COMPENDIUM

COVID-19 COMPENDIUM PANDEMICS ARE HERE TO STAY SYNERGIA FOUNDATION THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUPR IDEAS

SYNERGIA FOUNDATION P

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS EXECUTIVE SUMMARY Pandemics have always been an adjunct to human society since the viruses that cause them are as much a part of nature as other species on earth. Therefore, humanity has to live to learn under the shadow of the pestilence, as one follows the next. If they become the new normal in our lives, we must know them to defeat them. The lack of our understanding of the contagion is a serious limitation to our ability to find a credible strategy to combat the pandemic. An integrated national action plan, support by WHO, and global data sharing is the need of the hour and evolving a strategy against the threat in all dimensions — medical, social, economic, geopolitical, and cyber. If pandemics come back in fresh avatars, our counter-strategy should also be flexible. Delaying the spread of the coronavirus is not an end strategy. The aim is to defeat COVID-19 and return to normalcy, with minimum loss of life, keeping law and order intact, and restoring economic lifelines. The post COVID-19 World is going to be one full of disruptions. The economy, geostrategic, human security and the very concept how we live and work will change. Frugality will be the new norm for some time to come. Cyber world will be under great stress. A host of new mitigating strategies to deal with each of these threats will be required. Collaboration and not competition is the way forward. The pandemic has forced humankind to come together to find a vaccine- the world has to recognise it as a divine signal and try to incorporate the spirit of cooperation in all aspects of their transactions.

SYNERGIA FOUNDATION SYNERGIA FOUNDATION P

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS ABOUT US The Synergia Foundation is a strategic think tank based in Bangalore, India that works with governments, strategic thinkers, and corporate executive boards to provide both insights and intervention tools to augment decision making at a policy level. The foundation works on real-time primary information to pursue high-quality, non-partisan, evidence-based research and draws upon their global network of resources to deliver the most comprehensive analysis and impactful solutions. Synergia has over five hundred years of combined experience and is an aggregation of some of the world’s leading strategic thinkers, who employ 360-degree profiling to study situations, develop tools and outline execution road maps. Synergia has worked in multiple industry verticals and, over the last three decades, helped both governments and business to reimagine their business in an asymmetric digitized world using both linear and spatial thinking. The foundation has written a number of policy reports to global governments on Cyber Security ( Deep and the Dark web ), Threats to Critical Infrastructure, Affordable Health Care, Counterfeits as a Threat to National Security, Building Supply Chain Resilience, Pandemics, Building a Resilient 5G Telecommunication Ecosystem and Digitization of Defence.

SYNERGIA FOUNDATION FORWARD BY TOBBY SIMON PRESIDENT AND FOUNDER, SYNERGIA FOUNDATION

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS PANDEMICS ARE HERE TO STAY Humankind shares its space in the biosphere with many life forms, and viruses are chief among them. Viruses have shaped human history, created pestilences, and remain formidable foes. Humankind may counter them with vaccines and drugs, yet they comeback, deadlier than before. It would be easier to mitigate their devastating effects by an understanding of viruses and forecasting of their patterns of emergence. Diverse groups of viruses with varying host specificities are present in the global virome. So far, human race has encountered only 1 per cent of the trillion of viruses. A lethal virus emerging from the jungles of Africa, the wet markets of Asia, or the rainforests of Amazon is not a distant threat in this era of global interconnectedness. Viruses can overcome species barriers, down host defences, and effectively adapt to new species. Installing viral listening posts, enhancing global surveillance, and ensuring bio-security are some steps to deter the next viral emergence. Though pandemics have transformed history since time immemorial, sadly, this knowledge matters little when fighting a new threat as no two viruses are the same. They mutate rapidly so that specific vaccines developed to deal with one, may not be applicable for the next. There is no all-purpose universal vaccine for a pandemic of this proportion. However, COVID-19 has sent a powerful message to humanity. Mankind must understand the disease, estimate the magnitude of the disaster, and strengthen public health infrastructure for now and the future. Synergia Foundation has four decades of field expertise in crisis management, conflict resolution, public healthcare, nuclear, biological, and chemical (NBC) warfare, and pandemics. With a close connect to the people out in the field, the foundation has been closely monitoring the progress of the virus, right from its inception. It is our belief that pandemics are here to stay and COVID-19 is one in the series that humankind is destined to face in future. A deep understanding of the contagion is critical to deal with the virus. In this endeavour, Synergia is being helped by a network of experts in public health, disaster and crisis management, and NBC (Nuclear, Biological, and Chemical Warfare), a wide range of virologists, experts in infectious disease, public health, and economists and social and political scientists, both in India and abroad. COVID-19 took world leaders and international organisations by surprise and clearly demonstrated the deep divisions in the global political and economic architecture. Sadly, the first reaction that countries showed was not solidarity and coordinated action, but national egoism and a burning desire to husband medical and other resources with no thought for those who were worst affected. We hope better sense prevails and a more collaborative approach is adopted to deal with the challenges of a post-COVID world.

SYNERGIA FOUNDATION ACKNOWLEDGMENT The SYNERGIA FOUNDATION would like to express special thanks to the following dignitaries for their contribution. APPArrlleeeessxxididTTeehnhnoto,tmAm, AHaaHPssIPI HDeeHDaneedganodHgfooHVfnaoVgsnacpsguicpnluaiglnrargSSuurrggeerryy LFoauunrKFdeouinnrnmcgieeDMrBiEirryexaacehktcoemurt,ive Assistant DeDpeaprtamrtmenetn, tW, Wuuhhaann HimatloaythaenoCfoficneseonf Psurims e AAnnddrreewwHHaarrrrisis ReRnemnimniHn oHsopsiptaital l MDD--DDirierecctotor Er mEmeregregnecnycy Minister of Japan Meddiiccaall Department, F RFSRinSginhgvhivi RDiecphalartnmdeHnto, sRpicihtalalnd JoinJotinMt aMnaangainggingDiDreirecctotorraatt Lauri Aasmann Hospital SanSasnesraerEanEgnignieneereirninggPPvvttLLttdd DirecLtoaur roefnCcyebBerraShemcurity, Anthony Kalliath InformFoautniodningSyDsitremctor, HCcCHAeoaonarennetmChssmuuoeaalnlnttttaoatyonrlnoleKtotg,CagCiAslliesltllieaata&abr&tvrOahivemOniwecnawoCclooCalgnaoi-nsgt-ist RtFNthiuoeaeIIFRsn-tnnKieueIaotsnesau-tlnieKsrrtRonautcaueialhtrtLocelutCaiihFotoLuhteeniFfioeulaeolnnolllfgsRowIcewn(hIlaaItRaiettti)ro,tnnhase-(IIR), AuthoHrimityaloafyaEnstCoonniasensus AcerrvCinedntGreu, Aplatbaama UnNivaetirosnitayl Chengchi Director, Vivekananda FMAodrvKmisNDILoenaifrraroeurN,rcramGitaoyAOtariaotaIoinonsfnamaCnlSaySybnesentcerumSreitcyurity, IAnrtveirnndatGiounpatlaFoundation & University MathAeuwthoKriatylloiaf tEhstonia FDoirremcteor, DVievepkuatnyaNndSAa, GOI Gifty Immanuel Chief Surgical Resident International Foundation & InfGecifttioyuIsmDmisaenauseel UniveMrsKityNoafraPyeannnasnylvania. AForrvminedr DKeapsuttyurNiSA, GOI SpMecDia, PlishtD, ,MMDPH, P, FhFDP,H Head Community Health MPH, FFPH Former National Security CAarvrein, SdtKJoahstnusrNi ational MaxiAmdvVisiolirs, oGvOI AHceaaddeCmoym. munity Health Gina QIAO Associate Professor, SBCAecoanaroedino,eSrmHtDJyuoe. ihpKnushtyNoSaoteiocnrea-l MGThoaLCSypnesehiasnnieegHoiofinvnarMoKgnVraiuuDcrkepmierpPetairncentgsotidOrheoaffnifpctpearan, d LomoMnoasthoevwMKosaclloiawthState tary, Ministry of Home UniveCrhsiietyf,SRuurgsisciaal.Resident ABfofaoinrsH, SuiinKghapooore and Jacob Kalliath MichUaneivl eCrshiteyrotfoPfef nnsylvania. FFoorrmmeerrPPrerseisdiednetnINt ITNETREPROPLOL PhGysoicpiai HnaInntuemnaalnMtheadpicpinae, FSoercmurAMeistraysUxoCciSomiamHtVeomiPmliirssoesofieLvosansnoedrr, SwMedanisahgCinogvDniarencttoHroosfpital MukLuonmdoTnhoasotvtaMioscow State Chas BBoouunnttrraa NCBSU-nTivIFeRrs.ity, Russia. Prroo--VViciceeCChhaanncceellollrofrofror ThyssenKrupp IInnnnoovvaattioionnOOxfxofordrdUnUivneivrseitrysity Jake Moore NareMshicShhaeltCtyhertoff EmJearcgoebnKcyaMllieatdhical PresiFdoernmt,eMr U. SS.HRoammeaLiaahnd CFNCCCNFiieiareairasastnnttirrtiottoCaarrCnenenhnah,a,iUlLeiUlLCeKfiCiafKyEaymEbxmbxeeeMecr rMuuSatSetiarivcevtreueictnurOiOitnryfifftfiyciceer,r, PhPyhsiycsiiacnia,nRIunstehrnOaal Mk Pedairckine, MemSoerciaulrHityoCspoimtaml. issioner HoSswpeitdails, hCChiocvaegnoant Hospital Deepansh Somani SINncitikeerintnMNtaeiCfuitKcBkooSuDfnn-iTTrodheIFpciTRnath.oglatsrstaRteateviRseuasrsciahn GDeraedpuaantsehdSinomBeahnaivioural PiCJnaahgyJEcralaaicmiiaaroknnpememt,erRgMeSrmuesnisonnoitthaocnhteryOr,ayeeMaSkfeotPadranicrdka-lHPohsypsii-tal, and CNoanrseuslhtinSgheCtetnyter. EGcraodnuoamteidcsin Behavioural FinCahnicceagFoormer MoS Fi- NiruPpraemsidaenRta, Mo. S. Ramaiah Economics nance & Civil Aviation, GOI FormMeremFoorreiaigl HnoSsepcitrael.tary and Devi Shetty, Ambassador, GOI CDheaviirSmhaent,ty, Chairman Jayant Sinha NNaarraayyaannaaHHeealathlthCaCraere KuCnhiaMirpiyeraskoen, Parliamentary Nikita Konopaltsev FoSrmtaenrdiEnxgeccoumtivmeitAtesesifsotrant PankSacjiePnatitfieclDirector at Russian to FthineanocffeicFeoromf ePrriMmoeS Fi- ChairImntearnneCtaodfilTahHinegaslRthesCeaarrech Minnaisntceer &ofCJaivpilaAnviation, GOI and Consulting Center.

COVID-19 COMPENDIUM TTHHEELLEEGGITITIMIMAACCYYOOFFOOUURRTTHHININKKTATANNKKISISININTHTEHEPOPOWWEREROOF FOOURURIDIEDAESAS PFFNooairrrtmumrpieecarrkmFAoMamreeRiegnarnidocSiasencrdeitpalroymanadt EShmISAaeaSmrngjJeeaoenyinkcJtyeaSMjeTucaerydetlicaoarryl P, Mhyinsisictirayno,f AAUUTTHHOORRSS aAnmdbaasmsaidlitoarr, Gy OprIofessor MtD. eSfiennaci eHPorsopdiutaclt,ioNneGwOYIork CMMhaaiejjGfGIenenfnoArAjmajayaytSioaShnah Paranskaadj PCahtealndran ShSahraamdeTeykaegTi aylor OChffiiecfeInr,foSrymnaetriognia FCohuanirmdearnCChaadirilamHaenaSltEhECGaOreS, MaEnmaegrignegnDcyirMecetdoircaBloPehhysricniga-n, FOoffuicnedr,aStyionenrgia Former Chairman & Managing erMIntg. Seilnhaei iHmosInpditaial, NPvetwLYtdo.rk Foundation DPairtercictokrM, BeAnSdFisIndia Limited Former American diplomat and SuSdhhairraKdaTpyaadgiia Maj Gen CPa hSmaRiliirtamagryahnpa,rvoNafeanstisoonr.al Security PNCrhaMIenatsigmaoidnenblaehaegnelritiTnmoaogfxfIDnCtLidhroeeieamacdBPtmoveortermB,LroEtcbdeeYa.hyarinndger MaojnGi eCnhandi APdravsisaodryCBhoaanrddr,aGnOI CMhoienfi CSthrantedgiic Officer, RFoBrmaelar sCuhbarirammanaanniadn SuSnuYduhixriKapadia SCyhnieefrSgtiraatFeoguicnOdfafitcieorn, HMaarnvaagridngSDchireocotloorfof BASF FoNrmateiornCalhTianxesLeeader, EY and Synergia Foundation PInudbialiLcimHeiteadlt.h. AmPrbeassidseandtoorfttoheInBdoima bay Sambratha Shetty CShamiefbOrapthearaStihnegtty RPSajReasghhPaavnatn, Chief of Chamber of Commerce OChffiiecfeOr,perating Officer, NChaatiiormnalnC, Nybateiornal Security Tapan Singhel SSyynneerrggiaiaFFoounudnadtaiotnion CAdovoirsdorinyaBtoioanrdCen- MaSnuangYinugxDi irector & CEO tre (NCCC), GOI atFBoarmjajeAr lCliahninzese Ambassador Seher Dareen GetoneInrdailaInsurance Co. Ltd RSeesheearrDcharAesesnociate, RHRaaBrjvaealsarhdsuSSbcuhrnaodmoal aornfePisauhnbalinc HIIeSaclth. SRyenseearrgciha AFsosuoncidaatet,ion GTIAMoSTMavtaCaeVBpnhriaanjaijaeangmfyjiSnAeSBgilnelnihactDgnraoihrezsefetkcaKltaraoyrrr,n&aCtaEkOa. Synergia Foundation RFRoaarjnmejsiethrSPMhaaannhtaagnini g Director ViGjaeynaerRaal Ignhsuaravnacne Co. Ltd aCnhdiefVoicfeNCathioanimalaCnybaet r Principal Scientific Adviser, GOI TM Veeraraghav NCooovardritnisatIinodniCa eLntdtr.e (NCCC). CToMnVsueeltrinagraEgdhiatovr, TM Vijay Bhaskar SCyonnesrugltiangFoEduintodr,ation RaicjhesahrdSuFnodnatraeinshean IISc WIaAnSgCFheienf gSecretary, Synergia Foundation CEO, Center for a New EdGitovre-irnn-mCheinetfoFfinKarnn-ataka. Tobby Simon ARmanejriticSahnaSheacnuirity cial Times, Chinese. FTooubnbdyeSrimanodn Former Managing Director PForeusniddeernatn,d President, CMRaInnoidecduidhanViaLcitctayrdedlM.DCGeihramaericrocmtrioaiaarnlFHaetorrNsypovitaarlt,is VijayaRaghavan SSyynneerrggiaiaFFoounudnadtaiotnion WRiacshhairndgtFoonntaine WPrPaersninidgceiHpnautl,iSCycaCieoGntific Adviser, GOI SCaEnOj,aCyenJatejur for a New IAAmSeJoricinatnSSeeccrutarirtyy , Wang Feng Ministry of Defence Editor-in-Chief Financial Times, PRricohdaurcdtioGnarGcOiaI Chinese. Medical Director Ferry County Memorial Hospital, Wang Huiyao Washington President, CCG

