 performance in terms of the containment of COVID-19 is not very bad. We did not get unnecessarily worried by the rise in figures in between that reflected better testing. However, it's very clear it could have done much better on two or three ground, especially in its comparison with Kerala, with which its performance was always matched in the very beginning. And then after some time it fell behind, whereas Kerala was able to contain it, Tamil Nadu continued to throw up cases, and that phenomenon has not yet stopped. So I think we need to understand what went wrong in Tamil Nadu. There are two or three things that Kerala was better on and Tamil Nadu was poor on, and Tamil Nadu still remains relatively weak on this. The first most important thing was that Kerala was relatively free of stigma. Tamil Nadu had a very high degree of stigma, not only in that outrageous attack on the doctors' burial, but in attacks in many towns and cities on health workers, and also a very high degree of scare. And some of it has been provoked by the subtext of the government messaging that always tries to find an accused for the outbreak. So the government sort of takes a position that if everybody is following what they are saying, that there will be no outbreak, and if there is an outbreak, then somebody has to be blamed. First it was the Taliban, Muslims they were blaming, and later on they are now recently blaming the Coimbatore market vendors, saying if they had listened to our advice and shifted the market, it would not have happened. That's just not true. The point about this epidemic is that in an unpredictable way, you will get new clusters. And when you get new clusters, you have to go out there, identify the cases, isolate, test and isolate the positive cases, quarantine the contacts, and get on top of it. No sooner have you suppressed it in one cluster, some other cluster will rise. And you need a very, very good disease surveillance program across all districts, which can warn you when the cluster is a very small-sized cluster so that you can prevent it from going bad. And how do you look in a place where there is no disease? So what am I saying? I'm saying that you need to give more attention where there is no disease also. And then what do you do there? You look at all patients with fever of more than three days, or cough with more than three days, and you test them for COVID. There are 100 patients test all 100, influenza, like illness. So if you can't test all 100, at least test 50 of them or 25 of them. And among these symptomatic people, if you find a few positive, even three or four, you can detect a small-sized outbreak. If you are testing random and testing asymptomatic people, then you are likely to miss it. You have to focus it on this. And the very fact that aminide 90% are asymptomatic is a cause for worry, not celebration, which means you are not testing enough symptomatic. So therefore this Metra's cluster, this Chennai cluster, could grow to this size before it became noticed. Once they noticed it, they have got a reasonable containment going, and I am hopeful that it will come back. So I think this is the big thing about it, the lack of a disease surveillance, the high degree of stigmatization. And the third point is the degree of community engagement and participation that you need. In Kerala, the panchayats are very active. They are active like volunteers. There is a setup called palliative care where there is outreach going down to the village. People who are old and sick are being protected. They have confidence in the system. In aminide, it is a policing operation more than a community engagement operation. The police is not your first or even your last effort to trace a contact. The police should not be used in contact places. It has to depend upon social workers. I am saying containment is very police oriented. But that is not what works. What works is communities, people coming forward and reporting, oh, I was in that market on that particular day that you have notified, would you like to test me out? I am staying at home and being in quarantine, but would you like to test me out? You need that high degree of people, community engagement and cooperation and participation. You can't detect a person who wants to hide from you, even if you give him ROG. This notion that by giving him ROG, you can somehow catch the guy is a mistake. At some point, you need people to actively, actively collaborate. That is the third big difference. There are two types of problems here. One problem is of people who are at high risk because they are in direct coming into direct contact with COVID-19. Fortunately, the number of such cases are limited. So there are some 4,900 cases. And other than that, there is also the intensive death patients and ventilator patients are even less. And therefore, the available PPE, they are able to manage. If it goes further, I don't know whether they can manage. But at this point of time, this high risk PPE equipment seems simple. But I have one worry. I am one worried that they are partly solving this problem by pushing home isolation. They're saying, if you're positive and mild or asymptomatic, you can be at home. I am not in favor of that. Home isolation means that they may worsen at home without noticing and come to leave. This happened in Italy. It's not a good thing. A lot of mortality, it's avoidable mortality. More as they worsen and as they go around, they may not observe isolation even in terms of healthcare. They may not come because they are COVID. But most of them have home morbidities. They may come for their diabetes treatment. They may come for their cancer treatment. They may come. So they will be going to hospitals using the public bus. So they will spread infection. So you need to isolate them as a priority. So this means you will require more PPEs, protective equipment, and I think that should be an important consideration. But the other problem is what to do about many health worker staff who are not on COVID-19 duty but are getting infected because in the general outpatients they