10 Life Lessons : How India fought COVID

A year after the pandemic, most of the developed world has 10 times higher deaths per million, than India. Analysts credit this to some mysterious, mythological, genetic immunity. As a 3rd world country, Indians are hard wired to look towards the West for thought leadership. With COVID, perhaps the world can learn a thing or two, from India.

Lesson # 1 : In a crisis, stop and take a breath

We had a super early and strict lockdown with travel bans and institutional closures. 1.4 billion people were divided into 3 zones—red, orange and green. Each zone managed its containment locally. Overall, we were surprised with the efficiency of our own administration, also their quirks.

By June 2020, restaurants, cafes and transport re-opened in some zones. By the festive season in October, 2020, life was kind of getting back to normal.?

The sudden closure wasn’t easy for anyone. No conversation is complete without mentioning the migrant crisis where millions suffered. That was unfortunate, and perhaps avoidable too.

The lockdown gave doctors time to think. That was the only purpose it served.

?Pause, take a breath and think.

Lesson # 2 Repurpose what you got

Just like we repurpose many things in our lives to?find newer uses; similarly, drugs are also repurposed.

Identifying new therapeutic uses for existing drugs can give less risky, low cost solutions. Though globally,?this is an underutilized strategy.

Rather than panic and just wait for new inventions, India’s ICMR (roughly equivalent to CDC) went about testing many existing drugs, very swiftly.

• As early as March, 2020 HCQ was trialed for prevention [i].
• In my state - Haryana, every frontline worker and police constable was given the choice of taking HCQ, and it was distributed free!
• While controversies raged worldwide India stuck to its guns on HCQ [iii]?[iv]
• WHO recommended anti-HIV drugs. They were trialed, but as early as July, not found effective in most cases and India was one of the first countries to drop them off the protocol, while Spain and Italy continued with them for a much longer time[ii].

The mantra – Quickly repurpose existing resources.

Lesson # 3 : In every storm (if you look hard enough), a rainbow appears

While the world was going crazy over toilet paper, India quietly found its game changer.

At 2 USD for the entire treatment, Ivermectin was India’s jackpot.

India went hammer and tongs on Ivermectin. States like UP set up free kiosks for IVM distribution, as early as July - August 2020 [vi].

• Trials showed 73% reduction in infection. Death numbers dropped significantly [v]
• Everyone and their dog talked of Ivermectin. Manufacturing ramped up. New production lines were set up by manufacturers
• IVM sales zoomed 400% in 8 months of the start of the pandemic. [vii].

?Meanwhile Ivermectin controversies from Rest of the World.

USA - US has fought for prescription of IVM. Physicians like Pierre Kory, went up to the the senate, for approval for Ivermectin for treatment. Later, even their Senate testimony was censored by the media [viii]

South Africa banned Ivermectin only to have it black marketed.?People took to Scoial Media and went to courts to get a prescription.

The Facebook group - SAHARI - South Africa has right to ivermectin had over 88,000 people petitioning and lobbying for this drug !!!?[ix]

In EU – Slovakia, became the?first and only nation to approve it, as late as January 2021.

Lesson # 4: Create Local solutions

At the beginning of the pandemic, India was totally dependent on imported ventilators, PPE kits and N-95 masks.

For 1.4 billion people, we had only 16,000 ventilators in all our public health facilities.

In just 12 month, over 36,000 ventilators were locally manufactured and?stories of collaborative practices across companies started pouring[x].

As Indian doctors took time to learn about the disease, it was found that fewer ventilators were needed, than previously expected. Need for ventilators itself went down.

Lesson # 5 : Have an open mind. But exercise caution.

If anything promised even remote benefit, we put it on trial. Quick approvals were granted to experimental drugs - Remdesvir, Fabi Flu – as part of global solidarity trials.

A herbal combination – Coronil was approved as an immunity booster . A huge controversy erupted when it was promoted as a "cure" instead.[xi]

Despite the debate, Indians lapped up every treatment option. Priced at 7 USD, Coronil grossed 70 million USD in just 5 months.

Government kept an open mind. Anything with reasonable proof, was put on trial.

Nothing was ridiculed by the government.

