'Waiting for Godot' or One Hundred days of Solitude (With due apologies to the authors of both classics)

'Waiting for Godot' or One Hundred days of Solitude (With due apologies to the authors of both classics)

For many of us , the COVID scenario unfolding is not unlike what is depicted in “Waiting for Godot” by Samuel Beckett. Like the protagonists of the novel we have a lot of time and our minds are racing ahead with possibilities, expectations, even analysing multiple scenarios and mathematical curves. The participants in the novel do not seem to do any extraordinary things; they do the mundane stuff – wake up, spend time in finding food, argue, get tired, find food, argue more till they are tired again- not very different from how our current routine looks. They wait for Godot, who never arrives. But the metaphor of the novel or the core idea is a powerful one – that seeks to define the meaning of life and showcases the shallowness of our approaches to life.

You can ignore the ramblings, but when I was contemplating the consensus among the media and the elite that India as a poor country cannot manage the crisis due to our poor healthcare infrastructure, lack of knowledge and the overwhelming numbers, it seems to me that we are being led to be like the participants of the novel, waiting for something to happen.

But India is way beyond the conventional ideas and we have demonstrated it many times to ourselves and to the rest of the world. I always believe that India’s strength is in numbers. A parallel idea occurred to me to leverage the same to manage COVID crisis and I would like to expand it below.

As I understand from the readings and the media,

·       80% of those who are infected by COVID19 will manage without hospitalization, if they follow simple procedures.

·       15% of those who are infected will need medical care including hospitalization.

·       5% will require critical care, led by medical professionals and ventilators, etc.

But this fact is often overlooked in the common understanding of a normal citizen. Everyone is linking the occurrence of the infection to mortality and fear rules the actions. In a way, it is good because it helps the majority to adhere or try to follow the guidelines from the Government. But if we account for the panic and look for solutions in managing the crisis, we need the following elements in place well before the pandemic spreads in the community:

1.    An accessible location in the community where the ‘testing’ and ‘treatment’ can begin for 80% of the infected citizens.

2.    A medical facility to identify and treat the 15% of the serious infections where we need trained medical professionals

3.    A specialized hospital to take care of the critical cases, with oxygen, ventilators etc.

4.    We also need a logistics solution to move medicines, PPEs and even health care professionals

Please note that the personnel involved in the first category can be managed with good training and SOPs with very less ‘time intervention’ from doctors. Government has already mobilized the voluntary teams. The next two cases would require medical professionals and equipment.

Let’s translate these into actual numbers at a mandal/taluk level . (All these numbers are taken from the published sources and this estimation relies on averages. The accuracy will improve when actual data is substituted at a granular level).

Total population of India – 1,300 million

Total no of mandals/taluks – 5,650

Average population per taluk – 230,888

Testing: Assuming we need to test 100% of the population, if the test takes an hour to complete, then the daily average is about 10 people per COVID center. If there are 183 COVID centers (I will come to this number in a minute), then the no of days to complete testing will be as follows :

Number of people per COVID center : 1256 (230888/183)

Number of days to cover

10% of population   - 13 days

50% of population    - 63 days

100% of population - 126 days

This means in about 100 days, we can actually complete the testing. The testing kits are another story. Also, no one has recommended 100% testing. In this case, the ‘treatment’ can be standardized depending on the parameters and can be summarized in a SOP.

Now, let us assume a worst case scenario of infection at 10% (Pray to God that it is not the case).

Again, at a mandal level, this translates into :

Number of people in the 80% category : 18,407

Number of people in the 15% category  : 3,451

Number of people in the 5% category     : 1,150

Remember that we said we need medical professionals for the last two category. Let’s look at the broad numbers again.

Total no of healthcare professionals in India : 2.2 million

Average no of healthcare professionals per mandal – 389

If all of them are mobilized to focus on COVID at the COVID centers, then average number  of patients they need to work on is 12 ((3451+1150)/389), which is not a very high unmanageable number. Please also recollect that all the patient arrival will follow some mathematical distribution with intervals.

More importantly, we need an average of 25 beds in each of the 183 centers ((3451+1150)/183) and we will see how that can be made available.

Now, consider the actual accomplishment of India 12 months ago. If we turn the clock back one year, last April, the Election Commission of India managed this scale, of course for a different reason.

·       In 38 days, 1.035 million polling booths covered the nook and corner of India.

·       2: The maximum distance in kilometres from any given voter’s house to the nearest polling booth

·       3.96 million: EVMs in use this election

·       1.7 million: Paper trail or voter-verifiable paper audit trail machines. It is a documentary record of the voter having exercised his franchise

·       11 million: Election personnel being deployed 

·       Election commission has the SOP for mobilizing district administration, police and even para-military forces.

All of us can now see where the 183 number is coming from. Yes, that is the average number of polling booths per mandal. So, we need a plan that will convert each polling booth into a COVID center/booth.

Also consider this :

No of schools in India – 1.6 million

No of polling booths - 1.035 million

So, it is not a coincidence that you almost always encounter a school near your home as a polling booth. It is by design. And that is where we can get our 25 bed “hospitals”.

So, we need a 100 day plan for India to effectively combat the deadly virus.

·       Replace polling booths by Schools

·       Replace EVMs by Medicines and equipment.

·       Replace Election SOPs (quite complicated) by COVID SOPs ( for the 80%)

·       Replace High Risk Polling Booth Strategy with COVID High risk strategy (to address personnel, additional equipment)

·       Replace Counting mechanism data dissemination with COVID data to ensure that the entire nation gets to know the real-time-data on the progress of treatments.

·       Replace Candidates with COVID volunteers including the same political candidates to ensure the information dissemination happens to every citizen (voter).

·       Replace polling booth agents with Corporation/Panchayat staff and Govt volunteers (the volunteers are already doing a good job in conducting door-to-door surveys)

Of course, the challenges of ventilators and forming medical teams need to be addressed. But given the power of India’s inherent beliefs among the citizens, this can be done, with a lot of careful planning. Election commission usually takes about 365 days for preparation, but that includes electoral rolls, etc, but now, we can re-use most of the data, which is just a year old. Hence , a hundred days of solitude should be possible for the country !