COVID-19: Prof. Shubhashish Sircar suggests what we need to do

As education and public awareness is essential in matter of COVID-19, we are glad to share this priceless piece from one of India’s Doctors with a golden heart, Dr. Shubhashish Sircar, who is presently the Prof. and Head of the Department of PSM, Hazaribagh, Jharkhand. Editor.

I had posted some information to my students in Hazaribagh Medical College on 12th of April as part of the online classes I’m holding from my sick bed.
Allow me to share it with you.

This Novel Corona virus and it’s manifestation, COVID-19 will stay with us on this planet earth for a pretty long time….. measured in years !!! … Not months.

Yes, it’ll change the way we live, think and dream. The economic downturn of the well off countries of the “white” west and the rise of the “yellow and dark” east is inevitable. I’m eagerly awaiting for a new world order to take shape. I’m eagerly awaiting the east to rise once again, which it rightly deserves.

Presently, as I lie on my bed (under treatment at home and recovering from a near fatal road traffic accident), my heart goes out to the poor and downtrodden brethren of my beloved country who are facing the pain of an exodus, as bad as the exodus of 1947. I would urge you to read the Nobel prize winning novel for literature “The Grapes of Wrath ” written by John Steinbeck in this context.

An extension of the “Lock Down” period for the whole of the country is probably not a good idea, from the Public Health professional’s point of view….. or rather, my view. Though the WHO (an organisation where I worked for 9 long years), will beg to differ from my view.
What we need to do now, is to:-
1. Spot mapping of the cases
2. Line Listing of the cases
3. Demarcation of the Clusters (now rechristined as “Hot-Spots”.
4. Complete shut down in these areas only. Complete shut down.
5. Active and Passive Surveillance including Contact Tracing.
6. Test…test… and test ALL living in that defined geographical area.
7. Data analysis for policy initiative.
8. Allow the others to return to their normal business with safety measures/maintenance of safe distance/3 layered masks in place.
9. The Spanish flu of 1918 – 19 had 500,000,000 infected and left 50.000.000 dead. The normal flu, each year, kills 1,50,000 dead. The HIV/AIDS till date has left 60,000,000 inflected and has left 30,000,000 dead. No one raises a word ! I wonder why.

We don’t need to make a hue and cry of the Corona pandemic. Let us maintain “Social Distancing”, use “Home made masks” and wash our hand as and when necessary, with ordinary soap till our collective fear lasts or the Herd Immunity begins to lower the epidemic curve.

An “economic turn down” will kill more rich as well as the marginalised than the COVID-19 pandemic itself. Malaria and TB kill and will continue to kill more people. I’ll tell you why that doesn’t worry us. …… It’s the death among the rich, which is worrying most of us. The poor, marginalised and the downtrodden masses of my country don’t know that health issues could be powerful election issues. It’s time they did.

Besides, we don’t have the Tertiary Care facilities in place, to fight the battle. We can’t arrange it at such a short notice. Ventilators, Respirators, PPEs, medicines and what not, cost money and the logistics involved in getting them is complex and time consuming. We have ignored the Public Health department in the past. We never paid serious attention to prevention and epidemiological evidence based studies. We invested only in Secondary and Tertiary care facilities, because of two reasons. Firstly, we never prepared ourselves for disasters, even though Bill Gates had warned us of an impending disaster a year back. Secondly, if we prevent people from falling ill, the rich and the powerful, particularly those in the pharmaceutical/ biotechnology/medical instruments industry don’t profit.

We urgently need to return to our economic activities as soon as possible. The migrants in exodus need to return to their workplace. They need their jobs back and not sit in a single, shanty, overcrowded rooms which facilitate Corona virus transmission.
The storm will probably pass in a month or so. But here’s the catch, a “second wave” is coming, in not too a distant a future. It’s coming for sure ! ….. Just wait and watch. It’s time we learn to live with this mutating anthropozoonotic virus.

We need to remember that 96 to 97% (probably more) of those infected will NOT die. They may at best have very mild symptoms akin to common flu. (The “fear of death” from Corona virus infection is the handiwork of the media, particularly the TV journalists and their half baked knowledge).The 96 to 97% of the infected are part of the “Submerged portion” of the “Iceberg of disease”. We also need to remember, that most asymptomatic (cum infected people) will also transmit the infection to their contacts. These people can never be detected by our medical officials…. Never…. Unless community testing is done, which we initially didn’t invest in as in South Korea, Germany and Sweden.

Over a period of time “herd immunity” will balance the disease onset. I’m not saying it’s desirable, as we seem to be more interested in “flattening the (epidemic) curve”. All I want to say is that over the next one and a half years, it is inevitable……. Why? Because, according to Dr Ian Lipkin, world’s leading virologist and epidemiologist and script writer for the Hollywood movie “Contagion”, the vaccine will hit the market only after one and a half years. Believe me, we cannot stop the spread of the Corona virus, lockdown or no lockdown. I also wonder how many of downtrodden can afford the vaccine.

As I said before, we need to invest in the Public Health sector. Not in Tertiary case hospitals, as is being done now.

We need to aggressive pursue “active and passive surveillance”, “contact tracing” of “index and secondary cases”, ……… testing them without fail (even if they do not fulfil the testing criteria fully) and ensuring their quarantine/isolation and treatment of needed.

I have walked the dusty streets of thousands of villages for 9 years in 22 districts of Jharkhand, Bihar and Uttar Pradesh during my “foreign deputation” in WHO as State Surveillance Medical Officer and for 3 years in NACO as its Additional Project Director. I have lived, eaten and interacted with the poor, the marginalised and the downtrodden on a daily basis. I know that most of them will die due to the economic downturn and it’s subsequent collapse rather than from COVID-19.

They have no voice to express their concerns. Most of them live on a day to day basis. I know that most of India has little idea of their existence except from the photo shoot sessions of the media.

Please note:-
This is my personal view. I may be wrong. After all, there are wiser heads than mine. I leave it to them to save the empire and mankind.

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