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Covid-19:What India must do next

  
  
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  This war will be won by smart data-driven defence, coupled with strategic offence The decisive action taken by the Indian leadership in flattening the coronavirus disease (Covid-19) curve is laudable. In choosing between the proverbial kuan (well) and khai (chasm), one takes steps to avoid the most catastrophic scenario. With the Prime Minister announcing the extension of the lockdown, the valuable time that has been bought must now be used to prepare. But for what? A defensive war or an offensive one? The first will be fought by socio-political measures such as lockdowns and care of the vulnerable; the latter will be fought by science and technology. When physician Harvey Fineberg recently talked about 10 weeks to crush the curve in America, he outlined six key steps. With slight modifications, these are the following: One, establish a clear command system. Two, test widely. Three, protect health workers with proper gear and equip hospitals for a surge in demand. Four, determine and track who is infected, likely to be infected, exposed, unexposed, or recovered. Five, inspire and mobilise the public. And last, but not the least, learn from research to continually improve. These principles apply equally to India, but the relative difficulties of each step are very different. For India, the command system is clear and active, the public is engaged, but testing is low, the determination of the five classes (of step four) is not yet clear, and supply chains of protective gear and hospital equipment are thin and fraying. The sixth step, research, has to not only meet these defensive challenges, but also launch an all-out offensive against the enemy. We must innovate at every step, use our fabled “jugaad” as a stop-gap defensive measure, while our premier research institutions work to provide new weapons in this fight. While the challenges are severe, the unified response of the government, industry and academia in this time of crisis has been heartening. For example, to test widely, we need diagnostic kits. As global supplies of kits and their components start becoming scarce, Indian industry and start-ups, supported by academia, are developing indigenous alternatives. Medical researchers, epidemiologists, molecular biologists, and technocrats are jointly formulating strategies for minimum testing for maximum insight. Apps like Aarogya Setu leverage India’s digital and telecom infrastructure and tech talent to supplement community testing and provide virtual intelligence. Previous investment in high-quality basic research is also paying off. The recent development of futuristic alternatives such as a Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-based paper strip test, which may eliminate the need for expensive and scarce real-time Polymerase Chain Reaction (PCR) machines, came from years of background work. While issues remain in expeditiously bringing new tech to market — for example, sufficient quantities of the input materials for the CRISPR test are difficult to find — a strong academia-industry combine is working hard to overcome the obstacles. Meanwhile, numerous research labs across the nation are using their infrastructure to enhance the national Reverse Transcription (RT)-PCR testing capacity. Young companies funded by the Council of Scientific and Industrial Research (CSIR) and the Department of Biotechnology industry programmes are coming out with affordable and simple indigenous diagnostic systems that can be used by local centres without advanced infrastructure. Together, these form a viable plan to widen the testing net and effectively determine local and personal risks. Similarly, procurement challenges in personal protective equipment (PPE), hospital beds, oxygen, ventilators, and newer anti-viral drugs, must be met by focused science. Towards this, Indian research organisations are using cross-sectoral strengths to create the necessary pipeline of products. When biohazard suit production was constrained by the unavailability of seam sealing tape, a sealant glue from submarine applications was substituted by Defence Research and Development Organisation, ensuring that these suits can be produced in large numbers, forming a robust line of defence for frontline health workers. An indigenous oxygen concentrator from the CSIR Venture Centre may make the difference between life and death for hypoxic patients, if central oxygen supply runs short. Lifesaving drugs, with promise in Covid-19 treatment, are being synthesised by CSIR labs in collaboration with pharma majors. Inspiration from traditional medical systems is guiding the ministry of Ayush’s efforts. The idea is to not blindly copy anyone, but to take the best of what is available and by using universally-recognised scientific principles, modify it to local contexts and needs. We have bought ourselves time to prepare and have the scientific capacity to deliver. This war will be won by smart data-driven defence, coupled with strategic offence. While the medical side defends with what they have, the research side must support them with what they need. Importantly, we must not take our eyes off the real solution — effective treatment and vaccines; developed in India for the world. We have the leadership to inspire and mobilise the public. Can science guide decisions to shape the public health response and to restart the economy? If we do this well, not only will we save grief to hundreds of thousands of Indians, but also contribute to global good and emerge a stronger nation.
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