MANDAR PATKI

AIR 22 CSE 2019

Types of Corona viruses

How virus enters human body

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Stages of COVID transmission

 WHO identified 3 stages

1. Asymptomatic- transmission of virus from a person who have not developed any
symptom
2. Presymptomatic- transmission when person spreads Diesease before appearing
symptoms, eventually develops symptoms themselves
3. Symptomatic

Problem with Asymptomatic patients

 As Dr. R. Gangakhedkar explain : RT-PCR test comes positive only when persn is symptomatic. So
testing Asymptomatic is not a good strategy

Zones classification

Red zone - 170 District

1. Highest caseload dist contributing to 80% of cases of India or of each state OR

2. dist with doubling rate less than 4 days (calculated every Monday for last 7 days, to be
determined by State govt)

Orange Zone -

1. Area with limites cases in last and no new cases recently

o Number of cases differ from state to state
 Delhi- 1 or 2
 MH - 15
2. Hotspot, if no case in 14 days, can turn into orange

Green zone - 207 District

1. No reported case
2. Hotspot, if no case in 28 days, can turn into green (later changed to 21 days)

Success of Lockdown

1. V K Paul study- prevented around 14-29 lkh cases and 36000 - 17000 deaths as of June 10
2. Creation of Health Infrastructure capacity - to handle further cases
3. Reproduction Number- which means number of persons being infected by Positive person
o 1.83 on March 24 (by Institute of Mathematical Science s)

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o 1.29 on June 5
4. Increasing of doubling rate -

Hospital Classification

 3 levels

Covid Care Centre (CCC)

 for institutional quarantine for people such as slum dwellers

 Asymptomatic positive patients

Dedicated Covid Health Centre (DCHC)

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 Moderately ill patients, patient with comorbidities

Dedicated Covid Hospital (DCH)

 Critically ill patients who require ICU support

 High risk patients

Corona deaths

 Corona by itself alone does not kill, buht due to:

o Co morbidity
o Delay in testing
o Inadequate social distancing
o Lack of access to healthcare

Covid and Maharashtra

Why High Covid cases

1. No early steps - Lack of action in months of January and February untill March 9 (1st confirmed
case). Nearly 40% of initial cases were from UAE. But it took 10 days to start screening at
Airports. This was major loophole in screening process as nearly 42,000 travellers came through
Mumbai airport everyday till 3rd week of March when Universal screening started at airport
2. Lack of Physical distancing - nearly 50% of cases in initial period were from 8 out of 24 wards in
Mumbai. All these wards were densly populated like Worli Koliwada, Dharavi, Kurla, Byculla
which have popu densities anywhere between 3 to 10times that of Mumbai (21,000 per sqkm)
3. Population of MH - 41 of 100 most populated wards are located on MH. Popu density is 375 per
Sq km
4. Migration - migration from Mumbai sread virus to peripherial districts like Navi Mumbai,
Thane, Pune, even to Nasik
5. Role of Superspreaders - in Cities like Aurangabad

Healthcare system

Challenges due to COVID

1. Attack on health care personnel

2. Inconvenience to other patients - patients with other critical diseases like Cancer, CVD,
diabetes are not coming to hospitals due to fear of infection. National Health Authority Data
shows that claims under PM-Ayushman Bharat fall almost by 51%. Thus once pandemic is over,
this overload will again strain the healthcare system
3. Bed availability - According to OECD (2017), only 0.53 beds per 1000 in India

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4. Healthcare sending - National Health Profile (2018)-publuc Healthcare spending less than 1%
of GDP
5. Wide regional disparity-

Way forward

 Central Bed Buearau- as recommended by SC in Pachim Banga Khet Mazdoor Samity (1996)
to overlook the vacanies of bed in hospitals and emergency transfer of patients to hospitals

China and Multilateralism

Recent WHO stand on COVID

1. Mid-January: No evidence of Human to Human transmission

2. Over the top praise for China's effort
3. Criticism on countries putting ban on chinese national
4. WHO leadership accused for being tool of chinese propaganda
5. International Health Regulation (IHR) - authorises WHO to collect Diesease event information
from Non govt sources, seek verification frm govt about such info and if necessary, share info
with other states. Also gives power to WHO to declare pandemic as PHEIC, even if country
experiencing outbreak objects.

Why

1. China's increasing financial contribution to WHO

2. Role in election of WHO prez in 2017
3. China's raise in Multilateral institutes

WHO FUNDING

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WHO reforms

1. New international norms- to increase obligation of states and powers of WHO in facilitating
early detection and notification of pandemic
o This involves finding ways to bridge the contested notions of state sovereignty and
collective security
2. Funding- organization depending on donations rather than membership fees is set to propogate
the donor's agenda. Thus reducing WHO's reliance on voluntary contributions from govt and
corporations and increasing assessed contributions from member states.
3. Limiting agenda - WHO's initial success came when it focused on few Objectives like combating
malaria and elimination of smallpox. A limited agenda also make WHO a more effective
organization
4. Apolitical leadership - leadership positions should be filled, as far as possible, by appointing a
Apolitical person

