Unlock 3: No silver bullet yet, brace for ripple effects from Covid

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“We need to brace for impact,” was Dr Swapneil Parikh’s advice during an interaction in May, ahead of Unlock 1.

Restrictions were being eased on certain services after the first Covid-19-induced lockdown and Parikh cautioned that “more cannon balls” could come our way, as scientists were still trying to understand the novel coronavirus.

Come August, the country stands poised for Unlock 3. And Dr Parikh’s outlook is grim. “We are in the initial stages of this and nowhere close to having seen the worst of it,” he says, responding to a sentiment oft expressed that the worst is possibly behind us.

As the trajectory of confirmed Covid cases and mortality increases, there will emerge second and third-order effects like economic crisis, food production problems, housing issues, people losing jobs, disruptions in children’s education, and mental health, for example, says Parikh. And all this besides seasonal health concerns like malaria or dengue that come with the rains, the existing concerns of tuberculosis, and so on.

System inadequacies

Dr Parikh is co-author of The Coronavirus: What you Need to Know about the Global Pandemic, co-founder of health start-up, DIY Health, and a clinical researcher at Mumbai’s Kasturba Hospital for Infectious Diseases. The book is co-authored with Maherra Desai, clinical psychologist and medical researcher and (his father) Dr Rajesh Parikh, Director of Medical Research, Jaslok Hospital.

India has done some things right in terms of increased testing capacity, addition of oxygen beds and unlocking in phases, he says, but a huge challenge looms due to the inadequacies of the public health system.

“We have neglected public health for the last several decades,” he says, adding , “it has just not been a priority”. And now it’s difficult to make up for decades of neglect in months. Any investment in health would only benefit people in the future.

But unlocking is uncharted territory in that “there is no blueprint or scientific consensus available on how to do it.”

So countries will just have to take baby steps and go by trial and error. Micro-lockdowns in places with a high number of cases would require robust surveillance and high quality data, he says, on some unlock suggestions doing the rounds.

Since people will be mobile for work and healthcare services, the attention needs to be on avoiding crowds, close contact and closed places.

The strong underpinning of caution in conversations with Dr Parikh comes also from learnings from the Spanish flu in 1918. Past pandemics have ravaged India, he stresses, pointing out that it killed 6 per cent of the population.

“The odd thing about this (Covid) virus is that it is very mild in some people and severe in others. The spectrum of outcomes is perplexing,” he says.

Some features may go in favour of India, with a large young population, even as scientists look at things like pre-existing immunity to the common cold corona virus (being studied), etc. But the sheer numbers in India will make it devastating, he cautions.

Policy on data, not fear

Responding to the criticism of people who had painted a hugely worrisome picture of Covid in India, Parikh explains, “modelling is always only as good as the assumptions and that’s something all data scientists understand. ..That’s why they are projections and not predictions, they are subject to change.”

But, “It’s always better to prepare for a worst case scenario and say we over-reacted and there was not so much damage, than to under-react and be caught off guard.”

Public policy should not be guided by fear and emotion but by hard data, he says, adding that just because a projection is bad, it should not be viewed as “fear mongering.”

The virus has exposed how poorly prepared countries were to tackle such a crisis, but the worry in India is when the infection spreads from resource-centric cities to rural areas, he observes.

“A vaccine is not a substitute for everything else,” he says, as Governments and people wait for that promising shot.

When it comes to treatment, there are a bouquet of options in terms of vaccines, antivirals and other therapies. But given that there is no “silver bullet”, the best options are preventive. Parikh underscores the way to navigate the days ahead — wear a mask, maintain physical distance and stay away from closed places.