Later several natural drugs, plant based medicines and even homeopathy drugs were granted approval as early treatment options.

Lesson # 6 : Let experts lead. Politics follows

We also had our fair share of pandemic politics. A certain community was blamed for spreading COVID. The migrant crisis saw some nasty politicking.

Overall, our health policy was structured by medics. We didnt see them go to parliament or judiciary for approvals, like in USA or South Africa.

Lesson # 7 : You cant change behaviour amidst a crisis. Dont waste energy. (Hint: Masks)

State governments mandated masks. The PM made appeals on national TV, to wear them. Police collected millions for mask violation. Millions gathers at election rallies, protests, festivals and celebrations without masks. See images below, all from 2020 - where are the masks?

Beyond big cities and educated elite,?masses never took to masks. Ever!

Dont waste energy on things you cannot change.

No point making populations fight over behaviours they cannot change quickly. Don’t waste energy.

Lesson # 9 : Give people confidence

India tapped onto its rich traditions of Ayurveda and food traditions.?We have a ministry of alternative medicine called Ayush. Ayurveda self care guidelines for immunity and health were widely circulated?[xii].

Packets of herbs were widely distributed [xii].

Homeopathy doctors gave out prevention medicines and ran their own trials. Some corporates distributed these to entire workforce.

Many analysts now credit Indian food system, for our natural immunity. Am glad, we didn’t throw away anything. The govt didn’t ban anything. The scientific thought leadership didn’t ridicule anything.

Perhaps these interventions made us feel less vulnerable. There was more to talk about, than just death numbers. Picking up a healthy habit, felt like one was doing their bit for family.

Self care guidelines

What to do in case of dry cough?

How to deal with flem?

Which Yoga asanas can help?

What breathing exercises to do?

Lesson # 9 : There is no silver bullet

Trusting science is about being open to every possibility. Solutions may not come in a shape we imagine them.

True spirit of science is to be curious. There is no silver bullet to anything ever.

Lesson # 10 : Intellectual Arrogance kills?

India dealt with the crisis, with absolute humility, common sense and zero intellectual arrogance. We picked up and ran with whatever was available to us, with fortitude.

Good old values, we learnt in kindergarten, work best

You decide whether our leadership saved us, or we saved ourselves. Was it some mythical immunity, faith in a higher power, repurposed drugs, herb packets or just the turmeric in our food.

?Anu Lall

Disclaimer: I am not a doctor. I started my career in Pharma sales.

I teach Breath Work and during the pandemic, I have worked with many COVID survivors, which makes me watch this space closely.?

REFERENCES

[i] https://theprint.in/health/hcq-breakthrough-icmr-finds-its-effective-in-preventing-coronavirus-expands-its-use/427583/

[ii] https://indianexpress.com/article/india/hiv-drug-combo-found-to-have-no-benefit-for-hospitalised-covid-19-patients-in-uk-trial-6483412/

[iii] https://health.economictimes.indiatimes.com/news/pharma/why-icmr-continues-to-stand-firm-on-using-hydroxychloroquine-as-prophylaxis/76172274

[iv] https://www.newindianexpress.com/nation/2020/may/29/icmr-writes-to-who-disagreeing-with-hcq-assessment-officials-say-international-trial-dosage-four-ti-2149702.html

[v] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247163

[vi] https://www.hindustantimes.com/lucknow/lucknow-admin-to-set-up-kiosks-for-distribution-of-ivermectin-tablets/story-YNDN2GIdWHf7EsDgZQbmNL.html

[vii] https://www.business-standard.com/article/companies/sales-of-ivermectin-drug-to-treat-parasitic-infections-jump-fourfold-121020600005_1.html

[viii] https://www.wsj.com/articles/youtube-cancels-the-u-s-senate-11612288061

[ix] https://www.dailymotion.com/video/x7z5m4j

[x] https://www.investindia.gov.in/siru/helping-india-breathe-ventilator-manufacturing-during-covid-19

[xi] https://www.thehindu.com/news/national/patanjali-can-sell-its-drug-but-not-ascureto-covid-19-says-union-health-ministry/article31962529.ece

[xii] www.ayush.gov.in/docs/123.pdf