Editorials - 19-05-2021

States, especially in the north, are facing the brunt of the second wave, made worse by their poor health infrastructure

When the first wave of the novel coronavirus pandemic hit the country, the central government imposed the strictest lockdown for almost two months. For most of the migrants stuck in urban areas without incomes, jobs and food to survive, the only escape was to walk back to the rural areas where they came from. Migrants walked back thousands of kilometres to return to rural areas not because the villages were best equipped to deal with the pandemic but primarily because it provided them protectionfrom hunger and starvation. During the second wave now, it is the rural areas which are bearing the brunt of the pandemic with most cases being reported from rural areas. And, unlike last time, there is nowhere to go.

Estimates versus the reality

The second wave was expected at least based on past experience of other countries and of earlier pandemics but also because most scientists predicted it given the changing nature of the virus and the pandemic. However, unlike the last time when it was largely in urban areas, this time it has spread to villages. Also, in contrast to the previous episode, it has spread this time to the rural areas in Bihar, Uttar Pradesh, West Bengal, Jharkhand and Odisha — States which remained largely unaffected by the spread of the pandemic during the first wave. Most of these States are those with a low availability of health professionals and a lower level of health infrastructure. The result has been a much higher level of infections and deaths. Stories of bodies floating in rivers or left buried on the banks are being reported from both Uttar Pradesh and Bihar. While these are stark visuals of the nature of impact that the pandemic has caused on infections and deaths resulting from the infections, these are all estimates; gross underestimates of the actual reality in the rural areas in many of these States.

Neglect of primary care

The scale of the misery inflicted by the pandemic was expected in most of these States, where the existing health infrastructure has been found lacking. But what made it worse was also complete apathy and a lack of governance in improving the health infrastructure despite knowledge of the second wave of the epidemic.

As in the latest report of the Rural Health Statistics 2019-20 (https://bit.ly/3hAKHNC) released by the Ministry of Health and Family Welfare (MOHFW), not only are these States which figure among the States with the worst health infrastructure but are also ones where the situation has worsened over the years. Compared to 10,337 functioning subcentres in rural Bihar in 2005, only 9,112 subcentres were functioning in 2020. The number of community health centres declined during the same period from 101 in 2005 to only 57 in 2020. Despite population growth, during the same period, the number of primary health care centres increased marginally to 1,702 in 2020 compared to 1,648 in 2005.

The situation in Uttar Pradesh, another large State, is no different with the number of primary health centres declining from 3,660 in 2005 to 2,880 in 2020. While the number of community health centres increased from 386 to 711 during the same period, sub-centres increased only marginally, from 20,521 in 2005 to 20,778 in 2020. The situation with regard to the availability of health professionals is not very different, with most States witnessing a worsening situation. For example, only 29% of specialists were in place in the community health centres in Uttar Pradesh as against the requirement based on official norms. Compared to the norm, Bihar reported the highest shortfall in availability of subcentres, at 58%, followed by Jharkhand, at 44%, and Uttar Pradesh, at 41%, as on July 1, 2020. Similar numbers in the case of primary health care centres were 73% for Jharkhand, 58% for West Bengal, 53% for Bihar and 51% for Uttar Pradesh.

Avoidable events

Given the state of the rural health infrastructure, it was obvious that the pandemic would lead to catastrophic outcomes once the rural population was exposed to the virus. The lack of governance in this case is not the state of health infrastructure that the State governments inherited but the failure to contain the spread of the pandemic despite the knowledge of the state of rural health infrastructure. This failure to estimate the scale of the havoc created by the pandemic was obvious in the case of the central government — steps were not taken to contain the spread along with augmenting the rural health infrastructure and there were decisions such as prolonged electioneering in some of the States. West Bengal, which has seen the fastest rise in cases, was witness to the longest period of electioneering this time, with no precautions such as social distancing in place. Similar adventurism in the case of Uttar Pradesh saw hundreds of polling officials getting infected and passing away due to the pandemic during the conduct of local body elections in the State. The Maha Kumbh organised in the middle of the pandemic, with millions of devotees participating, further added to the spread of the infection with devotees returning to rural areas in different States. All of these were eminently avoidable, with the resources used to augment and strengthen the rural health infrastructure.