Economic Impact of COVID

 Uniqueness about Eco crisis due to COVID - unlike previous crisis which were majorly supply
side inflation concerns (3Fs- Food, Fuel and Foreign Exchange), the covid is expected to cause
Demand side deflationary shocks, which demands heavy expenditure from govt

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 Two types of impact-

o Primary Impact - related to restrictions imposed and social distancing : especially on
urban economy and service sectors (both formal and informal), tourism and travel, retail,
transport and real estate
o Second round effect - result of primary impact- Reduced income, reduced consumption
Expenditure (thus reduced expenditure multiplier), NPA among MSME, outflows of FPI.
o Impact of global economy- Reduction in demand for indian imports, outflow of FPI will
cause destabilized stock market and currency
 Malnutrition - loss of wages means decreasing income of migrant population (which happen to
come majorly from eastern India). This will reduce Consumption Expenditure by households.
o And as per NSSO CES data 2011, 45% of expenditure of indian household and 60% of
ex of Poor household goes on Food items. Thus this will result into malnutrition and
hunger deaths
 C. Rajmohan- de globalization, big govt, the focus on redressing inequalities and new
political weight of working class is likely to have powerful and lasting impact on national
economic strategies
 Banking sector-
o Increasing risk aversion attitude is affecting demand of and supply of loans:
 Demand- retailers and households and not taking loans
 Supply- banks risk averse to lend, thus parking funds with RBI
o Disparity in Credit giving- Banks are ready to lend to big corporates, who are now not
taking up loans as they obtained their full capacity. While small firms who are in dore
need of loams are not geeting loans as banks as sceptic about theie credit worthiness
 MSME sector- most of them are not registered anywhere due to informal nature. This apparent
Invisibility constraints govt's ability to help them. Developed countries are providing wage
subsidy amd extra credit to smaller firms and they are able to reach this sector due to
registration. This makes Indian MSME sector more vulnerable
o Other problems- ability to retain prolonged closure due to lack of buffer, ability to restart
the production after lockdown, drain of migrant labours
 Data issues - carrying out surveys such as Various surveys scheduled as follows
o Household Consumption Expenditure Survey 2020-21 and 2021-22
o Census 2021
o PLFC (last Annual data released for 2017-18 and quarter data for urban areas upto Q1
Jan-March 2019)

Positive side for indian economy

1. Collapse of oil prices- help in BoP

2. Plentiful food stock- Availability with FCI, good rabi crop, good projection of mansoon for next
year
3. Low inflationary projections- due to low aggregate demand will fampen inflationary impulses.
4. Proactive monetary policy by RBI- allowing moratoriums, setting prudential norms, infusing
liquidity
5. Fiscal policy- stimulus announced by Fin Min
6. Exports - help of weakened rupee

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Way forward for Indian economy

1. Infusing liquidity - to push up aggregate demand

o Helicopter money- as suggested by KCR
o Minimum basic income- sectorwise (loborers, etc)
o Provide working capitals for MSMEs ( like UK providing 80% of salaries "GET paying
MSMEs" for 6 months)
2. Arvind Subramanyam 3 pronged Approch :
1. Special Non Adversarial Procedure (SNAP) in IBC for COVID affected firms
 Mention in Chapter 11 of American Bankruptcy Act
 CoC to asses financial position of firm, and if it deserves, give it tag of Lockdown
Affected Enterprise (LAE)
 IP to work with management of company to arrange interim finance and prepare
proposal for debt restructuring
 If CoC reach 2/3rd majority on proposal, firm will be given proposed haircut and
immediately released from bankruptcy
 If no agreement - then IBC
2. Bad bank for stressed power and real estate sector
3. Revitalizing MGNREGA - increasing allocation from current 0.47% of GDP (which is highest
ever) to WB recommended amount 1.7% of GDP for optimal functioning of program
o Note- MGNREGA's demand increased by 31% in May month with 41 cr hours of man
labour generated

Steps taken by RBI

1. Operation Twist- simultaneous sale and purchase of G Sec under OMO of worth ₹10,000 cr to
o Reduce long term interest rates for loan
o Effective transmission of minetary policy
o Stabilize the yield rates
2. Special liquidity facility for Mutual Funds- Repo operations for MFs due to liquidity crisis MFs
are facing due to redemption pressure on them

Issue of Monetisation of FD by RBI

 FRBM- escape clause: RBI could subscribe to the primary issue of central government securities
in case the government exceeds the fiscal deficit target on “grounds of national security, act of
war, national calamity, collapse of agriculture severely affecting farm output and incomes,
structural reforms in the economy with unanticipated fiscal implications, decline in real output
growth of a quarter by at least three per cent points below its average of the previous four
quarters”.

