My Sharona 1979 to My CORONA 2019

I hope this note somehow reaches my Chief Minister Mamata Banerjee & Prime Minister Narendra Modi. @tanmoychakrabarty @mohandaspai @swapandasgupta @anirbanganguly @souravsanyal @tathagataroy @mousen if you can help! What worries me most in our keen focus on fighting the current battle, we will lose focus on "reinfection rates", something no one is talking about. In 1918 during the devastating Spanish flu, highly contagious wave of influenza appeared with a vengeance later in the same year. Victims died violently within hours or days of developing symptoms.

 I am no virologist or epidemiologist or an expert in the area of medical science, but a keen observer of data and a novice wannabe strategist who sees things as the way they are, the way of "Dhamma" - see things the way they are. The note below is completely a personal commentary and not an organizational statement. I have been too lazy to create a blog space. Most of the readers are probably COVID19 expert by now but just trying to lay it out as clearly as possible as an independent observer of the shameful global mismanagement of the greatest ever catastrophe we may have witnessed since the extinction of the dinosaurs. Where are the #Prince2 & #PMP certified experts who expected to manage large programs? This is the largest it can get. We are short of ~30K beautiful souls today and God knows how many of the 480,000 (03.28.2020) cases are on the line. TV anchors, doctors and politicians debating as experts everywhere sharing divergent views on who will make it and who won't and that the aged are more at risk, yet, a 101 year old Italian & a then 89 year old American survives. Are they outliers @thomasfriedman? The jury is still out there on what the right strategy is, because like me, everyone seems pretty clueless. UK increased testing by 500% over the last few days from 1,500 to 10K per day yet the death rate is second only to Spain.

First off, I think PMO Narendra Modi is an astute decisive leader. Quick decision, yet late by at least 10 days in my opinion, on lockdown may just save the nation from an imminent civil war. Are to too naive to think that the 90% marginalized will just sit and home & await death? US waited too long to lockdown and now New York is a case study of failure. Just like like demonetization, this is clearly as badly planned. Our PM absolutely needs a better set of strategists, maybe re-skill and job rotate his digital marketing strategists who do a far better job as his image consultant a.k.a branding. His bureaucrat advisers are outdated & pretty worthless. When you are leading a country of a few billion, you need to plug in the basic cracks your policies may fall through. For example it seems there was little learning from the botched up #Demo activity in remote areas like Sundarbans or Andamans. It left blood in the hands of our PM, whether he accepts or not. I have personally interviewed people from Sunderbans and whatever I pen here is primary knowledge.

Sundarbans is a collection of islands and not all islands have brick and mortar bank branches. Most people have mobile phones, but may not be smart phones. It can take a few hours for the ferry to get from one island to the other, of course factoring the designated timings. So a person could start his/her travel at 8 am from island A and could reach in 3 hours at Island B. During demonitization, the government fixed a couple of things - banking hours & amount of withdrawal. The bank employees lunch hours never changed. There were instances of people coming late from far off islands, travelling great distances to pick up money yet being so behind in the serpentine queues, missed the banking hours. Some either died out of fatigue, heat or just hung themselves in frustration. I see a similar situation playing out during COVID 19 outbreak and it's depressing. The government is running massive infrastructure projects in and around the nation's capital. A significant number of people who work at these construction sites are migrant workers who live on daily payouts. With the sudden declaration of this lockdown, all work was stalled and understandably these daily wagers needed to find a safe house. These poor folks are caught between the devil and the deep sea - if they stayed on the road side tents, they were whiplashed by the untrained non sensitized frustrated police (who barely recovered from a massive communal street fight) and if they did not migrate back to their homes, they would die of hunger. The visual images all over media, digital or otherwise, of hordes of migrant workers walking hundreds of miles to save themselves from hunger, is heartbreaking. As usual, governments have started the blame game. In India, almost every debate ends in politics. That's the law of the land. The state governments are not owning responsibility of these poor people and the centre is clearly hands off as employment/availability of work is a State subject. If you asked me, is there was anyone to blame it would be the home states of these migrant workers and the lousy archaic education system that breeds mediocrity and completely disconnected from the professional universe. I blame the home states because if they provided employment opportunities & inclusive growth, no one would like to leave home. Interesting point is all those pundits who pushed for globalization and free flow of labor are now blaming globalization for the spread of pandemic. This only shows how fleeting and opportunist human mind is. If you read Buddha, he would call this "Anicca"-impermanence. We just don't get it!