Judiciary and the state

While all these created the perfect breeding ground for the pandemic to spread to rural areas, the severity of the infections was also a result of the misgovernance of State governments. This bordered on ignorance of the level of severity to outright denial and complete apathy of the health and humanitarian crisis unfolding in the respective States. In most cases, the judiciary at the level of High Courts has stepped in to fill the vacuum created by an absent state. The judicial intervention of the Allahabad High Court last month directing the State government to impose lockdowns in Uttar Pradesh was in turn challenged by the State government in the Supreme Court. Attempts to voice concern over the state of health infrastructure and the spread of the pandemic by helpless citizens was countered with threats of legal action by the Uttar Pradesh government until the Supreme Court stepped in.

Instead of expanding testing and contact tracing, attempts were made to restrict testing and report a lower number of infections, leading to a sense of complacency within the State administration. The reality in rural areas of most of these States is worse than what is being released to the public through official estimates. This is true for the number of deaths which by all measures appears to be much higher than official statistics. The absence of testing and treatment infrastructure has left the rural population at the mercy of private health providers; a large majority of the population has been left unable to avail the services of private health-care providers. The slow pace of vaccinations in rural areas despite the vulnerabilities has only contributed to the rise in infections and thousands of deaths which could have been easily prevented.

Aggravating rural distress

Rural areas provided refuge to the majority of the migrant population which had lost jobs and incomes during the first phase. It also helped the economy revive given that rural areas were largely unaffected. However, this time round it is the rural areas which are facing the worst of the pandemic as well as economic distress. Rural wage data as well as data on rural non-farm income available from official and private surveys point to a dismal economic scenario. While many have lost their primaryincome earner, even for those who managed to recover, it has come at the cost of huge private health expenditure. Many are likely to fall into a debt trap with the usurious rate of interest from the private money lenders pushing them into chronic poverty. For the rest, the loss of jobs and income has come at the cost of depleted savings. Rural areas are not just staring at the worst of the pandemic but also at prolonged economic distress.

While the pandemic with its uncertain nature is certainly responsible for it, the blame must equally lie with the government, both at the State as well as central levels, for its failure to anticipate and prevent the thousands of deaths.

Himanshu teaches Economics at Jawaharlal Nehru University

India needs to enhance the surveillance system, vaccinate quickly, and reprioritise healthcare services

The failure to plan and prepare for multiple waves of COVID-19 in India has resulted in the despair and helplessness we are seeing today. Since more waves are expected, what lessons can we learn from the present in order to plan for the long term? This article speaks of the challenges and the road ahead.

Surveillance strategy

First, while it is easy to blame modellers for failing to predict waves, the reason why they are not able to do so is that clear data are unavailable. There is unreliable testing and under-reporting of cases and deaths even now. This does not instil confidence in any of the modellers to come up with realistic estimates. Under-reporting and manipulated data inputs can only provide faulty projections. The Central and State government should use real-time data by encouraging reliable reporting and initiating standardised definitions. This is the time to have a standardised definition of how many cases are expected per million population. Instead of admiring the efforts of administrations in the areas that have fewer cases, efforts should be made to detect the minimum number of cases, to instil confidence in people that the surveillance system works in the state. This can only be done through the syndromic approach of identifying suspect cases and through a reliable testing strategy which does not change when there is a surge in cases.

The COVID-19 trajectory in other countries shows that there will be multiple waves in India. In Japan, the health system is crumbling during the fourth wave. Identifying impending waves is very important in mitigating a catastrophe. India missed building containment and mitigation measures while Maharashtra was seeing a surge in cases during the second wave. This lesson should be incorporated into plans for future waves. A strong surveillance system reporting the minimum number of cases will thus provide reliable early markers of an impending wave. Review mechanisms should be strengthened to detect the outbreak in the initial stages and extinguish it before the pandemic spreads to other areas.

Concurrent genomic sequencing in real-time in the fixed proportion of samples will give us an idea of the likelihood of the variants causing several outbreaks. If the outbreaks in Kerala, Punjab, and Maharashtra were noticed from the results of genomic sequencing, India could have advocated for local lockdowns in high-burden areas and imposed severe restrictions to stop the wide spread of the second wave. We can prevent the adversities of future waves by relying and acting on the inputs of a strong surveillance system.

