab. A ‘proven nary description: “None of the vaccines platform’, in industry parlance. A study in claim to produce a sterilising response The Lancet found it to be both “tolerable and (protection against infection). In fact, most immunogenic” (stimulating an immune res vaccines protect against the disease in that ponse) 28 days after vaccination. they don’t allow the infection to escalate. Another front-runner was US firm Inovio, This is a fine point that must be understood. whose CEPI-funded DNA vaccine INO- Infections do happen, but the vaccine stops 4800 has had to weather accusations of the virus from spreading from the primary ‘charlatanism’. Their approach supposedly site of replication (throat and nasopharyn- involves having a hand-held smart device geal space) to secondary sites (lungs). It’s use an electrical pulse to open small pores the secondary infections that cause most of in cells through which optimised DNA the mortalities and morbidities.” Dr Jameel plasmids can enter—overcoming an issue is not one inclined to stand with all the nay- with DNA and mRNA vaccines—and gen- saying on COVID-19 vaccine development. erate antigens that trigger an immune res But outright credulity may be inadvisable ponse. In addition to triggering too. “There’s no vaccine for either the SARS neutralising antibodies in animal trials, or the MERS coronavirus in humans, a clue Inovio claims INO-4800 generated “high to how difficult developing a vaccine for levels” of T-cells—deemed a critical indi-

76 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

cator of the immune system’s chances of defeating the virus—specific to the spike protein. One of the fastest horses out the gate was the Jenner Institute at Oxford University whose adenovirus-based ChAdOx1 nCoV-19 vaccine—now being co-developed by drugmaker AstraZeneca— appears to have rebounded after taking a hit over a reported inability to both prevent, and stop the spread of, infection in animal trials. This vaccine also targets the virus’s S-protein. The India Vaccine? Factors beyond science are at play because of the stakes involved—national pride, big money. Dr Jameel cites the fact that China may suffer from a “capacity and trust deficit” that puts off foreign investment. And trade publications attribute a lot of the negative buzz to Wall Street short-sellers with vested interests. Adar Poonawalla, isolated and replicated” as in other app CEO of Pune-based Serum Institute— roaches. “All we need is the sequence. With among the Oxford vaccine’s suitors—has that, we can create AV agents after evaluat- said as much. A ‘gentleman’s agreement’ ing the best suited antigen cocktail to stim- between Poonawalla and Jenner Institute ulate the body’s immune response without head Dr Adrian Hill has been reported. On getting compromised,” says Dr Joshi, not- its basis, Serum is repurposing its factory ing the AV agents will target both SARS- One of the fast- to produce sufficient quantities of the vac- CoV-2’s S-protein and basic structural cine for low- and middle-income countries proteins. Scale is a challenge for “cash- est off the block starting September, when Poonawalla has strapped” Seagull, so it has entered into an said the vaccine will be ready. A claim only “in principle” agreement with Bangalore- was ChAdOx1 matched in ambition by the scale of invest- based Biocon. Kiran Mazumdar-Shaw, nCoV-19...it ment, given Dr Hill’s recent estimations of Biocon’s executive chairperson, tweeted the likelihood of a vaccine at “50 per cent”. about the project in April and is reportedly appears to have Serum has also reportedly hedged its bets keen on its ease-of-commercialisation pot through tie-ups with US biotech firms ential. As is Dr Joshi, though he says “deci- rebounded after Codagenix and Novavax, as also Austria’s sion-making processes in big companies an ‘inability’ to Themis Bioscience GmbH, to potentially take a long time”. manufacture three other vaccine Some Rs 56 crore has been earmarked for stop the spread candidates. start-ups working on COVID-19 solutions, On the other end of the scale is a start-up, says Department of Science and of infection in the Pune-based Seagull BioSolutions. The Technology (DST) secretary Ashutosh animal trials. first to be funded by the Union ministry of Sharma. There’s also Rs 100 crore for vac- science and technology in April, its expe cine development under PM CARES. cted timeline for entering Phase-1 trials is Helming this push are the Department of 18-20 months. Incubated under the Biotechnology (DBT), the coordinating Technology Development Board’s ‘Seed agency here, and the Biotechnology Support System’ scheme, Seagull will use Industry Research Assistance Council its proprietary Active Virosome (BIRAC). In April, DBT-BIRAC selected Technology (AVT) to create novel active three projects—from Zydus Cadila, Bharat virosomes (highly customised, replica- Biotech and Serum—for financing and reg- tion-deficient artificial delivery mecha- ulatory help. The selections, DBT says, nisms) through an attenuated measles cover both efforts to repurpose existing virus vector platform. Founder-director Dr vaccines and facilitation of novel ones, and Vishwas Joshi says his tech has the advan- fast-tracking will be enabled via a research tage of not needing the virus to be “cultured, consortium funded by the National

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Biopharma Mission, an industry-academia luding a DBT-funded DNA approach, while collaboration. The Indian Institute of an arm of the state’s DST has inked MoUs Science (IISc) too is attempting to design with three Gujarat-based private firms: and test derivatives of the spike glycopro- Hester Biosciences, Vekaria Healthcare and tein for potential vaccine candidates start-up Neuberg Supratech Reference through Mynvax, an IISc-incubated Laboratory. Caveat? As Dr Jameel says, “It start-up. “If the world is to get an affordable depends on what one means by ‘getting a vaccine, Indian companies will absolutely vaccine’. When one says a vaccine will be out play a leading role. No country can match by September, they are referring to proof-of- our manufacturing capacity and produc- concepts that show which approaches work tion rates. But much of what we do relies on or do not work. Beyond that, we are still, opt conventional technologies. Through collab- imistically, about a year from licensure.” oration or self-innovation, our facilities will need to be refitted with new technologies,” Mutatis Dr Jameel says. Speaking on National Technology Day (May 11), WHO chief scien- Mutandis tist Soumya Swaminathan too said, “The This is a parallel danger: virus mutations world will not have enough vaccines for rendering a vaccine inefficacious. Dr everyone if India is not part of the process.” Salisbury says this mechanism isn’t prop- It was nearly mid-May when India offi- erly understood, suggesting there could be cially tossed its hat into the ring, with “genetic drift”, like with the seasonal flu, ICMR tying up with Hyderabad-based which necessitates adapting the vaccine to Bharat Biotech (BBIL) to develop “a fully keep pace. “If the bit of the virus critical to indigenous vaccine”. Dr Rajni Kant, direc- vaccine development mutates, we’ll have “The world will tor of the ICMR-Regional Medical problems,” he has warned. But Dr Rajni Research Centre (RMRC) at Gorakhpur, Kant says changes so far have been within not have enough estimates six months to a year for clinical an acceptable range—“not so significant trials to be completed. “Of the 17 isolates of that vaccine efficacy will be affected”. An vaccines for the virus obtained at the National Institute IISc scientist concurs: “From a vaccine everyone if India of Virology in Pune,” he says, “one strain point of view, mutations are not yet a signif- that showed potential was purified, charac- icant issue. In the crucial S-protein, there’s is not part of the terised and transferred to BBIL to develop a widely-found mutation at only one posi- and manufacture a truly made-in-India tion, not in others.” process,” says vaccine.” ICMR has promised “continuous For all the competition and ‘vaccine WHO’s chief sci- support” to fast-track the work. BBIL has one-upmanship’, what will prove decisive is also received DBT funding to try re-engi- cumulative—and collective—science; the entist Soumya neer its inactivated rabies vector platform sharing of knowledge, resources and tech- for COVID-19. It’s also working on nologies. For all the bickering over who gets Swaminathan. CoroFlu, a one-drop nasal vaccine that the first dibs, there has also been an unpre uses a flu vaccine “backbone” being devel- cedented pooling of ideas—pharma majors oped in a global collaboration. Sanofi and GlaxoSmithKline, for instance, are co-developing an adjuvant vaccine (a Via substance combined with a vaccine antigen to stimulate a more robust, targeted im- Hyderabad mune response). Moderna CEO Stephane Since April, Hyderabad has become a hub of Bancel even hopes “regulators will approve vaccine development with Indian several vaccines from multiple companies, Immunologicals (IIL) scientists collaborat- because no manufacturer can make enough ing with Australia’s Griffith University to for the planet”. Nowhere is it written, Dr develop a single-dose, ‘live attenuated vac- Jameel says, that the “first vaccine to cross cine’ using ‘codon de-optimisation technol- the finish line would be the best or be pro- ogy’ while the University of Hyderabad has duced in enough capacity to save the entire designed a candidate using ‘T-cell epitopes’ world by itself”. The WHO Assembly that’s being analysed for viability. All of adopted a unanimous resolution overriding which prompted Telangana CM K. corporate patent rights in the interest of Chandrasekhar Rao to suggest the possibil- public access to vaccines. A good start, but ity of a vaccine produced from his state capi- as Oxfam International noted, even that tal between July-August. In Ahmedabad, left “too many barriers standing in the way Zydus Cadila is working on two options, inc of a vaccine for all”. O

