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Monday, July 13, 2020

Of Herd Immunity, Plasma Therapy, Vaccines And Drugs For COVID-19!

In view of the worrying surge of SARS-CoV-2 (COVID-19 or the new Coronavirus) the world over with the worst affected country USA having a second wave and in India, Brazil and others the infections going unabated desperation for treatment measures is growing all the time. Besides, the World Health Organization (WHO) has been consistently maintaining that possibility of having a vaccine is at least one and half years away. The WHO has also maintained that there is no proven cure for COVID-19 so far. The basic reason that justifies such kind of desperation is that this virus is far more dangerous than the recent viruses, its mortality rate almost 10 times higher than those. The virus has caused havoc on planet Earth before the humans came to understand and know much about it. Therefore, various issues concerning herd immunity, plasma therapy, development of vaccines and use of repurposed drugs are being discussed and experimented continuously all over the globe.

The term ‘herd immunity’ basically means that if most part of the population becomes immune to a particular infectious disease then they will get indirect protection than those who are not immune to it. For example, if 80% of the population gets immunity then four out of five people won’t get sick despite coming into contact with infected people. At least 70 to 90% immunity will be required for effective herd immunity that can keep the virus under control. The problems come when talking about how to achieve this herd immunity. There are two ways of achieving herd immunity: with precautions and social norms not being followed strictly a large portion of the population is likely to get infected and if it is at least 70%, the population can get herd immunity, and secondly, simply through the development of a vaccine. In the first case the cost of a large number of people getting infected will be very heavy and high in terms of loss of lives. In India and other populous countries large chunks of population are susceptible or exposed to the virus, and to achieve herd immunity through the first way is not advisable at all. Therefore, the only way to achieve this would be through a developed vaccine, and till it is ready for mass use the infections must be kept under control by enforcing strict social distancing and other norms.

Plasma Therapy has been emerging as a very positive development for treating serious COVID-19 patients where the blood plasma is collected from recovered Coronavirus patients is injected into them and the anti-bodies contained in that helps curing them. In India, this therapy is being practiced with good results; plasma banks are being established in Delhi, Haryana and Maharashtra among others with requests to recovered patients to donate plasma. In fact, the Health Minister of Delhi who got seriously ill with COVID-19 recovered finally with this therapy.

The WHO has stipulated very stringent procedures for development of COVID Vaccines: the produced vaccine has to go through three rigorous phases of clinical trials with increasing numbers of human volunteers given doses before being declared safe for use which would take several months apart from the months needed for mass manufacture and distribution. At the moment there are around 100 vaccine candidates the world over including seven firms in India with a few of them already approved for clinical human trials: the Oxford vaccine developed in the United Kingdom currently in the third phase of trial; CureVac from Germany approved for clinical trials; a Russian COVID vaccine claims to have successfully completed the three phases of human trial and now ready for mass production and at least two vaccines on trials in India with the first-ever Indian vaccine candidate Covaxin by Bharat Biotech getting approval from the Drug Controller General of India (DCGI) for human trials. In fact, the Indian Council of Medical Research (ICMR), the apex medical body, created a controversy recently by directing the stakeholders to fast-track Covaxin making it ready for mass use by 15th of August 2020 which was promptly rebuffed by the Government of India. It is to be emphasized here that even if a vaccine is finally approved for mass use its effectiveness will still be under scanner, because every vaccine mutates often and so, there is no guarantee that a vaccinated person won’t get COVID-19 in possibly a year or more.  

As an integral part of the desperate search for COVID cures or treatments various repurposed drugs have been tried continuously for treating the SARS-CoV-2 virus. Hydroxychloroquine, a drug used successfully for treatment of malaria in India, was first tried on the infected medical fraternity leading to a spree of exports by India on demand from various countries including the US. However, finally, the WHO has discontinued its trials in July 2020 for reasons of side effects and safety. Antiviral drug Favipiravir, originally produced in Japan to fight influenza, under the name of Fabiflu distributed by Glenmark Pharma was officially approved in June 2020 to treat mild to moderate Corona patients in several countries. However, its side effects are under scanner and the DCGI has only approved emergency use with prescriptions.

The WHO has been very hopeful on the efficacy of a corticosteroid called Dexamethasone as a life-saving medicine for critically ill Corona patients based on the clinical trial in the United Kingdom. Since Dexamethasone is basically an anti-inflammatory drug its use is only to cut mortality rates in patients requiring oxygen or ventilator support. Another antiviral drug, Remdesivir (Covifor) produced by Gilead Sciences is so far the only accepted medicine for treatment of COVID-19 given approval by the Food and Drug Administration (FDA), and recently distributed in India too that led to a craze with reported black marketing. However, this medicine not for public purchase in chemists, and only for supply to hospitals for doctors to prescribe under discretion for serious COVID patients. Its overall safety is yet to be proved though.