SYNERGIA FOUNDATION CONTENTS CHAPTER UNDERSTANDING THE DISEASE 1 PPAAGGEE 2 CHAPTER MITIGATING 2 STRATEGIES CHAPTER PPAAGGEE 162 3 ECONOMICS OF A POST-COVID CHAPTER WORLD 4 PPAAGGEE 5360 CHAPTER GEOPOLITICS IN THE TIME OF 5 A PANDEMIC PPAAGGEE 9504 CYBER DOMINATION POST-COVID-19 PPAAGGEE 16244 P

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS CHAPTER I P1

SYNERGIA FOUNDATION UNDERSTANDING THE DISEASE The lack of our understanding of the contagion is a serious limitation to our ability to find a credible strategy to combat the pandemic INPUTS BY They hijack the host cell invaders. Same is the case P.S. RAGHAVAN, to replicate their progeny. of SARS CoV-2 causing CHAIRMAN, NATIONAL Viruses emerge and re- COVID-19. This coronavi- SECURITY emerge from their habi- rus is understood to be a ADVISORY BOARD tats and reservoirs when descendant of an ances- GOI conditions are favourable. tor bat virus that jumped into an intermediate host EMERGING VIRUSES VIRAL ZOONOSES like the pangolin (anteat- Viruses are an enigma. Nearly 70 per cent of in- er) and then to animal ven- They are a miniscule bio- fectious diseases in hu- dors in the wet markets. mass of unique organ- mans are of animal origin Though cooking can ther- isms that existed on earth like influenzas, Ebola, ra- mally inactivate it, the act even before our descent. bies, and HIV/AIDS. Our of butchering and de-skin- Viruses have played a piv- increased contact with ning these animals in the otal role in shaping our ge- animals (wild as well as wet markets poses a great nomes. Annals of human domestic) amplifies the risk. Bats, pangolins, bad- history would be incom- chances of such virus- gers, palm cats, ferrets plete without a deeper dis- es doing a species jump. consumed as delicacies course on viruses. Adapt- Once inside a human host expose human population ed to extreme parasitism, they replicate and spread to exotic viruses. viruses lack cellular or- as the naïve human host ganisation or machinery. offers very little immuno- VIRUS CHIMERAS logical resistance to these Different species of viruses P2

COCVOIVDI-D19-19COCOMMPPEENNDDIIUUMM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS VHIuRmUmaaSrnea-sHlksOhhnaSoorTsewtIansNvTtleoiErkyRecAcolbCo-isaTnetIfsOere,cNlapttaaiolnnmi- akgnatoiownn; ittowtihlleenpdaleressnlyt vreirpulisc-ate highhavenbuemenbeprrodoufcemd. uSttiallnmtsany vi- withcvaitrsusees.tcO. uDr uorwinngceslluscmhakaen itesse.lfTehveenSifAiRt SmeCaonVs -e2xhvairuustsion arirsaelsdidseuaesetsoartehien smeaisrcthakfoersa cure. copieesvoefnthte, tinwvoaddinifgfveireusnutnvdireur tshees acnadudseiantgh otfhtehe chuurmreanthopsat.nT-he in copying. This results in righttgheantetiincfceocmtmthaends. aTmheeinttaerragce-t dhtiioossnetaicbdsceeeet.tlwmleIrnecmaeotntihneueaerldiscvaaitlrshsueewtsohoaafrunpoStdcAuoiRigtmtssShehCgouroeefmVn-t-aahe2nest, -- rdeseumltaicnteexxhtiinbcitisonsuofchtheprhoupm-an proMdAuNct-iMonADoEfVIdRrUuSgE-SreAsSis- it cansocrrtemateenant. aSbunocrhmaal phorostciems-s heorsttieissnepirtehveriofuorselsyeeunnnkonrodwoens it tanVtECaTnOdRSvOaFccWinAeR-FeAscRaEpe munoe frersepconosme rbeisnualttiinogninbceytowkeineen minatbtearttcooarvoirnuasv. iruses. mthauBtsotteiaxcotinljnsout,sgmsais.cnupaTdclshhfwueafnarsrergobfifa,maorwcreteiet,uarhaisnaet,hvsveiaribruniiunosis-tleeonsg,tiicntao-l stormvisruansdehsycpearn-acretisviutyltoifninaflacmh-i- VAViNrIoRTlIoAVgLyIREAiVsLOaALNUrDeTlaVItOAivNCeClyINnEaSscent maklillreosreirnvcoaipracaintadtechauumsaenss, ani- matomryemraa.rkeSrus.cThheadelcichaitme ienrtiecra- l fiVeilrdu. Isnetshehbarvieef hsihstoorrtyeorf rveacpcli-na- a pmaanlsd, eomr pilcanitns atsheanhauctmoaf nwar. An imanctateinonponismrribtomyerptoeuwefncerdeoteiisnsmeeyastsbhsteeeinmpavenirrdedduevdstieevaoranimurtdhisoi.tnlnhyees hhtuhuane-s- tcioant,iosmnatilmlpoexsv.aInccRinNeAwvaisruthseefsirst poapnuallaytsiiosnof whiisltlorigcealneatrtaetmepts at VIRUS MEDIATION sluikcceesSsAfuRl SvirCaol vVa-c2c,intheedifsicdoevleir-ed mothreismwuartfaanretsc.leSaurclyhilalupstoroatles the EXTINCTION inbcetyiyasntaEtiotoldiyfnownpaoerrefordvrsoeomJnfrertaneulpnlaapelrdoloryxinnilnebegdy.1i7ts1o9H98i7ten.h9nhIe. mceLeerorm-a,uudis-- eosf oadmnitnfhefuaietcttuuarrilngotaygtldleiyvdnreiosdrdcuicssbuotiyerfnrsbginuisiogniu-scwehcpricaneiredgafesabsmrse-eti.cwTaehneinds A virus is only focused on self-prop- Pasteur developed a rabies vaccine dilemma continues today as amply by 1885. The first antiviral idoxuri- highlighted by the COVID-19 pan- dine was synthesised around 1963. demic. P3 Till date, more than 100 antiviral As early as 600 BC, infectious

SYNERGIA FOUNDATION against host defences. close relation with virus- discovered by Edward Under natural selection, viruses evolve faster than es. Our own cells make Jenner in 1798. Immuni- their hosts do. This makes it hard to treat or prevent a copies of the invading vi- sation eventually led to the viral pandemic. rus under the right genetic eradication of smallpox by VIRAL HABITAT & ECOLOGY command. The interaction 1979. Louis Pasteur de- Viruses are incapable of living in isolation; they can between a virus and its hu- veloped a rabies vaccine only sustain life inside another living reservoir. man host determines the by 1885. The first antiviral Each virus is host-specific, for instance, a chimp vi- outcome of the disease. idoxuridine was synthe- rus predominantly infects only chimps. However, in In the case of SARS CoV-2, sised around 1963. Till the absence of the original host or the abundance of it can create an abnormal date, more than 100 anti- alternative hosts, viruses might take a leap over the host immune response re- viral have been produced. species barrier. Several factors aid in this kind of sulting in cytokine storms Still many viral diseases transfer. One is the spatial proximity of a new host, and hyper-activity of in- are in search for a cure. human infringement in a virus ecosystem, exotic flammatory markers. The animal foods, game meat, and contact with wild ani- MAN-MADEdelicate interaction be- mals. A reservoir is a sanc- tuary for a virus to live and tween the virus and the self-propagate while the human immune system host itself might have adapted to co-exist with VIRUSES ASdetermines the intensity the virus as in the case of of disease and death. bats and SARS CoV-2. VECTORS OF VIRUS MEDIATION VIRUS-HOST EXTINCTION WARFARE INTERACTION Humans share a very A virus is only focused on self-prop agation; it will endlessly replicate itself INPUTS BY even if it means exhaus- MAJ GEN AJAY SAH (RETD) tion and death of the hu- GEOPOLITICAL AND man host. The resultant STRATEGIC ANAYLST, extinction of the human SYNERGIA FOUNDATION host is neither foreseen Bnor does it matter to a vi-iological warfare uses biological tox- rus. ins such as bacteria, ANTIVIRAL AND viruses, insects, and fun- VACCINES gi, with the intent to kill or Virology is a relatively na- incapacitate humans, ani- scent field. In the brief his- mals, or plants as an act of tory of vaccination, small- war. An analysis of histor- pox vaccine was the first ical attempts at this war- successful viral vaccine fare clearly illustrates the P4

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS difficulty in distinguishing blankets that were ‘gifted’ pan and Germany were between a naturally occur- by one Captain Ecuyer to accused of conducting in- ring epidemic and one trig- Native American tribes in tensive biological warfare gered by bio-warfare. This the Ohio River valley. Con- research. The notorious dilemma continues today federate forces adopted Japanese ‘Unit 731’ was as amply highlighted by the same tactic in 1863 active in Manchuria. The the COVID-19 pandemic. against the Union soldiers Soviets tried Maj. Gen. As early as 600 BC, infec- during the American Civil Kawashima, the head of tious diseases were used War. Unit 731, along with 12 of to inflict death and misery his subordinates in 1949 on the enemy and its popu- Nineteenth century ad- for preparing and using lation. When the American vancements in microbiol- biological weapons. Af- West was being opened ogy enabled the isolation ter the war, there was an to settlers, it is alleged and production of stocks official Japanese apology that in 1763 Native Amer- of specific pathogens. In calling the experiments icans were “gifted” small- World War I, there were “most regrettable from pox infected blankets. Sir allegations that Germany the viewpoint of human- Jeffrey Amherst, com- resorted to biological war- ity”. The Nazis were not manding the British forc- fare by trying to spread accused of a biological es in North America, was cholera in Italy and plague offensive though there able to generate fomites in Russia. Germany denied were many instances of when smallpox broke out these allegations, and in German scientists infect- in Fort Pitt. These fomites 1924, a League of Nations ing concentration camps were then used to infect panel absolved Germany. inmates with disease-pro- ducing organisms. During World War II, Ja- The western allies were also not beyond suspicion. Joseph Goebbels accused the British of spreading yellow fever from West Africa in India. The Brit- ish were also known to be experimenting with Ba- cillus anthracis, a viable biological warfare vector, in uninhabited islands off the coast of Scotland, and these islands remained contaminated until 1986. The U.S. War Reserve P5

SYNERGIA FOUNDATION Service was formed in and death is not the goal, development, production, 1942 to supervise the but fear and uncertainty and stockpiling of patho- American bio-warfare pro- aimed to breakdown state gens or toxins in “quan- gramme in Maryland. To- authority. A good example tities that have no justi- day, it is known as the U.S. is the so-called ‘anthrax fication for prophylactic, Army Medical Research letters’ after the Septem- protective or other peace- Institute of Infectious Dis- ber 2001 attack, which ful purposes.” Unfortu- eases and is actively in- created a huge psycholog- nately, this treaty does not volved in the fight against ical impact despite infect- provide for inspections COVID-19. ing very few people. and coercive measures to prevent armament and After the end of World Choices for bio-weap- adherence to protocol. War II, many other coun- ons are: anthrax, because tries were reported to be it can be released quietly; Conclusions pursuing active biological smallpox, frozen stocks of weapons research, includ- which are still maintained Bio-warfare is no ing Canada, Britain, France, by the U.S. and Russia; tu- longer in the realms the Soviet Union, and later laremia, known as rabbit of fiction. It must China. During the height fever; and botulism, which be recognised and of the Cold War, the Sovi- is caused by exposure to incorporated into every et bloc spread the canard toxins made by C. botuli- country’s defence that British forces fighting num — the most toxic sub- protocols. To face the in Oman in 1957 were us- stances known to human- threat with calmness, ing biological weapons, kind. It attacks the nerves the medical fraternity while the Chinese blamed and can lead to respiratory and the public must the U.S. for the cholera failure. Now, even corona- be educated in epidemic in Hong Kong in virus could find itself in the epidemiology and 1961. armoury of some nation or control measures. terrorist group. A WEAPON OF CHOICE The COVID-19 Two characteristics make INTERNATIONAL pandemic has been bio-weapons an ideal SAFEGUARDS the closest thing to a choice for an aggressor — The ‘Convention on the mass bio-attack, and their invisibility and their Prohibition of the Devel- it is clear that even delayed effect. They can opment, Production, and advanced western infect the target popula- Stockpiling of Bacterio- nations are far from tion, escape undetected, logical (Biological) and ready to handle it. and leave a panicked pop- Toxin Weapons and on ulation and an administra- Their Destruction’, was tion, which is paralysed, signed by 103 countries in their wake. Sickness in 1972. It prohibits the P6

