COVID 2.0: Large-scale vaccination, not shutdown

It has been eight months since she spent a few nightmarish days in a hospital, but Purnasneha Sundaramahalingam, a 25-yearold editor in Chennai, still cannot take three flights of stairs without feeling utterly exhausted. The workout sessions that kept her going in the initial months of the lockdown are a no-go because she knows it will leave her tired for the rest of the day. Sundaramahalingam first tested positive for Covid-19 in June 2020.Untitled Carousel 81727146“The four days I spent in hospital, I could feel my heart beat loudly. My blood pressure was up and I was wheezing… I would never wish it upon anyone,” she says. The symptoms did not leave even after she was discharged from the hospital. “It was very scary because I don’t have comorbidity issues, I’m fairly healthy,” says Sundaramahalingam, a survivor of long Covid, who had debilitating fatigue for months afterwards.Move to Gurgaon. Aman Saha (name changed on request), 40, lost his job during peak lockdown when the HR head of the garment export firm, where he was working, asked him to resign, citing the company’s mounting losses. When unlocking began and flights resumed, the first thing he did was vacate his rented accommodation in a posh society of the millennium city and fly back to his hometown, Kolkata, where he has a house of his own. 81726738During the last six months, Saha has taken up a few consultancy assignments, even as he is frantically looking for a stable job. It seems like a return of that harrowing time from a year-ago for Sundaramahalingam and Saha, who are staring at India’s rising Covid numbers with unease. A year after India went into a national lockdown, dubbed one of the most restrictive in the world, the country is anxiously watching the rising curve of Covid numbers, with new daily cases touching the highs seen in 2020.On Friday, India reported 62,336 new Covid-19 cases in the past 24 hours, the highest daily rise since October. Such a dramatic surge of Covid cases has set off alarm bells in Delhi’s corridors of power. This time, the government could change the dose of interventions from harsh to mild. After all, another round of national lockdown will derail the fledgling economic recovery. The migrant labourers are back at work, factories are whirring and the collection of goods and services (GST) tax, an indicator of consumption, has been impressive in the last six months with the January figure, at Rs 1.2 lakh crore, rising to an all-time high. At this stage, the central government does not appear to be in favour of haphazard local shutdowns or night curfews even though states such as Maharashtra and Madhya Pradesh have of late resorted to such hasty measures. The Centre’s blueprint, according to officers in the know, has five key components — systematic testing, containment and surveillance, clinical care, Covid-appropriate behaviour and, above all, a massive vaccination drive to combat the virus, thereby bypassing a stringent measure like lockdown. Elaborating on each of these components, NITI Aayog member and chairman of the government’s empowered group on Covid management, Dr Vinod K Paul, tells ET Magazine that the solution lies in delivering a combination of all these tools. “If all the available tools are used effectively, there should be very little need for more stringent measures such as a lockdown,” he says, adding that the government is banking on a possible uptick in the supply of vaccines. “Once approval is given, Sputnik V vaccine will be made in India, possibly by as many as five manufacturers. That is one clear reason for increased supply,” says Paul. Currently, two vaccines, Serum Institute of India’s Covishield and Bharat Biotech’s Covaxin, are being administered million doses were administered domestically, with another 60 million getting exported to 77 nations. The government’s decision this week to allow people above the age of 45 years to get the jab was mostly driven by two factors. One, 88% of all Covid-related deaths in India were in the 45 years-plus category, and two, the government expects that more vaccine candidates will get approval soon in India. In addition to Russia’s Sputnik V, Bharat Biotech’s nasal vaccine and Cadila Zydus’ vaccine are at the threshold of getting approved. Clearly, in terms of Covid management, large-scale vaccination, not lockdown, appears to be the new mantra. “When risks are unknown, it is better to overreact and impose a lockdown. 81726742 A year ago that was precisely done. Now we know much more about the pandemic, fear is less and management strategies are much more clearer,” says Shailesh Pathak, chief executive officer of L&T Infrastructure Development Projects, adding that both the Indian economy and his company have shown great resilience, as the bounce-back is much better than what most people have expected. Dr Jayaprakash Muliyil, chairperson of the scientific advisory committee of the National Institute of Epidemiology, cautions against the reimposition of lockdowns as a means to curb the spread of the virus. 