Why necessary

 Because of combination of falling factors lead to Reduction in options to govt to borrow

1. Economic slowdown will reduce revenue collection from businesses
2. Need of money for bailout packages - thus meed to borrow more from market

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3. Fall in domestic savings - thus cannot fund govt

4. Pulling out of foreign investment - towards 'safer' economies like US
5. Crowding out effect - especially when businesses are in stress

Cons of monetization

1. Inflation - due to increased expenditure of govt

2. Macroeconomic instability - recently, D. Subbarao pointed that higher inflation along with High
govt debt leads to macroeconomic instability
3. Credit ratings of govt- suffers
4. Inefficiency in allocation - in economics, it is generally assumed that monetized monry cannot
be efficiently allocated.
5. Shifting of RBI control over monetary policy- as Monetization is driven by Govt's debt
demand, thus RBI has little say. This potentially leads to high inflation, thus jeopardizing the very
objective of monetary policy.

Way Forward

 The monetization of deficit should be last resort. RBI's credibility in delivering the inflation target
influences the growth prospect. This can be hampered in method of monetization of deficit.
 Also, monetization gives a signal to market that fiscal policy may slip and govt is ready to solve
the fiscal problems without looking after debt aspect. This leads to negative Perception in market
which can hamper bond yield.
 As long as there is stability of bond yield in market, OMO can be continued for debt
management
 When there is high shoot in bond yields and govt has very little options, then the monetization
can be acquired as one time measure

Conclusion - Definitely there are good opportunities, but first, we must survive. We can then reimagine
and thrive

COVID and IBC

Need for suspension of IBC for 6 month

1. Liquidity crunch at MSMEs

2. Defaulting payment of both operational and financial creditora due to economic slowdown
3. No financial viable company is in situation to take over another company

Liquor and State Revenue

Importance of liquor in State revenue

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 RBI's report last September titled 'State Finances :A study of Budgets of 2019-20' shows that
state excise duty on alcohol accounts for 10-15% of Own tax revenues pf states
o Total collection in 2018-19 - ₹1,50,650 cr
o Average collection by each state- ₹12,500 cr per month
o Top 5 states-
 UP (₹25,000 cr)
 KR (₹19,750 cr)
 MH (₹15,300 cr)
 WB (₹10,500 cr)
 Telangana (₹10,300 cr)
 Other sources for state revenues
1. Tax revenue
 States own tax revenue
1. Taxes on income (agri, professions)
2. Taxes on Property and Capital Transaction (land revenue, stamp and
registration fee)
3. Taxes on Commodities and Services (sales tax, VAT, State GST)
 Share in Central Tax
2. Non tax revenue

Issue of Relaxation in Labour Laws

Issues

1. PUDR vs UoI (1982)- SC held that laws protecting contract labour and inter state migrant
workmen were intended to ensure basic human dignity. Violating these laws violate Right to life
under Artcile 21.
2. Deterrence - for migrant workers to return back from native states
3. Constitutional provisions - Article 43 "to secure all workers a living wage, condition of work
ensuring a decent standard of living"

Supreme Court directive

 SC ordered media to "refer to and publish the official version” about COVID-19 developments is
in the spirit of the provisions of the Disaster Management Act of 2005.
 Provisions in DM Act, 2005
1. Section 67- government to direct the media to “carry any warning or advisories
regarding any threatening disaster situation or disaster”
2. Section 54- criminal offence punishable with imprisonment up to a year
 Mr. Ajay Bhalla, Home secretary, explaimed in report to court that any deliberate or inaccurate”
reporting by the media, particularly web portals, has a “serious and inevitable potential of causing
panic in a large section of the society” and harms the entire nation"
 WHO Director General - “we are not just fighting an epidemic; we are fighting an infodemic.
Fake news spreads faster and more easily than this virus, and is just as dangerous.”

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My opinion

 Science and Facts are true antidotes to Fear and Panic. SC definitely done appropriate thing by
ordering media to report the contents of daily bulletin of govt.
 However, in fight of this infodemic, only official version is not enough to unfold the true stories. It
is media reporting whoch makes administration accountable and force it to perform its duty
 Media is enabler of Informed Choice. This informed choice by people is most crucial to fight
infodemc.
 It ks put on essential service list because it can bring true and authentic information not just to
citizens, but also to govt.
 Thus, aling with reorting official version, it must be supported by unbiased and informed ground
reportings..

Govt Economic Package

 Package of 1.7 lakh crores for poor households and Small businesses for whom the outbreak has
became Crisis of Liquidity
 Includes:
o Individual level-
 PM Garib Kalyan Yojana- Free ration for 80 cr population for next 3 months
 ₹1000 income support to Senior Citizens, widows and divyang
 ₹500 transfer in Lady Jan Dhan account
 PM KISAN- Income transfer to farmers- ₹2,000 to 8.7cr farmers.
 Free cylinders to 8 cr poor families registered under Ujjwala for next 3 months
 ₹50 lakh medical insurance for health workers
o Unorganised sector -
 Daily wage under MGNREGA raised from ₹182 to ₹202 to benefit approx 13.6 cr
familiez
 Increased limit for collateral free lending for SHGs from ₹10 lakh to ₹20 lakh
 Centre to direct states to use welfare fund for Building and Other construction
workers
o Organised sector under EPFO-
 EPF Contribution by centre (both employees and employerz share) for earning
below ₹15000 a month in establishment up to 100 employees
 Amendment to EPF scheme regulations to allow non - refundable advance of
upto 75% of balance or 3 month of wages, whichever is lower

Sources of Money

1. KISAN contribution - already budgeted for 2020-21, govt just front loading payment for first
trenche
2. Construction workers- 1% cess on cost of construction which is already being collected by states
as mandated under Building and Other Construction Workers Welfare Cess Act, 1996.
3. MGNREGA - raise doesn't seem any significant effect since works are on hold due to lockdown.

