View of PANDEMIC EXPERIENCES: A RECAP OF THE HORROR AND A HOMAGE TO HUMAN SUCCESS OVER A VIRUS

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VOLUME: 10, Special Issue 01, (IC-IESP-MULTI-2023) Paper id-IJIERM-X-I, January 2023 258

PANDEMIC EXPERIENCES: A RECAP OF THE HORROR AND A HOMAGE TO HUMAN SUCCESS OVER A VIRUS

Professor (Dr.) Pawan Tiwari

Vice – Principal, K.K. Vigyan Avam Vyavsaik Adhyayan Mahavidyalay, Indore (M.P.)

1.

INTRODUCTION:

Ambulance sound, News reporters sharing the increase in the death rate and Health organisations inability to stop the spreading of the virus and financial distress: The world has been going through a very tough time due to a new Virus that started its first avatar as

―Novel Corona Virus‖ in the last quarter of 2019. The world awoke to the power and fury of this virus when it became an Epidemic in China, Italy, France, Germany, UK and some parts of the USA. What surprised and shocked the Governments across the world was the ability of the virus to spread its deadly tentacles in all countries including India, South Africa, Australia, Singapore, Japan etc. and soon attained the status of a Pandemic that threatened the very existence of humans. The virus is now named as ―COVID-19‖. World Health Organization intervened to take stock of the pandemic situation worldwide, monitor the spread of the infection and mortality levels, oversee relief operations, specify treatment protocols etc. Just when the disease was felt to be under control with all lock-downs and curbs in the movement of people, around February 2021, the virus mutated and a mutation which came to be called as ―Delta‖,spread with unimaginable speed and ferocity that caused enormous scare in the minds of people with its ability to cause destruction and mortality. The medical facilities were thrown out of gear by the sheer volume of daily arrival of fresh cases touching a million cases per day by April 2021. The resources were stretched to the extreme, treatment protocols were getting redefined, medical professionals were facing severe fatigue and all healthcare partners facing new challenges.

1.1 Need for the study:

Scientific community worked with extreme dedication and helped in stabilising treatment protocol based on the severity of the infection and need for hospitalisation or home isolation treatment.Researchers could identify the virus and its variants and come out with Vaccines in the shortest possible time.Sure enough, these two years exposed mankind to a new spectrum of experiences and have perhaps shaped a new world order of living, working, learning, Governance etc. This paper is an attempt to recall and record various facets of these experiences where most of the details are India specific and sometimes with an awe as to how this country with such a large and diverse population managed to survive the pandemic onslaught without any value judgement and ―would have been—could have been‖

critiques.

1.2 Objectives of the study are as follows:

1. To study the metrics and statistics of COVID 19

2. To analyse the role of government to combat the challenges of COVID 19 3. To analyse the healthcare and hospitality, travel, and supply chain challenges.

2.

METRICS AND SOME STATISTICS:

2.1 WHO, CDC, ICMR, Covid-19 task force and all related organizations had their own measures to track the spread of the disease which were rationalised into a few metrics across all countries for uniformity of understanding the behavior of the pandemic:

Number of new cases per day, seven day moving average trend of cases, test positivity rate and mortality rate and its trend.

2.2 The pandemic is still present in the world though the rate of daily cases, hospitalisation and mortality rates are very significantly low now.

2.3 The figures of total cases by the end of February 2022 are given below:

a)

About 44 crores people were affected by the virus, all variants included, and the number of deaths recorded from Dec 2019 to Feb 2022 was 60 lakhs approximately.

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b)

USA (8 crores), India (4.5 crores), Brazil (3 crores) and European countries accounted for 50% of the infected cases.

2.4 Total world mortality rate due to Covid-19 was 1.37% with higher rate reported in a few countries like Brazil. The rate was below this global average for India and the USA.

Worldometer.com and WHO shared the following data:

a) Feb 2020 to Feb 2021: 13 months--- Covid-19 variant-1

b) Mar 2021 to First week of June 2021: 3 months---Beta + variant-1 c) June 2021 to October 2021:4 months----Delta variant

d) Nov 2021 to Feb 2022 :4 months---Omicron variant.

It can be observed from the figure in Anneure-2 that it took about 10 months in phase- 1 to touch a daily arrival rate of 7 to 8 lakhs, whereas in Beta phase this level of infection was observed in just 5 weeks!Delta, which is considered as more severe variant, took about 3 months to peak and took a little longer to taper off.Omicron took about 4 weeks to reach the peak levels of all the earlier variants and established its own peak of 35 lakhs arrival rate per day in about 18 weeks‘ time!! Omicron tapered off with the same speed of its growth and came down to about a million cases per day in 4 weeks.