Vaccinating the population

Next, through vaccination, we can turn the story around. India can emerge as the world’s biggest exporter of vaccines in addition to helping citizens in the country. The Central government should proactively reach out to all the vaccine manufacturing firms in the west and invite them to collaborate with Indian firms under the ‘Make in India’ programme. India needs to fast-track the manufacturing of all vaccines which have been approved for use by various regulatory authorities through a single-window clearance. India can become a soft superpower if it facilitates faster manufacturing by helping the Indian industry. This is not an unrealistic ambition as the country has already proved how it can scale up testing facilities within a short period of time. At this stage, there needs to be greater impetus in stepping up manufacturing and coverage of vaccines. Not many countries in the world have the wherewithal to manufacture their own vaccines if India cannot cater to the vaccination needs of its own citizens and that of the world.

With newer variants of concern emerging, it is important to update the vaccines depending on how the virus changes. This provides a clear case and a good business opportunity for setting up manufacturing facilities in both the public and private sectors. Vaccines might be the shot in the arm for our economy. Greater financial allocations, stepping up systems to expand vaccination, applied research, enhancing effective communication, and monitoring effectiveness will solidify India’s role in the future for preventing and managing pandemics.

Since 2009, the World Health Organization has declared six public health emergencies of international concern, including COVID-19. In the near future, India has to have a system that can respond to newer pandemics in the making. We cannot build reactive systems for each wave and each pandemic. Nearly 60% of known infectious diseases and up to 75% of new or emerging infectious diseases are zoonotic in origin. Respecting the boundaries of animals and preserving the ecosystem in its natural form is important in order to prevent future pandemics. Therefore, the country needs to adopt the ‘One Health’ agenda in its entirety and ensure that environmental health and animal health are given similar priority as human health.

Robust public health workforce

The rapid spread of SARS-CoV-2 shows us the importance of timely and efficient public health responses. We can only fight better when we have a battle-ready public health workforce. Unfortunately, our health systems are collapsing. Doctors and nurses have to bear the burden mainly because of a depleted or absent public health workforce. It is an essential to hire front-line workers in public health who can engage in surveillance and contract-tracing, and mobilise people for primary healthcare services, including vaccination. The front-line public health workforce is particularly absent in urban areas, while critical care capacity (oxygenated beds, ICUs) is limited in rural areas. Irrespective of the urban-rural divide, the country needs to reconfigure the health systems to ensure that one Accredited Social Health Activist (ASHA) worker is hired for every 1,000 people, an Auxiliary Nurse Midwife (ANM) and nurse practitioner are hired for every 5,000 people and a hospital with at least 100 beds, including beds with emergency and critical care services, caters to a population of 30,000-50,000.

It is time to have plans for pandemics. We need to improve the health system and public health and regularly review plans to ensure that we prevent future disasters. For now, it is important to have enhanced surveillance to detect and contain future waves, expand vaccination, and work towards building a robust pandemic preparedness plan.

Giridhara R. Babu Professor and Head, Life Course Epidemiology at the Indian Institute of Public Health, Bengaluru

Russia and the other players in the Ukrainian crisis need to be prudent enough to resolve chronic tensions

The recent stand-off between Russia and Ukraine has again captured headlines in the international news media. This geopolitical situation appears to be complex due to the indirect involvement of its multiple stakeholders, including the United States, Turkey and the North Atlantic Treaty Organization (NATO).

Increased tensions between Ukraine and Russia can be viewed as a continuation of the unresolved conflict of 2014. Since then, the ‘illegal annexation of Crimea’ has become a buzzword in international politics, and Russia has been constantly painted as an aggressor and a hostile power. In addition to this, the country has been criticised for its involvement in the Donetsk and Luhansk regions in eastern Ukraine, where Russian-backed separatists have been fighting with Ukrainian troops.

From the beginning of April 2021, Moscow has allegedly deployed thousands of troops as well as tanks and artillery near Ukraine’s eastern border. It has also mobilised troops in the annexed Black Sea region of Crimea. This was enough to send a shock wave among the political elite in Ukraine, forcing them to appeal to the U.S. and NATO and ask for an intervention, if needed.

How dangerous can this become in the short term, and to which extent is the fear-mongering of the Ukrainian administration justified by the real situation on the ground?

NATO, U.S. response

On April 13, 2021, NATO Secretary General Jens Stoltenberg invited Ukrainian Foreign Minister Dmytro Kuleba to the NATO headquarters for a meeting of the NATO-Ukraine Commission on the security situation in Ukraine. Mr. Stoltenberg said, ‘Russia’s considerable military build-up is unjustified, unexplained, and deeply concerning.’ He underlined that NATO would continue to provide significant political and practical support to Ukraine. In turn, Mr. Kuleba made a strong statement that ‘the mistakes of 2014 must be avoided this time, so that Russia cannot catch anyone by surprise’.