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS POST-LOCKDOWN strategic vision to combat EXPECTATIONS the contagion and work on a calibrated post-lock- INPUTS BY an effort to balance them, down plan on the medi- T.M. VIJAY in a phased manner. While cal, social, and economic BHASKAR all are focused on the pan- fronts. CHIEF SECRETARY, demic from the medical GOVERNMENT OF standpoint, the govern- The panellists com- KARNATAKA ment’s biggest concern at prised of T.M. Vijay Bhas- this point is the economic kar (IAS-Chief Secretary, As Karnataka inches challenges, said Karnata- Government of Karnata- towards lifting of the ka’s Chief Secretary T.M. ka); Arvind Kasturi (Head lockdown on May 3, Vijay Bhaskar, at the Syn- Community Health Care, the government has a va- ergia Foundation webinar St. John’s National Acade- riety of plans on the table on ‘Coping Strategies for my); Naresh Shetty (Pres- for an exit. Owing to differ- COVID-19’ held on April ident, M.S. Ramaiah Me- ing opinions by experts in 22. morial Hospital); and R. both the medical and eco- Balasubramaniam (Found- nomic field, there has been The objective of the er SVY.M & GRAAM, Mysu- webinar was to develop a ru), along with the team at P7

SYNERGIA FOUNDATION THE SIZE OF CORONOVIRUS LOCKDOWNS Number of people placed on enforced lockdown due to the coronovirus pandemic per country 1380 Ongoing At height of outbreak 760 297 * At least partly enforced Source: Media reports (In Million people) 165 142 100 68 65 60 59 51 47 45 India China Bangladesh Russia UK* Italy Colombia Spain States Philippines France Africa Argentina United South Synergia.T.M. Veeraraghav isolated at home due to for people to learn about (Independent journalist, space restrictions. the virus, the better. His former resident editor with  Put in place early-warn- worry was over the ticking The Hindu, Sr. Editor CNN- ing systems for treatment time bomb -- when migrant News18) was the modera- using social media and labourers stuck in urban tor. other forms of communi- India, go back to their na- cations, to spread aware- tive villages, where the First to speak were the ness on the steps to take if spread of the disease has medical experts. Dr. Arvind one falls sick. been minimal. Kasturi expressed caution  The pandemic should moving forward and sug- be tackled with a teach- Mr. Vijay Bhaskar too gested a detailed step-by- er-with-a-stick model. At said the immediate fall- step procedure. the same time, we must out of the post-lockdown remember that migrant would be migration of peo-  The uninfected should workers are our people, ple to their homes. Fur- remain so by raising and we have to be the ones ther, people would want awareness on the bene- to get the message across to move around. The main fits of following hygiene, to them. concern then is how we avoiding gatherings, etc.  Prepare ourselves for ensure that this doesn’t  Medical services for some amount of human cause movement of infec- people with comorbidities cost. tion also. and other illnesses should continue. Dr. Balasubramaniam, Dr. Balasubramaniam  Facilities should be set was on the same page, envisaged that the Centre up for those who can’t be saying the more there is and the State could see a fourth sector arise that fo- P8

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS cuses on benefit-optimisa- tion. He offered his strate- gies:  Set up a ‘real-time re- sponse body’ to allow for the “accumulative cross-pollination” of expe- riences from all over. This would give people a better idea on how to tackle the pandemic.  Mobilise resources; en- sure short-term liquidity for the poor and vulnera- ble; keep basic services running; find ways to buf- fer economies (MSMEs and others); and leverage global support in the short term. SMALLER LOCKDOWN? patients, relatives, and final outcome could re- Post-COVID will be a dif- non-COVID patients inter- sult in living a new way of ferent way of living alto- mingle. life altogether, where new gether, said Dr. Naresh measures are put in place, Shetty, and there could be NEW NORMAL with no vaccine available. the possibility of a smaller On the strategic front, Maj. He suggested a way-and- lockdown after this one. Gen. Moni Chandi (retd.) means path: He also wondered why we felt that the post-lockdown  Play for time and wait for are so focused on COVID, could have three out- either the virus to mutate when there are many other comes: a professional win, until it dies, or delay the harmful diseases that still where the containment pandemic for as long as it exist. Is it because it is af- is successful, and we re- is possible through social fecting the rich? His point- store economic activities distancing, until we find a er to the government: and get a vaccine. Or, the vaccine.  tagger the population on situation could spiral out  To work towards a con- the day lockdown is lift- of control and the pan- trolled infection, which ed. Hospitals will have to demic would rage through. would give rise to herd im- cope with the possibility of Herd immunity would set munity, allowing the lock- spread of infection when in, but at a great cost.The down to be lifted slowly P9

SYNERGIA FOUNDATION while the most vulnerable The final outcome the government spends (children and elderly) stay could result in just 1.4% to 1.5% of the at home. living a new way GDP on healthcare, which  Control the time and of life altogether, is very low compared to place of when we expose where new other countries. people to the virus, and measures are put marshal our resources. in place, with no HERE TO STAY vaccine available All the speakers felt that Maj. Gen. Ajay Sah pandemics were here to (retd.), however, cautioned in the cities. A good way to stay and this would trans- against inculcating immu- also ramp-up testing was late to a different way of nity, as there were cases through pool testing or an- living altogether. Looking of re-infection in those tibody testing. forward, Dr. Balasubrama- who had recovered. He niam warned of increased also highlighted the mor- But on the matter of polarisation, an increase bidity and mortality as- controlled infection, Mr. in the rural-urban split, and pect of the disease. With Vijay Bhaskar stressed a change in our intercon- the morbidity factor, it is that medicines for COVID nected economies. If we important to keep in mind could be found faster than don’t come up with a solu- that COVID can be trans- the vaccine for it. Pro- tion that addresses all of mitted through a variety jections showed that it it, it would just be a band- of ways. More importantly, would happen within a few aid and not a systemic he said we must be aware months. solution, he said. of ‘superspreaders’ -- the spreading of the infection Corroborating Dr. Na- In conclusion, Tobby Si- to many more through one resh Shetty’s view that the mon, Founder and Presi- person who is highly in- healthcare system has dent, Synergia Foundation, fected. never been at its best in said there was a need to India, and if it had at least look at overarching issues Without a vaccine or 5% of the defence bud- of eating habits, especially a drug right now, there is get, it would have been a the wet markets in China. only the option of herd completely different story, After SARS, people had es- immunity and controlled Dr. Arvind Kasturi pointed tablished that the disease infection said Sambratha out that this pandemic is was coming from bats. It Shetty, Chief Operating Of- a good lesson to improve is important that this be ficer, Synergia Foundation, the medical system from controlled, else we would adding that there are dif- the grassroots --- both in- have more and more ferent factors to consider stitutional care and gener- SARSs. After all, there are here -- the density of a pop- al public hygiene. He said only two things that can ulation (it would be harder end mankind -- nuclear to control in metro cities), war and pandemics. and hospital-bed capacity P10

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS CHAPTER II P11

SSYYNNEERRGGIIAA FFOOUUNNDDAATTIIOONN MITIGATING STRATEGIES Bill Gates, during his TED Talk Tmaiiwcaron,baensd. SPinagratpooref stehreveraesaa- hseuacltchecasres isntforarsiterusctourfe Sisouetnh- in 2015, said, “When I was a msoodnelffoorr oththiesrs.isWtithhaint Ewuero’vpee, hKaonrceedaa, ndTiatsiwreaacnh,exatenndded.Sin- kid, the disaster we worried Ginevrmesantey doffears ahupogseitivae mconoturanst gapore serve as a model about most was a nuclear war. To- rstwinoeuseaIptln’taoviulneeysdca. TlnaiendhnaedvSrpUeha.sdeSinnt.erec,etwedeshphrooarvnveweesneerrmtyiessasw.nlloiyiBtdwtceultaleoyt- day, the greatest risk of global ca- ainckanoswylesdtgeemd astoeccsetnotrpicaandepperi- CfoOrMoINthGeTrOs.GRWIPitShWinITEHuTrHopE e, tastrSoYpNheERdoGeIsAn’t look like this. If sdoenmaliitcy-.dWriveen’r.e not ready for WEGNehEirlmMe bYaacntyerioa fafree ersasyatopfioghstitwiviteh anytFhOinUgNkiDllsAoTvIeOr N10 million peo- ttahineImnnetehnext watbaesseptnhidceeepomrfimaivcaar.”cycfionceu, scothne- acnotinbtioratiscst, tthoeyItaarleyuasenledssSapgaaininst, ple iRnEthSeEnAeRxtCfeHwTdEecAaMdes, it’s most worOldriogvienr.sWohfiltehweeCscOraVmIDbl-e1t9o vwirhuoseswaesrtehesylohwijactko trheesmpeotnabd- likely to be a highly infectious virus cboenatarinsthtaisrpkansdeimmiicl,atrhietynexwt oitnhe ooalfnistdmhemofhsetehlvneecsh.eoAsctchtooradcvirneegatteomcDlaoiannneyes rather than a war. Not missiles, but wim2tch0eaaetly0mrb3aaei.nrSikfnSAoerttARsehsteRStrsamS;diainnokogidunreeigtgxeb.opiIrtnnijecuatanahtnkgeelidemtrsoa;oilpinsnf-; Gcarisffiuna, lptrieofse.ssoTr hofemiUcr.oSb.ioloregy- microbes. Part of the reason for athndeinGa uhuanntegrd’sobnusgh mperaot,vainnucne- asnpdoimnsmeunisolowgyidatetlhyeaJochknnsoHwopl- konfowCnhpianthao,geanncoduldCbOe VevIoDlv-i1n9g. fkdpeiiondenndsrg’stdUedronduanimgvsaeaartlghsisetiatyttyh-:tdee“aIcrrctgiec’vselletebatennshet.wenrveihcilalr.ru”dsae, rbnutdot Bthis is itlhl atGwaet’eves,invdeustreidnga hhuigse IftroismtimWe wuehparenpairne fothr iet. Hubei TInhethveiruasbscaenncreemoafinaivnasicde- twaemem’ovuetonisTtnstvaiEoneipDsdntae,undc“TelWvepaeairrldhykedemleinttiietcnlr.eIrWeiwnne2t’aras0e.s1sBny5uosa-tt, MprEoDvIiCnAcLeC. OEPaINrGlySTcRaAsTeEsGIEaSt tchieneho, sctoanndtacionnmtineunettowraepslitchatee kreiadd,y tfohrethednisexatsetpeidremwice.” wor- Gthoeveernnmdenotfs 2ar0e1r9ecwogenriseincgotnhe- tipthsreeimlhf oaasntrdyisinaffseoycmct uopttshoemrtsah,tieecv.eTnwhwoehrdeledn- rieOdrigainbsoouftthme CoOsVtIDw-1a9sbeaar fWfctrrueaahnisalittlirleyteuycotdthftueotsrhesoetlioairnttcehhaedaoaleftlivtshehtelcehoaapertltiehnhoesgcyapsrcctpeoeoouminnnrs----. loavyeisrd. ueWtohtihlee bowdey taskcinrgatmimbelteo nsbtruaercakklseoiamf r2il0ar0wi3ty.aSwrA.itRhSTtohoerdiSgaiAnyRa, tSetodhuiten- traiegsiolikne wInadisa ilsossetv.erely wanting, ctoreatceonnewtaainntibtohdiises tpoadneadlewmith- gthreeGauteansgtdornisgkproofvingcleoobfaClhcinaa-, Undcee.rSvei.sedhlsiosMaptv,oeeatdaronelscaaoodlgiugbaennettmeerpni,reeeisoonxrfpstifouteisceerhossdfs.aocsIntotthhdnhaieea-t flttiycehhve,eseittrghhmnaresneadaonktfi,neitanfhxnlgaetdm.botmIohnndeaeyttsihoyfmimneghpaattrtiryoenomgabpcsbeticualicaiakknle-l. taandstCrOoVpIhDe-19 fdroomeWsnu’htan ilnotohke trasting examples. The Brayinthfeonr,eesitthse;r tihne hdosetewpouljdunbe- olHteihnkvuedebeooerpiftp2ph1o0rir0o1stv9u.inmnwiIctefieyrl.eltiaEoocnaolnornylcyctapehlcaieiaslneesoedgtpshsleaoektctiothlhilnanse-t owbginnelegetatokhsoeee;nlxraieenotdceto.bwivcyeeoraytthncemuirmraaviealrm,kloseern;titsfaso,nlitdtdrmaandiandy- tahgeionnweaxstlofset.w decades, it’s a hunter’s bush meat, an miTdnahtfoeeMe,sscuaotntcficfaloeiegkrsuessemsslcetyovonnirtrttioueroassfsobtrfiteanhSgotehauetcexhrhariKsmitighosp,hraleeltnasyo., a war. Not missiles, but PP612