78 OUTLOOK | JUNE 22, 2020 #indianeducationconclave

In conversation with

Knowledge Partner Ramananda Sengupta, Consultant editor, Outlook

Reimagining LeaRning with technoLogy- Being PRePaRed foR the futuRe

Hemant SaHal, akSHay munjal, dR aCHyuta Samanta, Founder & CeO, president, Founder, Collpoll Bml munjal university kiit & kiSS dR(mRS) pankaj mittal, dR C. Raj kumaR, Secretary general, Vice Chancellor, association of indian universities O. p. jindal global university

Join us on on @outlookindia @outlookmagazine June 14th, Sunday, 6:00 p.m. COVID-19 SPECIAL

PLASMA THERAPY SILVER BULLET OR NOT?

Preetha Nair

Leave, for a moment, those telescopic shots—those world maps filled with red dots, the Covid Tracker popups spinning and danc- ing on your screen. Come to a close-up. A place where death is intimate, proximate…and the walls are white with fear. Where the littlest medical decision can mark a before-and-after in your life…can change whether the one who gave birth to you lives or not. Krishna, the daughter of 67-year-old Tushar Mehta*, was there a handful of weeks ago. Imagine the scene. Mehta is losing his battle to the deadly pandemic in a private hospital in Delhi. His daughter is making frantic calls to her acquaintances to make arrangements to shift him to a government hospital. Krishna is holding on to a hope,

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an idea. The government hospital offers one last avenue to life: it’s authorised to conduct Convalescent Plasma Therapy. Infusing ant ibodies harvested from a survivor’s blood… that could give her father a fighting chance. In the bargain between life and death, Convalescent Plasma Therapy has emerged as a new buzzword in the absence of a preventive vaccine or effective treatment against COVID-19. It’s not a new idea, though, and has been around since the late 19th century. That was when physiologist Emil von Behring and bacteriologist Kitasato Shibasaburou arrived at the idea of using antibodies present in serum—another blood component—to fight diptheria. “In fact, the first Nobel Prize was given to Behring (in 1901) for the use of serum to treat diphtheria,” Dr Arturo Casadevall, a top US immunologist at Johns Hopkins, told therapy. And the IICMR launched a mul- Medical News Today. Case reports from the ti-centre clinical trial in 21 hospitals across Spanish flu epidemic of 1918 indicate use of India—to be done on 452 patients—to find blood products from recovered patients may out whether plasma therapy can be recom- have cut fatalities in the severely ill by half. mended as a standard cure for COVID-19. Dr Casadevall is now a steering figure in the Does the established world of medicine National COVID-19 Convalescent Plasma look askance at it? Not very much on the- Project, in which 57 institutions are collabo- ory—it’s the turning of it into praxis that’s rating. Early results from clinical trials on still a question. Experts point out that it’s 12,000 patients had, by late May, offered a too early to dub plasma therapy as a ‘silver modicum of certainty on one crucial aspect: bullet’ as it’s yet to be put through the litmus safety of use. A handful of other countries test of randomised controlled trials to prove too are at the clinical trial stage, but the jury its efficacy to treat any infectious disease. Dr Plasma is the is still out on whether it will be a game- S.K. Sarin, head of the Delhi government’s liquid part of changer in fighting the deadly virus. COVID-19 panel, expresses this qualified The treatment involves transfusing the ‘opti-scepticism’ when he says at this junc- blood, 55 per blood plasma of a recovered patient into ture the therapy can only be seen as a short- another patient. Plasma is the liquid part of term emergency aid until definitive cent of its total your blood, 55 per cent of its total volume— treatments are found. “I would say it’s an yellowish in colour when separated, it experimental therapy. We are still in the pro- volume—yellow- holds the blood cells in suspension, and cess of finding out whether it’s good or bad. ish in colour carries cells, proteins, minerals, blood-clot- But the scientific basis of plasma therapy is ting factors and antibodies. That last ele- very robust,” says Dr Sarin, who also heads when separated, ment offers the rationale behind turning it the Institute of Liver and Biliary Sciences into an instrument of therapy: the blood (ILBS). it holds the plasma of recovered patients contains sig- Dr Anoop Kumar, a key member of the task blood cells in nificant levels of neutralising antibodies force for plasma therapy set up by the Kerala that, if transfused into the blood of a se- government, too says more trials are needed. suspension. verely affected patient, can potentially “It was used earlier with many diseases: incl strafe the virus out of existence. The centu- uding MERS, SARS and Ebola. But no ran- ry-old treatment—which has shown some domised controlled studies have been done. results in treating measles, chickenpox and It’s not a magical bullet for sure. There’s clin- rabies over the decades—thus deigns to ical evidence but it has to be properly become part of the COVID-19 narrative. grounded in trials,” says Dr Kumar, who was A fortnight before India crested 2 lakh the first one to submit the protocol for cases, with the first signs of a post-opening plasma therapy to ICMR. up spurt staring us in the face, the health States like Delhi, Rajasthan and ministry gave the green light for clinical tri- Maharashtra are keen to go ahead with the als to assess the safety and efficacy of plasma therapy and have some positive results to

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VOX POP the deaths and the treatment to rule out the post hoc fallacy. “It may be a coincidence and may have happened even without plasma therapy. We do not have strong cor- relative evidence. Plasma is given only to fit aka Subrahmanyum. candidates,” says Passey. Patients with ext Dr. Larry American epidemiologist, ensive co-morbidities such as heart prob- instrumental in eradicat- lems, uncontrolled diabetes or cancer Brilliant ing small pox in the 70s. patients are not selected for the trial. That brings up the question of the eligibil- “I would just like my beloved friends in India ity criteria of donor and receiver. Experts say to remember that it was Indian doctors and the donors need to have tested positive for COVID-19 and then completed two to four Indian epidemiologists that eradicated small- weeks without any symptoms. In terms of pox and also who eradicated polio from India the receiver, there’s a debate about when a patient must receive plasma. Dr Sarin rec- and amazing Indian ophthalmologists at ommends that it be administered before the Aravind (the eye hospital in Madurai) and patient goes onto the ventilator. He explains that the virus attacks in three stages—in Hyderabad that have given back sight to mil- stage one, it multiplies; in stage two, the inf lions. Surely, great Indian doctors and epide- ection spreads to the lungs; the last stage sees organ failure. “Plasma therapy should miologists will rise to the occasion and help not wait till the third stage. It’s good to give defeat the scourge of Covid as well!” in the early stages so you can protect other organs and avoid injury. The basic idea of plasma therapy is to reduce the viral load and stop organ failure,” he says. Dr Anoop show too. However, the Union health min- Kumar also stresses on timing: “You have to istry has said the treatment should be done infuse the plasma in proper time. So availa- only on trial basis and warned against ind bility must be ensured.” That last has not yet iscriminate use. Delhi’s LNJP, one of the been a bottleneck, says Dr Passey. “There’s first government hospitals to get the nod no scarcity of donors; most survivors are from ICMR, has already undertaken 20 willing to donate plasma as their moral res clinical trials. “The results have been enc ponsibility. We have a reserve of plasma Experts say it’s ouraging so far,” says J.C. Passey, former from 700 donors,” he adds. Doctors also cite too early to dub medical director, LNJP. The largest Covid the fact that plasma therapy is relatively eco- hospital in the capital, LNJP has already nomical: a donor weighing 70 kg can donate plasma therapy treated over 2,500 patients. 800 ml of plasma. In Sawai Man Singh (SMS) Medical However, Dr Kumar says the therapy as a ‘silver bul- College, Jaipur, too, the trials have shown needs to score more on the efficacy part. let’ as it’s yet to promise, as they proceed under a protocol “None of the trials has shown any potential set by ICMR and with the permission of the risks, but it hasn’t shown any promising be put through Drug Controller General of India (DGCI), efficacy either. Not having a risk is not an the sanctioning authority for blood/blood argument to use a drug. We should be able the litmus test products. “So far, we have conducted three to establish its effectiveness as well, either of controlled successful plasma therapies and all of them in terms of mortality benefit or in terms of are showing improvement in their clinical thwarting complications,” he says. Timing, trials to prove state, oxygen saturation and d-dimer levels,” he reiterates, is crucial to fine-tune our says Dr Sudhir Bhandari, principal and understanding. “In a majority of cases, the its efficacy. controller, SMS. The d-dimer is a protein in therapy is being used after the patient the blood; a four-fold spike is strong predic- lands on a ventilator in bad shape. It may tor of mortality. not work in those cases.” Tushar Mehta, But the risks are being discussed too. tragically, was among those—he was too Reports of a doctor’s death in UP and ano far gone by the time plasma was adminis- ther from Maharashtra after infusion of tered. A grim vignette from a global crisis plasma have cast a shadow on the prospects that should only goad medicine across new of the therapy. Experts, however, say more frontiers. O conclusive studies are needed to correlate (*Name changed)