see, there are a lot of patients who are asymptomatic, mildly symptomatic with COVID-19. This is a serious problem. A lot of the people who are infected in Tamil Nadu health workers are not people who were on COVID-19 duty. And you need two things in it. One of course is hospitals must have better methods of preventing what is called the nosopomial infection, hospital acquired infection. You need to build the systems, processes so that hospitals don't become a source of spread. You can try and isolate these patients, suspect patients in a better way. And second, you need to actually follow some mechanisms of social distancing and all. Ensure that you are allowing testing to a much wider range of symptomatic patients so that you do not have so many people walking around. So if there is a person with cancer coming for care or cancer care, he should be given a test because he's likely to be COVID-19 positive even if he has no symptoms of it. And therefore you can prevent the doctors and nurses working in the cancer ward who are not dealing with COVID-19 from getting COVID-19 infection. So this I think is some of the key things that they need to do. I actually don't know. In fact, now everybody is mystified as to why they have to deny it. Community spread does not mean that the end of the world is near. It is not an apocalyptic situation. It just means that there may be cases where you are not quantizing to people, where you are not, some cases may come from unexpected directions. So they are the fact that you can go and inquire from them and find the contact. It does not come from the soil. It will only come from another infection. So it is mysterious except for one thing. I think when you say there is no community spread, you reduce your responsibility to test people who are symptomatic without the contact patient. You test only people with the contact. That is a very dangerous way of doing it because you will miss new clusters and that is a cost we are paying. This community spread has really, this stage two, three is not a logic of epidemiology. It came in from the clinicians. Stage three cancer has spread so much you can't do anything about. That's cancer staging. In epidemiology is stating that disease is widespread. So you have to have a disease surveillance program because you don't quite know where the next case is coming from. That's all it means. So I don't think this denial of community transmission is a needless thing. Somewhere the government is still oriented towards thinking that it will eradicate the disease. It will reduce it to zero. A recent statement says we will open colleges after we eliminate the disease. Believe me even after the vaccine comes, it will take another to one year or two after the vaccine comes to eliminate the disease. So you will never open colleges for two years if you go by that. Kerala for example still gets some 15 to 20 cases. South Korea gets some cases. Sweden gets some cases. They are well controlled but a few cases come here and there and you can manage them. The health system has been prepared to take care of it. Now get on with normal life. No need to. Some simple rules of distancing you follow. But I don't think we need this whole thing. So this is also leading to an unnecessary and unplanned and unfocused extension of lockdowns. It is not good. So I think it's though the mistake is a bit innocent, a matter of technical definitions in its impact is in terms of failing to test all symptomatic irrespective of project and extending lockdowns even if there is one or two cases in setting the goal at eradication rather than at containment. I think they are making a mistake. Kerala has reached what we can say the low endemic stage where there is a small trickle of cases coming in. Some of it from migrants, some of it locally. Never mind what they say. Everybody wants to say the thing. But they are on top of it. Whenever they fight a new case they are able to go and take the necessary. For every case some 100 people they are able to identify who need quarantine. In Tamil Nadu it is only 5 or 10 we are able to identify. So at some point that cooperation helps. So they are able to do a very good. Here we are still having large uncontrolled clusters. The major one is Chennai. But I'm very worried about the Kadalore and Murupuram clusters and about the cluster in I think of these places. Tirupur we are there. One of those areyalu cluster is there. But I think also we need to keep a better surveillance for new clusters. We should not expect you should be worried if all our district is reporting zero for a very long time. You should expect a small outbreak in thing and you'd like a cat and mouse game. There is a small outbreak there. You go ahead and stop it. Then another outbreak happens. You stop. And that is the way we will have to manage till the time of the vaccine. But believe me we can actually reduce the number of cases and I think very well if we have such a good surveillance system. I don't think it is the health network. It is at the level of the super specialists that we are failing. We are failing in our sense of humanity. We are failing in our sense of community. And this has been an old program. A problem of dominance. A very well-administered healthcare system. But it's very, very weak. The community links, the panchayats are almost not involved. The local public are not involved. The NGO involvement, civil society involvement is very weak. People's movements, trade union movements is very weak. Normally it did not matter. But now it is making a difference. Otherwise I cannot explain why the community health system is as good as care is. But in terms of how it deals with the community, there is a big difference. You are treating these people as objects, as carriers of disease. Not as people for whom you are providing healthcare. Your purpose of existence as a healthcare provider is to say that the migrant is sick. Oh, the migrant is sick. So I must bring him in first. I must send an ambulance to pick him. That should be the response of a healthcare system. That failure is going to cost us.