81726756 “I think wearing a mask is sufficient. Lockdowns make it convenient for officials to throw their weight around. It’s a bad habit, it’s undemocratic and it’s not needed. There’s no reason anyone should go into lockdown.” Meanwhile, the Madhya Pradesh government has extended its Sunday lockdown to four more cities — Betul, Chhindwara, Ratlam and Khargone — taking the total cities under lockdown in the state to seven. Since early this month, Bhopal, Indore and Jabalpur have been under lockdown. “There seems to be a change in the behaviour of the virus — those who are staying at home are getting more infected, compared with earlier. The young are also getting infected but certainly mortality is not as high it was earlier,” says Dr Salil Bhargava, professor of respiratory medicine at MGM Medical College, Indore, the first Covid hospital in Madhya Pradesh. But what is helpful this time around, he says, is that there is no shortage of healthcare staff. “The health care system is able to function without being over-burdened as many are vaccinated and well-trained. Also, only those who really need it are being hospitalised.” Maharashtra CM has announced a night curfew from March 28. Last month, a lockdown was announced in Amravati and Achalpur. However, all such restrictive-yet-porous interventions can’t help much in curbing the spread of the virus. These measures end up disrupting supply chains and stalling the regular flow of businesses. These will also create new problems for enterprises that source raw materials from multiple centres and have markets across several states and cities. Harsh Goenka, chairman of RPG Enterprises, recalls that during peak lockdown last year, he had to look into several areas where things could go wrong due to cascading effect. “There were many ‘what if’ questions that needed addressing. What if Covid restrictions affected an entire production line? What if demand fell by 25%? What if our SME suppliers couldn’t supply the raw material? What if state borders were closed for goods transport? What if collections dropped by 50%? What if utilities were starved of fuel? The scenarios were endless,” he says. While there is near-unanimity that stringent measures would jeopardise the livelihood of millions of Indians, experts and policymakers are also concerned about the galloping number of Covid cases. “The pace at which cases are increasing is what is really troubling and I would have been happier if numbers had stayed at about 10,000 daily new cases in India, which is where we seemed to have been stuck at for a few weeks,” says Gautam Menon, professor at Ashoka University’s department of physics and biology, who has been closely tracking Covid numbers. Added to this, he says, is the fact that the increase is no longer confined to one or two states. “That we are seeing a big jump in Covid cases in states and cities that have better surveillance on average even as states that neighbour them are not reporting significant increases is worrying.” Dr K Srinath Reddy, president, Public Health Foundation of India, ascribes this rise partly to the complacency that followed the steady fall in the number of cases and deaths during the last three months. “Public health precautions were being abandoned in terms of both personal behaviour and administrative controls. The virus always spreads much more in areas with more economic development, greater urbanisation and a lot of mobility and travel — it has a great opportunity (to spread), as we are seeing in Maharashtra.” Doctors from Mumbai, he says, are reporting that the virus seems to be spreading faster but with less symptoms. “This is not surprising because when the virus has infected a large number of people who are susceptible and the others are taking precautions or have been vaccinated, the virus adapts to spread faster but with less virulence, to sustain its species without exhausting the host species,” he says. 81726769Dr Muliyil of the National Institute of Epidemiology points out that practically every country has been facing this kind of double or triple peak. For a country of India’s size, the seroprevalence, according to surveys done by the Indian Council of Medical Research (ICMR), was not that high. “We expected seroprevalence in urban areas to be 60% and in rural areas to be 40%, which would give us adequate immunity to prevent big outbreaks. We never reached that.”Lockdown: A FLASHBACKWe decided we would not lay off people or cut salaries: Harsh Goenka, Chairman, RPG Enterprises, Age: 63 years l Location: Mumbai 81728147The pandemic descended all too sudden and no one was prepared for the immediate implications. The lockdown which followed soon after brought everything to a standstill. We had to quickly reorient and focus on our priorities. The first and foremost priority was self-protection and the safety of those around us. After people settled down in the safety of their homes and reorganised their daily patterns, we shifted focus to business continuity. This was a critical step that would decide the fate of our businesses over the next year and more. The third and equally important step was about our responsibilities to society in general and to the communities we serve. This three-pronged response has been the key to our navigating the pandemic. We had decided that we