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Avoid shipped packages/shopping Are smokers at high risk? carts/ATMs, or you’ll die. Yes. Smokers have higher level of a mole- No. Coronaviruses’ surface survival is one cule—ACE-2— that is the entry point for the thing; that surface causing an infection is an- coronavirus in your lungs. The virus causes other. Wash your hands; live your life. sudden strokes in heavy smokers, diabetes and those suffering from hypertension.

Pollution increases the spread of Covid. Very likely YES. There is enough data that shows this virus can get attached to particulate matter floating in the air.

The messages I receive are from doctors in China/Italy. Why shouldn’t I believe them? False. Real doctors publish their research in scientific journals, not on social media. Lots of good research is already published. I can catch COVID-19 from ordering takeaway and Chinese food. MYTHYA The coronavirus droplets travel fur- Wrong. COVID-19 is a droplet related infection ther than social distancing norms. (like flu) not a food-borne infection. There is no They can.An unobstructed cough can documented Covid risk with takeaway food. travel over two metres (six feet) in less than three seconds, and keep going. If I lose my sense of smell, I have Covid. Can COVID-19 be sexually False. It’s common to temporarily lose one’s transmitted? sense of smell with many viral infections/aller- Unlikely to spread through semen. gies. It’s a non-specific symptom that may/ Like ebola, zika and other viral pathogens. may not happen with Covid.

I receive messages that using garlic/ lemon with hot water/onion in the room will prevent or cure COVID-19. Is it true? No. It’s just made-up stuff. None of these substances have been scientifically tested against Covid. Don’t share such posts; they create confusion.

Taking hydroxychloro- Should I wear a face mask when I go quine and azithromycin for a run in the park? preemptively is a good Depends. You won’t need a mask while idea to prevent Covid. jogging or riding a bike if you’re exercising Don’t. These drugs should be with no one around. But it’s good to carry used in selected Covid pa- one just in case. If it’s difficult to breathe tients. They can sometimes through a mask when running or doing other cause fatal heart rhythm strenuous physical activity, find uncrowded problems plus other trails or times to exercise when you won’t side-effects. encounter others.

Always change my clothes/shower When will Covid go away? after coming home. Or I will bring Impossible to predict. WHO says it’s coronavirus to my family. possible the new coronavirus may be here Wrong. Cleanliness is a virtue; paranoia isn’t. to stay. This may become just another Our biggest return on investment is in hand- endemic virus in our communities. washing, staying six feet away, avoiding large Previously novel diseases such as HIV have crowds etc. never disappeared. O

JUNE 22, 2020 | OUTLOOK 83 WHO ‘CREATED’ COVID? Was the Moon landing fake? Do reptiles rule us? Is Elvis alive? When conspiracy theories start proliferating like mutant viruses…

KAJAL BASU

“When does a conspiracy theory become a conspiracy real- mier Xi Jinping’s side, was targeted swiftly after Gates (but ity? Covid-19 looks like a perfectly designed Disease X.” never—because he does not fund antiviral research—with an —William Ebiefung equal ferocity). It isn’t entirely transparent as yet how anyone would stand to gain from a deadly pandemic that’s pretty IKE a single COVID-19 virus playing Chinese whis- much an equal-opportunity offender for all countries, if not pers—and making a million bad xerox copies of itself— in the number of people culled, then in the devastation of Lthe conspiracy theories took no time at all taking off economies. But the idea lives. after China announced its animal-to-human vector in The galaxy of conspiracy theories spinning around the mid-January. In a week, stories about the involvement of Bill neocoronavirus was birthed by a complex network of right- Gates began circulating until he turned into what a Syracuse wing doomsayers in internet watering holes for paradigm University professor called “a sort of abstract bogeyman” for questioners such as 4chan, QAnon, QClearance, 8chan, 2 conspiracists. Multi-billionaire investor George Soros, a Staqe 2, Zero Hedge and InfoWars. And these are umbrellas thorn in both US president Donald Trump and Chinese pre- that shelter under them a joyous jambalaya of conspiracists

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from ideologies that range from the Alt Right to anarcho- titled “Psych” (for ‘psychological operations’), sent out by a capitalists to the radical Far Left, some of these opposites unit named “CS” (for ‘clandestine services’) The New York getting their feed from the very same disseminators. Far- Times obtained this document—which is real—through the left conspiracists quote the far-right Zero Hedge, and are Freedom of Information Act. But an Ngram viewer accessed often found on Reddit mixing it up with QAnonists, who through Google Books shows that the term was born in 1874. insist that Trump was made president by the US military to Then again, a deep search of its origins led to a letter in the save the country from a ring of paedophilic Satanists, which correspondence section of the New York Times dated includes the eponymous Mr Gates. January 11, 1863, that mentioned—vis-à-vis England taking In India, conspiracy theories that target China as having the side of the South in the Civil War—the “right-about-face engineered and released the neocoronavirus are being movement of the English Press and public, which is most plugged by several TV newschannels, and websites such as readily accounted for on the conspiracy theory”. (It is par- Great Game India. Coronacrisis spin-doctoring is not going ticularly delicious that a conspiracy involving the press is at to go away, because COVID-19 is being used to reset the heart of the first mention of a conspiracy theory.) Sino-US and Sino-India relations, and state-sponsored In truth, though, the seeds of a conspiracy mindset had conspiracy theories have become part of the arsenal. In a been sowed during the Anti-Masonic Party’s 1931 conven- sense, conspiracy theories are now born and propagated in tion where Freemasonry came in for a walloping. It’s plain sight as ‘infodemics’ with explicit statal purpose, another matter that the conspiratorial Freemasons carried their purveyors no longer visionary, echoic cabals but on but the anti-conspiracy Anti-Masonic Party, which was auditable government departments. Fake news-busters are founded by a lapsed Mason, imploded and disappeared not built to deal with this—and, sometimes, fact-checkers seven years later. Wheels within wheels. are conspiracy theorists themselves. It was a fecund time for theories, in general, that would lead on to both great sociological ideas and great intellec- LOOMBERG Quint reported that in late-February, “a little-known division of Bthe US State Department, the Global Engagement Center, or GEC, said the Russian government had pushed the Gates rumour. On May 8, the GEC said it had identified a network of fake Twitter accounts being used to spread disinformation, this time on behalf of China.” The problem with the GEC is that it is wedded to the Trump administration, which has been trying on overdrive to pin the coronacrisis on China (and, just as a bonus, on Russia). The GEC was a tiny division of the US State Department with a pointed mandate to “direct, lead, synchronise, integrate and coordinate efforts of the Federal Government to recognise, understand, expose and counter foreign state and non-state propa- ganda and disinformation efforts aimed at undermining or influencing the policies, security or stability of the United States, its allies, and partner nations”. In pursuit of this mandate, the GEC has built up a history of carrying out disinformation, often photoshopping images to suit its purpose. tual presumptions in the 20th century: murder theory was After it fingered Russia and China for disseminating misin- born in 1867, suicide theory in 1871, blackmail theory in formation (which charge Facebook has actively disputed), it 1874, and abduction theory in 1875. (Source: Conspiracy proposed to the Trump administration that its budget for Theory: The Nineteenth-Century Prehistory of a Twentieth- 2021 be doubled to $138-million. And Trump is said to be Century Concept, from Conspiracy Theories and the People amenable to the thought. Who Believe Them; Joseph E. Uscinski; OUP; 2018). It Conspiracy theories live on despite—and in many cases, would take nearly a century for the term ‘conspiracy the- because of—government denial. Governments denied con- ory’ to come into frequent usage. It gained quotidian pop- spiracy theories by reflex, because most conspiracy theo- ularity in the mid-1950s, taking off steeply during the ries were acridly anti-government. Today, however, aside anti-establishment UFO hysteria, and never quite halting from an unravellable welter of non-state conspiracism, its ascendance in the decades that followed. Today, the what we have are, seemingly, conspiracies by state actors term roams unchecked worldwide, and is, indeed, about conspiracies by other state actors! championed—if as an upstart cause célèbre—as a valid There exists a conspiracy theory that the term “conspir- expression of people’s political scepticism and even acy theory” was invented by the CIA in 1967 in a dispatch democratic impulse.