But let's leave politics aside. What does this massive migration mean to the fate of the country and its economy? Well here's my take. I have had a few WhatsApp exchanges with my sister who is in the front line at Harvard Medical and working very closely with US government to find a cure to this pandemic. Yes, she put her neck in the line so all you American's can be saved (and maybe friends of US)! She thinks she might have the bug too but feels strongly about the greater cause here, despite putting her entire family ( 2 small kids) at risk. That's patriotism. She assured me that most of us will live to see the day if we followed the basic protocols of safety - stay indoors, not to worry if there is a flowy nose, self quarantine if feeling a bit low but surely dial the hotline if there are signs of high fever and breathing disorder. The chances are low in folks with good immunity, but precautions are always good. Now let's jump back right into the problem at hand in India. On the one hand the central government has locked down the country to prevent a massacre, but on the other we have a few hundred thousand people congregating to get home hoping their home states will provide a safe passage. It will take one bad apple to rot the cart and India will dwarf Italy, Spain & New York in COVID19 death toll just because of the sheer numbers. The only silver lining is the success rate of survival of this cohort is much higher than those of the affluent community simply because of their strong immune system. Most Indians grow up in poor conditions of hygiene and sanitation and a country that has successfully wiped out polio & smallpox from the world. Thus garnering a strong sense of herd immunity by nurturing a massive diversified portfolio of bacteria in the gut and smoking unknown viruses 24/7. Almost every food ingredient has some toxic chemical mixed and fruits and vegetables galore in pesticides. The evidence can be found in high occurrence of kidney diseases & cancer over the last 10 years or so.

Now the question is, how will the Indian State governments really manage this huge influx of expats given a country wide lockdown and non availability of sufficient reliable testing kits? I hope our State governments took some learning from the catastrophe in Italy. We have a similar structure - health is a State matter. Thus the ability of the State to proactively Test and Isolate COVID cases will decide the fate of India.

So what should Indian States do? The easy way out is to mimic what Singapore, China, South Korea or Taiwan did. India however is a different animal and we need to modify our strategy understanding where all Italy faltered and what the social intersection point we have with the success stories. A one size fits all will not work in my opinion. The good part is most of us understand what it means if there is a .35% infection rate and a 10% death rate in India with a population of 1.3 bn. We are looking at .45 mn deaths between now and September on a linear scale. I want to be WRONG! I really have no clue how the government is planning to shoot this thing to oblivion by April 14. There is no correlation between this virus's ability to withstand high temperature nor does India have the magic pill yet although my organization has just found 31 potential compounds to treat COVID19. So what are the options in our hand? What we know is that the impact of the virus is exponential and that has been its consistent character. What we also know is that the massive exodus of infected people from Northern Italy to Southern Italy. I see a similar pattern in India right now. We are letting millions migrate to diverse parts of the country to the remotest areas without having the checks and balances. To me its cataclysmic, End Of Days scenario and as a nation find these people a home where they are. The opportunity cost is much lower. When I debate with people, they point me to a flattening graph for India. I argue with the example of the graph from Japan. Japan has been consistently showing a flattened graph. I think they are under reporting to avoid bad publicity before Olympics. I am reasonably sure that India is under reporting too and it's not long before that the skeletons will be out of the closet. You cannot hide the dead in India if you could not hide them in Iran. Someone is always watching.

Hoping it's not a doomsday situation because, India it seems to me the rich man's disease, we should clearly look at 2 cities from Italy and South Korea as our use cases ( & not be adventurous like Star Trek Enterprise to find new efficient frontiers) -

1) Lombardy - COVID19 wreaked havoc here because of the choices the city made. Lombardy tested symptomatically and paid little focus on either homecare or the safety of health care professionals. This is what most Indian States are doing now, and it worries me because under a lockdown, folks will just die at home untreated

2) Veneto - like Lombardy, they applied social distancing but greater focus was paid to containment. Extensive testing of symptomatic & asymptomatic cases early on, proactive tracing and isolation, self quarantine if testing kids were unavailable,, emphasis on home care & most importantly all protection was provided for the healthcare professionals.

3) South Korea - rolled out the a mass testing program. They decided to test anyone who might have been exposed to the virus - directly or indirectly. They were able to keep the mortality rate below 1% testing and re testing ~210,000 patients a day. They effectively used such test data to manage the next lot of testing, incrementally. South Korea refused to use the Chinese kits & used kits that followed WHO guidelines.