CCOOVVIIDD--1199 CCOOMMPPEENNDDIIUUMM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS buTLaEnekSkiSnenOgvoNowiSnlvtnFoiRnpOagcaM.ctoIThutHnoitEsgetPhtAniemSTcgeeonuwetlidec sttoartfgigenhetratwingitihts oawnntaibntiiobtoidcises, itniog nthae rdeesaigcntuofalvlayccsinigesn. sDeoepf bthefeoyre gaertetinguosveerlewsheslmaedg.aInintesrt- ltehaernbinogdisy aflisgohbteiinngg ubsaedckto. Biny- psimreiplaarirtieesfobretiwt.een SARS-Cov-2 fveirrounssearse darsugtshwehyichhhijealpcktrigthgeer vthesetinga, teeitthheer pthoteenhtioalstowf oavualidl- and COVID-19, scientists are trying phtmthoeaervesectihsaprtuerebmonaovtatelniedinsftimecomcltbomieonuoneensffe.fsectsothyivsfeteetamhgheaoiamnnssdtt- aCbobOerleVifoIaDnnot-il1vdt9ih.raaelndrdreucwgsoefvoaerkrueysneceaugdarivnbesyt, selTvheesm. oAsct cefofercdtiivnegvatcociDneias naree Matot ErtehDjeigItCdimArueLg.sTCthhOeatPbpiIorNotevGcehd effective tGhroisfefinth,apt rcoofaechsstoher ohufmmanicrimo-- ToHthEePrRaOiGlmNOeSnISts, it may be industry bmbeiufoonlreoesgiytysctaenmainntfdoecftiigtmhhtemocfeuflltnsh. oe lvoirguys Atoonelawtev.accine has to follow ShaTdRmAadTeEcGonIsEidSerable progress in at the Johns Hopkins Uni- time-tested protocols: identify- Gmaokvinegrndrmuges nfotrsSARaSreandrMecEoRgS.- AveI TrsOitTyH: E“IRt’EsSbCeUeEn harder to ing its genetic structure; ensuring nitsisAeinnnztgiy-mviterhasel adnrfudrgassuitlratfryagceetotpfhreotvtheirienuissr,, aCtvfhiionmermudCapschhad,inninrieubeessgeulevlstaiikrrenatdhlinIosanegnqots’vutytiesoantedrchmgeaaetvmhtetoroaugtuseghgeneehd- hweithaoltuht cdaamreagsinygsttheemhoss.t.WIt htriilees ethraetecaelDl NaAs-bwaseeldl.”vaccine called aLgEaSinSstOcoNllSateFraRl OdaMmaTgeH; pEre-trial INOT-h48e0v0,irnuosw cinapnrercelimnicaailntriinal-. rPeAseSarTch; animal trials; and finally tohewesaktaentethoe fvirhues,aplrtehvceantrienginits- MtsoiodcdreeeartntheaeaTvhhaeocrcasipnteeau, tnailcdssoaculsonodnuetsriencdluiAneI- eecTglsdaeitniknasicinveanaotlcgtitccrbiineaiflenosirstoseoniemMxhpuaaielrmaccctharceni2dots0i.tue2oTns1hb.tee efiatbehrleldei--- cfGcinraoiagtleirusoeanntsdsr.tSuricincRieetteosnumccredleeiselk,lssweiinvooirrrI,kndseptdedorvipowaediiulttiohscseprSdeAispnReblgiSy-- itcoal rteripallsi.cIat tteooitusseedlfthaengdeneitnic- tweOencne thSeAdRanSg-eCr ofv-C2OVIaDn-1d9 vCeovr-e2lyanwdains tbineign,g duesevdelaogpaiensdt bfelucetprointth, eporsst,eedvoenlninwe, htoefninatlhisee wCaOs VfIuDll-y19r,evesacleidenitnistJsanuaarrey, cCOoVuInDt-r1i9e.sPrsotuecashe ianshibthitoersU, l.iSke. tihddhoeeenOlsvatatniyfcciycseiinssaiesmscmdiiyleRaumnrNteiitpAsiet-ttss1oo2mi7na3tra.hevateriaciobb.uleTos hdvteiyo- rltaeruyseniancrhgcehdetrocslintriheceajilgwtroidarllrsdutgoovsteerstthheaaxdt- htLio-avpviiraeavlisra, aalstntodacRkbitteohneeanevnaziery,xmpHeoIoVsfeatdhne-. rtuaskeisngantdimteheitro cchraeraactteerinsteicws, ipstrionvgemdediceaftfioencstaivgaeinstatthe tnhewe Ivnirdusiatonmeeakdesittoinerret,ahliagvne bperein- admathmenatrocetehicubatinnottec,do-olafrieernaaersvdlnaaititnltoiaohgbndelseaelsgdaionaylrtmaiwtt,hhpiemetxthpsohetmduchaigtesne- tthimreaet. TShoefabr,iothteecdhataincdolulesctreyd like fever and inflamma- iSdphnooarimeondsgednitrvroeimetdsaugtsaamivldeeicennacstosemnsac,cpabolpuuknestiaisnnvreoigpdtraaeodnsmrsraawuiusbeginnrlesisg-. oforuintideesffesctoivetihnastomheecaoultnhtcriaesr.e vfoerrsaSl AcuRreS. CarnitdicaMllyE-iRllSv.olunteer iaabnnenitfniAdrbganoisodrtetisthesrseeuracrercocaltdlheuceecfrdhteeenidessifixsvrtohetemee nnmcehrdneegcaeaihtnndiaeocn.eniersemoddf pppthaeatsreiAisemionvnentitnsraiut-tavaesrl-ier,udasriateullsgrpesradeotdhgnryrruzoagrmyuesgmcmheeeitvh.tsiaengrcagonemexdt-- surface proteins, with- animals or recovered patients. TChtouHOmqTEMuahinecEIskiNNemlyaGmEnidMtuTienbOnYeotdsiGfyiyesRstteshImtPere,StnehngrWtaehbaelItinTnatgHnhidet While bacteria are easy PP173

SYNERGIA FOUNDATION out damaging the host. It have used the Chinese was fully revealed in Janu- viral sequence through a ary, researchers the world tries to weaken the virus, machine learning system over had launched clinical to generate a DNA-based trials to test existing med- preventing its ingress into vaccine called INO-4800, ications against the new now in preclinical trial. threat. So far, the data col- cells or stop its replication. Moderna Therapeutics lected does not give con- also used AI to create a clusive answers. Some Remdesivir, produced by vaccine, also under clin- treatments appear prom- ical trials. It too used the ising in individual cases, Gilead Sciences, worked genetic blueprint, posted but not as a universal cure. online, to finalise the vac- Critically-ill volunteer pa- with SARS Cov-2 and is be- cine mRNA-1273. Once tients are already receiv- scientists are able to iden- ing experimental drugs ing used against COVID-19. tify similarities in various through the compassion- viruses and their charac- ate-use programme. Protease inhibitors, like Lo- teristics, machine-learn- ing algorithms can detect FAILED piavir and Ritonavair, HIV correlations in the huge amount of available data, DRUGS, anti-virals, attack the en- expediting the design of vaccines. Deep learning is FIZZLING zyme of the virus to make also being used to investi- gate the potential of avail- VACCINE it inert, have been found ef- able antiviral drugs for use against COVID-19. INPUTS BY fective in some countries. GIFTY IMMANUEL THE PROGNOSIS INFECTIOUS Another defensive mech- A new vaccine has to DISEASE follow time-tested pro- SPECIALIST, MD, anism being researched is tocols: identifying its ge- PHD, MPH, FFPH netic structure; ensuring the creation of antibodies against collateral damage; W hen orthodox pre-trial research; animal medicine and collected from engineered trials; and finally clinical its great pro- trials on humans. The fessors abandon you to animals or recovered pa- earliest a vaccine is ex- the most horrible death, pected to be fielded is not when all the scientific pun- tients. before March 2021. Once dits with their Nobel Prize the danger of COVID-19 These antibodies strengthen the human im- mune system, enabling it to quickly identify the threat and start generating its own antibodies before get- ting overwhelmed. Interfer- ons are drugs which help trigger the human immune system and have proved to be effective against persistent infections. The most effective vaccines are those that coach the human immune system to fight off the virus before it can infect the cells. AI TO THE RESCUE Companies like Inovio 14

CCOOVVIIDD--1199CCOOMMPPEENNDDIIUUMM TTHHEELLEEGGIITTIMIMAACCYYOOFFOOUURRTTHHININKKTTAANNKKISISININTHTHE EPOPOWWEREROOF FOOUURRIDIDEAESAS ORPHAN RECYCLED HERD ANTIVIRALS CANCER DRUGS IMMUNITY Drugs developed for Monoclonal antibodies Allowing natural some other disease such as Tocilizumab infection in 70% and redirected to to target the cytokine population can be COVID-19 storm devastating in a dis- ease like COVID-19 Remdesivir-Minimal Convalescent plasma - reduction in the high cost-factor makes it Without immune number of days to difficult to implement for memory protection recovery observed a large population cannot be longlasting HYDROXYCHLOROQUINE Lost ground due to resistance from the parasite. Has serious cardiac side-effects UNHEARD IMMUNITY tection cannot be longstanding. Im- distancing, prevention of public blalHeenycetdtrudtasrhceiiemetmomnmpciiuessc,neeaibtlrtuvyastcebhisesloxeoaeblncsevuotiifnirfnmutlgeoserudietsitdcteciienandneg- eflbmiaefmueldlnieaoibnntryldgeeijesd,utenwdhaitetchhdifoii.linuesTaswelltyfeah.raosekneitsnisgecraiibetpenspthwteoiefuaielcndr aOwgtoaphntihepmeneeprsialotnircrgfiacsti,tintloyhhnateashdvoheenfeirrftpeihsrdgeot.hvHeedctonorwanuegoegvmfaefseryic,natdtisnuvodtee shapvieteuntfhoreeisreepnhceonnsoeqmueenncaesl. Trehe- community is puzzled by ChuOmVanIDm-1ob9iliwty,athseythcaennooltdbeainn- saartetceahnartciicohtnh.ebIofur7yd0hgpaeesrtacstet,rnathcotofewdthaelcpoaot pon-f tSChPOiAVsNInDISo2Hv0eF19lLUvi1r9u1s8.AND tdiemfinaitlealyrioablservheyd.droxychloro- yuolautiofnabilectoomgesoimamftuenre aaglaainsstt TheSScpieannischeFliusparendpeumripcoosf 1in91g8 ga ldimisemasee, rit oisflikheolyptehenreommainaintg- quine (a derivative of Qui- te3ev0erpr,ewtrhhceeernerteawr,eiiltlnwbeohpreorloultteiefcsttneodei.tcH. eOoswne-- owlads baynadsimfoilasrspilaitsheogdend, sriumgilsa.r sisaarlylo:wJiongse70f Spetreicnent people to Vtarraaoncusncmdinis5es0is0onmadiylnlnidoanmbiicnisfoealcnotdigocniacsuaasnlesdd ninCe oornJcesluuits’siBoanrk-sfrom utbaocerqceuEuosmiveoreeaefrtivmymhaecmecidniudnfeneeiecactttitoionhooientb.tnTiaasahintneudtsraheacealloyfdsnaaaddmnilside-s l5o0nmgilalibonandedaothnse. Hduanrderebd eyienargs teondptohinet. Idnobwothnftahell apopfroacshceis-, riplWtaeeetipcetrthraaeadwtcletlekoosaaufragreroaeeidudnbverantntoaecdrenbe?sedTsattrhpeeetrewh1pr9eiaos1ns8toiitpotiraeonenxn-.--. a PAeNrEuXvTiIaNCnTtIOreNeP)A.TH? ecaalnlnocwbeien.dgTetvhhaesisntaattpiunarganlinidnaefedmcitsiieocansreholauiktsee bCrOoVuIDg-h1t9. Ttohisawtatseansttriaotnegichmoiws- Tdehmeircedieisd annoatunrael wdeasthpweicthifoiuct There are important lessons to AutoitafnsdktpehvpertaohelpniepcacUynaedKrlmeeammtdeeiarcn.dwaetSneiidnminhtirlhaeaedrsalbtycloel,iygerpiennragonrcrpieeneosg.s-, mminugocalhesiicmnutiellarerveeinnntdito?hne. Apreipweelienxepeoctr- cnoenmtsboifniendnatewiimthmunleitaypbselieivne a bInrethaekatbhsreoncuegohf a bdriuogloorgaicvaacl- LOibcSesT.leWaGernRatrOferocUmeNrtpaDainstlypoanndaemma-ss tiwneicthhboonultsotilemorimgngyunheitam. seUminnofrsoyrt,titulhlneeadpterloay-, istlcnaiievnsetee,t,ramhepnseudosbrultoinhctiuoovherresriaaaszvlatroelhslynuemas.np.epStaIhlitimlocaadpabsgllelmeaa,,retieonhffteesshscttee- Onencxotetininhcttaeiorivlneepndaeta.hTsihfeascnpieeernnfcifceeiodcuotseisve sense of invincibility in us. SmAetRhoSdsCwoerVe -q2uicikslyrdeedpluoynedd,aanndt anctyimcleaolfairnifaecl,tiiotnhanadsreloinsfetc-its atdhonewdynsah, anivsteoilqaytuiieoalndt,eedqdu.bareannetfiintse., Lock- grotwiouitnhncdthanedemuvaeejnotruittoaylloyrfcetahstecishgltuoapbnalce The templates we devised social frohpmeoaplutthlhacteieonnpt.raWersia,thssuoirtvgeeinr.fglFocwuairsnteghs er, hyadnrdoexxyhcauhsltoiornooqfureinsoeurcesh, as for the containment of RECURRENCE OF seawrbieolewuloiskueldincb1ae9re1d8q.uiIaat lcilsyavutselnisdetare-- -ef- NOXIOUS QUININE fecmsctesien.ntcoUef enfavfietohnrwitnuetnhloiasoktlaeutelpyh,toouitr. is still the core drug in many guidelines around the world in the management of COVID-19. This danger- P9 P15

SYNERGIA FOUNDATION Taking into pandemic flu is being tried. designed anywhere in this account the genetic However the prospects of world must be eventually similarities between success are slim. These mass-produced in India. SARS-Cov-2 and are drugs which were de- COVID-19, scientists veloped for some other Hope was generated are trying to rejig disease and redirected when Oxford’s Jenner In- drugs that proved to COVID-19. This kind of stitute projected an 80 per effective at the time disease-hopping orphan cent success rate for their antivirals dominate the Chimp Adeno Viral Vec- ous trend is continuing de- COVID-19 scene. tor-based vaccine against spite conclusive evidence COVID-19. Disappointingly, that hydroxychloroquine RECYCLED CANCER the primate study did not has no beneficial effects DRUGS yield protection against the against COVID-19 (Nature, There is a sudden interest aerosol challenge. NEJM, Lancet). The sine in anticancer drugs, par- qua non of medical prac- ticularly monoclonal anti- A TRINITY OF LETHAL tice is to first ‘do no harm’. bodies like (Tocilizumab VIRUSES But in the curious case of and its analogs) to target There is no effective vac- hydroxychloroquine, the the cytokine storm, or in- cine against SARS-2003 prevention and treatment creased cytokine levels, a and MERS-2012. Both vi- seem to be worse than the major reason for fatality ral diseases are caused disease. in COVID-19. The second by viruses similar to SARS approach is to use the CoV-2 causing COVID-19. DISEASE HOPPING convalescent plasma of a If there was a SARS CoV- Orphan antivirals Remde- person who has recovered 1 vaccine it could have sivir was touted as one to from COVID-19. Though been rapidly deployed specially target the viral both these experimen- for COVID-19. It is highly multiplication. However, it tal methods have shown plausible that such a vac- failed with Ebola and Las- some anecdotal success, cine could have at least sa virus infection. It was there are adverse reac- afforded partial immunity repurposed for the man- tions which are not well against SARS CoV-2. The agement of COVID-19. highlighted. The cost fac- reason for not developing a The drug did not make tor makes it impossible SARS 2003 or MERS 2012 the mark in early trials al- for a large population. vaccine is partially profit though a minimal reduc- factors and technical dif- tion in the number of days India has the capaci- ficulties. It underlines two to recovery was observed. ty to successfully mass things: a missed oppor- Favipiravir another flu drug produce antivirals and tunity and developing an which partially worked in vaccines that can heal effective vaccine against the globe. Any vaccine or SARS viruses could be a drug against COVID-19 daunting process. P16