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ventional wisdom is sober presenta- tion by a conventionally respectable face. Luc Antoine Montagnier, 2008 Nobel laureate in physiology or medicine, endorsed the conspiracy theory that the COVID-19 is human-made and went public claiming that its genome has elements of both the HIV retrovirus, which he had discovered, and the malaria germ. Both claims are deeply questionable, but the theories themselves are now embedded in layperson and quasi-scientific circles. The fact that Montagnier has earlier supported anti-vaxxers and claimed that DNA emits “electromagnetic waves” has done nothing to diminish his oracular stature. Another sort of conventional wisdom is that the coronacrisis is a ‘plandemic’ (a portmanteau of ‘plan’ and ‘epidemic’)—the belief that it was designed by a shadowy cabal of US health experts and vaccine manufacturers. The 26-minute video that hardsells this idea is a study in the craft of making docu- mentaries: polished, low-key, with entirely believable (if unqualified) interviewer and interviewee (whom the NYT called a “discred- ited scientist” in a study of the social-media virality of the video). While the Plandemic video is slick, its USP is that it is that rare thing—a product that hit a starved and chaotic market, more by accident than by intent, at just the right time. From the time that it was launched to million-views reactions in the That the word ‘conspiracy’ is derived from the Latin con- social media on May 4, to its banning by Facebook, YouTube, spirare (‘to breathe together’) is seen as a good thing. Both the Vimeo and Twitter for content-falsity, to its resurgence Left and the Right view conspiracy theories as essentially through a rash of smaller sites such as BitChute and anti-establishmentarian: valid in principle and correct in con- Brighteon, every move to shut it down has only helped it to tent. But belief in the same things means that ideologies will keep going. Plandemic employs a rhetorical technique be diluted, adulterated or altogether dispensed with. known as the “Gish Gallop”, after the US creationist-bio- Conspiracism is now defined severally as a mindset, a pre- chemist Duane Gish, who often successfully buried disposition, a need to see conspiracies behind everything, Darwinists under avalanches of rapid-fire factoids in the innocuous and ostentatious, personal and public, secret and final two decades of the 20th century. Plandemic’s gallop declassified. But conspiracism remains poorly defined. cannot be halted by conventional means of countering with There are those who, like the historian Karl Popper, conflate hard-science facts. In effect, its narrative about the COVID- conspiracy theory with pseudoscience and superstition 19’s cabalistic roots has, like the most enduring of mod- about “powerful men or groups whose wickedness is respon- ern-day conspiracy theories—former BBC sports reporter sible for all the ills we suffer from”. The opposite camp David Icke’s idea of a global reptilian elite, aliens squirelled thinks of conspiracy theories as fairly reasonable responses away in Area 51, that Paul McCartney is dead (and Elvis is to modern life and its unprocessability. This camp also not), that the moon landings were shot in a studio—probably believes that, given time and air, most conspiracy theories come to stay at a slow but permanent boil. O

eventually turn into conventional wisdom. KAJAL BASU,A FORMER EDITOR OF TEHELKA,IS A SENIOR JOURNALIST All it takes for a conspiracy theory to establish itself as con- AND WRITER BASED IN CALCUTTA

86 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

Blaming 5G (GMOs) will play a big role in the COVID-19 Easily debunked: Viruses do not spread vaccine solution. using the electromagnetic spectrum. But Covid doesn’t exist this hasn’t stopped 5G towers from being Überconspiracists like David Icke and Alex vandalised in the UK. Jones of InfoWars are peddling the idea that COVID-19 is no worse than the Bill Gates done it common flu and is an enchaining ploy An “abstract bogeyman” for the Far by the globalist elite. It has gained trac- Right as well as the Extreme Left, he tion in India, among liberals, the Left has no reason to want a global pan- and the Right, because of the country’s demic—not even a connection with big notable deathcount deficit. pharma. Deep State ploy Chinese lab A global Deep State would make for a It’s plausible, but not probable. The borderless Illuminati with a remarkable serendipity of China’s leading institute confluence of intent and purpose, studying bat coronaviruses being which is why this idea might sound located in the same city as the extreme. In the US’s case, the Deep COVID-19’s origin is a dog-bone State is exemplified not by Donald for conspiracists. Trump, a practising capitalist himself, COVID SPAM but by Dr Anthony Fauci, the (mildly US military plot rebellious) face of Trump’s neocorona- Tired of right-wing conspiracy theories SIGHTED virus response. The Far Right believes targeting it, the Chinese government Fauci is working with Hillary Clinton to let loose Zhao Lijian, a Ministry of discredit Trump by causing an eco- Foreign Affairs spokesperson. He let off nomic collapse. For the Euroright, it’s a tweetstorm accusing the US of using German chancellor Angela Merkel. its military attendees at the 2019 India’s Deep State, the radical Left beli Military World Games to spread the eves, exists as a part-and-parcel of the virus to the Huanan seafood wetmar- incumbent government. ket, where the source of the outbreak was eventually traced. This conspiracy Big pharma plot theory, in turn, set off Trump’s by-now-infa- A few major pharmaceutical manufacturers mous takedown during a White House will make millions from the vaccine, but most presser of the “Chinese virus”, and his series pharma companies currently engaged in of anti-China trade threats that has now cul- vaccine research will bite the dust. The minated in a bilateral faceoff between the anti-pharma narrative has been written by world’s two leading economies. anti-vaxxers (for the uninitiated: those against vaccination, a goodly number)—and Bioweapon they have notable support from Greeners, In a survey in April 2020, the Pew Research Right Libertarians, and the Far Right that is Center reported that “nearly three-in-ten militantly leading anti-lockdown protests [Americans] (29%) say it most likely was cre- in the US. ated in a lab”. Some 23 per cent of adult Americans believe the neocoronavirus was Alien organism intentionally developed in a lab, while an- British-Sri Lankan astrobiologist Chandra other 6 per cent say it was accidentally Wickramasinghe believes COVID-19 arrived in invented. a meteor-fall in northeast China on October 14, 2019. The theory caught on in the global GMOs community of UFOlogists, already primed by In an article published in early March 2020 in the appearance of the strange, cigar-shaped the Italian newspaper Il Manifesto, an attor- extrasolar object, the ‘Oumuamua’, in ney named Francesco Bilotta blamed GM October 2017. Wickramasinghe also insists crops, claimed falsely that GM crops cause that SARS originated in space. Since 1979, genetic contamination, allowing viral prolifer- ever since he co-wrote the book Diseases ation and interspecies transmission. from Space with Fred Hoyle, he has been Researchers debunked the claim as “scien- trying to establish that the flu and the com- tific absurdity”. Indeed, it’s almost inescapa- mon cold have extraterrestrial origins. ble that genetically modified organisms

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IS SOCIALISM THE VACCINE? Not specifically…political ideologies take the backseat in global pandemics, but leadership counts

