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In four-hour video-conference with Chief Ministers, PM hints at resumption of economic activity

Prime Minister Narendra Modi indicated on Saturday, after a marathon four-hour video-conference with Chief Ministers, that the country could see a 14-day extension of the COVID-19 containment lockdown as that was the common demand of a large number of States, including West Bengal. The Central government will announce guidelines for the same in the next couple of days.

Remarks by Mr. Modi at the meeting, however, also indicated the possibility that some economic activity may be resumed in the extended lockdown period.

“For the last two weeks or more, people have shown great discipline and stayed indoors and tried to follow social distancing since, as we say jaan hai jahan hai [the world is for who is alive], now we must also say jaan bhi jahan bhi [for both life and world],” a statement from the PMO quoted the Prime Minister as saying.

Farming operations

Puducherry Chief Minister V. Narayanswamy, after the meeting, said Mr. Modi felt farm activity should continue, and said guidelines for the construction industry would be issued by the Centre in a phased manner.

The lockdown was formally announced from March 25thto April 14 (21 days) but the trajectory of COVID-19 cases has led most State governments to recommend an extension. Mr. Modi, government sources said, was considering the request favourably. Sources said a formal announcement would be made after the weekend.

“Most States requested Prime Minister Modi to extend the lockdown for two more weeks,” said government sources.

Punjab, Telangana, Odisha, Maharashtra and Karnataka have already declared an extension till the end of the month, and Delhi Chief Minister Arvind Kejriwal pre-empted a formal announcement by the Prime Minister by taking to Twitter and offering unstinted support to the decision.

Chhattisgarh Chief Minister Bhupesh Baghel, in his intervention at the video conference, said activity within districts unaffected by COVID-19 should be allowed to restart, albeit with sealed borders between districts and States very much in place and no train and air connectivity.

Andhra Pradesh Chief Minister Y.S. Jagan Mohan Reddy suggested that zones within districts be colour coded, and only the red zones undergo a containment lockdown.

Almost all want lockdown extended

Talking strategy: PM Narendra Modi in a meeting with Chief Ministers via video conference in New Delhi on Saturday.PTI

A majority of the Chief Ministers who participated in a video-conference meeting with Prime Minister Narendra Modi on Saturday flagged the issue of a crippling shortage of funds, with the lockdown choking revenue sources and also due to the delayed GST payouts from the Centre.

The video-conference, on the 18th day of the lockdown to contain the spread of the novel coronavirus, was attended by 13 Chief Ministers.

Rajasthan Chief Minister Ashok Gehlot favoured a “uniform model” of restrictions for the entire country if the lockdown was extended. He said since the Centre and the States were jointly fighting the COVID-19 pandemic, the States must get adequate financial assistance.

He highlighted the difficulties in handling the issues arising out of the lockdown in the State.

Telangana Chief Minister K. Chandrashekhar Rao said his State used to get ₹40,000 crore each month in revenue, but this had now come down to a mere ₹4,000 crore. He expressed his helplessness in handling the pandemic with limited resources.

More area under rice, pulses, oilseeds: Agriculture Ministry

A farmer readying his field in Madurai district of Tamil Nadu. G. Moorthy

Early sowing of the summer rice crop has covered 37% more area than the same time the previous year, despite the COVID-19 lockdown limitations, Agriculture Ministry data show. This is the pre-monsoon sowing of paddy, with the major kharif crop sowing to be done after the rains begin in June.

Overall sowing of summer crops, including rice, pulses, coarse cereals and oil seeds, is about 31% higher than usual. In total, 48.8 lakh hectares have been sown so far.

Availability of fertilizers

The Centre has exempted agricultural activity from the lockdown restrictions and has also taken steps to ensure availability of fertilizers and pesticides for the coming season.

So far, more than 32 lakh hectares of rice have been sown across the country, mostly in eastern India, including 11.3 lakh hectares in West Bengal, 7.5 lakh hectares in Telangana, 3 lakh hectares in Odisha and 2.7 lakh hectares in Assam. This is more than a third higher than the 23.8 lakh hectares sown with rice during the same period last year.

Pulses have also seen a significant increase in early sowing, with more acreage covered in green gram and black gram. Overall, there was a 32% jump from about 3 lakh hectares to 4 lakh hectares.

The growth in oilseeds is more modest with a 12% increase in sowing area to 6.7 lakh hectares. Most of the hike comes from more land sown with groundnuts.

Among coarse cereals, more maize and bajra have been sown than in the previous year resulting in a 27% jump to 5.6 lakh hectares under cultivation.

It will be used to disinfect people offering essential services

Bug killer: An old KSRTC bus that was converted into a ‘sanitiser bus’ in Bengaluru.V. Sreenivasa Murthy

The Karnataka State Road Transport Corporation (KSRTC) is converting old buses slated to be scrapped into “sanitiser buses” to disinfect people in public places. On Saturday, one such bus was launched in the city.

