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Spike of 905 new cases in past 24 hours pushes nationwide tally to 9, 352

India registered the largest spike in deaths due to COVID-19 on Monday, with 51 being reported in the past 24 hours, the highest since the first case was reported in January.

India’s tally with 905 additional cases has gone up to 9,352 and 324 deaths so far. Over 857 patients have recovered. The 51 deaths reported since Sunday evening include 22 from Maharashtra, seven each from Madhya Pradesh and Telangana, five from Delhi and four from Gujarat.

The Union Health Ministry, however, on Monday said that implementation of its action plan had started yielding results in 25 districts across 15 States, which had reported cases earlier.

“These districts have no case reported since the last 14 days and constant vigil is being maintained to ensure that no new cases may occur in future,” Joint Secretary ïn the Health Ministry Lav Agarwal said at the daily press briefing.

The districts include Gondia in Maharashtra, Rajnandgaon, Durg and Bilaspur in Chhattisgarh, and Davangere, Kodagu, Tumakuru and Udupi in Karnataka. COVID-19 cases have been reported from 364 of the 736 districts across the country.

Figures from the State Health Departments put the total number of cases at 10,439, with 9,015 active ones. The death toll stood at 358. With 1,957 active cases and 160 deaths, Maharashtra continues to top the list.

Delhi and Tamil Nadu reported 1,455 and 1,104 active cases respectively.

The Ministry added that Health Minister Harsh Vardhan had reviewed the research efforts for COVID-19 by the Council of Scientific & Industrial Research (CSIR) along with the DG, CSIR and 38 CSIR Lab Directors who are working in close partnership with the private sector, PSUs, MSMEs, departments and Ministries.

Relaxation made to kick-start agriculture, horticulture

No transport: Women walking back home with firewood on the outskirts of Bhubaneswar. Biswaranjan RoutBiswaranjan Rout

Set to enter the second phase of the lockdown imposed to fight the COVID-19 outbreak from April 15 to 30, the Odisha government has made relaxations to kick-start activities relating to agriculture, horticulture, fisheries, forest, drinking water and e-commerce.

One more COVID-19 positive case was detected in Bhubaneswar on Monday, taking the State’s total to 55. Active cases now stand at 41 as 13 have recovered and one has died.

Announcing modifications in the lockdown guidelines on Monday, State Special Relief Commissioner (SRC) Pradeep Jena said social distancing norms would be strictly followed while facilitating activities that were related to livelihood of people.

Home delivery

E-commerce activities would function during the extended lockdown period when companies engaged in home delivery of goods and services would be allowed to operate without any hindrance.

Restaurants could carry out home delivery but could not allow people to eat inside.

The SRC said farmers could resume all agricultural activities, including harvesting, selling their rabi crops and activities relating to preparing their fields for the coming kharif season. The shops and establishments engaged in selling agricultural implements, cattle feed, fish feed and food proceeding and packaging would also be allowed to remain open. The procurement of rabi crop would be resumed and all cold storages and godowns would be allowed to carry out their activities by maintaining social distancing.

Farmers could also purchase agricultural implements. The cooperative banks and other such institutions would disburse loans to farmers during the lockdown period, said Mr. Jena.

Activities relating to MGNREGA, Swachh Bharat and rural housing schemes would go on and the Panchayati Raj Department would also facilitate construction and repair of drinking water facilities.

People engaged in fishing, floriculture, tendu leaf plucking and collection of non-timber forest produce could carry out their work.

The Forest Department would be allowed to carry out plantation and take up construction and repair of waterbodies for wild animals, said Mr. Jena.

With worksites closed, activists urge SC to ensure wages for all those registered

Employment under the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) has collapsed to just over 1% of the usual rate this month due to the COVID-19 lockdown.

Activists petitioned the Supreme Court demanding that the government pay full wages to all active job card holders during this time, following its own instructions issued to other employers.

1.9 lakh families

Data from the MGNREGA website show that less than 1.9 lakh families have been provided work under the scheme so far in April 2020, in comparison to almost 1.6 crore households which were provided work in March, and the 1.8 crore households employed under the scheme in February before the lockdown began.

Chhattisgarh was the highest employment generator under the scheme in April, providing work to more than 70,000 families, followed by Andhra Pradesh with more than 53,000 households given work. However, these figures are a fraction of the usual employment provided in these States, and also raise concerns about COVID-19 infection being spread at worksites.

Key source

The scheme, which guarantees 100 days of work per year at an average daily wage of ₹209, is key to providing livelihoods to poor villagers and is a backbone of the rural economy in difficult times.