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS Proponents of the BCG the approaches, allowing effective, and universally and polio vaccine are the natural infection route applicable, these methods shooting in the dark. BCG can be devastating in a were quickly deployed, and is a bacterial vaccine that disease like COVID-19. they have yielded benefits. could only partially pro- This was a strategic mis- Lockdowns, isolation, quar- tect against tuberculosis. take the UK made in the antine, social distancing, The polio vaccine is suc- beginning of the pandem- prevention of public gather- cessful, but the polio virus ic and had to regress its ings, have proven effective is unrelated to the SARS policy later. Similarly, pro- when strictly adhered. How- CoV-2 virus. Both these ponents of innate immuni- ever, due to implications on vaccines are being phased ty believe in bolstering it. the economy and human out as polio is on its end- Unfortunately, without im- mobility, they cannot be in- game and resurgence of mune memory, the protec- definitely observed. tuberculosis has led to tion cannot be longstand- the development of BCG- ing. Immunity is the final Conclusions II. Both these vaccines frontier between life and cannot protect anyone death. Tweaking it should AN EXTINCTION against COVID-19. be done judiciously. PATH? There are important lessons UNHEARD IMMUNITY SPANISH FLU 1918 AND to be learnt from Herd immunity is an in- COVID 2019 past pandemics. teresting lecture topic at The Spanish Flu pandemic We are certainly on schools of medicine and of 1918 was by a similar a mass extinction science, but executing it pathogen, similar trans- path if science does can have unforeseen con- mission dynamics and not intervene. The sequences. The archa- caused around 500 million pernicious cycle ic theory has attracted a infections and 50 million of infection and lot of attention. If 70 per deaths. Hundred years lat- reinfection can cent of the population be- er we are in no better po- eventually catch up comes immune against a sition. With all our advanc- with the majority of disease, it is likely the re- es are we not expected the global population. maining 30 per cent will be to fare better? The 1918 With overflowing protected. However, there pandemic died a natural health centres, surging are two routes to it. One is death without much inter- cases and exhaustion allowing 70 per cent peo- vention. Are we expecting of resources, we would ple to acquire the infection a similar end? be equally vulnerable naturally and become im- like in 1918. It is a mune to it. The second is In the absence of a drug testament of faith we to use a vaccine to obtain or a vaccine, public health look up to science the same endpoint. In both methods are the last re- even in this late hour. sort to save us. Simple, P17

SYNERGIA FOUNDATION THE RACE Generally, after pre-clini- • LNP- encapsulated FOR A cal studies, the first phase mRNA (Moderna/NIAID VACCINE itself takes around six to in the U.S.) based on RNA 18 months. Once proved from the COVID-19 virus. SYNERGIA to be safe and success- FOUNDATION ful, licences are issued for The U.S. government’s RESEARCH TEAM commercial release. ‘Operation Warp Speed’ programme is expected T here is a global POTENTIAL CANDIDATES to name five or more vac- race against time WHO reported in the sec- cine projects, to receive to find an appro- ond week of July that billions of dollars in fed- there are 23 candidate eral funding, even before priate vaccine against the vaccines in clinical evalu- there is proof that the vac- ation and 137 candidate cines work. This is aimed coronavirus. While the ur- vaccines in pre-clinical at fast tracking the whole evaluation. Eleven of the process. gency is well appreciated, 23 are currently undergo- ing human trials, including In India, two vaccines there is no way a vaccine two Indian vaccines. The are in the works for phase top promising contenders I/II trials: Covaxin by for such a deadly virus so far, and looking to start Bharat Biotech and anoth- human trials, are: er by Ahmedabad-based can be fasttracked with- • Sinovac (Sinovac Biotech Zydus Cadila. According Ltd. in China) based on a to Zydus, the potential vac- out going through the es- SARS platform. Sinovac cine showed a “strong im- says its inactivated vac- mune response” in animal tablished and time-proven cine protected monkeys studies, and the antibod- against the virus, using ies produced were able to protocols. weakened forms of the completely neutralise the COVID-19 virus. wildtype virus. Vaccine trials can be • ChAdOx1-S (University of Oxford/AstraZeneca in the Different methods are broadly defined into three U.K.) based on influenza. being employed in making • Adenovirus Type 5 Vector the vaccine for COVID-19. phases: phase 1 focuses (CanSi no Biological Inc./ Considering that there Beijing Institute of Biotech- have been no vaccines for on the safety of the vac- nology in China) based on other coronaviruses such the Ebola research. It has as MERS or SARS, it is still cine on a small group of re- been approved for military largely an unknown field. use in China. Viruses morph and evolve, spondents; phase 2 tests and hence coming up with a definitive vaccine is quite the efficacy, determining difficult. the required dosage for an effective immune re- sponse; and phase 3 puts the vaccine to the test on a larger scale, across age and population groups. P18

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS One of the methods is cell’s protein-building fac- cut months or years off based on our immune sys- tories, and they make a vi- the vaccine research, but tem producing antibodies ral protein. The protein, in would put test subjects at that fight the virus. For this turn, comes out of the cell, risk. reaction to take place, sci- where immune cells make entists realised that they an antibody to fight it. This There is also the risk did not need to inject the is a method that Moderna that accelerated tests entire pathogen — just the in the U.S. has used. could lead to missing po- fragment that triggers this tential side-effects. A vac- reaction. These are now PITFALLS OF ACCELER- cine for dengue fever, and used against hepatitis B ATED TRIALS one for SARS that never and shingles. Scientists Writing in the journal Vac- reached the market, were can add a gene from the cines last month, vaccine abandoned after some re- virus they want to fight, developer Stanley A. Plot- spondents were found to thereby making a viral vec- kin and Arthur L. Caplan, be more susceptible to se- tor, which then stimulates a bioethicist at NYU Lan- vere forms of the diseas- the immune system to gone Medical Center, pro- es, not less. make antibodies. This is posed starting challenge a method being employed trials for the COVID-19 Vaccine making needs with the ChAdOx1-S. vaccine, which involves sophisticated equipment. infecting vaccinated vol- Microsoft founder Bill Some groups are inject- unteers with the coronavi- Gates has warned of a ing pure DNA and RNA, rus. The procedure might critical shortage of a vital which then is read by the yet forgettable compo- nent: medical glass. With- P19

SYNERGIA FOUNDATION out enough supplies of the some said the date paints which depends on the co- glass, there will be too few a slightly nationalist agen- vials to transport the dos- da to the pandemic, others operation of institutes. If es that will be needed by objected to the fixing of a billions. date for the vaccine, which we are going to start work, until recently was simply BIG PLAYER INDIA in pre-clinical trials, when we should do so with an The recent announcement vaccines that had been un- by the Indian Council of der more advance phases aim, and it should be of Medical Research that a had not yet announced an vaccine will be released official date. success.” by August 15 created a furore. On July 2, the However, in an inter- Soumya Swamina- council’s Director-Gener- view with Indian Express, al Balram Bhargava told Lokesh Sharma, a scien- than, Chief Scientist with 12 institutions to “fast- tist with ICMR, said: “It is track all approvals”. While not to be interpreted as a the WHO, has expressed deadline. This is our aim, doubts about the vaccine being available by August 15 in an interview with In- dia Today. “Most vaccine development projects take years to complete. But since we are in the midst of a pandemic, we P20

CCOOVVIIDD--1199CCOOMMPPEENNDDIIUUMM TTHHEELLEEGGIITTIIMMAACCYYOOFFOOUURRTTHHININKKTTAANNKKISISININTHTHEEPOPOWWEREROOFFOOUURRIDIDEAEASS hpwrahevi-ccehlinsuihcnaotlilrttrreieanclsee,ndwtlhytehnweavstaicmcsiimneelpsilnytehisant. A Mighty rush vheadrybeoenptuimndiesrtmicoreesatdimvanacteephisaseths at ihtadwniollt ytaetkaennaobunocuedt a1n2o-f1fic8ialmdaoten.ths taon EHdxopewrveeevssel,roL, pionkaeanshinSvtheaarcrvmiceiawn, eawistchaieIgnnatdisiin-t st CwoithviIdC-M19R,, safidro: “mIt istnhoet totbime ientery-ou sptreatretd yaos uardevaadclicnein. eThdiseivseoluorpamime, nt pwwinrhesotTiciscthhhueoetdsueeslsdp.u.Ie”nfdnwoldisessatooernewdgtihtoheiInnagcdnotiooaapsinetmraar, tvtaiwaonnocdrcokitif,ne mshoauklderbeBohf saurcacethss.”Biotech’s Covax- itednonotuSisrbseotttusacwmreatibyitvaohhueutStdhmwteharaemeWngvinHaucacOtlclha,iinnathenoiac,srbayeCelihnxatipgreprifaeapvsSlsarsceoiild--vfoarl iatbsleebxypAeurgiumste1n5tianlasnhinotte.rvIitewiswliitnhed 159 Pharma sector uInpdiatoTobdeay.te“Mstoestdvaocncinoe vdeerve1lo,p1-00 in development $100 pBmeuetonstpinplecreoijwnecettsawrteoakinepthyheaeasrmseitsdostfcrooofmmappleaJtneu-.ly. demSiec,rwuemhavIensshtoirttuetneedothfeItnimdeilaine(sS. II) 02 billion by 2020 hAavseryaolpretimadisyticsetsatimrtaetde isptrhoatdiut wcitlilon in phase 2 trials Medical devices ootvyaaopfkcueectihdnsatebeaoarauvtgttaayOi1cno2sxuc-t1rfiC8noovermavdciodccnU-ian1t9hnne,sidfvrdtioeoedmvradeselttoihvetpeeyml,dtoiepmeenvveateenl- (dose testing in tphroocuesgsh.” the drug has not been humans) $25 liceTnhse eudnliysteedt. IAnddiaanr vPacocionneamwaak-lla, 05 billion by 2020 cererhgBiuehlafatreoarxtyhecBapuiopttrievocveha’sloCftfooivcasextarinrot rfehScueImiIv,aetndold tchlienicaGl etrrimalsafonr iTtsVexpcehriamnennteall shDoet.ut- in phase 1 to 2 Pharma exports (safety and sItcihs elineWd uepllteo b(eDtWest-eTdVon) otvhera1t,10“0the efficacy trials) $19.14 dtrpheeeaeocdSpyeivlsersauitioncmarncttIweinndo[stetppoi]rthuoawstdsetueaaoscsftrfirItoonmnmpdoiaraJfodu(tSdhleyIeu.Is)vcohatcailcoesianlnyle- of 04 billion by 2020 to in phase 1 represents hcaanvdeidaate hdeevaeldo-psetdaarttOoxfnordmUannivuefr-ac- 18% of APIs tsuitryi,nevgenatnhdougtoh thheadvreugehnaos nuogthbedenos- supplied to US eleicscuetnaisvveeadoiyflefaitcb.eAlredoa.frTSPIhoIoe, ntoadlwdisatltlhraei,bcGhueiterimfoeanxn- of tThVechdaonsneelsDewuitlslchoenWlyellceo(mDWm-TeVn)ce othnact e“thtehedetcrisiaiolns [atorestasrut cpcroedsusctfiuonl”. ohaofanhvtTeheIaehnednved-aosrictueaacgrihntaaedosr]onewsaemashsaanminvguauahimfdlaaecbbetsluoeexr.lrpeiTnlehyogectfaodtnaIihsdntatdrivtoioe-ianns fbiurmtiosn oafrteheadolrseesawdiyll oknelyycpomlamyeenrcse in ttoahhsneecaTenghwtuhelmoroeebbtrarleairdraell’osshvfiaaIglrnhacedercsigxuaipncneecesfecitsrtiasmntfvuidsoalaun”cr.ssecotainrnlyrIee.naSddpiIyaIrois- dkeuycpelary. eHrsyindethreagbloabda-lbvaacsciende inBdhuas-rat Btriyo. tSeIIchis hthaeswsoorldf’sarlarcgoesmt mvacecrinceial- iBpsrieootddeucc1he6rh. avsHascyodcfeiarnraebcasodm,-bimnaescerlcduiadliiBsnehgdar1ao6tne avagcaciinness,t inHcl1udNin1g, oanne dagasinesltlsH1pNr1o, d- uancdtsseillns porvodeurc6ts5incooveurn6t5rcieousn.tries. P21 P11