TOBBY SIMON

HE world, irrespective of the political ideologies of its city under total lockdown. Result: Wuhan is now infection constituent ruling dispensations, has been brought to free. Private healthcare systems have been found wanting, T its knees by COVID-19. But the fight against this com- especially in India, and have not been at the forefront in mon enemy has shown that efficient administrations—and the fight against the virus. not political principles—have had an edge. On the shortlist It may be true that the socialist approach to governance of countries that have experienced remarkable success are brings greater focus on public healthcare and social sup- Vietnam, Cuba, South Korea, Australia and New Zealand. port systems. But an inefficient socialist/communist The first two are Communist-ruled, the rest are not. In each, dispensation could be worse than an efficient capitalist however, it’s efficiency at the top that has been vital. A cul- approach that has focused on public healthcare. In India, ture of according primacy to healthcare matters every- we have a point of analogy—partial though it is, because where—a key factor in this fight is the robustness of public states do not have total policy autonomy during epidemics. healthcare systems. Even in China, the chief strategy was That’s Kerala, which has a Communist-led government early detection, followed by free treatment and care to any- right now, and has had one for 33 of its 63 years of exist- one with an infection. Indeed, it tested ten million Wuhan ence. While Kerala’s commendable success can invoke residents at the height of the pandemic there and put the comparisons with Vietnam and Cuba, the key differentiator

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Rio de Janeiro may not be ideology per se but the fact of having a corona “psychosis” by mouthing a string of gems—saying responsive, empathetic administration. “the tractor and fields will heal everyone”, that ice hockey Kerala’s old object of infatuation, Russia, is flailing is “better than antiviral medication”, and asking his people meanwhile—partly under what BloombergQuint called to “wash their hands with vodka”. No lockdown, no border “an authoritarian regime that dislikes bad news”. A sealing, and (even if fudged) among East Europe’s highest microbe has outwitted President Putin’s helmsmanship: caseloads; the situation is being called a ‘viral Chernobyl’. from among the lowest caseloads in March, Russia soared But let’s go away from the mavericks and loo k at four ‘good’ to world number two (nearly 5 lakh cases), till it was case-studies, country-wise, to appreciate the variety of replaced by Brazil. The 75th Victory Day Parade—the mili- ways in which leadership can affect an epidemic’s passage tary showpiece commemorating Nazi Germany’s capitula- (for a continent that merits separate treatment, see la tion to the Soviet Union—scheduled to be held later this América, Going South).... month might hand it the silver yet again. A dizzy, sobering case of hubris, helped New Zealand along by inexperience with pandemics There was a touch The expeditious and calmly fervent reac- and an insufficiently funded/reformed of authoritarian tion of New Zealand Prime Minister health sector. The talking points now: Jacinda Ardern to the Christchurch shoot- allegations of fudged mortality rates (still surveillance in ing a year ago epitomised a leader who among the lowest) and a new Russian seemed almost a perfect fit for a crisis. The drug, Avifavir, to restore public confi- Vietnam’s strategy, compassionate messaging of March 2019 dence. For a picture of nationalistic but the difference affirmed New Zealand’s commitment to bravado and chest-thumping denialism, remain a liberal and free country that however, Alexander Lukashenko next with more ‘demo- stood against hate-filled ideologies—it’s door in Belarus needs an honourable the same spirit she took to the COVID-19 mention. President since 1994, the cratic’ nations battle. New Zealand managed to meet the ex-Soviet soldier has sought to dismiss wasn’t much. goals of mandatory quarantines, country-

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model to map/predict the disease, systemic weaknesses and pol- LA AMÉRICA, icy gaps have left its leftist government red-faced. With 1,14,000 cases and upwards of 13,500 deaths, a gradually-easing lockdown likely means more blushes ahead. Peru too is struggling, GOING SOUTH despite a responsive centrist leader in President Martin Vizcarra and one of the earliest lockdowns. Its case graph mirrors India’s: The Covid footprint in Latin America is now inching close to 2 lakh, with infection reaching even interior characterised by wide disparity Amazonian communities. So do other factors—a large informal economy with severe income inequalities forcing people into poor grim shadow stalks the Andes, playas and Pampas—the observance, a “severely underfunded” and decentralised health- continent is “losing its battle against coronavirus”, CNN care, even a balcony show five days before India. reported on June 7. WHO calls it “the new Covid epicentre”. Costa Rica is poor too—16th in the world in fact—but has one A With good reason: 1.2 million cases, over 60,000 deaths— of the lowest Latin American Covid mortality rates (0.2 deaths amid soaring food prices. But South America offers an illuminat- per lakh). Why? A robust democracy, unified healthcare with ing, if frequently tragic, case-study of how political ideology can universal coverage, and a centre-left president in Carlos interface with pandemic control: a full panoply that defies gener- Quesada—a 40-year-old journalist and political scientist, pro- alisations. The most flagrant violator? Of course, Brazil’s army- gay rights, serious about the environment, quite the antithesis man-turned-strongman Jair Bolsanaro, a “polarising and to Bolsanaro. Chile has recovered politically from the Pinochet controversial” figure who comes closest to fitting the era, but has its first right-wing president since him in description of a far-right despot. The Lancet called him Sebastian Pinera—a billionaire with interests in banking, “the biggest threat” for Brazil; an opposition MP con- aviation, media and a publicity hound nightclub-owner curred, saying: “We’ve unfortunately discovered that for a brother. But, down the line, there are stark income the virus’s main ally and best friend is the president.” disparities. Result: 1.3 lakh cases and food riots. (The Brazil now is second on world charts, with nearly new global popularity of quinoa as health food has led 7 lakh cases and over 36,000 deaths. In stark contrast, to that staple grain being diverted to exports from all President Alberto Fernandez’s comparatively decisive Andean countries.) By contrast, Uruguay too has a Peronist government in Buenos Aires has seen centre-right president in Luis Lacalle Pou, but regis- perennial rival Argentina score higher on the ters only 845 cases and 23 deaths. Then responsiveness index (concerns about there’s Venezuela—that other US bugbear, testing and data quality notwithstand- where Nicolas Maduro, operating with a ing): to the tune of 22,000 cases and $15 million US bounty hanging overhead, around 650 deaths. Costa Rica is poor, but presides over a Communist lodestar- Mexico, polar south to a Trumpian turned-red dwarf. Stuck between a ‘North’ ideal, has been a study in contrasts. has one of the lowest S. crude oil-shocked economy and wider President Lopez Obrador asked, with culti- American Covid mortal- socioeconomic crises, it has recorded vated casualness, what “pandemics can scarcely-believable (and widely dis- do to us” and also shook hands with a ity rates. A robust missed as under-reported) pandemic drug lord’s mum—but Mexico also rolled figures: the 28 million-strong country out a comprehensive response plan in democracy, unified has apparently had just 2,300 infections January, ahead even of WHO’s declaration healthcare with blanket and 22 deaths. Everywhere, it seems, of the pandemic. But, despite being the politicos self-congratulate while the first ‘Latam’ nation to use a mathematical coverage did the trick. credibility gap widens. O

wide lockdown and social distancing without being too draco- ulation, a key factor in its low caseload of 2,173, with just 83 nian about it. Some blips were seen along the way—including deaths. Besides, it called on nearly 28,000 medical students eager mobs outside a burger store chain and a trip to the who, under supervision, offered door-to-door assistance beach by the health minister! But, on June 8, New Zealand across the country and hands-on care to those who contracted cleared its last active case, and with no new cases for over a any sort of pulmonary infection. Cuba also made headlines fortnight, it’s geared to ease all restrictions. The good news with its ‘medical internationalism’—sending doctors and sup- prompted “a little dance” around the lounge by the PM, as she port staff to crisis-hit Italy. Also integral to reducing the num- herself put it. Still, Ardern was holding off firmly against open- ber of deaths globally—from Wuhan onwards—is a Cuban ing up a ‘travel bubble’ with even Australia, saying the latter antiviral drug, Interferon alfa-2b. The Canadian pharma was still grappling with cases! major BetterLife is now en route to taking up this 30-year-old Cuban invention for trial and mass production—medicine Cuba sans frontiers and ideologies, if you like. For a country nicknamed ‘El Cocodrilo’, there’s one thing Cuba is not: that’s being cold-blooded when it comes to South Korea human health. Its renowned free public healthcare system is Here we have a swift response that stood out as an exem- in the limelight again, leading the fight against COVID-19 with plar of the key principles of crisis management. It was evi- much aplomb. Cuba has the highest ratio of physicians to pop- dent that South Korea had begun stockpiling coronavirus