2.5 Indian scenario:

a) India witnessed a total case load 4.3 crores and total deaths of 5.14 lakhs (1.2%) between Jan 2020 and Feb 2022.

b) Unlike the USA or UK which experienced 4 or more variants, India went through the first type of Covid-19, then Delta and then Omicron variants, each one causing a separate wave of infection. Wave-1: Covid-19 first type: March 2020 to Jan 2021.Daily arrival of new cases built up gradually to 1 lakh cases per day by Sep 2020.

Delta wave from Jan 2021 to October 2021 with a peak arrival rate of 4 lakh cases per day by April 2021. The level of new cases came down rapidly to 20000 per day by mid July 2021. The pattern of growth was very steep and the fall also was equally sharp and quick.

Omicron: November 2021 to end Feb 2022: Omicron perhaps ensured that almost everybody has some experience of Covid-19 and spread very fast to a peak arrival rate of 3 lakh cases per day by Jan 2022 and the curve tapered off with the same speed to register an arrival rate of less than 10000 cases per day.

3 CHALLENGES: THERE WERE CHALLENGES TO BE FACED AND OVERCOME IN EVERY ASPECT OF GOVERNANCE AND MANAGEMENT OF THIS EXTRA-ORDINARY EMERGENCY ACROSS THE WORLD:

 Governments-Intra-national measures and International arrangements and adjustments,

 Regulatory bodies like WHO, ICMR, CDC etc.

 Health care-hospitals, doctors, testing labs, pharma companies, researchers for vaccine and cure, distributors and retailers of medicines….

 Society, people- livelihood, freedom, rumours,scares, hopes,good news, loses etc.

 Industry, trade and economy- activity, labour migration, bank credits and dues payments,small/tiny trades existence, survival, Intra-national and international factors etc…

 Travel, hospitality, logistics and transportation, tourism, airlines etc.

 Education: keeping children in front of a screen, loss of camaraderie and peer learning, strategies to handle the fatigue, teaching and evaluating methods etc.

 We will try to discuss some challenges and the method adopted to face these concerns successfully.

4 CHALLENGESFOR REGULATORY BODIES:

Understanding the nature and seriousness of the problem was time consuming as scientists across the world viewed the virus from different perspectives and ultimately zeroed in on a particular new strain of Corona virus and agreed on its shape, nature of its construction and composition, common medium of spreading and method of spreading, how long does the virus lives on surfaces like metal, wood, plastic or air etc.

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The treatment methods, medicines, dosages, and when to start certain intensive treatments like Oxygen etc.we‘re getting evolved over 5-6 months‘ time in various States.

Interestingly certain drugs and medicines considered essential at the start of the epidemic were found to be not so important in treating the patients at a later stage. Example:

Chloroquine based drugs were initially believed effective in treatment of Covid-19 and this prompted powerful nations to procure and store these drugs aggressively. When it was not found effective later on and removed from treatment protocol, the entire stock had to be dumped as waste. Same is the case of Remdesivir which caused stampede in procurement, black marketing and hoarding as the single ‗life saver‘, only to be kept aside when it found to be not essential for all. The situation took funny proportions when the state governments blamed the Central government for ‗short supply‘ and some states went to the Supreme court for directions to the Center. Most of the stock so procured went waste as treatment protocols changed.

The regulatory bodies have to decide and prescribe a set of treatment protocols based on the strength of available evidence and experiences gathered by different scientific and medical fraternity across nations. Within India, NCDC and ICMR prescribed the protocols based on international experiences and W H O tempered with Indian experiences, resources availability and complexity and volume of population to be handled.

The protocols were revised from time to time based on scientific evidence and the pandemic intensity and more authentic guidelines were issued perhaps at the fag end of the first wave. One such ‗Clinical guidelines for treatment of Adult Covid-19 patients‘ was released by the ICMR and is given in Disposal of bodies at Covid mortalities was another major challenge for hospitals and Governmental agencies like Health department, municipal agencies and Pollution control agencies. The issue involved religious practices and requirements, cultural and social practices besides the public perceptions regarding possibility of spreading the disease while handling bodies and medical wastes. Due to these factors, bodies started piling in the mortuaries as there were no claimants‘ initially, lack of cremation facilities and burial areas and lack of clarity at all levels. Stories of bodies being abandoned near cremation facilities or thrown into the rivers occupied headlines in news media.