would not lay off people or cut salaries. On the contrary, we gave increments in the early part of this year. There was mayhem in the job market with job losses and salary cuts — and the media was full of stories of distress. We had lived through many crises in the past and we trusted our instincts that if our people were comforted and secure, they would find a way through all this. For mental well-being, we started counselling sessions for our people, and for physical fitness we had our chief fitness officer providing online daily workouts and tips. Many outreach programmes were started to engage with the families and these group sessions proved to be excellent emotional support to many.We realised early on that we had to variabilise our costs to the best extent. Task forces were put into action and we set ourselves ambitious targets on cost. Some costs, like travel and consumables, got reduced automatically while some others which were non-essential were cut. We delayered the organisation, brought in better spans of control and improved overall efficiencies. We went back to basics with zero base budgeting and strict monitoring. What we didn’t cut were spends on innovation, marketing, R&D and hiring talent. Over the past few years, we had already invested in augmenting our digital capabilities across the spectrum of the organization — from digital labs to showcasing remote project progress to clients via tech tools, hot-desking in offices and factories and a work from anywhere (WFA) policy. Despite the pandemic there has been no drop in productivity or output and it reposes my faith in people. We announced India’s first permanent WFA policy, which will be effective even after the pandemic is gone. I am humbled to say that we bagged India’s most coveted innovation award, the ET Innovation Award for 2020, during this most difficult period which is a testimony to our reliance on innovation during these times.We classified scenarios into pessimistic, realistic and optimistic. Supply chain and logistics were the main hurdles which needed innovative solutions. Besides, there were several areas where things could go wrong due to the cascading effect. There were many “what if” questions that needed addressing. What if Covid restrictions affected an entire production line? What if demand fell by 25%? What if our SME suppliers couldn’t supply the raw material? What if state borders were closed for goods transport? What if collections dropped by 50%? What if utilities were starved of fuel? The scenarios were endless. I would say my biggest learning from the pandemic has been how resilient the human spirit is and how at a time like this our social conscience comes to the fore and we are willing to make great sacrifices in order to alleviate the suffering of others.————————————————————————————What moved me a lot was the gratitude of my patients: Dr Bornali Datta, Director, respiratory medicine, Medanta Age: 48 l Location: Delhi-NCR 81728168When the lockdown began in March, we doctors continued to go to the hospital every day but patients weren’t coming unless there was an emergency. I had never seen the hospital so deserted — it felt like a ghost town. There was an overwhelming sense of apprehension about what turn things would take. Covid-19 patients started coming in around April and with cases surging in May, five-six floors of the hospital were dedicated to Covid. At that time, no one knew what to expect, what worked. There was zero evidence for any medication. Remdesivir, developed for Ebola, began to be used for Covid. Then in mid-June, both my husband and I got Covid. Thankfully, my symptoms were mild but after a week, my husband, also a doctor, began developing more symptoms and had to be admitted. These days I can confidently reassure my patients that they will get better because the vast majority do well but, back then, we didn’t know that. He got better after five days, but it was a harrowing experience. After I rejoined, it was the busiest time in my entire career. We were working seven days a week, our phones were on all the time. It was an extremely difficult time because the patient was alone and isolated, the family was stressed out. But all the doctors and nurses in my team just worked and worked. I felt privileged to be able to give that service and be part of that fraternity. Now, after a slump of three months, cases are on the rise again. But now that we understand the virus better, our fears have reduced. Ultimately, we have to co-exist with the infection, with adequate medicines and vaccines.In the last one year, we all went through a lot of emotional upheaval. What moved me a lot was the gratitude of patients, even after I had told them I was just doing my job. One particular incident stands out: There was a young man who had got admitted with Covid just after cremating his father. You can imagine his mental state. Fortunately, he recovered completely. When he came for his final follow-up, he said he had been told doctors don’t like to touch patients. But the fact that I had put my hand on his shoulder made him feel he could cope. It was such a little thing but it meant so much to him. It emphasised the core of what medicine is about — doctors taking care of patients.