KSRTC Managing Director Shivayogi C. Kalasad said the buses, to be called ‘Sarige Sanjeevini’, would be operated in city limits for police personnel, health workers, pourakarmikas and others carrying out essential services during the lockdown.

“There are various measures to curb the spread of COVID-19, this is one among them. We can’t say that the buses will completely disinfect people. They have to follow other measures, such as maintaining personal hygiene, and washing hands. This is one of the proactive measures taken by the corporation,” he said.

The bus was modified at the central workshop of the KSRTC at a cost of ₹20,000. Modifications include installation of sprinklers. People need to enter from the front door and exit via the rear end to get disinfected.

“In districts such as Mysuru, Mangaluru, Chikkaballapur and others where COVID-19 positive cases have been reported, the KSRTC is planning to operate sanitiser buses. We may convert 18 to 20 buses for now,” he said.

Centre justifies steps taken to fight COVID-19

With India recording a first-time-ever three-digit rise in the confirmed cases of COVID-19 in the past 24 hours, the Health Ministry on Saturday said that had a lockdown not been imposed, the country would have been staring at at least 8,00,000 cases by April 15. The Ministry reported at least 7,529 cases on Saturday.

Reports from State Health Departments put the nationwide death toll at 287 with the number of active cases at 7,303. Maharashtra had 1,446 active cases with 17 more fatalities on Saturday, while Delhi recorded 1,024 active cases and five deaths.

The Indian Council of Medical Research (ICMR) — the technical arm of the Ministry that is overseeing testing and epidemiology — was not involved in preparing this estimate, Lav Agrawal, spokesperson of the Ministry, said at the daily media briefing.

He displayed a graph that showed three curves: One a red curve, denoting neither lockdown nor containment in place, that steeply rose to 2,08,544 cases on April 9 (and with a note that it would extend to 8.2 lakh by April 15); a blue, gentler curve that rose to 45,370 by April 11 (and 1.2 lakh cases by April 15), the blue indicating the situation with “containment measures but no lockdown”; and the final green line indicating the 7,447 cases at present.

“Lockdown and containment measures are important to fight COVID-19. If we had not taken any measures, we might have had 2 lakh cases at this time (April 11),” Mr. Agrawal added.

There were no further details available of how the projected figures were arrived at.

Determining the rate of spread of infectious disease is different from extrapolating a given number of cases at an initial point and assuming a particular rate of growth and plugging it into an exponential mathematical equation, experts told The Hindu.

“From just this graph alone, it isn’t possible to work backward and figure out the assumption used by the modeller to arrive at the (2,00,000) figures. The curves assume a constant rate of growth, which is not what we’ve seen how the cases increase in India, or anywhere else in the world,” Aritra Das, a medical doctor with a doctorate in epidemiology, who consults with IQVIA. “Estimating the growth in cases requires knowing an R0 [reproduction number that denotes how many an infected person will further infect] and that can’t be derived from what we now have.”

Modelling study

A study in February, which was publicised on March 23, remains the only actual modelling study involving ICMR epidemiologists and international experts in the field. That study didn’t estimate numbers but — based on the state of affairs in February — recommended that India should have focussed on finding transmission in the community and quarantining instead of “border control” because of the large uncertainty in detecting asymptomatic travellers harbouring the infection and becoming spreaders.

Another ICMR study published this week found that 40% of those with severe respiratory illnesses sampled and detected with COVID-19 could not have their contact history established.

The ICMR said 1,71,718 samples were tested, including 16,564 in the last 24 hours.

The government said it was containing the wide spread of the disease by establishing containment zones.

‘Lockdowns alone can’t be effective unless combined with other health measures’

Dr. Soumya Swaminathan, Chief Scientist at the World Health Organisation, says in an interview that the fight against COVID-19 is likely to be long-term, and lockdowns alone cannot be effective unless combined with other health measures. Dr Swaminathan, who has worked in research on tuberculosis and HIV for 30 years, was Director- General of the Indian Council of Medical Research from 2015 to 2017. Edited excerpts:

What do we know so far about how SARS-CoV-2 is spreading around the world?

Viral evolution and transmission dynamics can be studied by analysing genetic sequence data. There are over 4,500 viral sequences currently deposited in the GISAID platform, with around 10 Indian strains. What we see is, that over time, there is some variability in the strains. That is to be expected, as all viruses develop mutations as they transmit from person to person. What is not being observed so far is any mutation on any of the important sites of the virus, such as the spike protein or in the RNA polymerase or protease enzymes, which are relevant for drug targeting and vaccines. So we believe whatever strategies are now being used to develop both therapeutics or vaccines are not threatened by any changes in the virus.

What does the evidence tell us about the effectiveness of lockdowns as a strategy?

