Dr. Debasish Sarma Roy

April 27, 2020, 04:51:16   

How is Tripura similar to Iceland? The question may seem perplexing in the perspective of the present pandemic. Apart from their being in the same side of the equator, skeptics won't find much of a similarity between them of course. But if we consider the COVID-19 factor here, this North Atlantic Island might shed us some light on what should be our next step.

For the epidemiologists, Iceland is a dream place to study the progression of an infectious disease or the manner of unfolding of an epidemic. The island's only major port of entry is the international airport in Reykjavik, The nation with a population of about 364,000 (one tenth of that of Tripura) has high literacy rate and a well established universal healthcare system. All of these give the epidemiologist almost a perfect condition to see how an infectious disease spreads. And in this pandemic Iceland initiated measures by targeted testing from January '20, one month before the first case of COVID-19 was detected there. To clearly understand the rate of actual infection in the population, 3 types of testing strategies were undertaken there. First one was a targeted testing protocol, testing highly probable group of people. This included - those who have probable symptoms of the disease, who have a recent travel history to high risk areas, or who came in contact with those two groups. Second is random testing, you can randomly select people and test them. Third, an open invitation group, where people at their own will may come forward and test if they feel they are having any symptoms or even if no symptom. Of the three cohorts tested 9199 individuals were in the first cohort (targeted population) from January 31 to March 31. For the second cohort they sent random invitation to 6782 persons, of those 34% responded and about 2300 people were tested in this group. In the third cohort there were 10797 persons, where people came forward on their own to test, and not surprisingly 57% among those had some sort of symptom which prompted them to come forward.

Now data analysis showed that while 13.3% of the first group (targeted testing) was found positive, only 0.6% of the random testing group and 0.8% among the open invitation group were so. Of the 6.37% of the total population screened till March 31, a total of 1331 persons were found positive, among which none were below 10 years of age. The random testing group best represents the percentage background infection in the population. At only 0.6% it certainly showed the positive effect of social distancing measures etc taken up there, but at that incidence level there also a long way to go before the society develops herd immunity.

The major question that we are facing in our country is whether to open up the society and let the herd immunity develop at the cost of perhaps 1 to 3 percent mortality among susceptible persons of a particular age group, or continue the 'lockdown' and face economic bankruptcy. Third option is to follow the middle way and selectively isolate the population, what China had done successfully and saved the both ends. With partial withdrawal of severe social distancing measures already at places of the country, the government is certainly weighing future course of actions, but how long one should wait? While in one hand there are organizational support for the persons / communities in need, on the other hand a vast majority of people too shy to accept that dole. Many of whom had barely lived above the poverty line and who also make up the major force behind the unorganized or ancillary industries. They will be forced down to the already wide bottom of our heavily lopsided economic pyramid. Already weighed down with communicable diseases like tuberculosis, diarrhea etc, further malnutrition in the masses will raise the burden of death steeply. With more people in the jobless and below the poverty line category, weak and diseased, and therefore reduced productivity, the so far upward economic growth curve will head down under.

With the discovery and clinical testing protocol initiated for several vaccines against the disease there is hope around the corner, but no one knows for certain how far we have to go to reach that corner. More over haplotypes of sequenced SARS-CoV-2 viruses in different countries at different times, including those in the Icelandic study, showed they were diverse in nature and changed over time. And as antibody tests are also till date inconsistent somewhat, may be due to varying immune response of the infected person, or may be changing antigenicity of the virus, so for the vaccine to be effective, that probable deviation of its antigenic properties has to be kept in mind before jumping into vaccinating the entire population of the planet with the same agents. And even if some vaccines come out successful in preventing the disease, that is not probably going to happen in a short while, in spite of all the media propaganda.


That leaves the government with only one option of opening up the lockdown in selective places with more stringent imposition of the rules in selected others. Being able to take that decision takes a big gut in a country like India, where rhetoric for the mere sake of opposition and appeasement of vote banks are the norms from all the major political parties nowadays. So, if one ruling party hides the facts and figures one has to think for what reason this is being done? At the same time if another ruling party is unwilling to lift the lockdown even on the face of disruption of the social and economic structure of the entire state and when no or minimal documented cases are there then what it is afraid of? Is it just fear or ignorance about how or from what corner the virus will creep out or just afraid of a political backlash if some bold and pragmatic decisions fail to show positive effect?


People of this country, even those who are living in the villages and small towns, whom usually the more 'clever' and more 'educated' city dwellers or some political supremos consider as simpletons, God only knows for what reason, and try to sell their own ideas (and malign the rival parties), are really fad up with these rhetoric for a long time now. That they don't get a better alternative is their hard luck. But showing a matured reaction and not politicizing the present adversity will definitely go down well with the masses and whoever shows this will reap a positive result for a long time to come.


Now to come back to the Icelandic connection of Tripura, we are also quite isolated if the border with the neighboring country is sealed, and the only air connecting port closed. The gates of entry thus remain are through the 53 km border with Assam and 109 km long hilly terrain shared as the border with Mizoram.  We may conveniently take it granted that Tripura is COVID-19 free now. That leaves us with the only chance of getting another case is from outside the state. And if the government opens up the economy in the state, the huge number of security forces now deployed to disrupt a social gathering in the cities/towns/villages can easily be mobilized to guard the ports of entry of the virus. More explicitly speaking fit a mask on the face of the state more tightly now. That will save the economy as well as keep people safe from the infection. Of course this pandemic does not seem to be over so soon, when the herd immunity develops it may persist as sporadic disease. Then Tripura may have to face a major crisis again when the virus is imported afresh from the mainland, with no herd immunity in the people here. But the current lockdown in no way will serve any benefit now or in the future if extended further, unless several new cases are detected.