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Atmanirbhar Bharat Abhiyaan

Package

1. Agricultural - ₹1.63 lakh cr

o Farm gate infrastructure
o Fisheries, animal husbandry, vaccination for FMD
2. Non Bank Liquidity package - ₹5.94 lakh cr
o MSMEs, NBFC, MFIs, Housing Finance companies, power discoms, tax reliefs
3. Migrant and farmer package- ₹3.16 lk cr
o Concessional credit via KCC, farmer working capital, affordable housimg, street vendors,
microloans
4. Welfare and health- ₹1.85 lkh cr
o Women and pensioner benefits
o MGNREGA
o Emergency health response
5. RBI Liquidity Measures- ₹5.24 lkh cr
o Targeted LTRO, CRR Cut, refinancing, Mutual Fund Liquidity facility
6. Structural reforms-
o Essential Commodities act, 1955
o APMCs and Contract farming

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A. First announcement

1. FULL Credit Guarantee of ₹3 lakh cr - to MSMEs having outstanding loan of ₹25 cr or turnover
less than 100 cr
o Tenure of loans- 4 yrs with moratorium of 12 months
2. Partial Credit Guarantee Subordinate Debt scheme- ₹20,000 cr for those MSMEs who are
already categorized as 'stressed'
3. MSME Funds of Fund - ₹50,000 cr for equity infusion in viable MSMEs to help them expand and
grow

 Problems
1. Moral Hazard- 100% credit guarantee disincentives MSMEs to pay back the loan
2. Rise in NPA- once moratorium of 12 month is over
3. Stressed MSMEs- may use 20% backed loans to Cover losses and pay interest
4. NBFCs- may be sufficient to prevent liquidity crunch, but will not suffiice to help them
grow

Self reliant Economy

Dependency of India

1. Energy dependency - crude oil

2. Foreign Exchange inflows- remittances and financial flows from global capital market
3. Defense dependancy- for equipments
4. Electronics goods and Pharma- mainly from China

 Dependency of country is both import dependency and export dependency.

o Export dependency - China dependent on exports to US which Trump is utilizing to wage
trade war

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What is Atmanirbhar Bharat

 Rather than being isolationist and inward looking, It is decentralised localism that takes pride in
local brands, emphasises resilience and flexibility and encourages local capacity building and
Indigenisation
 Self reliance implies that product and factor markets are made flexible in order to problems and
opportunities of emerging post COVID world
 Self reliance requires generalised system of social trust and confidence.
 5 pillars pointed out by PM for Self reliance
1. Economy - economy that bringing quantum jump rather than incremental change
2. Infrastructure - world class infrastructure will become identity of Modern India
3. Technology driven system- to fullfil dreams of 21st century India
4. Demography - vibrant demography as source of energy for self reliant India
5. Demand- demand in economy needs to be fulfiled with strengthen Supply chain, supply
system built up with the smell of the soil and the sweat of our labourers

Migrant labourers

 Labour Ministry Does not kee record of Migrant labourers

 Economic Survey 2018 - estimates migrant labourers to be about 20% of total workforce.
 Economic Survey 2017- interstate migration at 60 Million
 Sociologist Sanjay Shrivastava - In a country where 20% of population are intra-national economic
migrants, our policies are geared towards those who are not. We are much mobile country than
west. Thus idea that we can cut and paste policy from west is more than Aspirational Policy
Making. The Epidemiological crisis will be compounded by Social one.
 Vulnerability of urban migrant labourers- while Farmers get cash transfer, the rural labourer
gets MGNREGA, the urban migrant having no visibility due to lack of registration remains
vulnerable to shocks
 Solicitor General in SC- around 97 lakhs migrant workers transported back home during
COVID

Why migration necessary in India

1. Economic differences in states- Per capita income of richest state (HR) is 6 times more than
poorest state (Bihar). Thus, wage differential exists between states, which propels migration
2. Work opportunities - states like UP, Bihar have more workforce than actual availability of work
3. Competitive labour market - migrant labourers provide cheap labour, thus enabling businesses
to reduce business cost
4. Service led growth - India's growth largely has been service led. For most of services, availability
of physical labour is must.