The WHO has laid out quite clearly that physical distancing, of which one extreme form is a lockdown, does help bring down the transmission of the virus in the population. What they saw in China [after locking down] was transmissions within households were still going on, so they then took an additional step that was basically testing everyone with symptoms, and taking those who were positive to a separate facility where they could be kept and treated, and the exposed persons to a separate quarantine facility. We need to think about this in terms of the logic for doing that, which is if you are living in a crowded setting, chances are you are more likely to transmit to others.

Other public health interventions that are shown to be effective like hand-washing, disinfecting surfaces, covering the face and mouth when coughing, and usage of masks need to be all implemented together, to be effective. We also need to remember that we are going to be facing this infection for a long time, and will need to think of sustainable strategies, as we exit lockdowns eventually. People will need to change behaviour — continue to follow physical distancing, isolate if sick, improve personal hygiene, while the public health system will need to detect, isolate, treat and track cases.

Should everyone wear a mask?

Anybody who has symptoms should be wearing a mask. There is also no doubt that healthcare workers need to wear masks and proper Personal Protective Equipment (PPE) as they are the ones likely to see a lot of patients. When we are talking about the general population, the logic there is if you don’t show symptoms but you still have the infection, you can still be spreading it. That is the logic for everybody wearing a mask. Asymptomatic people spreading infection is not the bulk of transmission and whatever studies we have seen till now suggest it is not more than 10 to 15%. Wearing masks does not protect the wearer. You are wearing masks to protect others, so it’s more of a social good.

Should India be testing more broadly?

Data is key to the control of this pandemic. We need to expand the number of people who are being tested. The fact is, because of shortage of testing kits, we cannot simply test everybody. One way is looking at sentinel surveillance where you test a proportion of people with influenza-like illness (ILI) or Severe Acute Respiratory Infections (SARI), which the ICMR is already doing. Serological testing is also beginning to be used in many countries, from which you can get an idea of the extent of the population exposed and also the geographic spread of the virus.

Is there any evidence to suggest Hydroxychloroquine should be included in the treatment protocol?

The Solidarity trial launched 10 days ago is comparing Hydroxychloroquine, Remdesivir and Lopinavir/Ritonavir with and without interferon beta. The goal is to include more treatments as they come through and collaborate closely with groups around the world as they develop new therapies. The approaches are to find an antiviral drug, monoclonal antibody treatment or an adjunct therapy that helps modulate the body’s response to the virus. There is currently no drug with proven efficacy against COVID-19. Some are being used on a compassionate-use basis, and not based on scientific evidence. Soon, we will get results from clinical trials which should inform us.

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Findings highlight that virus replication inhibitors could be effective: expert

A recent article published in the journal Science has shown that the already-promising drug candidate remdesivir, on trial now, exhibits promising activity against the COVID-19 causing virus and might work well in retarding virus replication.

The SARS-CoV-2 virus exists as a mere strand of RNA and it requires a host to replicate. Scientists have discovered that the active site of RDRp shows striking similarities with the Polio Virus and the Hepatitis C virus, and using that knowledge, they have tried to use known drug candidates that work in that RDRp environment and work back to see if they are effective with the novel coronavirus. They also showed exactly where on the RNA dependent RNA polymerase — the main machinery to form strands of RNA — that this drug will bind with. Remdesivir, a nucleotide analogue, then acts as part of the growing RNA chain, fooling the virus into believing it is replicating, and thereby stops true replication.

In the article “Structure of the RNA-dependent RNA polymerase (RDRp) from COVID-19 virus” Yan Gao et al., a group of researchers from various institutes in China and one in Australia, describes the biophysical and molecular interactions between COVID-19 virus RDRp and the antiviral drug remdesvir. “The findings highlight the fact that virus replication inhibitors hold promise and that the virus enzyme protein nsp12 represents a high value target to develop novel therapies for treating COVID-19 patients,” explains Panduranga Rao Varada, director, Animal Science Centre, Boston University.

“The RNA polymerase is what is used to replicate. Here, it began with the identification of similarities in viruses with which we are already familiar — Polio Virus and HCV. If the binding happens with the drug, virus proliferation can be reduced. Then, the stress on the immune system too will come down. This can reduce, to a large extent, the number of people slipping into a critical stage, having a positive impact on mortality and survival rates,” explains V. Dhanasekaran, a structural biologist, who also runs an education start up.

The good news is that these candidates that seem to work well have already been tested, the safety and efficacy has been proven for other usage, Dr. Dhanasekaran adds. The study indicates sofosbuvir, along with remdesivir as probable candidates. Sofosbuvir is already being made in India to treat Hepatitis C, he adds.

Currently, remdesivir, which is made by the American pharma company Gilead Sciences, is not available in India. With over 16 lakh cases of Corona-19 in 213 countries across the world, as per WHO statistics, and a record 99,690 confirmed deaths, the race to pick a winning candidate for treating COVID-19 and reducing the mortality and morbidity from the disease. A couple of trials, are already ongoing to test remdesivir, which has already emerged as a promising candidate. This study further reinforces the viability of using the drug.

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