Besides powerful rhetoric from NATO, Ukraine seems to be desperate to receive more commitments and concrete actions. Dealing with Russia, a powerful and unpredictable neighbour, forces Kiev to rely on NATO/U.S. military support if Russia is to continue with its provocations. The question though is how far the NATO alliance can go in its support, given that Ukraine has not yet obtained membership. In June 2020, NATO recognised Ukraine as an Enhanced Opportunities Partner, along with Australia, Finland, Georgia, Jordan, and Sweden. This partnership aims to maintain and deepen cooperation between countries that have made significant contributions to the NATO-led missions and operations.

The Ukrainian President Volodymyr Zelensky has also used the current tension as an opportunity to push for NATO membership, arguing that ‘this is the only way to end the war in Donbas’.

Notably, the U.S., under the new administration, has taken a more resolute stance towards this conflict, unlike the predecessors of the U.S. President, Joe Biden. Mr. Biden seems to be less apprehensive about provoking Russia and is ready to support Ukraine militarily, if the need arises. The recent visit of the U.S. Secretary of State, Antony J. Blinken, to Kiev indicates the U.S.’s foreign policy priorities. The underlying rhetoric of this visit was to support the ‘independence, sovereignty, and territorial integrity of Ukraine’.

Support from Turkey

On April 11, 2021, Mr. Zelensky visited Istanbul to mark the 10th anniversary of Ukraine’s strategic partnership with Turkey. This was also an opportunity for him to be reassured by Turkish President Recep Tayyip Erdoğan, that Turkey stands by Ukraine amidst the current tensions with Russia. Both leaders discussed the security issues in the Black Sea region. During the bilateral meeting, Mr. Zelensky emphasised that ‘the visions of both countries regarding geopolitical threats coincide with each other’. In other words, the visit was a diplomatic success for Ukraine as it had obtained the necessary guarantees from Turkey should tensions with Russia escalate.

It is worth recalling that Turkey has not acted in synchrony with Russia during several conflicts, e.g., in Syria, Libya, and, most recently, in Nagorno-Karabakh.

Russia’s moves

So what is Russia’s end goal? Arguably, the cornerstone of the Russia-Ukraine conflict is insufficient communication, especially on the part of Vladimir Putin’s Russia. It is very difficult, if not impossible, to speculate on the overarching rationale behind Russia’s tactical decisions towards Ukraine. There are more questions than answers regarding the strategic calculus of the Russian administration. A deficit of explicit messages from Moscow creates room for misinterpretations and exaggerations on the part of Ukraine and its western supporters. This misunderstanding can be best illustrated by the Russian explanation of its recent ‘military build-up’ in western Russia. According to the Russian Defence Minister, Sergei Shoigu, it was just a ‘three-week drill’ meant to test combat readiness to respond to NATO’s threats.

Russian President Vladmir Putin has been known for his geopolitical adventures, especially in West Asia. In the case of the eastern Ukraine, it is highly unlikely that he would be willing to make further territorial gains this time around. He possesses enough diplomatic (and pragmatic) skills not to indulge in yet another geopolitical endeavour, that might entail serious repercussions from the international community. Mr. Putin is aware of the ‘red line’ that should not be crossed. Hence, from the Russian perspective, the current ‘military build-up’ can be viewed as another round of muscle flexing and an attempt to perpetuate the narrative of a powerful and capable Russia.

For a peaceful resolution

All the stakeholders in the ongoing crisis should focus on establishing a constructive dialogue among themselves using clear and unambiguous language. The only way forward is to seek a peaceful resolution to the Russia-Ukraine conflict rather than exacerbating the reality and usingquid pro quotactics. Both countries do need support from the global community, but not in a military form. There is a need for a platform (similarly to the Minsk Agreements) that will facilitate negotiation, mutual consensus and possible compromises, as well as engagement with mediators.

The long-term solution should be sought out in order to break the vicious cycle of animosity and misunderstanding.