Desperate times call for desperate measures. And the quest for a possible cure for the killer virus goes on. In the meantime, humankind must adapt to the new normal following stringent social distancing norms and other precautions, for at least a year more, hopefully.

Saturday, July 11, 2020

India Fights COVID19: The Surging Numbers & Lockdowns Galore!

Similar to the three formats in the game of cricket Lockdowns in India are also under transformation from traditionally longer duration to shorter and the shortest. Various terms are coming up with the local necessities brought on by the surging new cases of COVID19: Sunday lockdowns, mini lockdowns like the week-end ones, 7-10 days lockdowns and the longest ones mostly at national level. The national lockdown since 25th March is still in force in all containment zones till at least 31st July. Lockdowns of different formats are under enforcement at the moment in more than 11 states of the country including various parts/districts of Maharashtra, Tamil Nadu, Assam, Karnataka, Telengana, West Bengal, Uttar Pradesh and others. In the last twenty-four hours new cases in India were more than 27000 with Maharashtra, Tamil Nadu, Delhi, Karnataka, West Bengal and Assam registering the highest spikes. The peak of COVID19 in India is somewhat eluding still and the reasons for this we can guess as we go on with this piece.

The worst affected countries of Europe, although started lockdowns late, enforced the strictest lockdowns till the peak was reached and the numbers started declining; no relaxations were given during the period except for essentials. But India, although lockdown was imposed early, was bent upon giving relaxations from the second lockdown onward in view of economic or livelihood considerations and this strategy is basically responsible for the delayed peak which should have been reached at least in Delhi, Mumbai and Chennai by now. Further, new guidelines for doing more and more tests including rapid antigen tests and even door-door tests in some parts are also contributing to this. We had mentioned such points in our earlier pieces. Now, let us consider how much success has been achieved for livelihoods and economic momentum so far.

With trains, buses and planes operating, e-commerce of both essentials and non-essentials brightening up and factories/industries/private offices/markets/malls reopening in various parts of the country the economy was steadily easing with people returning to work following the precautions and advisories. However, the continuing spikes breaching the 20-thousand mark, 25-thousand mark in the last few days frightened many of the state governments leading to the enforcement of lockdown of different formats, and this unpredictable policy is disrupting the livelihood activities and the smooth flow of the easing-up economy. For example, factories/industries/private offices under smooth operation have suddenly to adapt to the new directions resulting in less attendance and disruption. In Thane, adjacent to Mumbai, the municipal corporation suddenly imposed total lockdown for ten days which again got extended till 19th July in view of heavy spike in new cases, and this decision has led to disruptions of various types: e-commerce of non-essentials that was almost normalized got stopped again; shops and markets coming back to a new-normal have to close shutters again and all sorts of public/private transport services in a very uncertain state. Naturally, such disruptions do not remain restricted only to the affected locality due to the interlinks of businesses, operations, activities and transportation.

With an eluding peak uncertainty is increasing. Unemployment is on the rise worryingly, small shopkeepers and vendors going back to their villages due to uncertain work opportunities, the scare of further retrenchment and sacks growing in various sectors like the hospitality, the film/entertainment industry, e-commerce, private firms and business/marketing establishments, transport services and the media—particularly in the print media. Besides, other stakeholders like small shopkeepers, tea and snack vendors, the laundry, newspaper agents, the barber shops etc. are yet to be back in business in most areas due to the national lockdown, pointing towards a bleak future. Therefore, unfortunately, the lock-down-strategy adopted by India is not paying the expected dividends to the desired extent in both fields—containment of the virus and boosting livelihoods and economy.

However, hope is not running out. The scare of rising numbers is somewhat neutralized by a very healthy recovery rate which is now more than 62%, in Delhi it has crossed 70% mark. Out of a little more than 8,20,000 total infections in India at the moment more than 5,00,000 have already recovered leaving around 3,00,000 active cases, and this number is not very imposing for the enhanced healthcare infrastructure of the country except for some states like West Bengal and Assam. Further, the death rate is also coming down to around 2.7% from about 3.1% a few days ago. Therefore, when the peaks are reached, hopefully within a month, in various parts at various times the country should still be able to defeat the virus spread and slowly return to a new normal state of affairs. 

