“Leakiness of the lockdown is worrying”

The lockdown has proved to be a fruitless exercise in ensuring social distancing and reducing people-to-people contact, explains Dr. T Jacob John. In a tete-a-tete with Jagdish Rattanani , he also spoke about ramping up testing centres, PPE kits and other issues

 

Now Vellore is already declared hotspot

JR- Yes, places within Vellore, not all of Vellore?

No, no, the whole district, this is a district, district is red.

JR- Okay

Okay, so 170 districts that were announced on 16 April includes the Vellore district. Still people are not very worried or alert or all of them not wearing mask, and they are going about. In the morning, the place is relatively busy. Lots of people walk around and two-wheelers goes. So, it doesn’t seem to be….in other words lockdown is leaky.        

JR- Correct

Okay, and that gives you a false sense of confidence and yet it is not completely effective. Now, there is lot of attempt on the past of various former leaders to show that the lockdown is effective, “successful” is the word. To me that is little worrisome because a lockdown is a lockdown. You don’t prove that it is successful, because if the lockdown is good, it has to be successful ….If you kill a snake, we don’t then come and turn around the snake and say, “No, it’s truly dead.”  

If the lockdown has been successful, it has to be successful by the success of the lockdown. That is where I am saying it is leaking. Now if you go by the diagnostic number criteria, I have no idea what that number means actually. The numbers diagnosed are the minimum positive numbers. Because the testing is targeted for some criteria, essentially following the lead of the foreign travellers first, their contact next, and now the Islamic Tableegi Jamaat, and there is beautiful description by one of them in Triuchirapalli, Trichy, that I have read earlier in the evening. He said that their meeting was scheduled for March 22-24 last year.

JR- That is correct

And that so they arrived and on 23 March they were told you have to disperse, and so they try to disperse, by the time they went to the railways…there were no train to Chennai. Then people scrambled. This man had a return flight on 30. And so he managed to buy, discarded that ticket, managed to buy another air ticket, on the 24 or 25 March and because of the lockdown and because of the issue of somebody infected, he went on a self-imposed quarantine. But on April 1, the Chief Minster had appealed to all those who have gone to go for testing. So his first test was negative and then, I think he had some mild respiratory trouble. He tested again, he was positive, he was admitted in the Trichy government hospital, looked after very well, after some days test was negative, and the second test I think was negative and he was discharged.

So what he is saying is, they had no clue what’s going on, until the police came and told the organisation that you have to disperse and immediately the chief said, “okay, that is law of the land, so you all disperse”.

JR- That is the correct position as I understand it.

I was always saying that the announcement of the lockdown was too abrupt and without giving a few days of preparation for everybody, I was saying at least four days of preparation and that is for the local governments to assess the need, at the time only the number of infection was only 200, between 200 to 300. Okay.

Somebody asked me when would I have suggested a lockdown. I said lockdown is a must, lockdown is freezing the time, it’s a time machine. You freeze the time and you wake up at the end of lockdown and the life is back to normal, and virus can also go into its natural cycle, but in the lockdown period everything is frozen. However, a mere four-hour alert is cruel to people. So, somebody asked me when would I have done…I would have set an objective mark and said the day we hit 1000 diagnosis cases, lockdown take effect.

JR- And announced it in advance

You announce it in advance, saying we are waiting for the number, the day 1,000 is hit…we are only 200-300 right now, on 21 March. That would have been reasonable. I have no idea what triggered this sudden lockdown as if there was a fire breaking out. There was no fire breaking out. The only data could have been the ICMR saying that severe acute respiratory infections, two out of 100 turned out to be positive. That information became available the previous day, I think. Whether that triggered the lockdown, I do not know.

Somebody recommended lockdown and lockdown was announced. But the way it was announced we were all shocked. Eight O’ Clock we listened to this and Twelve O’ Clock. But I had told my wife that lockdown is a foregone conclusion, so we go and buy one month supply, so we don’t have to scramble at the last minute. And I told all my friends, and everybody saying, my Rotary friends, I told them, “prepare for a one-month lockdown”.

So we were stocked up on the provision ten days ahead of time. So we didn’t panic. A four-hour notice was okay for us. Only thing was the perishable things like milk for every three to four days, I go and buy milk and fresh fruits. We both like lot of fresh fruits. So that we have to go and buy. Early in the morning 7:30 is the right time. 7:30 the street is not relatively full, but there are...

JR- But there are many people…

So that’s about the lockdown. Success of the lockdown is that its job is to “freeze” time. So the success is to be measured by how successfully time is “frozen” the people are not out of their homes, except for…I saw people drinking chai at the chai shop, sitting and chatting away…those kinds of things, I mean, the leakiness of the lockdown is what I am worried about.