Inter-state Migrant Workmen Act, 1979

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 Aim - to prevent exploitation of inter state migrant workers by contractors and to ensure fair and
decent conditions of Employment

1. Comtractors who recruit migrants must be licensed

2. Comtractors are obliged to provide details of all workers to authorities
3. Migrant workmen are entitled to wages similar to other workmen, displacement allowance,
journey allowances and payment of wages during period of journey
4. Contractors to ensure regular employment, non discrimination, free medical facilities and
protective clothings for workmen

Problem with Act

1. Non compliance with act by state- thus states have no database of migrants
2. Higher compliance cost- makes hiring migrants less remunerative and intra state labourers
3. Applicability of act- only for establishments employing 5 or more migrant workers

Way forward for migrant labourers

1. 5R strategy- Recognize, Register, Responsibility, Ration Card, Residence

2. One nation one ration card scheme
3. Amend ISMW Act, 1979- to reduce compliance cost and mandate states to create database for
migrants
4. Partha Mukhopadhyay Committee recommended portability of PDS benefits
5. Universalisation of registration and issuance of Aadhaar-based Unique Worker’s
Identification Number (UWIN).
6. Empowering the Inter-State Council, set up under Article 263 of the Constitution to
effectively and comprehensively deal with larger issues related to migrant workers.

Steps by Govt.

1. Unorganized Workers Social Security Act, 2008-

o Registration of UW
o Portable Smart I-card with UWIN
2. Pradhan Mantri Shram Yogi Maan-dhan Yojana: To ensure old age protection for unorganised
workers
3. Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat): It aims at providing health cover to
protect the migrants
4. Atal Pension Yojana- pension benefit after age of 60 to migrants also
5. 4 labour Codes- addresing minimum wages, working conditions and allowances

COVID and Hygiene

 Mr. Parameswaran Iyer: Blessikng in disguise should be behavioral change of washing hands. It
needs to be Sustainable behavioral change
 Even Richard Thaler pointed that Sustainance is the key in behavioural change

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 Washing hands can be made priority under SBA and objective of ODF++
 Innaate immunity due to BCG vaccine is an advantage to india to fight COVID, but poor hygienic
practices are balancing it out

Social Distancing

 non-pharmaceutical infection prevention and control intervention implemented to

avoid/decrease contact between those who are infected with a disease.

Pandemic Financing and World Bank

 WB's Pandemic Emergency Financing Facility is under heavy criticism as it set maturity period
of 12 weeks to withdraw money from date of outbreak of pandemic.
 Bonds were issued in 2019.
 Interests to bond holders are paid by Govt of Japan amd Germany.

Medical Tests

ICMR approved tests

 RT-PCR (Reverse Transcript - Polymerase Chain Reaction) - tests the genetic material of virus, ie
RNA
o Taking Swab from oral and nasal tract, extracting viral RNA and amplifying it to detect
SARS Cov 2
o Earlier used for Ebola and Zika diagnosis
o PCR is method to capture a specific gene from DNA in swab sample, multiply it through a
series of chemical processes so that it can be detected through fluorescent dyes. As SARS
CoV2 virus does not have DNA, Reverse Transcription (RT) is done to convert RNA into
DNA
 Antibody test- proposed to be carried out as screening test - examines body's reaction to virus
based on antibodies.
 ELISA test- to detect the enzymes or antibodies produced in response to SARS Cov 2
 TrueNat test- private designed test working on similar principle of RT - PCR but faster result
 Antigen test- reports the foreign substance (antigen) present on or within SARS Cov 2
o Thus not rely on antibodies develope, but check for presence of protein signatures
associated with SARSCoV 2 virus.
o Diff from RT-PCR - RT PCR detects RNA signatures.
o Being used in Delhi for rapid testing

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Pooled Testing

 Samples taken from nose or throat are pooled together by suspending them in solution in laid
down proportions

ICMR guidelines

1. Maximum pool of 5 samples to avoid false negative

2. In districts where no cases have been reported or areas with low prevalence of COVID
3. Mainly on Asymptomatic patients
4. Strictly exclude known contacts of confirmed cases, health care workers (their samples to be
tested individually)

Benefits

1. Increases testing capacity

2. Reduces costing for individual
3. Checking community spread in no case araeas

Ways to check Community spread

1. Positivity rate
2. Pooled testing

ICMR strategy for testing

March : Reserved testing

 To avoid indiscriminate testing and reduce panic and optimally utilise the available resources
 Also, private labs were till not roped in for testing, ICMR was in process to expqnd laboratories
 Test only 3 kinds of persons

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1. International traveller
2. Contacts of positive cases
3. Healthcare workers

April : New Techniques

 Rapid antibody testing first approved, later reversed decision due to false positive and negatives
 Added symptomatic cases in hotspots, large migration gathering and evacuee centres in testing
 Pooled sampling adopted to test in regions with Low spread

May :Expanded protocols

 Added symptomatic migrants, hospitalized patients and Frontline workers

 Also added "hospitalized patients who develope ILI symptoms", returnees/migrants due to
concern of community transmission
 Nation wide sero survey were strated to asses the spread
 ICMR once again reintroduced advice to states to use antibody tests on returnees, people in
containment zone, police and paramilitary personnel, prisons

June : rapid antigen testing

 Antigen testing for containment zone, healthcare settings, all patients with fever and cough, on
Asymptomatic people with co morbidities.

