By Dr Vimal Krishnan
The new coronavirus outbreak will surely leave an indelible mark on world history. The outbreak has resulted in destruction unmatched in scale and impact since World War II. The next decade will be known as the post-Covid period, mainly because of the effort and resources needed to rebuild the world. Different nations are fighting Covid-19 with different strategies suited to their specific conditions. But unlike the Wuhan-400 virus outbreak narrated by Dean Koontz in his 1981 thriller The Eyes of Darkness, the coronavirus disease will have a unifying effect on the world.
At the time of publication of this article, the outbreak has resulted in 1,19,666 deaths and there are more than 1.92 million confirmed cases globally. The global response to the pandemic differs from nation to nation as there cannot be one strategy suitable to all populations. Even within countries, one could see this variance in approach. India is at the fag end of the three-week Covid-19 lockdown announced by the Union government. There is a strong demand to lift the lockdown in the various states. Health being a state subject in India, the terms of the lockdown have been dictated by the state governments with additional directives from the Centre.
Kerala was one of the first states to release a document (April 6, 2020) on the coronavirus lockdown reversal strategy followed by Karnataka which released a Phased Exit Strategy report. The central government is also planning for a phased removal of the lockdown. There is no clarity on whether an exit strategy for one state can be extrapolated nationally. Kerala was the first state to come up with a measured strategy. The document is the result of several brainstorming sessions and efforts of a group of goal-oriented individuals striving to come up with an optimal plan. The same can be said of the strategy report from Karnataka.
There are multiple confounders at various levels that complicate the situation. The sieving of zones probably is based on inadequate data. The testing strategies adopted by various states are different. There are some states that aggressively test, trace, isolate and treat. There are others which were in limbo and started testing clusters from a sentinel event that happened in Delhi. Such states suddenly had a surge in numbers that shook the administrations out of inaction.
Kerala has tested around 319 people per million population which is 3.36 times the national average of 95ppm. Tamil Nadu is on the other side of the spectrum with 74ppm, but the numbers will significantly improve over the next week as the state is out of limbo now. Population density is another variable that poses a challenge. The diversity in the geography of each state would also confound the implementation of the testing strategy. The costing plan or the health economics is another confounder that needs mention here. The allocated budgets for the current crisis from the state and central governments vary. This would impact the strategies for testing, tracing, treating and mass isolation plans. Kerala’s response seems to be working well as the state has a casualty rate of 0.54% against the global average of 5.9%. But the state’s response cannot replicate in others because of the specific situations prevailing in other states.
Challenges are mounting in the global struggle against the new coronavirus outbreak. Reports of multiple strains of Covid-19 have emerged from around the world. New reports from South Korea say 91 patients cleared of the new corona virus have tested positive again. The introduction of rapid testing kits which may not pick up cases in the first few days of infection has also led to complications. The false negatives associated with the current testing strategies also pose a significant risk to the plans for a phased lifting of the lockdown. The policy makers will have to collaborate with multiple stakeholders to wade through these murky waters to create tailored plans for states under broad central guidelines.
Like politics, pandemics also make strange bedfellows – the US is getting help from Vietnam, Russia and China. Cuba is sending medical workers and drugs to several European and Latin American countries. The coronavirus outbreak has shaken humanity like never before, making it cherish the ideals of unity, synchrony and harmony once again. Survival hinges on everyone playing their part. This war is unique — there is just one enemy and everyone is a hero.
(Dr Vimal Krishnan is an Associate Professor in emergency medicine at Kasturba Medical College, Manipal.)