90 OUTLOOK | JUNE 22, 2020 Havana testing kits long before the outbreak had occurred there. daily public dissemination of information, and a hands-on It was able to provide close to 10,000 tests per day when the health minister, out in the field. The approach was empa- infection rate started to climb, and supplemented it with a thetic and grassroots-oriented, not one driven top down. mobile app that allowed citizens to keep themselves con- In a country of India’s scale and inequities, a bottom-up stantly updated. Despite the fiasco over the Shincheonji approach that ensures economic and social security also cult, Patient No. 31 and threats of recrudescence, the coun- proved the best pandemic shield. try is on the ball, as it were—even if 50 new cases reported “There’s no playbook for leadership when the stakes on June 6 have sparked a debate on whether lockdown are high, no playbook for what must be done in the face restrictions were eased too soon. of a 21st century pandemic,” leadership consultant Mark Nevins wrote in Forbes. An inclusive, cohesive society, Vietnam one not polarised on ideological, racial, ethnic, or reli- Vietnam and China share a land border stretching about 1,444 gious faultlines, cannot harm the cause though. Both km. With a population of 95 million and a relatively low per finally come down to biological security—life itself. A lot capita income, Vietnam is an outlier success story. It has had of focus has now shifted to Africa, an understudied conti- only 329 cases and no reported deaths so far. The country is nent where COVID-19 has affected all countries by now— beginning to lift the strict lockdown measures it imposed in and Congo battles it as part of a “triple threat”, alongside February, reopening restaurants and barber shops last week. a recrudescent Ebola outbreak and measles. Africa is It has yet to generate the global applause many other nations largely caught between a picture of stark leadership have received, perhaps only because Vietnam does not fit the deficit and a vulnerable populace. At one end, Tanzanian political narrative required for a success story. There was a President John Magufuli ridicules testing kits, saying touch of authoritarian surveillance built into its control strat- even “a goat and a pawpaw” (papaya tree) had tested posi- egy, but the difference with more ‘democratic’ countries tack- tive. At the other, a French scientist said on TV, “If I can ling the pandemic was not much—either in degree or in be provocative, shouldn’t we be doing this study in kind—and there was wide social consensus for the same. Africa...”, prompting outrage across La Francophonie and beyond. Among the angry decrials: the Ivorian foot- ESPONSIVENESS begins, well, in the beginning. ball star Didier Drogba memorably proclaiming that Look at Kerala: its efforts to address the pandemic Africans are “not guinea pigs”. Racism, of course, is alive Rstarted as early as January. As The Guardian noted, and well on other continents too. To face down such an on January 20, K.K. Shailaja, the state’s health minister, unprecedented assault on human security as COVID-19 read about “a dangerous new virus spreading in China” represents, what one needs is collaborative, people-ori- and enquired if Kerala needed to be on guard. Result: it ented leadership—and a Trumpesque spirit may not was combat-ready “by the time the first case arrived from ensure that security in either a medical sense or a social Wuhan on January 27”. Its signature moves: participatory one. No country in the world matches the US’s nearly 2 contact tracing, a supportive quarantine for nearly 2 lakh million cases and upwards of 1.1 lakh deaths. O people, feeding and supplying provisions to some 87.28 TOBBY SIMON IS THE FOUNDER AND PRESIDENT OF SYNERGIA FOUNDATION, lakh ration card holders and 1,50,000 migrant labourers, A STRATEGIC THINK-TANK BASED IN BANGALORE

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 91 COVID-19 SPECIAL

WHY DOES SCIENCE COME LAST? History shows us that there is no alternative to research in the battle against pandemics

Genome sequence of SARS-CoV-2. The coronavirus genome has 30,000 base pairs, a human has over 3 billion.

P. BALARAM

HE term coronavirus entered the scientific litera- Guangdong province of China. At the end of February ture with little fanfare in 1968, when a short news 2003, a hospital in Hanoi requested help from the WHO to T item appeared in the journal Nature. A letter had study the case of a patient with an unusual, influenza-like been received from a group of virologists, suggesting the infection. Dr Carlo Urbani, a specialist in infectious dis- name for a recently discovered class of viruses causing mild eases, arrived in Hanoi. He quickly realised a new and viru- human respiratory infections. A couple of years earlier, a lent infection was emerging and set in motion the new group of viruses had been identified in the nasal secre- appropriate public health response. Three weeks later, on tions of persons suffering from the symptoms associated March 29, 2003, Dr Urbani died in Bangkok, of the infec- with common colds. David Tyrrell at Britain’s Common tion contracted in Hanoi. Five healthcare workers died Cold Research Unit in Salisbury and Dorothy Hamre at the shortly thereafter. By the time the spread of infection was University of Chicago had independently managed to grow halted, 774 people had died out of a total of 8,098 infected the new virus in the laboratory. The strain 229E, isolated persons. (https://www.cdc.gov/sars/about/fs-sars.html). by Hamre in 1966, yielded the now-famous image, visual- A truly extraordinary scientific effort, coordinated by the ised under the electron microscope by Tyrrell and June WHO, was mounted by a worldwide network of laborato- Almeida in 1967. In cross-section, the approximately circu- ries, primarily across Europe and the US, to understand the lar image revealed a spiky exterior with uniform projec- coronavirus. A full genome sequence became available as tions, a corona or halo, from which the virus derived its early as May 2003. In a tribute to Carlo Urbani, an article name. The new virus seemed to be the cause of a significant in the New England Journal of Medicine, on May 15, 2003, number of common colds, which until then had been noted, “In some ways, the SARS outbreak in Hanoi is a thought to be almost entirely caused by a different class of story of what can go right, of public health’s coming before viruses, the rhinoviruses. politics”. But with that first SARS epidemic ending quickly, A relatively benign, new infectious agent did not really with it the coronavirus too faded from public view...for a attract a great deal of attention in the world of biomedical handful of years. It swam back into the spotlight briefly in research. Over 35 years were to pass before the coronavirus 2007-2008, with the outbreak of infection in the Middle bared its fangs. In late 2002, reports of a new and East. The disease was named after the region, as the Middle life-threatening respiratory infection emerged from East Respiratory Syndrome and the causative agent was

92 OUTLOOK | JUNE 22, 2020 COVID-19 SPECIAL

christened the MERS-CoV virus. with the world waiting impatiently for science to deliver a But 17 years after Carlo Urbani’s death, a new coronavirus solution. It is this very science—the acquisition of basic, strain, SARS-CoV-2, now has much of the world locked fundamental knowledge absolutely essential for practical down—a public health crisis of unprecedented magnitude. solutions—that has been neglected and downgraded in The lessons of the 2003 epidemic have been forgotten. India over the past several years. The catchy phrase ‘trans- Politics has determined public health responses. Witness the lational research’ and related slogans like ‘bench to bed- dominant role of China in determining the WHO’s initial side’ have forced researchers to work in ‘fundable’ areas, response to the outbreak in Wuhan, and the increasingly determined by agencies that are under governmental pres- antagonistic attitude of the US to international organisa- sure to make extravagant claims for the outcome of funded tions—capped by President Donald Trump’s announcement projects. A heavy price will be, and is being, paid for inade- of American withdrawal from the WHO. Ironically, in the quate support of fundamental studies in disciplines like aftermath of SARS (and with news dominated by the US inva- immunology, virology and many allied disciplines of cellu- sion of Iraq), Barry Bloom of Harvard University had touched lar and chemical biology. The sudden flurry of calls by gov- on precisely this aspect in the May 2003 issue of Science: “In ernment agencies for proposals to do ‘Covid research’ in a world...increasingly angry at the US, the lesson here is that ridiculously short timescales, with unrealistic goals, is it is time to support a global war on disease. The US should be patently a kneejerk reaction to the current situation. investing efforts and funds to strengthen health structures in The virus is a formidable foe. We might do well to remem- countries around the world. If we were to help train experts ber Michael Corleone’s sage advice in the sequel to The in epidemiology and surveillance, strengthen laboratories in Godfather: “Keep your friends close, but keep your enemies key regions and link them to the best labs in this country and closer”. Scientists, diverted from their favourite problems around the world, and support WHO, we would help to create to the task of attacking the coronavirus, will be confronted a true global health network. This investment would protect with a formidable body of scientific literature that needs to our country and every other against global epidemics, save be assimilated. The international scientific response to millions of lives, and change the US both the 2003 SARS outbreak and the image from one of self-interest to one of current SARS-CoV-2 pandemic has human interest”. been staggering, with the full power of modern technologies being focused on N 2003, WHO had emerged as the understanding the virus. Yet a solution key protector of global health. does not seem within our grasp. In an IToday, the novel coronavirus has March 23 editorial in Science, the jour- exposed how international power nal’s chief editor Holden Thorp had struggles can render such organisations good advice: “When science addressed irrelevant. The political leadership in the HIV/AIDS crisis, it took years of many countries has been found wanting careful virology, drug development, and too, with responses that sometimes epidemiology. The global scientific seemed poorly thought out, leading to assault on COVID-19 is faster, and as I chaotic situations. The virus has see the research that comes to Science exposed the cavalier approach to public and that appears on preprint servers, I health even in the developed world. The Chromosomes where our DNA resides am hopeful that science will deliver on spectacle of ever-inflating defence this challenge, too. But I worry that budgets and declining emphasis on health and social secu- engendering false hope will cause complacency that will rity must concern those who determine the course of pub- deprive us of the time needed to find a lasting solution. And lic policy. The misplaced priorities of governments have I worry about lasting damage if science overpromises. Let’s been brutally exposed. Many world leaders have displayed underpromise. Let’s overdeliver”. a unique combination of arrogance and ignorance; a combi- There are no drugs or vaccines in sight, even in the US nation invincible in political arguments, but woefully inad- and Europe, as everyone moves to an ‘unlocked’ world. equate in confronting the forces of nature. Politicians and their advisors are already preparing us for The general public, caught in an unanticipated crisis, has this future, by pronouncing that the coronavirus is here to been left learning the new vocabulary. Terms like ‘social dis- stay and that the world must get ready to coexist with the tancing’, ‘flattening the curve’, ‘sanitising’ (a term hitherto latest addition to the pantheon of viruses. Nature, as reserved for security operations) and R0 (a mathematical always, has the last word. A constant exposure to microbial descriptor of viral infectivity) now roll off the tongues of most pathogens can enhance the level of human immune compe- educated people, who a few weeks ago would have had little tence. In the words of Joshua Lederberg, one of the high interest in viral disease. Tongue-twisters like hydroxychloro- priests of microbiology: “Paradoxically, improvements in quine find their way into the speeches of the US President, sanitation and vaccination sometimes make us more vul- albeit with a little slurring. Our Supreme Court is now able to nerable because they leave the larger human herd more weigh in on the issue of middle-seat occupancy in planes— innocent of microbial experience.” O with a sudden, but touching, interest in public health. THE AUTHOR, A BIOCHEMIST AND FORMER DIRECTOR OF THE Viruses, vaccines and drugs are suddenly centrestage, INDIAN INSTITUTE OF SCIENCE, IS WITH NCBS, BANGALORE