Plasma Therapy

 Convalescent Plasma Therapy is concept of passive immunity involves transfusion of blood

plasma of recovered patients into another patient
 Plasma is matrix on which blood cells float.
 Plasma houses antibodies

Problem

 Kit to check level of Antibodies is not available in India amd has to be brought from Germany

Diff betn active and passive immunity

1. Active immunity - inserting attenuated pathogen into body to generate immune response (eg-
BCG vaccine)
2. Passive immunity - inserting antibodies already developed

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Clinical Trials

Phases

1. Stage I: R&D - Research is done on virus strains and vaccine content is developed accordingly
2. Stage II: Preclinical - to test on animals to get info on toxicity and safety before approaching
regulator for Human trials
3. Stage III: Clinical Trials- Based on Data submitted to Regulator, the Regulator approves for
Clinical trials
1. Phase I - given to small no of people to check if antibodies develope
2. Phase II - given to hundreads of people to check 3 parameteres
 Reactogenocity - to check Side effects
 Immunogenitics - to check Immune response
 Safety
3. Phase III - testing vaccine in large population
4. Stage IV: Regulatory Review - check data of clinical trials and give approval
5. Stage V: Manufacturing
6. Stage VI : Quality control monitoring

COVAXIN

 By Bharat Biotech India Lmt, an indigenously developed vaccine in collaboration with NIV
 Inactive vaccine - vaccine serves a dead virus and triggers an Antibody response
 CDCSO gave approval for Phase 1&2 trials

Other global Vaccines

1. ChAdOx1-S :by Astra Zeneca in collaboration with Serum institute

o Already in Phase 3
2. Moderna comp - along with US national Institute of Infectious diseases
o Close to beginning of Phase 3 vaccine

Abhijeet Banerjee's Suggestions

1. Make sure that every household has at least one person who knows the symptom
2. Offer multiple ways to report- Hotline, ANM, ASHA
3. Train Rural health pactioners to detect the symptoms and report to relevant authorities
4. Collate the reports quickly to identify hotspots
5. Create large mobile teams of health professionals, doctors and nurses with testing kits to be
deployed if any area emerge as Hotspot.
6. Adequate social transfers to avaoid people defying the curfew

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Public Health VS Right to Privacy

 Some states publicly disclosing info of those who are home quarantine, some not disclosing.

Legal backing

1. Absence of national law or protocol

2. Code of Medical Ethics enforced by IMC- bars disclosure except in circumstances of serious and
identified risk to person or community + in case of "notified" diseases by state govt
3. MoHealth Guidelines - provides sharing of info with state or district level surveillance units of
Integrated Diesease Surveillance Programe
o Note - Section 2 of Epidemic Act has been invoked which gives guidelines of Center to be
enforced across the country (as Health is a state subject)
4. Section 4 of Epidemic Act, 1897- provides indemnity for actions taken in "good faith"
o Also section 73 of Disaster Management Act, 2005
5. Clause 12 of Data Protection Bill- processing of personal data is necessary for "prompt actions"
ie in medical emergency

 My opinion- must pass proportionality test laid in puttaswamy judgement.

Aarogya Setu App

 Contact tracing app

 App traces physical location and notifies if individual is in close contact with Positive or
quarantine patient
o Uses GPS coordinates and Bluetooth data to track users location
 Also notifies to "At risk patients" who came in contact with positive patient
 Guidelines by Empowered Group on Technology and Data Management
1. Data can be shared with Various dept of govt like Home, Health or NDMA or SDMA if
necessary for appropriate health response
2. Data can be share with Research institutes in anonymised form
3. Breaches will attract penalty according to relevent section of DM Act

Kerala Govt issue

 Kerala govt hired US private firm Sprinklr to collate and handle health data of thousands who are
quarantine

Informal Workers and problems in enforcement of Wage payment

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 Centre and several states asked shops and establishments to pay wages to workers during
lockdown

Problems

1. Non registration of many of unorganized workers with state- restricts state's ability and
administrative control to execute such order
2. Many establishments not registered under Shops and Establishments Act- thus problem to locate
them
3. Fiscal capacity of states
4. Liquidity crunch with informal industries
5. Nature of market - eg: construction workers, which form biggest junk of Migrant labourers, are
not tied to any one contractor. Thus difficulty to put Accountability.,

COVID and Federalism

 This subcontinental lockdown has brought into focus role pf state govt, their uneven capacities
and capabilities and varying quality of provincial leadership- both political and administrative.
 Post COVID era is also projected to be returm of 'Big Government' which has larger role in
shaping economy, society and personal habits of people.

