It's time to build a predictive model to fight Covid-19. This is how it can be done

Despite best efforts across the world, the threat posed by Corona virus remains unabated. Despite different approaches by the policy makers, the results so far are a mixed bag of successes and failures where humankind is still trying to catchup with the virulent pandemic. Lockdown, which several countries have now adopted, and in some, ruthlessly enforced, was considered to be a panacea by all but cases continue to rise in spite of this unprecedented measure.

The lockdown might have produced relative benefits but paradoxically countries like Pakistan, Bangladesh and Sri Lanka without lockdown measures have not fared any badly. This brings us to the same question again and again: Are we doing enough by imposing lockdown at the cost of larger and individual economic hardship?And, if not, what is the alternative?

Let us accept the lockdown gave us confidence and time to build on our resources and re-strategise. In the current scenario we are not certain at which stage the disease stands – second or third – so far as India is concerned. However, it is question of semantics, since the strategy needs to be formulated around knowing the extent and potential severity of the disease. Till then policy makers are shooting in the dark hoping to find their target and win this war.

Here is how we can proceed to build on a scientific database while helping Covid Warriors with reliable inputs on which they can build a solid defence and switch to surgical strike against the viral agent instead of carpet bombing.

Armour-up your warriors, test extensively

If we know the exact case load from asymptomatic to mild, moderate and severe across the zones, it would be possible to plan the use of our resources appropriately, minimise the damage and cut costs. Extensive and repeated testing is the key. First and foremost, it is imperative that we periodically test the medical and paramedical work force who are the frontline defence battling the pandemic. This will help us provide the best medical care to the affected.

Analyse the cases under three groups

While we are continuing to trace the contacts, testing and isolating them, we must analyse random samples from three asymptomatic groups to identify the silent carriers. These are:

1. The cluster area – The epicentre of the spread in a city or town where an entire cluster of population stands
2. The new but smaller hot spots – The new hotspots where the first signs of a potential explosion in cases are evident 
3. The virgin areas – Places from where no case has been reported so far and remain practically untouched

A working mathematic model

The outcome of segregated analyses of the three groups over the next 2 weeks will provide us with the near-possible mortality and morbidity through a simple mathematical model. This model van be used to redirect our scientists towards formulating a better and correct strategy that can help mitigate, suppress and even kill the virus.

Segregated therapy for patients with different progression

The cases need to be administered treatment under three groups of asymptomatic carriers: Mild, Moderate and Serious.

1. Mild case: To be quarantined and isolated at home
2. Moderate ones: To be treated at medically supervised quarantine centres
3. Serious cases: To be admitted to hospitals with Covid-19 intensive care services

A thought for relaxation could be given to shops that service electrical, optical, kitchen and mobile related needs. Similarly, the agriculture product supply chain and processed food industry, including theDaal mill, Atta Chakkiandothers can be considered to bolster the supply line and services the requirement of a large segment of population under lockdown

Regulating the use of drugs

There has to be a proper medical and research group that should decide on the prescription of chemo prophylaxis to medical and family attendants of patients. While HCQS has been cleared by ICMR someone has to monitor its use. Another time-tested anti-parasite Ivermectin has shown some promise in killing corona. But its use needs to be regulated as well. The time one chooses to employ it, therapeutically or in prophylaxis or on compassionate grounds, needs to be assessed and cleared by the team.

The medical and research team needs to define the corona clinical syndrome and create a protocol for management to be followed across the states. This can be done by telemedicine education to the administration in the districts and ensure that it percolates down to the peripheral area.

In the meanwhile, social isolation and distancing, hand washing and wearing masks or face covers should be mandatorily enforced. The corona warriors should have adequate PPE (Personal Protection Kit). The private clinic and nursing homes should be provided the equipment by district authorities to allow continuity of their service and involve them in fulfilment of the essential public services. 

Lockdown exemption for essential services and agriculture supply chain

Any relaxation in lockdown has to bear two things in mind: One, a strict ban on any activity that leads to mass gatherings. Two, a holistic approach that allows for regulated mobility to essential those involved in essential services. The high-risk group needs to strictly follow lockdown. This includes elderly people who are more prone to be affected by the virus. Schools, educations institutions and cinema halls should remain shut. There can’t be any excuse for social gathering.

However, a thought for relaxation could be given to shops that service electrical, optical, kitchen and mobile related needs. Similarly, the agriculture product supply chain and processed food industry, including the Daal mill, Atta Chakki and others can be considered to bolster the supply line and services the requirement of a large segment of population under lockdown.

This can be done by introducing a non-negotiable set of protocols conforming to the hygiene guidelines for fighting Covid-19. The collector of each district can take a call based on the demand and the assessment of the situation in the area that falls under his or her jurisdiction. The war is challenging but a holistic approach can take us through. 

This is the original draft of my write-up published in First India in its edition dated April 8