SYNERGIA FOUNDATION ACCELERATING THE DEVELOPMENT OF also have an inhibiting ef- NOVEL AND AFFORDABLE THERAPIES fect. Regulatory authori- ties across the world have Based upon Virtual Forum Discussion Participated by created a maze of rules Chas Bountra, Pro Vice Chancellor at the University of Oxford, and regulations that cre- K Vijay Raghavan, Principal Scientific Advisor to Govt of ate hurdles rather than be India, Pankaj Patel, Chairman of Cadila Pharmaceuticals, supportive of expeditious Sharad Tyagi, MD Boehringer Ingelheim India research. Is there a need to generate a huge volume of The high cost of thera- and therapies, there is no data to support new drug pies is due to the cumu- surety that the product will research if a reasonable lative effect of research, sell, no guarantee of an amount of data can lead cost of production, cost of assured market, and the to equally effective thera- raw products and labour. nagging fear, that some- pies? In the past, effective While only 20 percent of one else has beaten them drugs have been invented the research cost is what to even more effective with much less data min- is done in laboratories, therapy, rendering their in- ing. It is understood that while 80 percent is spent vestment redundant. there are concerns of pa- on clinical trials, thus tient safety and fear of making the cost of devel- Due to the all-pervasive side effects, but research- opment prohibitive. To sense of rivalry in the in- ers and companies are make matters worse, over dustry, there is intense sensitive to this. There the years the clinical trials secrecy in cutting edge is a need to focus more have gone haywire, requir- research and IPRs are on data on the premise of ing huge quantity of prov- jealously guarded. As a “Must to Have” rather than ing data and so many pa- result, there are multiple the present concept of rameters to be measured, researches being conduct- “Good to Have.” large number of biomark- ed at any point of time ers to be found out, that by different agencies on The pandemic has ex- cost of research has gone the same drug and thera- posed the state of the up exponentially in the last py leading to duplication health care system in al- two decades. and avoidable waste in re- most all countries across sources and time. the divide between the For the private indus- rich and the poor. The try investing in new drugs Government regulations health care system is crip- governing drug research pled, facing a major chal- lenge of making two ends meet, despite working day and night. It is feared that many in the health care business will go bankrupt. P22

COVID-19 COMPENDIUM TTHHEELLEEGGITITIMIMAACCYYOOFFOOUURRTTHHININKKTATANNKKISISININTHTEHEPOPOWWEREROOF FOOURURIDIEDAESAS brought down by encouraging EXPEDITED TREATMENT FACTORS muOltiv-seoruarlclewesunpepleyd ftoorinwvheischt ctineorlglapobveoeorranptmiloeen,ntwianillltoihnbanveoearvtaportebiosesnuinsre-, Quality Infrastructure ocnreparotifnit-gortihenetreadppireivsataencdomepna-- Create and mainain quality in- nsiuers.inTghetghoavetrnumlteimnt ahtaes ltyo ttahkee frastructure which would ensure aappaciaetlsilefwnohrtetithsheecrpuotrooerpdoa-rytpfhoairysaolinlsltyhthfeorer- that the tasks needed to be tmhoosse twimhicphoarrteanvterpyaerxtpoefnstihvee. carried out are done Thheearletahreceaxraemsplyess tinemInd. ia where Policy framework private companies treat cancer patients from below poverty line Need for a policy frameworkd that supports innovation as sGuOppVoErtRedNbMy tEhNe cTost being borne the top agenda of bpIFNyaoytITrihTnhaegIecsArttceaThteaeIerlVgeehoEredvaSaiefltrftienhnrmgecneatntrhtem.eocrodaseptlssi-efinosr-, government across the world swuerancnee, erdeimabnurseampepnrtopbyriatthee gebebtoecy.vcoaeTursthnhsyeemessieitttneuUitsmantalianiovradngeseifrslryseofaimxotrueymtomwooofrpnfeplpiaofOocciuekcxktede--t Sound regulatory system mfoordde.l-most patients end up pay- dittnhoogaTyntotahthuhkeeegemceotstegsahtlovipeesvastet.hlieereHnnaatomdcwctoeeeisvnnbseetarc,nardbmehlheaoaorttwsoe- Authorities need to differentiate ainffgordthtihse menedviicrionne mwiethnotu.t Thhave- between the ‘must-have’ and the pIibennanagsrvsuttnrieoraeodnrsscnhheeomiplinlsewitnofintitohveue,tthpsoeuihfnbgotdloihucivec-eldarppnotrmoicvkrebaesntetet-. ‘good-to-have’ in the quantum of squupapolirttyinpghtyhseicparilviantefrainsdturustcry- data generated before a novel wTtuhitreheAiwynufirstahhmisnuanpInpBodhritaara,antadmhofoudnleidlsihtniagcs. therapy is accepted for mass usage gproealitcpyromlaisyeinpgrovitdheed itfirsatmakeen- fworowrakrd tinoanseuffpecptiovretmainnnneorvanad- Strong linkages shttiaorsuncth,tuermepteuodtsitcuianplpghoeratliittnhsnocobarjveeacitntiivforeasn-. at Tthheegotvoeprnmoefntitmsusatgcerenadteaa, Needs to be a strong link between scirnegaletrineggulaatonryeanuathbolriintygforreagp-- academia, industry and govern- pmurleoanvttaolsrayynstdesamyt.sraCtneosumpnatrreainenst dparlol lcahuasrvete-, ments. Research hubs where tbhueitr ninodtivitdhueal lreeaguslta,tiponrsovthidat- there is an interaction between ainctgasabaprrliaetrfsotormworflodwr idsetruosangge people, industry and the tools for ocliofnsdktroaufggtseh, tehdubrseuagtd.wdIiefnaegdntroutgthhheeaosvbeaeraecln-l innovation, would be beneficial pardoevemd tiao ,beinefdfeucstitvreyinaonedcotuhne- ostbgrcbyoyrt,uavOtisenihxnroayfnpuoomplfrdrdmeoivuntUaltltan,imgpiaavluiesenlrtrieipsulgllniuuetdlytsaei.tmrtogrraeosstatebnhedde- wfriothmthperciuvmatbeertsroumset,sanadnedxptehne- togTehtehesurpnpolyt ochnaliyngoefneesrsaetne- foreTiht cean bOe xinftorordducedininititahetiIvne- asUinvKceelGsegoianvl pmt.ruolDcteirpsusle,gocfroseuesenketrianiegrsccolhenaicrse- otminaol odrnereugcrsoemmspuoasutnrync,oeotsnbeebcdoueuptnetnardylesnoort dbtpheiuaeanIllnnsmtaecagrrrronkeeaseesttmti?oo,enunarwtlcltyeoo, srstkthrieetnoargme lshinhawesaittrhtheoe tehxeosrabmietahnastlbyeeenxopbetanisneivdeinaonnde esvperneaonde trheegiornis. kE.ncourage new rneignuelatloarrygperopchesasrfmoradcoienugtaiwcaayl nbceheranapitntsitoigerndedinnouhwionnrendmveretersh.sneitntTmcthoerisreistnsnwakbttuisilotlcnnwooaoilfmlltlyotianhnalsclgeoy- etechnnretteTersaarhtnptaeertbsiis,lgeihrtsoeyudtvhobuefacstrepncotfmrlhoieceareytrenaidsntakrdfhf,uoreagrendswsaurabterrlodee- etonsuarentoheugnhewt. drFuogsr agreremataeder mseedairccarhe. where academia, companies, several pa- atmrinhivsieagdkisdla-aclsbema-lheeinnatnctrioomionmetpgeafb,rtgaieremosnudetipnsoacscnionteehuenlositfrwrouimelnaesondlriynde- tmgthhoaeedGvwetopavhyberyartenhrsmtmehyeeeaanilortrioscnrkhedhsaauptveseltachttretbioyvspecrcohocgaoamrnunegnsdees- dbeyvetlhopeedpchoaurnmterapairntds.ustry or troiegse. Ttheesrtataenofda cowmomrkunitiny oraa tient organisations, funds the government or by aca- conducive environment in demia by itself, but all put a spirit of togetherness. P13 P23

SYNERGIA FOUNDATION Here innovations will take The Oxford support and funding. The place once clear India initiative pulls Ayushman Bharat model specific and global priori- resources to share the has great promise provid- ties have been identified, cost, working with nine ed it is taken forward in an and adequate funding as- large pharmaceutical effective manner and has sured. Such an organised companies, several the medical health care in- environment will have its patient organisations, frastructure to support its payback in motivated re- funds from private objectives. searchers working to find trusts and the UK Govt affordable solutions in The government must well-defined timelines. pay only for those which create a single regulato- are very expensive. There ry authority for approval A word of caution; large are examples in India and a transparent procure- scale drug manufacture where private companies ment system. Countries all can impact the delicate treat cancer patients from have their individual reg- environmental balance, below poverty line sup- ulations that act as barri- and the regulatory author- ported by the cost being ers to worldwide usage of ity has to be mindful of borne by the state govern- drugs, thus adding to the this. The objective should ment. overall cost of the drug. If be to ensure sustainable a drug has been proved to growth without damaging There are different be effective in one coun- the ecology and the envi- models for paying the try, should it again under- ronment. health care costs-insur- go the scrutiny of multiple ance, reimbursement by regulators and obtain ap- The government will the government and from proval multiple times be- have to play a significant own pocket. The situation fore it can be introduced role in making new ther- is far more acute because in the Indian market? apies affordable. Many it is largely out of pocket countries take on the ex- model-most patients end Internationally, there penditure on high-cost up paying themselves. has to be an agreement to therapies as in case of However, more than the streamline the regulatory HIV. The prices can be cost is the access and how process for doing away further brought down by do you get a patient to be encouraging multi-source able to afford the medicine with the cumbersome, supply for which collab- without having to shell it and expensive legal pro- oration will have to be in- out of the pocket. Insur- cess, of seeking clearanc- tergovernmental to bear ance is one, public- private es in multiple countries pressure on profit-orient- partnership with the gov- once the same has been ed private companies. The ernment supporting the obtained in one nation government has to take a private industry with infra under internationally ac- call whether to pay for all cepted norms. This will therapies for the poor or not only bring down the cost but will also ensure P24

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS the new drugs are made its citizens, rather than by INITIATIVES BY THE available to patients in low pure financial, economic INDUSTRY and middle-income group practices. This will mod- The scientists in the in- countries in the same time ify the way countries in- dustry must focus on pro- frame as their more devel- vest in health care; this cesses which answer to oped counterparts. should be in a more holis- the creation of new drugs tic manner, not just phar- and therapies that will not The supply chain of es- maceuticals or therapies only be state of the art but sential drugs must not be but overall how to ensure also due to reduced cost dependent on one com- the entire humanity is get- of research, more afford- pany, one country or even ting healthier and is better able across the globe. one region. Encourage cared for. new entrants, reduce the The Oxford experience risk, ensure the stability of COVID-19 showed the has shown that collabora- policy and reward enter- relevance of public health tion and not a competition prises that create afford- care system in the service in the field of drug research able medicare. of its citizens. This sec- is the only way forward. The tor demands the greatest key lies in pooling resourc- Governments have to attention from the gov- es to share risk and focus change the way they look ernment in terms of bud- only on entirely novel ideas, at the progress made by getary support, research, as is being done in study their respective countries. multidirectional approach being conducted in Oxford. The state of a communi- and collaboration at an in- ty or a country should be ternational scale. Every day scientists measured by the health of working at Oxford are cre- P25

SYNERGIA FOUNDATION ating novel genes or pro- waste. Collaboration is the enable how early the dis- teins to generate tools as primary central theme, but ease can be diagnosed starting points for drug why do we need a disaster akin to onboard diagnos- discovery, for producing to tell us about the impor- tic systems in highend a molecular inhibitor or tance of cooperation to cars. Scientists in the antibody etc. These very make us work in a much health care field have to high-quality tools are be- better manner. It should identify the markers and ing provided to nine very become the norm. Sharing indicators that will help in large pharma companies data and knowledge will re- setting up such an early driving innovation while duce the cost of therapies. warning system. This is keeping down the costs. greatly required for can- The collaborative ef- cer and rare diseases. All these tools do not fort is exemplified by the draw IPR; Oxford does not “Moonshot Programme” The industry has to fo- patent them. These are being run by Oxford Univer- cus on major global prob- freely available and as a sity. A group of highly tal- lems and come out with consequence being used ented persons have been comprehensive solutions. in over 300 academic labs working with the govt and Today there are only four all over the world, includ- the regulators and funders or five companies that are ing in India. This is the and with AstraZenica to trillion-dollar conglom- best example of crowd create a partnership to erates-Apple, Microsoft sourcing science. generate a billion sample etc and these are all data of vaccine as quickly as tech companies. With- Crowd sourcing has possible. AstraZeneca will in the next decade, we the advantage of avoid- now give a licence to the shall witness the rise of ing duplication. There is Serum Research Institute trillion-dollar health care no need to research in an in India to generate another data companies. Today area which is being done billion samples. The single Johnson & Johnson is the somewhere else also or goal is to generate a vac- largest health care com- has already been done; cine which is effective and pany but is worth only this is just waste of time. safe, is made as quickly as about US $ 400 B. cheaply as possible. To sum up, the lessons The message is that emerging from Oxford Uni- Technology has to be with better management versity; (a) Pool resources developed to have the and innovative applica- to share risk (b) work in health care equivalent of tion, the health care in- novel impossible areas to an early warning system dustry will attract higher drive innovation, (c) make in diagnostics; technol- investments and partner- everything freely available ogy, which will ultimate- ship across other busi- to crowd source science, ly create a trillion-dollar ness fields. COVID-19 has (d) release everything to health data-based com- definitely given a boost to the world immediately to pany. Technology must this sentiment. reduce duplication and P26