The overcrowded places like slums and basti, lockdown would not have worked at all, physical distancing and staying at home away from the next home, all homes are one meandering continuum. So that had to be thought about ahead of time. And if I were asked I would have said announce for the day 1000 infections are reached, where everybody will be watching the numbers. Okay.

The other thing is, mandatory masks before lockdown. Okay, so that the slums and bastis people wear mask and make it compulsory. Even this morning I was seeing…yesterday I saw the funeral I told you, 42 people out of whom 8 only were wearing the mask. So the leakiness of both mask and the lockdown is, as I see in my town, may be representative of all other towns, is the reason why I think that we are not getting the full mileage of the lockdown. We are going through the economic severity of the lockdown, but we are not getting the full public health advantage

JR- So it is a double whammy?

Yes, a double whammy.

JR- yeah, I understand. But, now they have announced that they are going to open all inter-state and intra-state movement of goods, services and trucks. Instructions have been issued. So the traffic will start plying and goods will start coming.                                    

I believe the railways have carrying the goods; goods trains have started

JR- But even trucks and tempos they will allow, so that will also introduce the certain sense of leakiness. Isn’t it?

I mean people would see and realise that things are not that bad. And there is a lot of messages going around that things are looking very good. India is a different from all other countries and others have doomed, say… there is almost conspiracy against India’s success. Those kinds of messages are also going around.

JR- That narrative is coming from the very top also. And that is the narrative that we should be worried about?

Definitely, because these are things that you could speak about after the avalanche is passed. Before the avalanche, or before the peak has reached, you don’t have a clue as to what is peak is going to be like? So it is….is it optimism or is it denial of the reality, I do not know. Both are bad for the…..it is not like a tsunami; it comes and goes, finished. Then you pick up your life and restart. It is like that for 21 days. For 21 straight days, like it is like tsunami damage, 22nd day, now that date is May 4, you restart your life. Natural disaster hits and it goes. This is not something that hits and goes away, it is something like a smouldering epidemic.

JR- It will keep, it will keep hitting…

Exactly…. That’s what we see by the numbers going up. If numbers going up is the result of a leaky lockdown.

JR- So it is not over, even when it’s over. After the lockdown also, the threat has not passed, you know?

Yeah, after the lockdown, it will restart. Then it will…you know…will not be able to control it at that time. Unless another lockdown is imposed. So the numbers are low. I think personally, predominantly, because of our testing strategy is geared to find these infections hiding among the community. That is, they are based on risk factors of contacts and travel. But if test today all the symptomatic people with criteria of COVID 19, cardinal criteria of fever, cough, loss of smell or loss of taste, that are highly specific for this disease, and breathlessness and minor symptoms are there, body ache, very tired and if you select those symptomatic people who come to hospitals and test them all, immediately a different number will emerge. And that will tell you whether transmission is traceable or untraceable; untraceable equals community transmission; traceable, you missed tracing it by your technique of contact tracing. Okay, so the failure of that would be picked up as a case here and the same time the moment you see the case and if the contact history is not obtainable, you already know community transmission is happening, and then you protect the environment of hospital, the doctors and nurses have to protect them.

Now what is happening is that the patient comes to hospital, he tested positive, and hospital is closed down… that you know… is slightly an old saying in Malayalam, “the Namboodri burned his home because he couldn’t chase the rat out.” Okay, I mean that is a drastic way of closing down hospitals. Doctors have not been given very clear picture of what to expect, what to do, what precautions they should do, how they should…what they should do in this bio-medical field in this pandemic.

JR- So you are writing a paper with Sheshadri on that, is it ready?

Ya. I think it gone around. The clinical diagnosis by criteria, that’s widely…. That is what I said on a power-point.

JR- Okay. But it is not a paper written; it was only a power point, is it?

No, it was a paper for private circulations to small hospitals…

JR- Is this paper shareable, can I put it on the website?

Yeah sure, sure

JR- Then please send it…

But then, we have now revised in a sense that hydroxychloroquine, the euphoria people had is given way to a lot of caution. Hydroxychloroquine seems to be not doing all that well, so we have kind of watered down that recommendation. Okay, so, I believe that department in Madras Medical College was shut down because a doctor got infected from the patient; and the whole unit had to be shut down. That is evidence-based reaction. We found a positive that is evidence, you shut down. The proactive thing was that all patients should be screened; all doctors should be wearing complete protective wear before you do any surgery. So doctors should have been protected.

JR- So, you have a paper also on PPE, right?                                             

That is still incomplete; I mean I was so tired today…I was supposed to finish today, but I just didn’t finish it. Tomorrow is Sunday; I will have little free time. I am also asked to write something on health security by the government of India, I am also attending some important meeting on Monday morning. I am kind of overwhelmed with the…work ….

JR- Monday morning also government of India meeting, is it?

No, Kerala government meeting. Again through Zoom.

I am not used to zoom and all, but I think…we will figure it out. Necessity is the mother of invention.

JR- Correct!