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 93 Review / ART AND CULTURE PEGASUS

Camera Confined ‘I enjoy Oddbird Theatre and Foundation, New Delhi, has commissioned 13 teams of artistes, dancers, musi- being at cians and thespians under its Quar- antine Video Project 2020. “Projects home, are on hold, performance spaces are closed, and planning seems specu- reading lative. We wanted to put together an initiative that encourages continued and creation of artistic work, within confines—literal and otherwise,” their statement reads. singing’ So far, they have released five films on their website (oddbird.org). Dilli Kiski Hoti Hai? by BAAN G and Khwaab Tanha Collective features visual art and footage of migrant workers walking to their homes overlaid with an evocative poem. Kathak dancer and choreographer Aditi Mangal- das’s Amorphous—The Zero Moment explores how time has become warped during the pandemic. Shot with a microscopic lens attached to a phone camera, Miya Biwi’s brilliant Starting her career with Khichdi: The Movie, Kirti Kulhari has delivered power-packed Corona Cam stands out. It begins as performances in diverse roles. She has never shied away from talking about issues an intimate exploration of domestic- in society and the film industry. Currently, Kirti is basking in the success of the ity and effortlessly transforms into second season of Four More Shots Please Season 2. She talks to Lachmi Deb Roy a biting satire. Tadpole Repertory’s about life during the lockdown and her post-pandemic plans. Private Language Argument and Aranyani’s Lockdownatyam are some Streaming platforms during the lockdown of the other films commissioned It is the best time for OTT platforms because everybody is at home. We have to admit > under this project. O that there is nothing much to do and people are getting bored. There are no other forms of entertainment for many of us. We can’t go to theatres or malls. So, it is understandable that the viewership of web shows has gone up during the lockdown. OTT platforms have become the most happening place for entertainment and people are busy consuming content non-stop. This is indeed a great time to catch up on shows—people in big cities with busy schedules are hardly left with much time for leisure when they return home from work. So, this is the best time to be with your loved ones and pamper yourself. Staying at home > I enjoy being at home. I have got back to reading and since I love singing, I am doing riyaz regularly. Post-pandemic plans > I have a bunch of things waiting to be released and shot, but I don’t know if these will be released during the lockdown. I am hopeful that things will start returning to normal. I have quite a few series that will be releasing this year. Four More Shots Please Season 2 has already been released and the response has been overwhelming. The show is doing well—it feels good that people have embraced it in a bigger way this time. And I am glad that women are connecting with the series and getting inspired. O

94 OUTLOOK | JUNE 22, 2020 #BollywoodTalkiesOutlook Bollywood TALKies with

Episode - 6

Producer Atul KAsbeKAr Talks about his journey from fashion photography, talent management to producing award winning movies

in conversation with

Watch on June 12, 2020 (Friday), At 9 PM @outlookindia Mitrajit Bhattacharya Columnist & Author @outlookmagazine CINEMA/OBITUARY

BASU CHATTERJEE (1930-2020) Middling Perfection His self-deprecatory movies about middle-class society trod the fine line between popular and art house cinema

Giridhar Jha A veritable institution in the art of simplified filmmaking, he churned out an array of whole- some family entertainers, from Saara Akash F Basu Chatterjee had a middle name, it (1969) and Rajnigandha (1974) to Chitchor (1976) would be simplicity. One of the pioneers of and Baton Baton Mein (1979) without leaning on middle-of-the-road cinema, he passed away any superstar. In fact, his films with some of the Iafter a protracted illness at 90 in Mumbai on big stars of the time—Priyatama (1977) with June 4. His movies neither looked like hardcore Jeetendra, Chakravyuh (1979) with Rajesh masala ventures of the likes of Manmohan Khanna, Manzil (1979) with Amitabh Bachchan, Desai nor the art house cinema championed by Dillagi (1978) with Dharmendra and Manpasand Shyam Benegal and others. Instead, he chose to (1980) with Dev Anand—failed to click at the box be the Buddha among the storytellers of his office. It was his collaboration with everyman time, choosing the middle path traversed by actors such as Amol Palekar, who played the only a few in the film industry. quintessential middle-class hero in eight of his

96 OUTLOOK | JUNE 22, 2020 CINEMA/OBITUARY

Stills from Rajnigandha (top) and Baton Baton Mein films, that elevated his status as an auteur extraordinaire with a refined sensibility. Basu da, as his colleagues affectionately called him, excelled in telling stories of common people and their struggles with dollops of subtle wit and humour. The USP of his films was that he did not present any of his heroes as a superman with a traffic-stopping eye candy in his arms, capable of demolishing an army of 40 armed goons at one go without batting an eyelid. Instead, his protagonist was invariably a middle-class youth with follies and foibles, who was at times upstaged by a smarter adversary. His actors were anything but larger-than-life or over-the-top and looked no different from the man-next-door, someone the audience could instantly relate to. It was the sheer simplicity of his movies that made Basu da’s repertoire stand out. He began his career as an illustrator-cartoonist in the now-defunct Blitz tabloid in Bombay before he moved to cinema to work as an assistant to director Basu Bhattacharya on Teesri Kasam (1966). In 1969, he began his innings as an independent director with Saara Akash, based on a novel of the same name by littera- teur Rajendra Yadav. It was the year when Mrinal Sen released his iconic Bhuvan Shome and Khwaja Ahamad Abbas introduced a new actor called Amitabh Bachchan in Saat Hindustani. Moreover, a new sensation called Rajesh Khanna had taken the industry by storm with Aradhana and yet, Basu da’s ‘small’ movie received rave reviews and set the template for his signature style of cinema—no tropes or frills of masala movies that Hindi cinema was notorious for in those days. Basu da went on to make Piya Ka Ghar (1972), Us Paar (1974), Chhoti Si Baat (1976), Safed Jhooth (1977), Priyatama (1977), Swami (1977), Khatta Meetha (1978), Apne Paraye (1980), Shaukeen (1982), Kirayadar (1986), Chameli Ki quality cinema. Considering that the Hindi film Shaadi (1986) and a slew of other movies. He industry was under the sway of action-packed also ventured out of his comfort zone by making multi-starrers, it is remarkable he dared to make experimental films such asEk Ruka Hua Faisla such films. For nearly two decades, Basu da argu- (1986) and Kamla Ki Maut (1989), which under- ably remained the only successful filmmaker lined his versatility and control over his craft. alongside Hrishikesh Mukherjee to buck the There was hardly any filmmaker of his genera- BOLLYWOOD trend and make self-deprecatory movies about tion as prolific as him in his heyday. During his FOLLOWED middle-class society. illustrious career, he directed 40 feature films, BASU DA 30 YEARS Basu da’s style of filmmaking went on to including five Bengali movies.Trishanku (2011) TOO LATE BY inspire generations of filmmakers in the dec- was his swan song. He also found time to direct ades to come. One could say that Bollywood a handful of successful television serials, such ACKNOWLEDGING began to follow his filmmaking template 30 as the iconic Rajani (1985), Darpan (1985), THAT NO STAR IS years too late by acknowledging the fact that no Kakaji Kahin (1988) and Byomkesh Bakshi BIGGER THAN THE star is bigger than the character he plays (1993) for Doordarshan. onscreen. It is a greater tribute to him than all It is to his credit that his heavy workload could CHARACTER HE the awards and laurels he deserved, but did not never bog him down nor diminish his passion for PLAYS ONSCREEN. get in his lifetime. O