Issues

1. Issue of fiscal resources- especially given falling revenues and rising claims of public exchequer
2. Issue of internal migration - also eco and social interest of migrant workers

Mass Labour Migration in lockdown

Reasons

1. Poor implementation of meal program

2. Low awareness
3. Harvest of standing Rabi Crop
4. Visibility of arrangement of transports by Govt - which brought those migrants on road who
accepted confinement in house

Solidarity Trial

 4 drugs being investigated against COVID under solidarity Trial

1. HCQ
2. Remdesivir
3. Ritonavir and Lopinavir combined

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4. Ritonavir and Lopinavir combined with Interferon Beta

1.Hydroxichloroquine

 It is Anti-viral drug used in treatment of autoimmune diseases like rheumatoid arthritis and is
derivative of anti-malaria drug Chloroquine
 Combination of Chloroquine (which is malaria drug) and HCQ is
 How it work against COVID
o HCQ reduces Acidity in compartments of cell membranes.
o Since virus uses this Acidity to break the membrane and start self replicating process, the
drug reduces virus's capacity to self replicate

ICMR guidelines

 To be used d against
1. Asymptomatic health workers involved in containment and treatment of COVID-19 +
working in Non COVID hospitals of COVID block
2. Asymptomatic household contacts of laboratory positive cases
3. Asymptomatic frontline workers such as surveillance workers and police personnel

2.Remdesivir

 Drug for Ebola being tested for COVID

 how it work? - coronavirus is single strand RNA as their genetic material. When COVID enters a
human cell, an enzyme called RdRP helps the virus replicate. Remdesivir works by inhibiting thhe
activity of RdRP
 Approved in India for patients with moderate COVID

3.Ritonavir and Lopinavir combined

 This too inhibit virus's RNA. They specifically target the enzyme that helps virus split proteins
 Not permitted till now by ICMR in India

4.Ritonavir and Lopinavir combined with interferon Beta

 Interferon Beta is immune system messenger that regulates inflammation in body

 This combination is used to treat chronic Hepatitis C infection
 Not permitted till now by ICMR in India

Dexamethasone

 Anti- inflammatory steroid which is found effective against COVID

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 Reduces death risk for patients on ventilator by third, and by fifth for patients which oxygen
support

US - CHINA

 Impact on US economy, its current confusion at top leadership and its effort at internal
stabilization may compromise US power
 China, whos is accused of spreading the virus, is also in unique position to help world to bounce
back
 China BRI may go uncontested due to lack of US's intervention.
 US too will not abandon its interests only for economic well being.

Global Order and Pandemic

 Following are 4 changes which pandemic brought

1. Re-emergence of Nationalism- With the virus that emerged in city of china wrecking
the whole world, the feeling of transnational humanitarian crisis has lead to bring
nationalism to fore. Trumps immigration ban, China's assertiveness all aresigns of
nationalism
2. Death Blow to Multilateralism - Fall of WHO, WTO as well as UN failure to generate
coordination among countries are indicating disinterested sts of majority of countries to

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cooperate on global platform. This shows unwillingness to accept rules made by supra
national entities
3. Retreat of Globalisation - ironically, this is coming from those countries who were
founders of free global trade. Attitudes like Trade is okar if it is in my favour, Foreigne
investment is okay if it is coming in my country, migration is okay if it is within national
boundary is showing signs of deglobalisation
4. Rise of new global power - China is rising rather assertively. It is defying the global
norms and increasing its stature in international institutes. World either needs to accept
its hegemony, or be ready to fight it.

FDI rules amended

 The entity of country that shares land border with india can now invest in firms here "only under
the government route"
 Even if owner of entity is citizen or resident of such country, rule will apply
 EU, Australia, Spain, Italy and USA also applied similar investment related restrictions

Fact

 People's Bank of China raised its share holding in HDFC to over 1%

China's objection

 Discriminatory practice and violation of WTOs principles

 Also, goes against general trend of liberalization and Facilitation of trade and investment
 Do not comform to G20 leaders call for Free, fair, non discriminatory, transparent, predictable and
stable trade

India's stand

 Move not aimed at any particular country but aimed to curb opportunistic takeovers of Indian
firms who are under Strain due to COVID
 Moreover, rule not prohibit investments, but just chnage the route which is already existing for
many types of investments

Kerala model

1. Robust healthcare system- management of PHCs in hands of local bodies, many PHC have
modern diagnostic facilities and offer tele medicine
2. Past experience - of NIPAH virus which helped state to put in place rigid surveillance.

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3. Screening - from early march, state screened all international passengers. Even local bodies and
village committees kept health registry for new arrivals
o Some panchayats lunched call centres which connected quarantined people with
authorities
o Even rail travellers and interstate road travellers were isolated
4. Contact Tracing- route maps of those who tested positive thr GPS were released to help people
self report if they came in contact.
o Geo mapping of those under observation enabled better cluster management
5. Social participation - towards "Break the Chain" campaign
o Kudumshree Mission- provided volunteers to make masks and launching community
kitchens- thus no mass migration of laborers
6. Political leadershil and administration - daily briefings by CM, daily meetings of Health minister
with District Medical Officers

Agra Model

 Model useful in areas with High density of Population

1. Immediate sealing of area of positive patient found

2. Massive Contract tracing campaign
3. Coordination between diff teams using existing smart city Integrated Command and Control
Centre (ICCC)
4. Cluster containment and Outbreak containment plans- identification of epicenter, delineating
impact of positive confirmed case on map, deployment of special task force as per micro plan
made district administration
5. Hotspot and containment zone-Containment zone within 3 Km radius from epicenter, Buffer
Zone within 5 Km buffer zone
6. Survey of containment zone- screening with network of ANMs/ASHA/AWW