Overall, 7.6 crore families hold active job cards under the scheme, and almost 5.5 crore families found work under the scheme last year.

The crash in employment rates under the scheme is despite the fact that migrant workers returning to villages should have increased demand in rural areas.

With seven new cases, Andhra Pradesh tally rises to 439, Kerala has 378

Tamil Nadu Chief Minister Edappadi K. Palaniswami announced the extension of the lockdown in the State till April 30. The announcement was made on a day when the total number of COVID-19 cases increased to 1,173, and 98 persons tested positive.

In Chennai, the COVID-19 tally stood at 205 on Monday.

Puducherry Chief Minister V. Narayanasamy also announced an extension of the lockdown till the month-end.

Mr. Palaniswami said that the decision followed his earlier consultation with the Prime Minister via video-conferencing, the advisory from the World Health Organization (WHO), recommendations from medical and public health experts, and the decision taken at the Cabinet meeting. Besides, COVID-19 could spread if the lockdown was relaxed, he added.

In the other southern States, Andhra Pradesh had seven new cases, Karnataka 15, and Kerala three.

Kerala Chief Minister Pinarayi Vijayan said the steady decline in new positive cases should not be taken as a licence to violate the current restrictions.

Even though there was no evidence of community transmission, the disease might flare up once the safeguards are relaxed, he said, briefing the media on Monday.

The State also recorded 19 patients who tested negative following treatment. Two of the new cases, from Kannur, were contacts of imported cases. The other was a person who had returned home to Palakkad from abroad. Of the 378 COVID-19 cases reported so far in the State, 178 were under treatment.

A.P., Karnataka tally

With seven new cases Andhra Pradesh had 439 cases in all, an official bulletin said. Of the new ones, four were from Nellore and three from Guntur district.

Karnataka reported two more COVID-19 deaths on Monday, taking the total toll in Karnataka to eight.

The deceased were a 55-year-old man, who had self-reported at ESIC Hospital in Kalaburagi on April 7, and a 75-year-old woman, who was admitted to the Rajiv Gandhi Institute of Chest Disease in Bengaluru.

Karnataka reported 15 new positives including four children, taking the total to 247. These include eight deaths and 60 persons discharged. Six were discharged on Monday.

Except for a 62-year-old man from Bengaluru Urban, 13 persons had contact history with those who travelled to Delhi and one travelled to Delhi.

The Bengaluru Urban patient had Severe Acute Respitatory Illness (SARI).

Preventive measures point towards the Prime Minister’s plan of staggered exit from national lockdown

No exception: Finance Minister Nirmala Sitharaman being checked before she entered the Finance Ministry in New Delhi on Monday. R.V. Moorthy R.V. Moorthy

As work from home ended for Ministers in the Union Council and senior bureaucrats on Monday, some activity slowly returned to hitherto deserted corridors of power in New Delhi.

Ministers were seen at work at their Ministries donning masks and after going through temperature checks at the entrance of their office buildings.

While the Ministry of Culture saw some heavy duty sanitisation and social distancing, standard protocols were applied at the Jal Shakti Ministry.

“We have very little staff coming into work today, basically the Minister, personal secretary, the Secretary, two Additional Secretaries and Joint Secretaries came to office,” said a source. Only two of the six attendants were asked to report for work and sent vehicles as public transport was not available. “Sanitisers at the doors and appropriate distancing and donning of masks have been made compulsory,” added the source.

The Ministry of Minority Affairs too had these SOPs in place but instead of providing vehicles to lower level staff, those who had their vehicles were encouraged to report for work. As for touching of files, an aide to the Minister said the Ministry had long shifted to an “e-office” set up. “Barely 30% of the staff made it to work today,” said the source.

Meetings are being held as far as possible through video conferencing and the return to office for the government of India is being seen as part of Prime Minister Modi’s evolving response to COVID-19 , from “jaan hai toh jahan hai” (the world for he who lives) to “Jaan bhi, jahaan bhi” (Life yes, but the World too), pointing towards a staggered exit from the lockdown post April 14.

We don’t know yet what will work against the novel coronavirus, says senior NHS surgeon

British Prime Minister Boris Johnson’s fulsome praise for the U.K.’s National Health Service (NHS) for his treatment for COVID-19 has raised the profile of the public-funded healthcare service. A senior member of the NHS and alumnus of the Madras Medical College Pala B. Rajesh details the protocols to combat the pandemic:

How helpful is a lockdown in containing the spread of the infection?

Any decision that has been made thus far, regarding this unprecedented epidemic has been binary. Public safety and economic backlash have been the two considerations. In the United Kingdom, we took a decision in late March that the lockdown would be total and we would have a review it in three weeks. Public health experts have recommended the three week lockdown based on the experience of China, Italy, Spain and Singapore.