Central Pollution Control Board issued the ―Guidelines for handling, treatment and disposal of waste generated during treatment of Covid-19 patients ―. This also went through a few revisions based on new evidence and socio-economic and cultural orientations. We may recall that the bodies of Covid-19 victims were not given out in the initial stages as were disposed by the health care professionals and few approved voluntary agencies only, sometimes in bulk transport, and mostly buried in large pits dug up by the Government.

Surviving relatives could not even see the bodies. Even the body of our former President was handled only by the army men in PPEs and the President‘s son was in PPE during the cremation. The situation improved sufficiently during the middle of the Delta variant and with grater experience, scientific evidence and understanding, a set of guidelines were issued which allowed more honorable and socially acceptable ways for disposal of the covid- 19 victims.

5 GOVERNMENTS:

The National governments faced challenges in the following areas:

a) Restricting entry of people from the places with high infection levels and preventing entry/movement of infected persons into the country,

b) Isolation of affected patients and Control of infection within each geographical area lie States, districts, towns, zones local areas etc. by establishment of containment strategies,

c) Educating the people about the nature of the covid-19 disease, speed of infection, prevention methods lie hand hygiene, social distancing and masks and ensuring the local administration keeps up the momentum in the awareness campaign,

Creation of additional facilities for testing, isolation and treatment of covid-19 cases,

Issue guidelines and revisions in consultation with ICMR, WHO, CFDC and Central Covid-19 task force and ensure that these guidelines with respect to treatment of patients,

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isolation methods and disposal of medical wastes and casualties are scrupulously followed by every person concerned,

Authorization and training of new testing facilities based on norms regarding knowledge, skill, infrastructure, reputation etc. This had to be a continual exercise based on the demands of additional requirements.

Procurement and distribution of RTPCR kits and ensuring uniform costs.

Creation of new facilities for cremation of bodies posed a big challenge to all governments particularly during the Delta phase as the rate of infection and rate of mortality due to Covid were nearly exponential. Existing gas/electric crematoria were overloaded and the workers involved in these activities were fatigued physically and mentally. Mortuary vans carrying bodies queued up outside the crematoria or burial grounds and political influence and touts played important roles in allocating slots for last rites. Adding to all this, governmental agencies have to spend considerable time convincing the people in the vicinity who protested for the increased pollution.

Facilities for receiving, isolation and treatment of patients:

 Assessment of the number and type of facilities required as per the arrival rates projected was a dynamic exercise as the behavior of the epidemic could not be accurately predicted,

 Projections included- number of beds available Vs required, places to create/expand treatment areas, educational and social meeting places that could be altered and used for the purpose of receiving and treating cases that do not require hospitalisation, number and type of beds required like Isolation centres, Covid care centres, Covid hospitals with SpO2 facility, multi-speciality hospital beds with advanced treatment methods/equipment‘setc.

 Personnel/ Human resources: Assessment, identification, selection, recruitment, training and placement of doctors, nursing staff, lab technicians, health care and sanitation people, ambulances and transportation personnel, public work personnel who arrange for testing campaign, quarantine and isolation supervision, and people for maintaining public awareness etc. all became continuing exercises for the health and social welfare departments.

Medical Oxygen (SpO2): Availability of Medical Oxygen became a major issue during the Delta variant phase in India and even in developed countries as production and distribution were designed to service a normal requirement which was far below the demand during this phase. The Central Government handled this with extreme seriousness and the Industry leaders came to the rescue. Production levels were romped up in war footing and the Oxygen tankers were moved by defense aircrafts, copters, trains and ships across India. Lot of heat was generated in this matter and some states went to the Supreme court which started monitoring the distribution of SpO2.

5.1 Hospitals and healthcare facilities:

In the initial stages of the pandemic, anyone and everyone who tested positive for Covid-19 were taken away to the hospitals as the treatment protocols have not stabilised and only a few doctors in every place were having some knowledge about the virus and its behavior.

Consequently, the hospitals were getting overloaded, private hospitals have to be authorized for admitting and treating Covid-19 positive cases.

As the governments and regulatory medical bodies learnt more about the disease, cases were segregated into different types depending upon the severity of infection and other comorbidities and risk factors like age, diabetes, hypertension, heart disease etc.

Patients with mild infection and no risk factor comorbidities were advised home isolation under the supervision and assistance of health care workers who monitored the patient‘s condition in person or over phone.Other patients were admitted in Covidcare centre if the infection is known to be high or admitted to a Covid hospital if comorbidities are also present or to multi- speciality hospitals if advance treatments like ECMO were required.