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 97 Craig’s la Added List Something changed in the very soul of James Bond dolce when Daniel Craig took over—the stiff upper-lipped, upper-class debonair rakishness was replaced by a muscu- vita lar, strong-jawed, thin upper-lipped show of serious intent. Bond’s latest, the topically named No Time To Die, will now release in November (instead of February). Still more serendipitous is the theme: Bond rescues humanity from a pandemic. And, in the most shattering departure ever, Bond is married (what!!!), with a child. Will wife Madeleine (Lea Seydoux) and daughter Mathilde cramp Bond’s free-ranging style as a buccaneer of boudoirs? But listen; Daniel, it looks, performs better with responsibility.

Not So Loverly? Is this the new normal? The pandemic imposing a new danse macabre, an equalizing hand that falls on commoner and royalty alike? When did we ever think the glamor- ous and good—in tuxedos and gowns, weighed down with stones—would be subject to a walk through a thermal screening doorway? But such are the times: at the Daejong Film Awards in Seoul, actress Jin Seo-yeon, looking as nonchalant as possible, crosses over into a safe zone. But ah, she’s not wearingSmithy the ubiquitous Ofmask! AHis Blade minor concessionVirat Kohli tohas showbiz? misgivings about T20’s bad habits creeping into one-day batsmanship. For Steve Smith, who got a royal welcome as skipper in Jaipur ahead of the IPL, it would be the only match practice he (and David Warner) would get ahead of the World Cup. The ban is done; let the bat speak.ith, who got a royal welcome as skipper in Jaipur ahead of the IPL, it would be the only match practice he (and David Warner) would get ahead of the World Cup. The ban is done; let the bat speak. la dolce vita

Never Get Out It’s one thing to pose in bikinis—you’re well-acquainted with those here—it’s another to cavort in workaday lingerie, with its frisson of intimacy, abandon, a whiff of cool, stale, slept-in sheets. That’s what Mandana Karimi suggests, as she digs her knees in and tells us that the bed is her favourite place these days. At the height of the Vietnam War in 1969, as American and Vietnamese kids reaped the tragic fruits of a generaton of US politicians’ pig-headed folly, John Lennon and Yoko Yono staged their famous bed-ins for universal peace. Mandana here aims for universal love.

A Victim’s Tale We don’t know much about Meera Chopra—though she looks inviting enough here, tumbled down on a fine-sanded beach in a swimsuit that bears closer inspec- tion than we are allowed—but the actress has had a traumatic experience at the hands of livid, and criminally stupid, NTR jr fans when she said in a social media chat that she liked Telugu superstar Mahesh Babu, but was ignorant about the junior. Abuse followed, together with threats of assault, morphed photos and curses of coronavirus on her parents. NTR jr, meanwhile, kept up a loud silence. Meera deplores this sick dictatorship of the ‘fans’, and has reported this to the police. We hope their fetid ardour gets a good shellacking.

OUTLOOKINDIA.COM JUNE 22, 2020 | OUTLOOK 99 COVID-19

Rijuta De is a junior doctor at Peerless Hospital and B.K. Roy Research Centre

The Biggest Test (Rs 1,500 per test) and is being used more Oath may seem like a tiny word, often as cases increase. It gives results in but it contains a universe of five to six hours. RT-PCR is more expen- expectations. To live up to the sive (Rs 4,500 per test) and can take up vows one swears allegiance to to 10 hours to provide accurate results. is a big challenge. Our leaders, Both tests are equally good. unfortunately, have failed to serve and protect the people of Positive to Negative India during the pandemic. I had weakness, chills at night and bouts I, however, hope I have of high fever—symptoms of COVID-19. remained honest to the Hippo- This escalated to breathlessness, chest cratic oath I had taken in August pain and anosmia (loss of smell). I tested 2017. In the past few months, I have positive on April 25. The hospital gave me a faced the biggest test as a doctor. separate room and the staff took good care of April-May will be engraved in my mem- me. Since no cure has been discovered, there is ories for the rest of my life. I treated not much one can do for a COVID-19 patient. Apart patients, tested positive for COVID-19 from the usual checks, I was on medicines as per the WHO and emerged from the disease a stronger protocol—Vitamin C, antibiotics, hydroxychloroquine and paracetamol. person. Within three days of testing neg- Since I had lost my sense of smell, I couldn’t taste food either. It was frustrat- ative, I was back in the COVID-19 ward at ing at times, but since I was a house physician, I could at least talk to the Calcutta’s Peerless Hospital. nurses. And thank god for my smartphone! It’s been a fortnight since I returned. I was still positive after two weeks, but I knew I would get well. Age was As patients with other diseases too on my side, so it was only a matter of time.. When I did not show any fresh come to the hospital, the COVID-19 symptoms for more than a week and my chest X-ray showed signs of section has been completely isolated. It improvement, I knew I was recovering. Finally, when I did not get a fever can be mentally damning to stay so for three consecutive days and my vitals were stable, I was allowed to go secluded. But that’s the nature of our home, but only on the condition that I would be quarantined for a week. work. As they say, it’s the new normal. It was relaxing as I was back in an intimate space and my parents and sister were around. On May 26, my result was negative. March Of The Virus From March onwards, we started get- Flatten The Fear Curve ting patients—both symptomatic and When I joined the hospital after four weeks of treatment and quarantine, asymptomatic. There was a paucity of I was not forced to join the COVID-19 ward—I made a conscious decision testing kits. One day, we admitted an to work there. As a doctor, it’s my commitment to serve humanity to the 86-year-old Bengali lady. She suffered best of my ability, without discriminating among patients. While people from Parkinson’s and was weak and do not stimgatise COVID-19 like they do tuberculosis, leprosy or sexually feverish—practically bed-ridden. We transmitted infections, there is still tremendous fear of the disease. didn’t test her for COVID-19 though. However, to treat a person with coronavirus as if they were untouchable Old people need a lot of attention and I, is unacceptable. Indeed, the curve is anything but flattening in India, but along with some nurses, looked after unless medical personnel eschew fear, we will not be able to stop the her fondly. Unfortunately, we could not spread of the disease. That motivated me to return to the isolation ward save her. Soon, I too started showing and work for people battling the virus. symptoms, as did a couple of nurses and However, to see people risking their lives being treated like outcastes was other staff attending to the lady. shameful. Fortunately, the attacks on health workers and nurses attached As far as testing is concerned, things to COVID-19 wards have stopped. Cases are rising though—we are getting have gotten better compared to the an average of five patients every day, quite a high number. Unlike before, initial days of the pandemic. Earlier, we are unable to trace the source of the infection. This shows that lockdown we relied on Chinese kits that some- rules have been thrown to the wind. With things unlikely to get better soon, times gave erroneous results. Now we we have to step up as a team. Right now, our commitment, willingness and have two types of kits—GeneXpert courage matter as much as our MBBS degrees. O and RT-PCR. The former is cheaper (As told to Soumitra Bose)

100 OUTLOOK | JUNE 22, 2020 ILLUSTRATION: SAAHIL