What we follow here is quite simple. Step 1: If you have fever, cough, muscle pain, stay at home. A high viral load usually lasts five days, but you may get a second peak- which is why we recommend the two-week isolation period. You may feel well in a week but please do not go out. If any one was in quarantine with you, your family, this applies to them as well. Step 2: If you are still ill, go to a hospital. In the NHS, you will be tested for COVID-19.

What about non-COVID treatments/surgeries?

Hospitals in the U.K. have a primary triage in place — COVID-19 and Non-COVID-19 sections. I know there is opinion in India that elective surgeries must be stopped. I both agree, and disagree. In the U.K., since the outbreak, we have prioritised surgeries as per the level.

Priority level 1 is divided into emergency (Surgery must be done within 24 hours), and urgent (surgery in 72 hours); in Level 2, patients can wait for up to four weeks; in Level 3, the surgery can be delayed for three months, and Level 4 comprises of people whose surgery can be delayed for over three months.

Every speciality has been given guidelines as to what constitutes an emergency.

Every hospital in the U.K. has ensured a few operation theatres remain reserved for non-COVID-19 surgeries. The rest of the theatres have become extensions of intensive care units.

COVID-19 theatres have intensive care specialists, anaethetists and general medicine practitioners. But at the moment, we have not been overwhelmed in our hospitals, possibly because 90% of the population has been following the lockdown.

India has done very well with the lockdown as well. There is infrastructure in place — both Central and State government health systems. Perhaps, the government may think of farming out non-COVID-19 patients to the private sector, as has been done in Assam, according to experts there.

What about treatment options for COVID-19?

We are collecting a lot of pre-publication material. At the moment, whatever we are doing is speculative measures taken by each group in their circumstances. In the U.K., we have begun to use hydroxychloroquine with antibiotics on a trial basis, of course, because frankly, we don’t know yet what exactly will work.

Meanwhile, BCG seems to offer some kind of protection mechanism.

But in the U.K., we are mainly offering supportive treatments. One thing that is appreciable during this pandemic is that everyone is freely exchanging information, so that other nations do not make the same mistakes

In U.K., we seem to be on the upward crest of the curve; and experts are saying we should remain there for a couple of weeks. We will know the effect of the lockdown in a week’s time. So far, we have been recording only the COVID-19 deaths, but there may be others who do not come into hospital. The assumption now is that everyone is COVID-19 positive unless he or she tests negative.

We have reports from America of the particular vulnerability of African American people. Are you seeing some thing similar in the U.K.?

What we are noticing, however, is a certain predilection among doctors from overseas working here. There have been 39 deaths among NHS doctors and nurses so far in the epidemic. These include people from India, Pakistan, Sudan and Egypt, for instance.

COVID-19, I’m sure, will remain in the community, like perhaps dengue or chikungunya. It will raise its head during winters in this country. Once a vaccine is ready, recommendations may be made for vulnerable populations, including senior citizens.

Focus must now be on testing and contact tracing, says epidemiology expert

Madhukar Pai is Canada Research Chair in Epidemiology & Global Health and Director, McGill Global Health Programs and Professor at McGill University. In an e-mail interview, he explains the debate on BCG vaccine’s purported effectiveness against COVID-19 and how global approaches to communicable diseases might change.

You have advised against over-optimism with regards to the link between BCG and COVID-19 immunity. What are your reasons?

As a TB researcher who was born in India, I would be thrilled if BCG worked against COVID-19. It is a cheap, readily available, safe vaccine. But we are not there yet. Currently, what we have are a few ecological studies (not peer-reviewed) which take country-level BCG and COVID-19 data, and report a correlation that countries that give BCG to children have a lower rates of COVID-19 cases and deaths. Based on this early signal and based on our prior knowledge that BCG does have non-specific immune-boosting properties, it is perfectly fine to conduct trials to confirm the hypothesis.

But the current ecological evidence is far from sufficient for any immediate public health or clinical use during this crisis. Ecological studies offer a very weak level of evidence because correlations that are true at the country level might not hold true at the individual level. For example, we know not everyone who lives in a low-income country is poor — some individuals are very rich. Same logic applies to ecological comparisons. In addition, ecological studies have been done at a time when the epidemic is exploding in many low/middle income countries. Repeating the studies in a month might produce different results. We also know many low/middle income countries, including India, are seriously under-testing for COVID-19. Lastly, there is also bias due to confounding — countries that give BCG are mostly in Asia, Africa and Latin America, with much younger populations than Europe or North America.

