 Hello and let's talk about the COVID-19 situation in India. The number of cases in India has crossed 6 lakh as it looks like India has soon set to be the country with the third highest number of cases reported overtaking Russia. Meanwhile, we are in this nebulous zone called Unlock 2.0 even as both the central and state governments have no clear answers as to the rising number of cases. Prime Minister Modi in his speech a few days ago stayed away from any concrete details on the government strategy. When Maharashtra Chief Minister Uddhav Thakre on Wednesday did a pooja and went on to say an I quote, we want to see a miracle, human beings are given up. We will discuss some of these issues but first here are some numbers. As of today morning nearly 6.04 lakh cases have been reported across India. India currently has the fourth highest number of cases behind the United States, Brazil and Russia. The number of active cases is around 2.26 lakh. Between 10.30 am yesterday and today 19,148 cases were reported during the same time period 2.29 lakh tests were conducted. The number of deaths in India is 17,834. We are 8th on the list of countries with the highest death toll and in the past 24 hours 4.34 deaths were reported. Maharashtra continues to be the worst affected state in the country with over 5,500 new cases reported yesterday and 198 deaths. The Thane Municipal Corporation, the Kalyan-Nobibali Municipal Corporation and the Meera-Bhayandar Municipal Corporation have all gone into total lockdown mode for 10 days from today. These three are part of the Mumbai metropolitan region. The corporations of Navi-Mumbai and Panvelu will follow suit tonight. Tamil Nadu and Delhi are the second and third worst affected states. The city of Chennai and parts of neighboring districts continue to be in lockdown as well. We have with us Prabir Purkayasar to talk about some of these issues. Thank you Prabir so much for joining us. So India continues to report a high number of new daily cases. We are almost close to the 20,000 cases a day mark. And right now it doesn't look like the government has too many answers. Like we just mentioned Prime Minister Modi has almost didn't talk any details in his speech. Neither are many of the chief ministers. So how do you see the rise in the number of cases happening especially over the next couple of weeks? Well if we look at the figures right now and I'm looking at the worldometer figures which gives you the total figures from different parts of the world country-wise also. You will see India is not only high in terms of the number of cases. It is the fourth highest but in a couple of days maybe two to three days it's going to overtake Russia and the third highest number of total cases. But if you look at the new cases that's where you will see the speed at which we are moving and that's quite disquieted because the US of course always holds the number one position with regard to total number of cases which is nearly now 3 million. Brazil is 1.5 million. We are at the moment about 600,000 plus. But in terms of new cases US is 51,000, Brazil is 44,000, 45,000. We are nearly 20,000 as you have said. And other countries are well below that. Below that is South Africa, Russia, Mexico and so on. What we are seeing is essentially a now two global centres of pandemic, new epicentre shall be said. Apart from the United States which continues to be the epicentre which is Latin America. It has Brazil. It has Mexico. It has Colombia. It has a number of other countries but these are the three major ones. And then we have South Asia, India and Pakistan, Pakistan is about 200,000 given its size of its population. I think that's also quite disquieting. So we are seeing a new epicentre emerging now with the COVID epidemic and that shows that we are in by no means in the home stretch globally as WHO's warned the numbers are going up and of course in India as well. If we look at the Indian figures first and looking at compared to the global figures, these are the charts we have. And as you can see, Malaysia which was lower than us initially in the first couple of weeks is now flattened. Most other countries which are the grip of epidemic earlier like Iran, Italy, France, UK all seem to have flat curves. Of course some of them as we know are seeing some recurrences again. But most of the European Union countries and even Iran and UK which were relatively badly affected earlier seem to have flattened. The only exception here which you can see on this chart is really Brazil and then India who are going up very steadily over the last 30, 40, 50 days. The slope in India has not changed of the graph over the last 50, 60 days and that's true for Brazil. Brazil we can understand because after all Brazil did not have any lockdown. India these figures are disturbing because we have had a very draconian lockdown on the most draconian in the world and yet our figures do not show any changes. And it does appear that the central government now has almost given up. It is offering nothing to the states and it's only thing that it has come out from the Modi's speech was about food grains but it really does not have anything else with respect to the epidemic. So I think that's a very disquieting scene that we see over there. The other part which I would like to focus on in terms of the epidemic itself that what are we are seeing now and this is again a disturbing issue that we are seeing about six cities having the bulk of the COVID infections. In this Mumbai, Delhi and Chennai almost cover 40% of India's total infections but that's not the full picture. If you add for instance to Delhi, Murugan, Faridabad, Noida and a couple of other urban areas as Mumbai you add for instance the Navi Mumbai you add Kalyan and other things but most important news you add Thane which is about 33,000 cases. You will get the picture is that this six cities including cities like Andhra Madh which are also fairly high figures you will see six cities nearly have 50 to 60% of the total COVID infected persons and this is because it's really spreading in urban areas in densely populated areas where this question of physical distancing it's a trend, isn't the rise and they also contain a very large number of what we are being called essential workers who effectively run the city and also work on healthcare facilities in a lot of the hospitals. So the centers of infection now are becoming those which are densely populated but people have to go out do go out and work in places where they are open to infections and you can see if we don't control those numbers you are going to see a continuous rise of the numbers and as of date there are steps that Maharashtra has taken vis-a-vis Mumbai particularly Mumbai they have seemed to have done some amount of control but it is exploded now in the suburbs or the urban continuum which is the Mumbai urban sprawl so to say and that's similar things we are also happening in Delhi we now know about Gurgaon and Faridabad but the figures from Noida etc seem to be underestimates maybe because the testing figures themselves are pretty low in those places but in terms of lockdowns and other containment zones Noida is not very far behind either right so and the key question here also is that we have discussed this of course that there was no real preparation done during the lockdown to strengthen the public health infrastructure there was no real attempt made to give it a community uh so give it a to give add a community element to combating