Tatiana Belousova is Assistant Professor, International Institute for Higher Education Research and Capacity Building (IIHEd), O.P. Jindal Global University, Sonipat, Haryana. She also teaches the course on the ‘Evolution of the Post-Soviet Space’ at the Jindal School of International Affairs (JSIA)

The Tamil Nadu government should reclaim the lost political vision in city planning

In the last few decades, Tamil Nadu, the most urbanised among the major States, has lost its political vision in city planning. Housing policies and urban planning have been presented as a techno-bureaucratic exercise, preventing the political leadership from taking ownership and responsibility. In the process, the citizens find their needs unrepresented. With large urban projects on the anvil and the third master plan for Chennai on the drawing board, it is time for the Dravida Munnetra Kazhagam (DMK) government to repoliticise planning and adopt a vision consistent with its people-friendly promises.

Planning of the past and present

For long, the State government stood apart with its innovative planning practices. In 1948, it produced a comprehensive housing report and impressive solutions for the housing shortage. As early as the 1960s, it created a comprehensive plan for Chennai. It set up the Slum Clearance Board in 1971, the first of its kind in India. The then DMK government adopted a radical policy to make the State slum-free. The iconic photograph of then Chief Minister M. Karunanidhi taking a boat ride in the rejuvenated Cooum is a telling example of how urban development projects remained an essential part of the political agenda. Former Chief Minister Jayalalithaa supported solar-powered greenhouse schemes for the rural poor. State leadership directly associated itself with planning policies, and building liveable cities was central to political action.

What changed over time? First, policymakers depoliticised planning and presented it as a mere technical exercise of allocating resources such as land and money. They deployed what political scientists Matthew Flinders and Jim Buller describe as ‘institutional and preference-shaping tactics’ to achieve this. Institutions were created to give experts a longer rope, reduce political interference, and avoid short-term considerations in planning. However, they are meant to function within the parameters set by the elected political leadership. This appears increasingly absent in Tamil Nadu.

As Flinders and Buller point out, using the ‘preference-shaping tactic’, institutions create a choiceless situation by offering the opinions of experts as the only solution. They exclude contesting views from public discussion. There is no political moderation of expert-driven agendas. While theorists may argue that depoliticisation improves efficiency, on the ground, as planning and policies keep failing, the credibility of politicians erodes significantly.

A telling example of depoliticised planning is the Tamil Nadu Affordable Urban Housing and Habitat Policy, 2020. It thrives on ambiguity and opaqueness. It has reduced state role and allows the market to take care of low-income housing without providing any information on shortage, household incomes, and affordable housing prices. It remains silent on the numbers of households that cannot afford the housing supplied by the market. On the contrary, early plans, such as the 1948 report, offered empirical evidence, transparent assessment, and a clear political agenda. That report acknowledged that 75% of the population in Chennai belonged to the low-income group with an income of Rs. 50 or less a month. These families could not afford houses built by the market at the cost of Rs. 5,000. The government then took full charge of providing housing for lower-income households. Similarly, in 1971, the government admitted that the Housing Board had failed to deliver since it had diluted its mission by focusing on higher-income groups. The government created a separate board and invested its resources in low-income housing.

In contrast, current policies do not disclose the conditions of housing and cities. They do not clearly commit to keeping the sale price of low-income housing within the affordable range in private projects that avail themselves of financial support from state-supported shelter funds. The case of the third master plan for Chennai appears no different. The activities have commenced without any political framework. Will the government agree if the planners again propose a market mechanism to allocate land use and resources? What outcomes do they want the plans to achieve?

The way forward

As economist Allan Drazen explains, the government must acknowledge the divergent sets of interests and choose the mechanism to negotiate them. Only political leadership can offer a widely accepted framework. The government must take ownership and ensure specific outcomes. The possibilities are merging the Housing Board, which increasingly functions as a developer, with the Slum Board; pooling all land and resources and using them only for low-income housing; enforcing wider consultation; moving away from conventional land use planning; and adopting strategic urban design projects to make spaces for people and safe streets.

A. Srivathsan is a Professor at CEPT University. Views are personal

India should note that it was the progressiveswho pushed the U.S. to back the TRIPS waiver

It is tempting to surmise the shift in the U.S.’s approach on providing COVID-19-related aid to India as well as on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver on COVID-19 vaccines, drugs, therapeutics, and related technologies as being driven by the Comprehensive Global Strategic Partnership with New Delhi. But it is more than just that. The development was a result of the determined push by some sections of the political and business class, civil society, and Indian Americans. Besides them, the progressives in the Democratic Party made a big difference.