The government hospitals took the major load and responsibility of treating Covid-19 patients whose arrival rates were alarmingly high during the entire Delta phase. Most

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government hospitals were only treating Covid and all other disciplines and all surgeries, save emergency, were stopped.

Both Government and private hospitals who were pressed into Covid treatment faced tremendous resource crunch at various stages of the epidemic.

6 PHARMACEUTICALS AND TESTING LABS:

Testing labs: The rapid and exponential growth of Covid-19 in the middle of phase-1 tested the capacity and efficiency of the specialised labs in the country who were commandeered to test for the disease. There was inordinate delay, even up 4 days in some places, in knowing the results of the tests as samples started piling up the known labs. This delay could endanger the lives of potential positive cases waiting for start of the treatment for Covid-19. ICMR and other regulatory bodies had to hurriedly get applications for new labs, assess their capacity and technical capability, approve labs selected, train the technicians in collection, transporting and testing and fix the rates for testing. Government took the responsibility of procuring RTPCR kits and distributing the same as per request of the States and hospitals.

Pharmaceutical companies: Changing treatment protocols and varying composition of moderate cases, severe infection cases and very serious cases demanded flexibility in production of deferent drugs and medicines and this was compounded by the sudden spurts in demand. Pharma companies and their distributors were thankfully alert to this challenge though there were a few hiccups like the artificial shortage of Remdesivir.

6.1 Industry, Trade and Employment:

Real estate and construction: This segment is dominated by migrant workers in most of the states in India. The panic in the minds of the migrant workers coupled with the uncertainty in resuming activity as lockdowns extended in various states resulted in the exodus to their respective home states. The train services and inter-state transport was restricted to the defense and governments and this added to the misery of the fleeing millions who took to travel by trucks, containers, bicycles and even by walk. The Central government was forced to operate special trains to move these migrant workers. Real estate, building and construction industry was the worst affected due to this exodus as their dependence was the maximum.

Agriculture sector was partially affected by the exodus of migrant workers and shortfall in supply of fertilisers and pesticides as the industries concerned were affected by the lockdown and transporting from factory to warehouses to distributors to farmers were all affected.

Manufacturing: The manufacturing industries in many states were dependent on migrant labour from the North-Eastern states, Bihar, Jharkhand, UP and Odisha. The exodus of workers to their respective home states at the beginning of the lockdown affected these industries badly as the migrant labour were reluctant to return even after relaxation of travel curbs. Perhaps the pharmaceutical and food products industries were not affected much as their working was allowed as essential services. MSME sector was the worst affected sector as they depended heavily on migrant labour and their economic viability was threatened as they could not meet their obligations to the lending institutions/ banks.

Education: The first lockdown did cause a serious worry in the minds of parents, educational institutions, educators and the governments about how the children would catch up with their studies.

The possibility of conducting classes ―on-line‖ was tried and evaluated and the demand for smart phones saw a spurt as the kids needed smart phones to attend the classes. This was a blessing in disguise as most of the kids in urban settings and about 50

% to 60% of rural children had an opportunity to learn about operation of smart phones or laptops and online data web addresses and knowledge sources. The challenges were as mentioned below:

a) Training teachers in teaching and handling classes without the physical presence of students,

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b) Providing teaching aids like internet, Wi-Fi, laptops, microphones, white boards with colour markers

c) Deciding how much to teach full syllabus or a truncated portion,

d) Ensuring availability of internet/ Wi-Fi, laptop or smart phone etc. in rural areas and arranging kids to attend in batches depending upon the availability of the new aids, e) Tackling student fatigue and boredom as the kids are compelled to sit before a screen

and miss out on the company of their friends,

f) Arranging some physical activity within the confines of Covid appropriate behaviour to beat the boredom,

g) Working out a set of evaluation methods to assess the effectiveness of teaching and learning outcome.

h) Impact of near 2 years stay away from the physical schooling in terms of loss of peer learning, soft skills and behavioral aspects on the children and also the teachers is being studied by the experts in these fields.

7 TRAVEL AND HOSPITALITY:

Perhaps the worst affected segment of the economy across all countries is Travel and hospitality sector. These two sectors go hand in hand and are mutually dependent. As the travel within the country and within each geographical area was restricted by total or partial lockdowns, domestic airlines, luxury bus operators, taxi and cab booking were all affected. Excepting for special train services to help the migrant labour, movement of defence and governmental supplies and movement of medical supplies, no other regular railway services were offered. The movement of people, which is essential for travel and hospitality came to a standstill.