Testing is effective only when we are able to establish full spectrum contact tracing followed by rapid isolation - test-recovery protocols. This has to be supported with effective communication on recovery rates and traceable failure rates. Governments will always try and fudge bad numbers but trust me, this is not the time to play the one up game that State governments in India are playing. Government should focus how it can garner NGOs working in healthcare area to rapidly set up home care support - A PPP model that will help the government focus on the bigger issue of containment strategy rather than operations management.

I believe the prime driver for success in this bio war would be the protagonists ability to track each and every case, bring the largest population under the testing ambit and analyze data with the highest precision. Best practices will only work to the extent of figuring out how to do the right things, data analysis will help do the things right for example from Veneto we may understand what we need to do but using the right set of comparable data ( In Six Sigma there used to be a term Gauge R&R). What worries me is that India in not testing enough and that's simply because we do not have enough testing kits. Is our Foreign Secretary speaking to his South Korean counterpart?

The mass scale migration now poses additional burden on distribution channels. We do have the options of buying Chinese kits but clearly those haven't worked in Spain with 30% accuracy rates, 1.3 million masks supplied to Netherlands have defects & 640,000 test kits to Italy have clearly ended in disaster. I mean, c'mon, It's "Made in China" after all. Nothing personal! The next best alternatives until the bulk supply chain of kits is worked out is isolation and martial law that would force everyone to just stay put at home especially if you are above 55 years and are somehow immuno-compromised. I sincerely hope Mylab, Pune is quickly able to scale up beyond 100,000 kits a week and make sure they have the last mile delivery capability.  I am not a technical expert but am assuming that the test kits from Mylab are capable of performing PCR testing. @sudeshnafisch, any pointers?

As a person deeply entrenched in spirituality (don't mix it with religion please!) couple of realities of life emerged in my spectrum of thoughts. I witnessed the ugliest side of humanity with people fighting and bleeding over toilet papers and cup noodles. I, for one, decided to be civil about my approach so as a matter of principle didn't hoard. I was left out and almost ran out of food a few days back with aged and minors to fend for. Luckily there was a mom & pop shop selling some essentials under the radar of the lockdown. Most of these mom & pops used this opportunity to fleece and rob.

It was frustrating to hear that even my closest friends, families of 4s & 5s bought 40 lbs of Rice & lentils, 50 bars of soap, 10-12 block of butter, 20 litres of milk etc to survive over 21 days of lockdown. You give it to a family living below poverty line, the family will survive on it for a year. The good thing is, my hypothesis that most human beings are manipulative & selfish, was confirmed beyond doubt. I was also distraught about the fact that this is a disease brought about by the selfish rich and just dumped on the unsuspecting poor. Expats in scores, who bear no loyalty to the motherland, depended on the government to bring them back from rich nations at the cost of domestic tax payers money (a.k.a Air India, the bleeding national airlines that is up for sale that always saves the nations face, akin to the today's 40+ age group employees in a tech company). I know of so many cases where COVID19 patients consumed paracetamols on their flight back, to avoid temperature gun scanning at the ports of entry bringing a bio war right at India's doorstep. Not a single #SoMe post on this but I know it happened. This is a criminal act because if this spreads deep and wide, the poor will die and the rich will just look away like Nero. The other thought that frequently crossed my mind is, despite prolific investments to the tune of over $ 300 bn in emerging tech like #CyberSecurity, #AI, #ML, #DeepLearning, #PredictiveAnalytics #ConnectedHealth #MachineVision #Drones et al no one was either able to predict the probability of occurrence of such a bio war that will cripple the global economy or was able to predict the extent of damage - human and financial loss or for matter manage the aftermath using something like delivering care using drones. We are still clueless where these numbers will go - cases vs deaths vs recovery. Question - where is all this tech investment really going when no one knows jack about what's going on?

As a tech takeaway here is my final thoughts on how Wars have been fought and will be fought. Drop in a "Comment", there is always something to learn

War 1.0 - Religion/Holy Wars (Middle East)

War 2.0 - Industrial Revolution (Europe)

War 3.0 - Arms & Ammunition (Britain)

War 4.0 - IP/IT (Data as new oil) (USA)

War 5.0 - Biochemical War (COVID19) ( China)

Future of War, War 6.0 - Virology (USA/Israel/India)

IMO, if you are pursuing research on Virology this is the time you up the ante. The leaders should be able to effectively use #AI #ML to list out the possible strains of a virus like COVID19 and pursue an ecosystem play with pharma companies & tech startups to develop possible remedies.