President Joe Biden called Prime Minister Narendra Modi in late April expressing the U.S.’s determination to be with India in its most difficult hour. To reduce the negative perception over Vice President Kamala Harris’ tepid response to the crisis in India, the administration arranged for her to address a diaspora event where she brought up her Indian roots and lamented over the deteriorating situation in the country.

The responses by these top leaders to assuage the Indians and Indian Americans came at a time when a section was seeking to underscore New Delhi’s past folly of banking on Washington in times of need.

Urging Biden to act

Among the progressives who urged the President to act soon were Congresswoman Pramila Jayapal, Chair of the Congressional Progressive Caucus, and Congressman Rohit ‘Ro’ Khanna, the Democratic vice chair of the Congressional India Caucus.

Incidentally, while Ms. Jayapal’s comments on human rights violations in Jammu and Kashmir annoyed New Delhi earlier, Mr. Khanna urged the Indian government to maintain democratic norms and allow peaceful protests by farmers, at a meeting of the leadership of the India Caucus with Indian Ambassador to the U.S., Taranjit Singh Sandhu. Irrespective of these positions, the progressives saw the aid and TRIPS waiver through a different prism.

To contextualise the role of progressives, days ahead of the May 5 decision of the Biden administration on the TRIPS waiver, 110 members of the U.S. Congress wrote to President Biden urging him to support the waiver. The signatories included Ms. Jayapal, Mr. Khanna, and Congressman Raja Krishnamoorthi who represents Illinois. At the same time, Senator Bernie Sanders and nine other Senators made a similar plea to the White House. Thus, the Biden administration’s decision on the waiver and the vaccines, characterised as courageous by many, was a result of the push by the progressives.

Joining in this effort, the co-chair of the Congressional India Caucus, Brad Sherman, and over 50 colleagues wrote last week to President Biden seeking supply of specific items amid concern that as long the virus persists in India “there is the potential for additional variants that could pose a threat to a vaccinated America”. The overall approach is to work with India in its battle against the second wave and prepare for subsequent ones.

Not to be ignored

The outreach by Mr. Sandhu and his South African counterpart to members of the U.S. Congress on the waiver notwithstanding, it is evident that the progressives have a grip on policymaking. Its members’ pronouncements on other issues that India finds unpalatable could happen again. But India will have to remain engaged with this section instead of offering a cold shoulder as it did in the recent past. As the adage goes, all politics is local.

K.V. Prasad is a journalist and former Fulbright-APSA Fellow with the U.S. Congress

The ICMR must assess evidence and be very specific with recommendations on treatment

The Indian Council of Medical Research (ICMR) has finally dropped its espousal of convalescent plasma therapy (CPT) as treatment for moderate COVID-19 in its latest guidelines. In its guidelines of April 22, CPT was already on its last legs, with the advisory recommending that it is advisable only in early moderate disease, or within seven days of symptoms. These updates flow from periodic reviews of medicines and treatment protocol by a task force of doctors and experts of the ICMR. Practising doctors are not legally bound to follow these recommendations to the T but are expected to circumscribe their treatments within the guidelines. Last year, the ICMR, in one of the definitive clinical trials in the world, demonstrated that CPT neither saved lives nor improved patient outcomes but was equivocal about it in public. This gave leeway to some States, particularly the Delhi government, which openly disavowed the ICMR’s findings, encouraging several doctors to put the onus on hapless caregivers to source such plasma from those who had recovered from the illness. The clamour for plasma had birthed its own kind of ecosystem. There were apps designed to connect donors to recipients, an inevitable black market, and, if the plasma did not seem to be working, the tendency was to blame the quality of plasma rather than recognise the futility of the treatment.

Last week, it took a letter by a clutch of concerned public health professionals to India’s Principal Scientific Adviser as well as results from a trial, published inThe Lancet, spanning around 11,000 patients — that again found no benefit — to demote CPT. Further evidence is emerging that CPT may be contributing to the evolution of coronavirus mutations that, together, may have been the final nail in the coffin. However, this is not the end of the road for treatments with limited scientific basis finding a mention in the ICMR guidelines. Hydroxychloroquine and the anti-parasitic drug, ivermectin, continue to find a place for the treatment of mild disease despite a specific mention of “low certainty of evidence”. There is an argument that doctors, battling a disease that has so far defied a predictable treatment regime, cannot always observe the necessary clinical equipoise. Unlike doctors on the frontline, a collective of experts such as the ICMR taskforce, has the comfort and the distance to dispassionately assess evidence and be very specific with its recommendations. Publicising these at regular intervals serves to educate the public about the evolving nature of treatment and be better prepared as future patients and caregivers. This will work better towards easing the pressure on doctors as well as in improving trust in systems that are designed to offer the best possible expertise.

