Dear Shree Narayana Murthy jee,
It is with humility that I write to an accomplished person such as you who has always put the benefits of people above his own. I have no doubt that your comments in the recent interview to The Economic Times must have been well thought out and maybe I have not understood the depth of your answers.
However I am unable to console my mind about some of your comments and wish to write my thoughts here with the hope of a dialogue with you on this.
Comparing mortality of Covid-19 with other causes – apples and pears?
Putting mortality numbers in your opening paragraph you have compared 1000 deaths in 2 months (due to one severe pandemic after a successful lockdown) to the 7.5 lakh deaths that we get from all causes per month.
At the end of March 2020, a few thousand to 5 million people were projected to die in India due to Covid-19. Due to one single cause. This is because in India, the death rate from such diseases has been historically higher such as with Swine flu (6% in India compared to 0.1% in western countries) probably due to lack of healthcare facilities, access, affordability etc. Hence the global Covid-19 death rate of 2-3% may be higher in India although we have some immunity due to a different strain of the virus or due to BCG or higher Malaria incidence (inconclusive evidence). The ability to infect others is also higher due to congested living spaces. Not only towns and cities but even in our villages one finds that people live in small houses cobbled together. Finally, during the lockdown, there have been fewer road traffic and other communicable disease related deaths.
Hence if we really must compare, then it must be deaths prevented by lockdown vs deaths projected without Covid-19.
Are we underestimating the current workload?
Currently our healthcare facilities, essential services such as police etc. are facing an unprecedented workload – working in shifts – round the clock. For a whole month they have been wearing personal protective equipment (PPEs) such as the N95 masks and the suits. This causes fatigue and disturbs sleep patterns. One look at the police officers on the road will show you a glimpse of their plight.
Now the fight has moved from hospitals and quarantine centres to home based containment as all existing facilities are fully occupied. Covid-19 is a unique disease. It is not only highly infective, it has a higher mortality.
Once a Covid-19 patient gets sick,
they need Intensive Care.
not just ward care.
Many smaller cities in our country are yet waking up to the concept of intensive care units (ICUs). The condition is not much better in suburbs of larger cities like Mumbai. We are converting existing wards into ICUs. It is difficult to build facilities and train the staff required in such a short time and then motivate them to work long hours. Healthcare worker deaths due to Covid-19 are mainly due to accidental exposure in such scenarios. Once the lockdown is removed, we will see a spurt in other causes of disease such as road traffic accidents, gastroenteritis and other communicable diseases.
Right now, we simply do not have the workforce to deal with a high incidence of sick Covid-19 patients plus routine causes of illness.
Are we prepared for the worst?
Like the method you have employed at Infosys, some models of lifting the lockdown need to be built, studied and experimented in various Covid-19 hotspots to see the effects before actually going ahead with it universally.
You have mentioned financially supporting small entrepreneurs and companies at this time. However these measures should be directed in coming out of this crisis right now. The aim should be to fix healthcare for the medium term at least. Let such financial interventions be maximum in healthcare and related industries. Let the government support small nursing homes, hospitals, research into medical diagnostics (as you have suggested), manufacturing of basic consumables required in hospitals, innovations to keep the country clean, etc. to first fight this battle effectively.
Truly this crisis has helped us differentiate what is essential to our lives and what is not.
Let us take this opportunity to change our focus from other aspects of the economy to healthcare based economic activity.
I hope you have comprehended that without such a graded intervention, the essential personal such as police and healthcare workers (HCWs) will get exhausted further. They will then stop working or keep sacrificing their lives both of which are painful circumstances to a HCW like me.
You may also read my blog about unlocking the lockdown at https://kantshah.com/unlocking-lockdown/
With warm regards
Dr. Kant Shah
1st May 2020