the disease itself so right now as we as we are seeing a drastic impact can some of these steps be implemented or do governments have no other option but just sort of sit back and hope for the best like Uttar Pradesh said that we are hoping for a miracle well miracles aside I thought you can hope continue to hope for miracles but unless we do something miracles don't occur so one of the things we can do first is reduce the death rate one of the important lessons we have learned is that hospitals can handle this disease much better because you have a much better understanding of the disease today the two major reasons for deaths that are taking place the primary one and once you are very serious that this becomes a primary really issue is the inflammation of the lung it's no longer COVID-19 the disease itself it's not the virus itself that's a problem but the fact your body reacts against it and by reacting it actually overreacts leading to essentially damaging the lung in very different ways and that means the patient that needs to be provided oxygen and other support now while doing it earlier ventilators were used and people were intubated now they're finding oxygen support and controlling the infection by using corticosteroids dexamethasone is a obviously the primary one at the moment the dexamethasone brings down the inflammation it has to be controlled dosage because if it's given in a fairly reasonable dose not too high not too low then it sort of has the benefit of reducing the inflammation but does not really lead to antibodies or your immune system becoming lower so that you don't find the disease itself which is there of course the virus so both have to be sort of you have to hit the sweet spot so to say by which you don't give too high a dose and not too low a dose either which seems to have now been reached with the various information we have the second of course is the other one which has also been mentioned in the serious cases you get a certain number of cases but blood clotting is a serious issue and therefore medicines which lower or which are essentially blood thinners that seems to have helped so that worldwide seems to have brought down the the death figures compared to the number of hospitalization we have to see that this happens in Indian hospitals as well so this the question of intubation being not done quickly probably would also help because that itself has of course an adverse reaction on the patient then you may not need to intubate if you can provide oxygen supply initially and then control the inflammation this is what we seem to read in the various technical papers that we are now going through and the second part of it also is that you must have enough beds beds you must train in the hospital system now that is something which we should have done in all this period which we didn't do now we have we are opening covid hospitals for example in Delhi new hospitals but do they have the ability the preparation to be able to handle this disease is a key question we can take of course create new facilities which are for essentially quarantining not so serious patients but the next issue really apart from quarantine treat track all those things which are being said the question is to treat the serious patient so you bring down the death figures and that is something entirely doable at the moment of course we can only reduce them we cannot bring it down to zero and then secondly protecting the hospital staff and hospital itself not becoming a central infection unfortunately some of the steps we see apart from whether the protective gear etc available or not is also the fact that you then need to tell the doctors tell the nurses tell the health support staff what they have to do so that it is limited in the hospital and most important the hospital administration has to see how the covid and non-covid parts of the hospital can be separated other is one part of in fact the other the hospital will become as it has become in fact in large parts of the world including India as new centers of the epidemic and that would be disastrous when treating the epidemic you're actually creating more problems and more infections so I think these are two things the government should have done and this needed coordinated work with the government of India and the state governments the last part which you have raised should we give up the spread of the epidemic no I think you still have to trace track quarantine these are three measures we still have to take and we have to also involve as you said not only the administrative apparatus but also involve the people it cannot be done without the large-scale support of the people now the only support that people have been asked to express is Halib Bajana bang your pots and vessels and then switch off your lights for 10 minutes that is not an involvement of the people involvement of the people has to be at the grassroots level which is where Kerala really scores they have involved the panchayats they have involved the state administration they have involved the whole number of voluntary systems which exist in Kerala which work all the time and they have supported the government by doing other you know support activities so it's a whole range of support that needs to be provided instead of teaching it treating it as a law and order problem you can even see I was looking at the pictures in the morning on television police brandishing their latis and we had a very strange case in Telangana where in Hyderabad affidavit has been filed in court which says that the police constables or officers were checking coronavirus presence in the people with the latis now if that is your understanding of the health system that you can check coronavirus infection using latis we are indeed in trouble and I think it's that approach that that also marks the way we are not able to involve the people because you know brandishing latis does not really get shall we say it may get compliance but it doesn't really get cooperation and involvement and I think that's the key issue where we are lacking because it's a mystery Brazil did not do a lockdown they have a rate of curve which is quite high United States as you know had lockdowns sporadically did it lay didn't have testing properly and now it's the process of lifting lockdowns again and you can see the lockdowns correlate fairly well to the infections they have opened the lifted the lockdowns infections have started going up rapidly India you see irrespective of what we do a very steady growth which means our long term was ineffective and the steps we are taking are also proving to be equally ineffective so I think this is where we need to analyze and then take corrective action I think giving up is not an option because this will destroy the economy it's not going to restore the economy but if the infections are there people are not going to strong to the shops buying stuff people are not we will be able to turn off our work so the economic downturn will continue we are looking at a five to seven percent drop of GDP which is probably very conservative so I think that the precondition for winning the battle again on the economic front it really hinges on winning the battle against COVID-19 therefore I don't think this giving up or waiting for a miracle is an option at all thank you so much for talking that's all we have in this episode let's talk we'll be back tomorrow with major news developments from the country until then keep watching news click