Accurate forecasts and resilience-building hold the key to handling severe cyclones

Millions of people wearied by the onslaught of the coronavirus have had to contend with a furious tropical cyclone that has left a trail of death and destruction before making landfall in Gujarat. Cyclone Tauktae swelled into an extremely severe cyclonic storm, dumping enormous volumes of water all along the west coast, and caused loss of life in Kerala, Karnataka, Goa, Maharashtra and Gujarat, before weakening overland. To thousands who had to be evacuated to safe locations, this year’s pre-monsoon season presented a double jeopardy, caught as they were between a fast-spreading virus variant and an unrelenting storm. Many coastal residents would have felt a sense ofdéjà vu, having gone through a similar experience last year, when the severe cyclonic storm, Nisarga, barrelled landwards from the Arabian Sea, pounding Alibaug in Maharashtra as it came ashore. The cyclones in both years spared densely populated Mumbai. The twin crises have, however, strained the capacities of multiple States, especially the coastal ones, although the impact of the storm was considerably mitigated by disaster response forces. Once again, the value of creating a trained cadre, supported by the defence forces in rescue and relief work, is seen. The heralding of the 2021 monsoon season by a cyclone comes as another reminder that the subcontinent is at the confluence of more frequent, extreme weather events originating in the Bay of Bengal and the Arabian Sea every year.

How well India is prepared to handle cyclones depends on developing greater expertise in forecasting and disaster mitigation, and crafting policies to increase resilience among communities. Last year, the India Meteorological Department (IMD) launched an impact-based cyclone warning system from the October-December season designed to reduce economic losses by focusing on districts and specific locations, and incorporating such factors as population, infrastructure, land use and settlements. The IMD also claimed that its accuracy of forecasts, for instance, in plotting landfall location, is now better. Together with ground mapping of vulnerabilities, this is a promising approach to avoid loss of life and destruction of property. The importance of precise early warnings cannot be overemphasised, considering that the Arabian Sea has emerged as a major source of severe cyclones, and their intensity is aggravated by long-term rise in sea surface temperatures linked to pollution over South Asia and its neighbourhood. Climate-proofing lives and dwellings is a high priority now, a task that warrants a multi-sectoral approach: to build sturdy homes of suitable design, create adequate storm shelters, provide accurate early warnings, and ensure financial protection against calamities through insurance for property and assets. Governments must rise up to the challenge.

It is a debatable question how the criminal codes have succeeded in preventing crime in the world. One thing is obvious that criminal law only punishes people after they have committed the offence and the matter of detecting the real culprit is one of no little difficulty. But, even in countries where the whole moral order has been upset by external or internal shocks the remedy, as a writer in the “Science Siftings” says to be sure, does not lie in placing whole communities under virtual martial law in response to hysterical public opinion and shooting down people on suspicion. This is merely bringing about what may well be called police anarchy. “If we arrest wholesale and punish on suspicion, we are going to inflict such punishments upon the innocent, for whom legal procedure has built up — and justly — protective barriers. Men, even those guilty of crime, must be properly tried and duly convicted; and the moment we lower these standards and permit police dragnets to enmesh the innocent with the guilty, then we are reverting to primitive methods which civilisation has long discarded.”

New Delhi, May 18: As part of its general diplomatic drive to build up international opinion against Pakistan’s barbarous behaviour in East Bengal, India is deputing special emissaries to the more important world capitals to put across its point of view forcefully at the highest levels of Government. The idea is to explain personally to the heads of State and heads of Government — on a selective basis wherever it is possible to establish direct contact with the top men — the magnitude of the refugee problem and the inherent dangers of an Indo-Pakistan conflict, if the Yahya regime persists in its present policy of massacre and mass expulsions to alter the population balance in Pakistan. The high level contacts with various countries, which are in a position to exert pressure or exercise influence on Pakistan either through gentle arm-twisting or friendly persuasion, are intended to supplement the diplomatic efforts already being made by the Indian missions there to rebut the mischievous Pakistan propaganda that the so-called secessionist movement in East Bengal is of India’s creation — and that if in the bargain India has saddled itself with this refugee problem it has only to thank itself for it.