International travel came to a grinding halt except for repatriation of stranded people in various countries due to the sudden imposition of the travel curbs in all the countries. The major challenge was collecting data on people who were stranded on different Visa types, nationality, domestic addresses, networking with concerned agencies and assembling them at central locations for repatriation through Vande Bharath flights or other approved flights.

Airlines in general faced severe funds crunch as they could not operate domestic as well as international flights excepting the flights for rescue and repatriation, medical emergencies and medical supplies. Loss of job for ground staff and flying staff alike and also in all allied areas of work like food service, airport operations, cabs and taxi operations etc. caused tremendous agony across the world. Even the skeleton emergency flights operated needed the inflight crew to wear PPEs in the beginning of the pandemic and the crew had to be motivated to travel. Social distancing requirements forced airlines to operate with about 40% of full capacity in every flight affecting the economic viability.

The hospitality sector had to face serious loss of business in the last 2 years due to- a) Low or even nil occupancy for prolonged time,

b) Very low business in the boarding/ restaurant and food sale business as eating in the hotels was not allowed for a long time and even when it was allowed, social distancing norms resulted in less than 50% occupancy,

c) Exodus of the migrant labour who helped in serving food, cleaning and housekeeping activities,

d) Operating the catering and take-away food services only meant partial operation of the kitchen ---- consequently low revenue Vs cost balancing,

e) Cost of extra sanitisation and Covid appropriate behaviour within the eatery.

7.1 Supply Chain Challenges:

We can view a supply chain in terms of its components Viz., Manufacturing, Intermediate storage, Transportation to a bulk storage or wholesalers and distribution/supply to the end customer. The effectiveness of the supply chain is determined by the efficiency, or speed of fulfilling a customer requirement and the cost of providing theequipment. Increasing efficiency (or reducing lead time) would increase the cost and hence the Supply chain operators have to strike a balance between cost and lead-time.

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When the first national lockdown was announced suddenly, all the components of supply chain were thrown out of gear--- manufacturing had to stop abruptly, stock of intermediary products or work-in-process piled up and finished goods could not be moved out to the warehouses or to the market. Cost of inventory that was not planned earlier had to be handled by the producers—industrial or agricultural. The sheer uncertainty as to how long this lock down would go on forced people to initially hoard house hold consumables, groceries and vegetables and even medicines resulted in a chaotic market situation. The position stabilised after, perhaps, a week and panic buying was reduced. Lack of transport for perishables like vegetables and fruits resulted in wastages and shortages at the same time. The governmental agencies had to work out plans to operate the supply chain for essential goods, medical supplies and perishables within Covid-19 restrictions and containment strategies like splitting markets based on the type of goods, staggering markets on different dates etc. After about a month of operations of the markets with masking, sanitisation and social distancing norms, the supply chain for perishables and essentials settled down.

Consumer durables markets inventory management issues as the activity levels fluctuated based on varying levels of relaxations given by the regulatory bodies. Estimation of demand every time new relaxations are announced and sometimes working with smaller lot sizes posed new challenges in consumer durables. Inventory pile up and consequent strain on working capital tested the ability of larger outlets like super/ hyper markets.

Another factor affecting the larger players was very low availability of migrant labour as most of them went back to their home states. Quite a few retail show rooms and even supermarket chains folded under the low revenue—high interest and taxes payables.

An interesting fall out of the situation was the growth of food delivery services like Swiggy, Zomato or Uber eats and also the remarkable growth in business achieved by Amazon, Flipkart and even new on-line portals like Ajioetc. who were able to operate with small lot movements through courier and local transport to fulfill the demand lost by physical outlets like shops, malls etc.

8 CONCLUSION

The pandemic which took mankind by surprise like a predator, rattled and harassed mighty governments of the world and which challenged the commitment and ability of the scientific community to tame its aggression is finally brought to its knees after 3 years of dreadful dance. The virus is surfacing here and there with a new mutation but the ferocity is largely gone. The rate of arrival of infected persons and the mortality seems to have abated due to better preparedness and established treatment protocols and the extensive coverage of vaccination all over the world. In India about 8000 to 9000 cases are reported everyday even now but the mortality is below 0.5% as the Omicron variant or its latest mutation is not spreading fast or causes fear like Delta variant as about 75% of people have received at least one vaccine dose.

People have learnt that shopping can be done without going to the shops and even when you go to the shops, one need not carry the purse and your smart phone will do to pay for the purchases. The human resilience in the face of unexpected loss of kith and kin and loss of livelihood was demonstrated again and again and humanity has bounced back happily as the restrictions on movements are removed gradually.

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