So, until trial results are out, countries like India must focus on interventions such as large-scale testing, isolation, contact-tracing, and physical distancing (where feasible).

TB continues to kill thousands of people in India. How might coronavirus affect TB services in India and what can be done about that?

This is my biggest worry — even without COVID-19, TB kills 1,000 Indians every day. No country has more TB patients than India. And now, with the lockdown, things are going to get much worse. Already, there are preliminary reports of a 80% decline in TB case notifications. People on TB treatment are struggling to get their medicines on time, and people with new TB symptoms are unable to access medical care. TB patients and survivors often have lung damage and if they got COVID-19, they could be at higher risk of complications. I worry about an increase in TB mortality in the coming months, and that will be so sad. There is also the risk of running out of anti-TB medicines, since India relies heavily on China for raw materials.

What can be done to avert this disaster? Right now, all known TB patients could be supported via remote or tele-consultations using call centres, or other digital technologies. Drugs could be sent to their homes via couriers or through local pharmacies (that are still open). For any new TB patient, TB medicines could be given for a longer duration (e.g. 2 or 3 months) to ensure they have enough.

Has the TB programme lessons for the COVID-19 response? Or vice versa?

Yes, TB programmes are known for public health interventions such as active case finding, contact investigations, respiratory isolation, and community-based patient support. These skills and expertise could be leveraged to tackle COVID-19. Also, some of the existing TB technologies could come in handy. For example, India has two molecular technologies in use (GeneXpert by Cepheid and TrueNat by Molbio) that are used for TB testing and both can now be used to test for COVID-19. India is already using digital adherence technologies such as 99DOTS and Everwell Hub and these could be repurposed to also work for COVID-19. India has shown great commitment to tackling COVID-19 in a short period of time. I wish some of that commitment will also be shown to tackling TB.

How can a country prepare for a pandemic?

I don’t think any country in the world was adequately prepared for COVID-19. Even the richest countries in the world are struggling right now. A big lesson for India and many other countries is that no country can prepare for a crisis within days or weeks. Being prepared means having a robust healthcare system, especially primary healthcare. In short, universal health coverage is a pre-requisite for real preparedness.

We know India has failed to invest in health for decades, barely spending 1.5% of the GDP on health. Even the bare minimum recommended health spend of 2.5% of GDP has not been realised. This chronic under-investment has left the public health system weak, and has allowed the private and informal health sectors to thrive. This means, access to healthcare is not equitable – the rich and the middle class will manage, but what happens to the millions below the poverty line?

If any good comes out of this crisis, then it will be India waking up to the reality that investing in health is paramount for economic growth and security.

How do you think COVID-19 will/should change global policy approach towards communicable diseases?

COVID-19 will change global health in many ways. The optimist in me hopes all countries will learn from the pandemic and invest in universal health coverage and re-affirm health as a human right. Global health must be more than just fighting one epidemic after another. I hope investments in public health and developmental assistance will no longer be viewed as a drain on resources. I hope countries will understand the need to build a social safety net for all.

Millions of paedophiles have migrated online, making Internet extremely unsafe for children: ICPF

Online child pornography traffic after the lockdown in the country has gone up by 95% with online data monitoring websites showing an increase in demand for searches like “child porn”, “sexy child” and “teen sex videos.”

“Traffic from India increased by 95% between March 24 and 26, as compared to average traffic before the lockdown,” the India Child Protection Fund (ICPF) said in a statement citing data from Pornhub, the world’s largest pornography website.

The ICPF was set up in January 2020 and aims to support NGOs with funding resources for curbing exploitation of children. The fund is managed by Nobel Laureate Kailash Satyarthi’s son, Bhuwan Ribhu.

The spike in consumption indicates “millions of paedophiles, child rapists and child pornography addicts have migrated online, making the Internet extremely unsafe for children. Without stringent action, this could result in a drastic rise in sexual crimes against children,” says Nivedita Ahuja, spokesperson for ICPF.

Unseen threat

As children spend more time online during the lockdown, international agencies like Europol, the United Nations and ECPAT (End Child Prostitution and Trafficking) have reported that paedophiles and child pornography addicts have increased activity to target children online to ‘groom’ them — befriending them on social media, building an emotional connection and luring them to perform sexual activities through photos and videos.

In a survey conducted in December on demand for child pornography in 100 cities, the ICPF found that on an average there were 5 million downloads per month. It also pointed out there was an increase in demand for violent content involving children.

It demands an urgent crackdown on child pornography through a pan-India tracker through the use of artificial intelligence which can monitor hosting, sharing, viewing and downloading of child sexual abuse material and provide the information to the government agencies.

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