—————————————————————————————-As I reach home, my two-year-old coos out, ‘Amma… Sanitiser: Dr Divya S Iyer,Kerala State Mission Director, MGNREGS Age: 36 l Location: Thiruvananthapuram 81728170I remember writing an essay on “The Importance of Hand Washing”, paying an ode to the practice exhorted by the Hungarian physician Ignaz Semmelweis in the 19th century. It was an essay-writing competition at the Christian Medical College, Vellore, where I was a medical student, way back in 2004. There is no denying that I was over the moon when I became a prize-winner then. But 15 years later, to witness the results of putting it into practice in public health, has been more than heartening; it catapults itself into being one of the most remarkable experiences in my career. When the Covid-19 pandemic was still in its nascent stage, the state of Kerala sprang into action with a multipronged strategy to rein in the beast, the most notable being the Break the Chain campaign that was set in motion much before the mandate on wearing masks and social distancing came into being. As the State Mission Director of the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), I remember visiting worksites, promoting proper hand-washing techniques, and nudging the 20 lakh-strong workforce to be the messengers of hygiene in their communities. That 90% of our beneficiaries are women definitely helped us in getting families onboard to act as the fundamental unit of awareness creation. I remember receiving phone calls from citizens in those early days of the pandemic, seeking advice on precautionary measures. I believe that it is this heightened state of health-seeking behaviour among our citizens that enabled the state of Kerala to withstand the onslaught of Covid-19 infections, owing to its large NRI population and high population density, which make it a highly vulnerable state. Yet, it was interesting to note that mortality and morbidity due to other communicable diseases have significantly come down during the pandemic year — the silver lining of which being the reinvention of self-hygiene for mankind. The days I served as the commanding officer for Covid operations in the field witnessed my shielded presence in containment zones alternating with a sanitised presence at home, which included my baby, who was one-year-old then, and aged parents. The climax of the year was a particularly challenging period when I tested Covid-positive, and was under quarantine with my son who quickly adapted to the fact that his mother had to mask up and glove up in order to breastfeed him. Even today, as I get back home, my two-year-old fondly looks out for me with eager eyes and coos out loud, “Amma… sanitiser.” We have indeed successfully raised a generation that is more hygieneconscious than any of the previous generations, albeit with a heavy price to have paid for that.Writer is an IAS officer. Views are personal——————————————————————————————–Pandemic helped me beat my fears & work on my strengths: Nitasha Nayak,Teacher, Global Public School l Age: 43 l Location: Kochi 817281852020 was paradoxical in a way — we faced a global pandemic and a recession, but it was also the year that gave some of us time to reboot and relive our lives. When the lockdown began, it was hard to adjust to the very idea of being cloistered in our homes even though the announcement was expected. With zero social interaction, I felt anxious and restless. To cut down on the anxiety and boredom, we started binge-eating and binge-watching! By May last year, the home front was under control but there were apprehensions and unpredictability regarding work. With Covid cases at its peak, the probability of schools opening in June was remote. Online teaching was a completely new zone for all of us. The question — what if I am not capable of catering to the needs of my pupils — always hovered above me. I am truly grateful to my school for guiding me and the rest of my clan every step of the way. Everything was meticulously planned by the core team and several online workshops were arranged for all the teachers. To let go of the comforts of teaching in a classroom and tread on the online education platform was a battle that needed faith, determination and perseverance.And thus began my new life in 2020! It took me sometime to strike a balance between managing work at school and work at home. I can proudly say that the pandemic taught me to be more responsible and disciplined. One of the most positive things was meeting our pupils. Their love and happiness were a real morale booster. It was amazing to see children adapt so quickly to the online mode. From being their favourite in school, now our roles had changed to being a part of their family. Reopening of schools in June is uncertain but now I am confident of taking on whatever comes my way, thanks to the nearly year-long training and experience. This pandemic helped me overcome my fears, keep aside my anxieties and work on my strengths. It taught me to be grateful for all the little things in life, to have faith and work harder than usual to achieve my goals.

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