Friday, July 10, 2020

India: A Notorious Gangster Eliminated And Doubting Thomases!

It has been observed throughout the world at various times that when a criminal kills a cop the case assumes an altogether different dimension, and the elimination of the said criminal becomes a priority—by any means. Whatever connections or clout the criminal might be having with politicians or influential persons or even the police become secondary, irrespective of the elections the criminal might have fought and won with tickets of whatever political party. In the case of Vikas Dubey, a notorious criminal of Uttar Pradesh in India since the early nineties, as many as eight cops were killed on the 3rd of July 2020 when a police party went to arrest him in Kanpur, and the police party was reportedly ambushed by Dubey’s goons, supposedly on a tip-off from inside the police, resulting in the brutal killings of eight policemen including a DSP (Dy. Superintendent of Police). The fate of the gangster was sealed then and there, and his elimination was only a matter of time.

The first crime against Vikas Dubey or Vikas Pandit was registered in the early 90s and over the decades more than 60 criminal cases were registered including murders, particularly of a minister of state in 2001. Several times he got arrested during the period up to 2017, but due to his political connections he got acquitted all the time. Yet, he remained a most wanted criminal in the state.

Now, it is a common fact in India that every political party in existence here is used to maintain private armies consisting of goons on direct payroll for the dirty work like arm-twisting rival businessmen or rival political leaders or garnering votes by intimidation during elections. Every locality, particularly crucial ones, of the northern states of the country has a ‘Bahubali’ (Strongman) who reigns in the area like a parallel government. Such Bahubalis are recruited by various political parties and at times, through negotiations areas get assigned to a particular strongman of a particular political party. They even have moles in the state police forces. The point being made here is that the allegation of a political nexus of a criminal cannot be made only against a particular political party, because in the case of Dubey he had been enjoying political patronage of various ruling parties over the decades. A huge quantity of movies and television films have been made on this ‘Bahubali nexus’, and we have to admit that some reality has to be there to justify so many reel-works including a few artistically serious projects.

After the July 3rd escape Vikas Dubey roamed free for six days traveling through four states and finally landing up in Madhya Pradesh. On the morning of 9th July 2020, the dreaded gangster visited a most famous temple of the city of Ujjain to offer prayers. A shopkeeper selling flowers recognized him and tipped off the temple security. On interrogation by temple security men the criminal became violent following which the security called the police. The police came immediately and marched him off to the local station, and in the afternoon handed him over to Uttar Pradesh police. There had been allegations by opposition political parties and the media of a ruling party nexus that created an intelligence failure and allowed the criminal travel undetected. However, in view of his links with various political parties and his ‘friends’ even in the state police force we cannot be too sure on the veracity of such allegations.

The doubting Thomases became berserk. Although the media had been criticizing the government relentlessly over the six-day ‘intelligence failure’ this action, supposedly a success, did not get any thumbs-up from them, but only created more doubts for them: had this been a ‘staged arrest’ or a ‘meek surrender’! Debates raged over this throughout that day and night. Nobody seemed to remember that the criminal killed eight cops, and that after that why would he surrender only to get encountered!

As was inevitable, early morning on the 10th of July 2020, the dreaded gangster was killed in an encounter while he was transported to Kanpur in a police convoy. The police gave their version of having to kill him since he managed to snatch a gun from one of the policemen and tried to fire at them trying to escape. The doubting Thomases in the opposition political parties and the media again became berserk criticizing the police for a ‘staged encounter’ or an extra-judicial killing. From a logical point of view the opposition has no business to criticize another political party because of the simple reason that Vikas Dubey enjoyed political patronage from almost all the parties considering his ‘career’ over the decades. That the society has been freed from a dangerous criminal failed to get any attention from them. Of course, it is not considerate or even safe to support extra-judicial killings in a democracy; but exceptions must be considered in view of the circumstances like those brutal killer-rapists eliminated in a similar fashion in Hyderabad in 2019.

Ideally, we feel criminal-politician-police nexus must end as soon as possible. However, it is highly unrealistic to expect any change in the time-tested doctrines and ways of the largest democracy of the world in near future. Influence, clout and corruption go hand in hand in a democracy like India. Even the biggest ever crisis faced by humanity, the COVID-19 pandemic, has not yet been capable of uniting the country in its fight against the killer virus. Here too, tragically, the doubting Thomases are seeing a ‘scam sold to the world by the Chinese’ conspiracy angle! And, whenever elections are around everything falls into a set pattern, unfortunately, generating more redundant debates. 

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