The central government spends nearly Rs. 650 crores per year as subsidy for sugar supplied to the AAY families through the PDS. We all know that sugar is white poison, and we are already world leader in terms of diabetes, heart disease and cancer. So, that Rs. 650 crores subsidy forces the government to spend another similar amount as health subsidy to those families for the diseases caused by this subsidized sugar. Did we ever hear from any 'scientific body' or medical associations ask any government to stop this sugar subsidy? But when it comes to the distribution of a homeopathic prophylactic for COVID-19, for which ironically a similar amount of money will be needed to cover the entire population of the country, all hell breaks loose from the medical associations, even though a single person (Mr. Rajiv Bajaj, MD of Bajaj Auto) has pledged to bear that entire amount of money from his own pocket! It is just like Erdogan, Slaman Bin Abdulaziz, Mohatir Mohamad, Ibrahim Awad al Badri and co (not to mention our indigenous products as well) who always describe our PM and our entire nation as Islamophobic, whereas Xi Jinping who is re- writing the Holy Koran and killing hundreds of thousands of Muslims is the best friend of Islam and honored as a special friend of the Organization of Islamic Cooperation (OIC). Why so? Quite obvious, for the OIC the holy religion, and for the so called scientific bodies and medical associations the humanity and patient first motto are defeated by the greed for the greenback! One small (!) data will make it clear. The yearly medical spends in the world is USD 8 trillion, out of which 15 to 25 pc goes to middle men and doctors as commission, let alone the 100 to 500 pc profit to the manufacturers. And in our country the margin of cut money is even bigger, according to a British Medical Journal report ((Ref. BMJ2014; 348:g4184 doi:10.1136/bmj.g4184). At 30% of the 8 trillion USD it nearly touches the total volume of Indian economy! And even after all that, medical error is considered as the third leading cause of death in the USA, as per John Hopkin's study, attributing 250,000 deaths a year. Other studies report much higher figures, claiming the number of deaths from medical error to be as high as 440,000 (Ref., 22 Feb, 2018; and BMJ 2016; 353). And among the top 5 medical errors first place goes to medication errors (wrong drug, wrong dose, bad combination, and bad reaction).  Anyone out there may guess what that number will be in India. Still all the medical associations gear up armed to the teeth on any hint of homeopathy being given a miniscule choice by the government to tackle any disease, in spite of its repeatedly good performance in many such epidemics. So, the epidemic act is invoked to arrest a homeopath for dispensing a prophylactic for COVID-19 in West Bengal, even though the GOI (AYUSH dept) released a memo describing Arsenic album 30 as the drug of choice for this purpose, and our Honb'le PM advising people to follow AYUSH ministry directive!

And allopathic doctors went scot free even after reporting in live television that they have developed/discovered a cure for COVID-19 in a drug combination of multiple antivirals with or without an antimalarial, though all of them failed miserably in all trials across the world and left patients with serious side effects.


Back to the state of Tripura, many of the AYUSH dispensaries have been closed and the doctors transferred to the PHC / CHC or similar establishments as part of integrated health care delivery. But there many of them have no duty but to assist in different health programs or other official works which may be done by paramedics. With the government AYUSH dispensaries operational in grass root level, most of the upper and lower respiratory viral infections could have been tackled with ease there, and the ultimate burden on the referral (allopathic) hospitals would have been minimum, savings people's lives and government's money, not to mention the chance of spreading an infection exponentially when people are forced to flock in the secondary or tertiary level centers for minor cares.

Now, as far as the situation in Tripura is concerned, considering there is no COVID-19 case at present here, the best thing to save the poor and lower middle class could be -

1.  Open up market.

2.  Seal the borders tightly.

3.  In case of emergency entry into the state from outside, check all people with either antibody or RT-PCR tests and keep in quarantine.

4.  If found negative after quarantine for 14 days (preferably institutional quarantine - with a schools or even some passenger train carriages may be utilized according to the situation) release them - just like present day norms.

5.  The government may call all party meeting inviting major opposition parties, and make them a party of the decision, so that they may not utilize the situation if a decision later misfires. Because no one can be 100 per cent sure how long the virus would last in the population and how exactly would it behave as far as epidemiology is concerned.

6.  Schools, especially junior and senior basic levels may be opened, as the incidence is very low below 10 years. And though a good number of kids nowadays suffer from allergic rhinitis and bronchial asthma, thanks mostly due to inappropriate use of antibiotics, gas medicines (PPIs), and vitamin supplementations (Ref-'Chest', October 2006, June, 2007, 'Pediatrics', July 1,2004, BMC Pediatrics, vol.19, 2019, just a few from the unending number of such articles), bronchial asthma is not found to be a risk factor for COVID-19 mortality decisively so far.

7.  May ask Mr. Rajiv Bajaj to organize mass preventive medication in the state with homeopathic medicine as he has openly offered to bear the costs. Who knows this may even open up the scope of his future investment in the state in the form of a large scale industry!

8.  Moreover try to maintain the good social and hygienic behavior like wearing a mask not to spit openly, covering up while coughing and sneezing, washing hands etc as has been learnt during this period- which will not only prevent corona virus infection, but also reduce the burden of tuberculosis, other droplet and airborne diseases, and diarrheal deaths. 

These are my personal opinions. Not intended to hurt or dishonor any person/ community / organization. If in any case due to erroneous use of words anyone feels hurt or dishonored my sincerest and unconditional apologies to him or them.


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