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS EVOLVING A MEDICAL STRATEGY SYNERGIA FOUNDATION RESEARCH TEAM EVOLVING With the limitations in bed ca- ers and PHCs. “It is here where the pacity in India, a graded approach battle needs to be fought and won,” Its widespread tuo spaatiegntecare ehavs etonbe abdoeptfeod resaystAhrveind Kpasatutrii,eHneatd, Commu- A MEDICALhe aim should generated is admitted. Hospitalsso that only the most deserving nity Heath Care, St. John’s National STRATEGYbe to create a re-would have cases reach COVID hospitals. “In Academy. As R. Balasubramanian track the should have a fever clinicabout 90 per cent cases, COVID-19 (Harvard School of Public Health) T sponsive health- useful data to only causes mild illness which rightly put, social distancing is dif- Tcare system designed to infection and supplement outside, where blood testhe aim should be to create a does not require hospital care and ficult to enforce during agricultural responsive healthcare system can be cured at home, with remote activities. In rural areas, lack of wa- it dwesiigtnhed too ttachklee prancdeomnicst.aimnemdicealnsutperviasionnd,” saXys-rAarvyinsd caternmabkees hdygoienneedi.ffiAcult; doctors While measures. rapid test would expediteWhile there will be a specific role for Kasturi, Head Community Heath do not have PPE and social stigma tackle pandemics. the National Disaster Management Care, St. John’s National Academy. of the disease is also a big issue. there will be a specific role dAagteinoncyWaonf diIttnhhdeiaP,utbahlicpeHubelailclit–hmpFrioviutantae- tioNmanariaeshshMSiehnmetotyri,aPltrHhesoeisdpeinitadtl,,eMisn.So.ftRtihafe-icaSItMioUnLATpOrRoMcOeDsELsS. view that it is critical to establish Rajesh Sundareshan from the IISc. for the National Disaster bed capacity in India, a The supply chain for PPEpartnership would be critical. A well-integrated strategy several layers of filters even before Bangalore, has been working on Management Agency and shogulrdabde beasdedauppopn 3rCosa: cconhvert-o pthae tpiaetienntt is adsmhittoedu. lHdospbitaels rsoimbuulatsorts, fopr CaOrVtIiDc--19, in con- care has to be adopted so ularly in private hospitalsgence of policies between govern- should have a fever clinic outside, sultation with foreign universities. the Public Health Founda- ment, local administration, public where blood test and X-rays can be By factoring varied population sizes that only the mostand private hospitals; proper com- deserv- for they continue to attractdone. A rapid test would expedite and types, living conditions, rates of tion of India, a public–pri- the identification process. infections, and hospital capacities, munication strategies; and coordi- COVID scores ofThe supply chain for PPE should patients whosimulation can give us an idea of vate partnership would be ing cases reachnation. While public healthcare is be robust, particularly in private morbidity/mortality rates. After ideal in a pandemic, the private sec- critical. torhshoousldpniottabelslef.t o“uItn. about h9o0spitpalsefror thheyacovnetinuceotonafti-dethnisc, aevarinety otfhinetemrve.ntions can cent cases, COVID-19 only While urban areas are rel-The Aarogya Setu app has failed tract scores of patients who have be applied to mitigate the scourge. A well-integrated strate- in its objective. Its widespread us- confidence in them. While urban For better efficacy, a simulator gy should be based upon causes mild illness which atively well-cared for, theage would have generated useful areas are relatively well-cared for, model should cover the smallest data to track the infection and sup- the greater worry lies in rural areas, possible scale, i.e., at the local level, 3Cs: convergence of poli- pledmoenet ist witnhoottherrceonqtauinimreent howhsepreipteaoplle arge dreepeandteenrt onwloo- rrpyroploiseessMuinkundruThraattlai of NCBS measures. cal-level care suachraes aASsH,A wworhk-ere-TIFpR.eToheprelseultsawroeuld be easi- cies between government, and can be care cured at local administration, pub- home, with remote med- dependent on local-level lic and private hospitals; ical supervision,” says care such as ASHA work- P15 proper communication Arvind Kasturi, Head Com- ers and PHCs. “It is here strategies; and coordina- munity Heath Care, St. where the battle needs tion. While public health- John’s National Academy. to be fought and won,” care is ideal in a pandemic, Naresh Shetty, President, says Arvind Kasturi, Head, the private sector should M.S. Ramaiah Memori- Community Heath Care, not be left out. al Hospital, is of the view St. John’s National Acad- The Aarogya Setu app that it is critical to estab- emy. As R. Balasubrama- has failed in its objective. lish several layers of filters nian (Harvard School of P27

SYNERGIA FOUNDATION Public Health) rightly put, created symptomatic ‘su- When healthcare workers social distancing is diffi- per-spreaders’. observe illness and fatal- cult to enforce during ag- ities among their infected ricultural activities. In rural COVID-PROOFING colleagues, it can lead to areas, lack of water makes HOSPITALS mental exhaustion and hygiene difficult; doctors For an exotic contagion poor clinical judgment. do not have PPE and so- like SARS CoV-2, much cial stigma of the disease more preparedness is re- THE PRIVATE is also a big issue. quired. Orchestrating a na- VS PUBLIC tional and global response DEBATE SIMULATOR MODELS lies within the network Rajesh Sundareshan from of hospitals. Shortage of Inputs by  the IISc. Bangalore, has PPE shows the lack of al- Tobby Simon, been working on simu- ternative manufacturing Founder and President, lators for COVID-19, in options. The rising de- Synergia Foundation & consultation with foreign mand for ventilators and R Balasubramaniam, universities. By factoring a diminishing stockpile Founder, Swami varied population sizes of oxygen can have dev- Vivekananda Youth and types, living condi- astating consequences. Movement and tions, rates of infections, Pre-designated isolation GRAAM, Mysuru and hospital capacities, venues and decontamina- simulation can give us an tion sites are not routinely idea of morbidity/mortal- incorporated into hospi- ity rates. After this, a va- tal design. Further, shut- riety of interventions can ting down hospitals as be applied to mitigate the contaminated sites, even scourge. For better effi- temporarily, deprives the cacy, a simulator model citizen of routine health should cover the small- services. est possible scale, i.e., at the local level, proposes IFATIGUE & SYSTEM t has emerged clear- Mukund Thattai of NCBS ly that the delivery of -TIFR. The results would FAILURE healthcare, either by the be easier to re-calibrate ‘Prevention fatigue’ can on a larger scale. Howev- set in due to long hours private or the State-run er, evolving a model for COVID-19 is proving to be of work in an overload- system, is a national pri- difficult, as it does not be- have like earlier viruses, ed system. The doctor or ority. All such resources especially in how it has nurse could lower their are “public goods” to be guard, resulting in expo- shared equitably for the sure. The second aspect common good. Most is the ‘bystander effect’. countries have a dual sys- P28

and higher cost, the number of such and ward-level to carr patients has so far been low. In conceived at the natio CseOmVIiD--r1u9 rCaOlMaPrEeNaDsI,UMthe private sec- The districtTHE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS adm tor hospitals are not comparable to key in successful im the of the national plan. her ofafrhsbuaecevhnelpoaawt.cieItnnitssveamhtai-serudrsaoltheir c run ahroesmapsit,eatnlshetarpegrirvnaootteucposemscptoaar- nd co All rabilne toathposreoinatcheticviteiesm. anne ds” Tsthrteuyoctounrcely.ohIntavifserbaoalssnoictwinotfrrhrai--e deve om- ea ipsnorgimotvaiheftooemCnthhoeaOsstwpVmiintaeaIlcnslDilyta.ien-ssd1mTn9hauhalrlveiseesr- natio clear: icnlopisadetideendntoftwaicnfiilticthieeaisrt. oioutnan, disolatio tem of private and public authorities, on the other A robust public health- healthcare, yet the public hand, operating under a care sector, on the other system is most accessi- centralised system, took hand, can ensure pro- ble to those with lower quick decisions to stem active responses at the income. Public hospitals the tide by building new national and local-level, get quickly overwhelmed COVID-19 hospitals over- making it easier to handle while catering to all seg- night. The U.S., largely crises. Public health re- ments of society. But, dependent on a private sponse usually demands a private institutions are healthcare system, found multi- and interdisciplinary inclined more towards itself poorly equipped to approach to management super-specialisation and deal with the pandemic. and many times, it goes hence, are expensive. Deterred by expensive even beyond a medical Consequently, they are healthcare and absence of approach to the problem. not well-equipped to in- adequate insurance cover, Private hospitals usually tervene during pandem- people chose not to go to operate on commercial ics. Responding to pub- hospitals. This compound- principles and there may lic health emergencies is ed the infection rates and be no space for free ser- resource-intensive and is stretched the public health vices during public emer- not commercially attrac- system beyond its limits. gencies. But, they have a tive. In India, the response to role to play by continuing the pandemic has largely to address regular health SYSTEMS AROUND THE been confined to public issues. WORLD healthcare. Some private Governments also need Though Italy and Spain hospitals have been di- to build complementary have excellent public rected to treat symptomat- partnerships with private healthcare systems, they ic patients, but due to lim- and civil society. It is only were not equipped to han- ited testing facilities and when all players work to- dle a pandemic. Chinese higher cost, the number gether that such situa- P29

NDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS SYNERGIA FOUNDATION itical, tions can be managed. to confront the developing and creating additional lation d not FJFmaIIGGipgHHarnTTa,nFLSOOtsoCRufAWrthLoAmRKDom,reeag, aSciint-iessac. illteudaairr:teioscutnirvvweeeiolllfla. nCTihctOhoeoVe,srIpiiDndnia-et1gtna9iotlissfniisu--fosprttICehhfeeecUvtadebvircseatadcirlshsiacebetsalcetnokdavseemamnnnsotoiudlnnargeitmtootrorthsihnneieign-r ed by gTaHpoEreAManEdRTICaiAwaNnEhXaPdERcIaEtioNnC, iEsolations,taanffd. qCuoanr-tacatvahilaasbitliotybwehmeninreimquiisreedd. orker eTnhdeurred ithse amonsteeodf SAtoRS rea-netningein, tehenr treatth. rough strTichte ovffiisciitaol rin pchroartgoecowlsil,l s war. aCnOdVkInDew wtrheaattwmaesnbtrews-paceRs iskwithcompmautnieicnattionprohtaovceoltso, utrgeele-pmriveadteichinoes,- aught bbinniRnsaeeegilncgi.ddechaeefeTatfsihertivfheadgeeytanteGctoedhpapdterihrefdecertlasioouastcvepu,iadh.rMrluaeHosgnenoeddarcvteieslahciernnea-nlpoDakioilsnlnfiihrtodceteowhrerciasetmtiptcoetpiiahrtcolea,spa–l:aunssldatatairpciowkthlonsaoasrduomgtnalpfdeganopiygpnnaneabgotirrnesittemgnebpZtesdeiilkteKaitaaccleovseatraiaxthavipillaonoeaedsbnrisplleeepuitnarttorcaraogneclemptstairitntlaiifceoderkhosnsqesm,eiunraifvs.crnikiesttldosy-- g and lCiehsiethfeomf Satnatrfaf,fFoer rwraygCinogunptyosMedembyo-this qviuruesn.t.TMheatthtraecwkeAdndothwonncylusKtearlslioaftihn,- vigi- arialsHucocsepsistfaull, Wcaamshpianiggntoncommunity woCrkheireifs SthuergifceacltioRnse.sTidheeyntu,seUd nanivgearn-- to de- agaiInnst Uth.iSs.,instiodoio,ufsrvoinrutslinefrodntolicnteorssoldiseirtyinof tPhiesnnwsyaldviananiad MKuedduicmablaCshernee- d dis- p—tefeaoaralrnoc,nceaencdamndhgorcrpacteywyohtawooiaettur,ethstsraihdnttnaihhogsdrerteertlwioppaclacltgera,aroeandltrg-eolcngrehfooevisPnnevsil--sl,gPoEowshaf.ninatacHsdhsrt.heotooeTwphfhajeobeosnvmeob--lecotaicaualgtatql dhehiurptireas-,orttcfaaphHionnuelntatclaierbdinncrraeigeit-.isisboeundwttohfiriofge-ngderitck,gocaheotalsarirdsyvimnvsse’ttuiaoosaerpfevgmpiecdnaiyonsfisengnu,tcdspotauttigooncetrndtnhas‘bddse.uruKoisevnoareaierrgdk--- epare cdeeimveidca. tTthheenraetiiosnaslcloevpeel. foCroinnsntaonvtav-igilarnucse. has to nataka created a Municipal flood- to be tioTnheanddisitrmicpt raodvmisinaitsitoran- fobreremfianinintagined toJdaekteecMt ooCroerp,oEramtioenrgWenarcyRoMomedtio- pport, thitMpmiiaooavepnnteidlaSeeliihmsancapcatemktllnamievtneyaaa.PetteniihkDondayenisgssttoehiurTciefmcciiacttareshyencnels,ortstihnsr.faau,Mist-l oEumsdtbonyeisemrpttrrropiegcfStpeotcianmbnarcoseasydei.fsioeTrsfhlaoewpcoloaaftiodetlruragihnPleledsg,ghinlnuIhyuaeLolsmneasi,ddcr--siaatrnnttCrre,daaEsccRNskkaeTuicndRsccghEau.tsrAhOeaNesatDekiumSsmPiTnpaeAgrosTkrsmEtaHagoniobncislege- addi- mMaendaigceaml eCntengtroeur,psNaenwd Ypoitarkls,. Tdhee-focuasbhoaustttohbeepaCnOdOemRDiIcN. A“ETIvOeNryone ap- ng the istrict cscornitbroeldcethnteresininnovaatpirvoe- woanysenuhsaendcing plraebcoiraatteosryknSotwatienggotvheernhmaerndtstrmutuhsst when atoctifviellmgaanpnse; rew.gil.l fbaeceabmleasskuspdpiovret,rtis-olataiobnouwtatrhdse, paenxdpeanmdict,h”ehirehsoasypsit.aPl ecoa-- harge pitals ed from construction workers and ple should be informed about the ble to 3D printers used for making face risks and stigmatisation should be ka ex- shiePl3d0s. Dynamic inventory man- nipped in the bud. down used agement should be practised to an- shree -door ticipate demand with more flexibil- pping tions. icipal track xpand econ- erting