Bhilwara Model

 Ruthless containment strategy

1. City isolation - imposition of Sec 144 and sealing of borders of city

2. Zoning- containment zone within 3 km from epicenter, buffer zone within 7 km
3. Disinfectantion- of entire city. Also of personnel daily
4. Screening and testing - mass screening of people and identify those with flu symptom
5. Institutional quarantine - of those havinf flu symptoms
6. Door to door supply - of essential services

Bangalore /Karnataka Model

1. More, aggressive and early testing (unlike Mumbai and Delhi which started late testing)
2. Tracing of primary and secondary contacts within 24 hours

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3. Institutional quarantine of all primary and secondary contacts

COVID and Biological Warfare

 Many experts see COVID as quasi-biological warfare in its scale, scope, duration and impact
 UN Chief called it biggest international crisis since WWII

Risks

1. High transmission and deadly nature

2. Time lag in finding treatment and vaccine causes high mortality and morbidity on defenseless
population
3. Latency and Mutation into diff strains makes disease detection and control difficult
4. Double jeopardy - loss of lives and weakening of infrastructure of Defence
5. Bio-Terrorism - biological agents are now more amenable to be used hy non state actors

Way Forward

1. Dedicated National Rapid Deployment Biosecurity Force

2. Effective and efficient Bio-intelligence and Bio- Surveillance systems - for proper disclosure of
origin, Information and data
3. Security Protocols for research labs
4. National defence intelligence should include medical intelligence and infectious disease risk
assessment
5. Empowering trustworthy International institution for bio surveillance to surveil and access
facilities in groumd zero countries
6. National sufficiency of medical and healthcare supply chains amd essential goods, services and
technology

Epidemic Disease Act, 1897

 Legislated at time of Bubonic plague in 1897

 Enable state govt to take special measure and prescribe regulations in an epidemic
 Defines penalties for disobedience of this regulations
 Provides immunity for actions taken under "good faith"

Epidemic Disease Ordinance 2020

 Commission or abatement of act of violence against Healthcare service personnel shall be

punished with imprisonment for term of 3 months to 5 years with Fine ₹50,000 to ₹2,00,000

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 In case of causing grievous hurt, the imprisonment shall be for 6 months to 7 years with fine
₹1,00,000 to ₹5,00,000

Innovative Measures for COVID

SciTech Airon generator

 Developed by pune based startup under NIDHI PRAYAS programme of DoS&T

 Air purifier system which generates negatively charged ions of Hydroxyl Radicals which forms
cluster around airborne particles and render them inactive.

COVID Quarantine Alert System (CAQS)

 Application tested by DoTelecommunication and C-DOT in coordination with telecom providers

which is used to "geo-fence" person who is in quarantine. This is done by accessing Person's
mobile cell tower location.
 Authorities get alerted when person escapes or breaches quarantine

PM - CARES Fund

 Why- Keeping in mind the need for having a dedicated national fund with the primary objective
of dealing with any kind of emergency or distress situation, like posed by the COVID-19
pandemic, and to provide relief to the affected

Objectives

1. To undertake and support relief or assistance of any kind relating to a public health emergency or
any other kind of emergency, calamity or distress, either man-made or natural, including the
creation or upgradation of healthcare or pharmaceutical facilities, other necessary infrastructure,
funding relevant research or any other type of support
2. To render financial assistance, provide grants of payments of money or take such other steps as
may be deemed necessary by the Board of Trustees to the affected population
3. To undertake any other activity, which is not inconsistent with the above Objects

 Foreign Contributions allowed like PMNRF

 CSR contribution allowed- unlike PMNRF and earlier guidelines regarding CSR which says that
CSR cannot be used to fund any Govt Scheme

PM- National Relief Fund

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 Established in 1948 to accet public contribution to assist the partition victims

 immediate relief to the families of those killed in natural calamities and the victims of major
accidents and riots and support medical expenses for acid attack victims and others.
 PM has sole discretion to utilise fund
 Balance currently - ₹3,800 cr

Concerns regarding PM CARES

1. Unclear whether RTI or CAG's jurisdiction will apply

2. opaque regarding the amount of money collected, names of donors, the expenditure of the fund
o PM NRF provides annual receipt and expenditure info without any detailed breakup

Expenditure

1. ₹1000 cr- for relief of migrant labourers

o Each state will get minimum 10% or 100 cr from sum allocated to migrants, with
additional grants to be decided on basis of state's population (50% weight) and no of
covid cases (40% weight).
2. ₹2000 cr- purchase of 50,000 ventilators
3. ₹100 cr- for vaccine development

Biological Waste

 More due to gloves, PPE kits, used mask and tissues by COVID positive patients

CPCB guidelines

1. Waste generated should be disposed in Yellow bag meant for incineration at Common
Biomedical Waste Treatment Facility (CBWTF)
2. Waste can either be taken to CBWTF or Watse to Energy plant

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