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS pacity by decongesting Shameeke Taylor, Emer- thony Kalliath, Chief Sur- hospitals and converting gency Medical Physician, gical Resident, University public accommodations Mount Sinai Medical Cen- of Pennsylvania Medical into makeshift holding ar- ter, New York, described Center, Harrisburg, ad- eas and isolation centres. the innovative ways used vised upgrading air-con- The existing staff must to fill gaps; e.g. face masks ditioning systems to en- undergo a crash course in diverted from construc- sure the filter is effective epidemiology. Final-year tion workers and 3D print- against the virus. trainees (doctors/para- ers used for making face medics/nurses) must be shields. Dynamic invento- Jake Moore, Emergen- trained and provisionally ry management should be cy Medical Physician, certified. Lack of timely practised to anticipate de- Rush Oak Park Hospital, IL, sharing of information mand with more flexibility stressed the importance of hampers the fighting abil- in financial controls. regular and accurate mes- ity of States and local saging about the pandem- bodies. A good example PROTECTING HEALTH- ic. “Everyone appreciates was the mass movement CARE WORKERS knowing the hard truths of migrants from megac- Human Resources should about the pandemic,” he ities. look into rotation of shifts, says. People should be in- scheduling flexibility, em- formed about the risks and THE AMERICAN ployment of volunteer stigmatisation should be EXPERIENCE staff, and ensuring cor- nipped in the bud. There is a need to re-en- rect wearing of PPE by gineer COVID treatment the staff. Work shifts in Conclusions spaces with negative should be reorganised pressure as no hospital is looking at a long-term bat- An integrated designed to handle pan- tle. national action plan, demics: Richard Garcia, support by WHO, Medical Director – Chief of It is essential to set up and global data Staff, Ferry County Memo- kiosks in hospitals for fe- sharing is the need rial Hospital, Washington. ver checks and monitoring of the hour. South suspect cases among the Korea introduced a In U.S., too, frontline staff. Contact has to be drive-through testing doctors faced the short- minimised through strict method to get as age of PPE. However, doc- visitor protocols, patient many people tested tors are learning on the job protocols, tele-medicine, as possible. Cuba along with the progress postponing elective sur- and Germany also of the pandemic. There is geries, and changing med- followed broad testing scope for innovation and ication to make visits of patterns. improvisation for refining patients to hospitals less patient management. frequent. Matthew An- P31

SYNERGIA FOUNDATION SYNERGIA FOUNDATION GOVERNANCE INCPOAUNNDTEMRIIECSS ANDhen written in Chinese, the word ‘crisis’ is com- WPANDEMICSposed of two characters. One represents danger, and the other represents opportunity: John F. Kennedy, 35th U.S. president tbtichiyoainslCTsciOh,doSPIFFTheVmeNOOYROaoIwPmsDNlUUEBooUbSoNNE-BgreT1nlIiRYDD9deDeSeG.n,sAEESnBiBITRbNroIAeuYrMIrfmTAOeto,sOrNuNtypuhgNDhelehiacntftsigitgsvohhediotitoswsafpgnkpeannotihenlsieaasts--tt efficient administrations — and not political principles — have had an Wstehudacgtcee.hsOasvnaetrheeexVpsiehenhrotineeertnanslmciesewt,,dCroriuftettbhcmeaoean,urSnkiotnarwubiCteloheshrdi- alicntceeownmdfirsdue.gn,EAcevv.iefanviri,nto rCehstionrae,putbh-e FCtoUhrBeAa locwouensttry cnaisceknloamadeds ‘iEnl Korea, Australi‘ac, rainsdisN’ewiZsealacnodm. - cAhsieanf esxtarmaptelegoyf nwataiosnaleisatricly CMocaodrcrihlo,’,itthesroea’sroende tthoinwg Courlbda Thepfirosst tewdo aoref Ctowmomucnhiastr-aruclteed.rs. bradveadteo,cAtlieoxna,nfdoerlloLuwkeasdhebnykofroefe isnnuomt: beeirngtwcoold,-btilloloidtedwwahsenrei-t KeyOfancteors irnetphirsefsigehnt atsre efdficaineng-er, Beltarreuas,tmpreesnidteannt dsinccaere19t9o4 aanndy- copmlaecsetodhbeyalBthrcaazreil..ITtshreencoowunned- pcyubalaticnthhdeeahtlthehlecmaroeantshdyesrtreombruess.ptEnrveeessnseionnf ts ecox-rooSnnovaeieawts iastoh“ldpaiseynrc,hinohsfaiess”cdtaiinosmdni.ssasPieddr,i- finrteretyhepwuliabmlsieclwighheetaiglathghaceiandr,eldesoaydwsitnengmtbhiyes Chinoap, tphoercthuienfitsytr:atJeogyhwnasF.eaKrley n- “thveattreactohreaanldthficeladrsewilsl yhseatleemv-s fiignhet xagpaeinriset nCcOeVIDa-n19dwiathnmuinch- detencteiodny,, f3o5llothweUd.Sby. pfrreeestidreeant-t eryhoanve”e; tbheateincefhooucknedy iws a“bnettitnerg, apsluofmfibc. iCeunbtalyhafus nthdeehdigheesat lrtah- ment anTdhcearewtooarnldyo,nierwreitshpaencinti-ve thaenspaenctiivairlalyl imneIdnidcaiatio. n”; and tisoeocftophr.ysTichiaenstatolkpinopgulpatoioinn,tsa fhlyeacivnteioroIubnnfeld.ienPipnarg.oifvolaiudttnieicdshapwelaealnntidhtsicenaagort,eileoossnygpsseitece, ismahls-aosf asking people to “wash their hands k2onmen,1y7ono3wef,raawtc:ratlaioytllhril2teyj8iugn,0srat0aitt08tsi3eomlsndoeewsdaaitonchcafdasls.fseIuatltuodcdangadeelenlewodtdsf nwoitIhbSorvSdoOedrkCsaeI”Aa. liWLnIgiSt,haMnndToaHmloEocnkgdoEwanst, been brought to its knees EuVroApeC’sChIiNghEe?st caseloads, the sit- wdhrouwge, ntAdvoiofar-vtoir-,dotoor acrerosstsotrhee IS SObCyICALOIVSMIDT-1H9E.VBAuCtCItNheE f&ight uatIitonmisabyeibneg ctarluleed tah“avitratlhCehesro- - copuunbtrliyc. 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COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS rope’s highest caseloads, ulation, a key factor in its capita income, Vietnam is the situation is being called low caseload of 2,173, an outlier success story. a “viral Chernobyl”. with just 83 deaths. It The country is beginning called on nearly 28,000 to lift the strict lockdown Here we look at four medical students who measures it imposed in success stories where went door-to-door across February. It has yet to gen- leadership can stall an ep- the country. Cuba also erate the global applause idemic’s passage. made headlines with its it deserves, perhaps be- ‘medical international- cause Vietnam does not NEW ZEALAND ism’— sending doctors fit the political narrative The expeditious and calm and support staff to cri- required for a success sto- reaction of New Zealand sis-hit Italy. Integral to ry. There was a touch of Prime Minister Jacinda reducing the number of authoritarian surveillance Ardern to the Christchurch deaths globally is a Cuban built into its control strate- shooting a year ago, af- antiviral drug, Interferon gy, but the difference with firmed New Zealand’s alfa-2b. The Canadian more ‘democratic’ coun- commitment to remain a pharma major BetterLife tries tackling the pandem- liberal country. It’s with the is now taking up this ic was not much and there same spirit she took on the 30-year-old invention for was wide social consen- COVID-19 battle. New Zea- trial and mass production. sus for the same. land met the goals of man- datory quarantines, coun- SOUTH KOREA Responsiveness begins trywide lockdown, and It was evident that South in the beginning. Look social distancing without Korea had begun stock- at Kerala: it was ‘com- being draconian. On June piling coronavirus testing bat-ready’ by the time the 8, New Zealand cleared its kits long before the out- first case arrived from Wu- last active case. break in its cities. Provid- han in the end of January. ing close to 10,000 tests a Its signature moves: par- CUBA day, and supplementing it ticipatory contact tracing; For a country nicknamed with a mobile app for cit- a supportive quarantine ‘El Cocodrilo’, there’s one izens to keep themselves for nearly two lakh people; thing Cuba is not: be- constantly updated, the feeding and supplying pro- ing cold-blooded when country was on the ball. visions to some 87.28 lakh it comes to healthcare. ration card-holders and Its renowned free public VIETNAM 1,50,000 migrant labour- healthcare system is in the Vietnam and China share ers; daily public dissemina- limelight again, leading a land border stretching tion of information; and a the fight against COVID-19 about 1,444 km. With a hands-on health minister. with much aplomb. population of 95 million The approach was empa- and a relatively low per thetic and grassroots-ori- Cuba has the highest ented. In a country of In- ratio of physicians to pop- P33

SYNERGIA FOUNDATION dia’s scale and inequities, DESTROYING one. From Washington to a bottom-up approach DISSENT IN Rio de Janeiro and Hun- that ensures economic DEMOCRATIC gary to India, the space and social security, proved FRAMEWORKS for dissent in a demo- the best pandemic shield. cratic framework is under INPUTS BY enormous duress. Brazil’s “There’s no playbook TM VEERARAGHAV President Jair Bolsonaro’s for leadership when the CONSULTING administrative campaign stakes are high, no play- EDITOR, against COVID-19 has book for what must be SYNERGIA been plagued by sackings done in the face of a 21st FOUNDATION of a string of Health Min- century pandemic,” lead- isters. ership consultant Mark Aclutch of powerful Nevins wrote in Forbes. world leaders, at the Luiz Henrique Mandet- An inclusive, cohesive so- helm of some of the ta, a paediatric orthopae- ciety, one not polarised most significant democ- dist, was sacked from his on ideological, racial, eth- racies, have demonstrat- post by the president in nic, or religious faultlines, ed their intolerance for early April after he defend- cannot harm the cause. dissent and the spirit of ed and pursued quaran- Africa is largely caught democratic debate during tine measures to fight the between a stark leader- the pandemic. Their abil- pandemic, in opposition to ship deficit and a vulner- ity to dismiss opposing the line advocated by the able populace. At one voices has grown stronger president. His successor end, Tanzanian President because of their power to Nelson Tich, a practising John Magufuli ridicules outshout them on social oncologist, fared no bet- testing kits, saying even media and during a calam- ter. He too quit in disgust “a goat and a pawpaw” ity like a pandemic, giving after just a month in office had tested positive. At them enormous ‘emergen- when confronted with the the other, a French scien- cy’ powers. U.S. President president’s brazen disre- tist said on TV, “If I can be Donald Trump is a prime gard for containment mea- provocative, shouldn’t we example of such leader- sures. He was replaced by be doing this study in Afri- ship. His method is clear General Eduardo Pazuello ca...”, prompting outrage. cut: remain silent or leave with zero health-care ex- Among the angry decri- the corridors of power. perience. als: the Ivorian football star Didier Drogba mem- HEALTH MINISTERS AS Democracy is all about orably proclaiming that CASUALTIES IN BRAZIL accepting differences Africans are “not guinea But POTUS is not the only along political and ideo- pigs”. What one needs is logical lines and building collaborative, people-ori- consensus through de- ented leadership. bates. However, with po- larisations gaining deeper P34

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS roots amidst the disrup- pandemic to pass a ‘Coro- to a naysayer may indeed tions caused by falling navirus Bill’ that gives him save the day. national incomes and the enormous emergency pandemic, the resistance powers with no end date SE ASIA, to engage with opposing and arguably makes him SURGE AND points of view is growing the government judge, THE COVID stronger in ruling estab- jury, and executioner of STRATEGY lishments. the European nation. SYNERGIA The enormity of the Unfortunately, the over- FOUNDATION pandemic in India and arching feeling is that al- RESEARCH TEAM the lockdown measures lowing dissent is a sign only intensify the barriers of weakness and debate South East Asia rep- to a factual exchange of could lead to indecisive- resents a kaleido- thoughts and reduce the ness. But, the true art of scope of governance, impact dissenting voices statesmanship is to bal- with both democratic and could have on the admin- ance decisiveness with istration. Liberals fear that dissent and democracy. during the postCOVID pe- National and global emer- riod, which could last for gencies are what put lead- a long time, the situation ers on the line, and crush- may get more extreme. ing dissent may often lead to catastrophic decisions, In Hungary, Prime Min- whereas lending an ear ister Viktor Orban used the P35

SYNERGIA FOUNDATION autocratic systems, and been unique and allowed numbers, and today China different levels of econom- it to control the infection is supplying to other coun- ic and social indices. Per- rate without a lockdown. tries. haps it is this diversity that Yet, in April, there were has shaped their strategies cases of viral reactivation. TAIWAN against COVID-19. Singa- Since most of its new cas- Taiwan has had better re- pore, South Korea, Taiwan, es have been imported, sults. It has not closed its and Vietnam have emerged South Korea has enforced borders, although quaran- as models of efficiency, stricter measures. Short- tining of travellers is still while Indonesia, Malaysia term travellers without on. SARS taught them to and the Philippines stand a place of residence are be better prepared with out for their laggard and allowed to use the quar- a national health com- chaotic response. antine facility provided mand centre, stockpile of by the government for a supplies, and restricting VIETNAM fee. Routine updates are the price of masks. To Vietnam launched an ag- still in place, with the Ko- ease screening, it merged gressive response. Com- rea Centres for Disease peoples’ international munications was trans- Control and Prevention travel history with digital parent through clear issuing daily status brief- health-insurance files, al- public messaging and re- ings. Smartphone alerts lowing doctors and phar- al-time sharing of data. It are sent on infected peo- macists access. Those was equally prompt in iso- ple’s movements. Testing violating quarantine were lating and tracking individ- has been free and those heavily fined. uals and their second- and quarantined are treated in third-hand contacts, quar- hospitals that are stocked JAPAN antining travellers, and sufficiently. During the early stages of enlisting services of all the pandemic, Japan ap- medical professionals — CHINA peared to have a grip on students, retired doctors, Current indicators show things; infection and mor- and nurses. The outbreak that China has managed tality rates were low. It did was contained, without to contain the contagion, not go for a complete lock- resorting to mass testing but has seen a second down. People were ad- as Vietnam does not have wave. There were many vised to work from home the capacity. Lockdown gaps in its strategy, both and stay indoors, but this was enforced in pockets, in sharing of data and en- was not strictly enforced. instead of a blanket ban. suring an adequate supply Businesses were also kept of masks and sanitisers. open. In the first week SOUTH KOREA However, manufacturers of April, a second wave South Korea’s model of soon rolled out PPEs and came, spiking infections. ‘trace, test, and treat’ has other essentials in huge International flights were P36

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS owinselylybwaelnl neqeudippoend wAipthriPlP3E. aAnd Conclusions lvoenctkildatorws,nenwabalesd fiitntaollsyaviemth-e pliitvyoerssaoteefdplo.awti.eTnhtes,gkoeveeprinnmg ietnstmaolsrobeids-- In future, humanity will face COVID-19, despite their trade new challenges, so we must trajectory with China. tablished an online app called Trac- build an inclusive, cohesive society that can help lead- Every country has a lesson for SeTIoNgeGthAePr (OakRinEt:o HouIrGoHwnSAarogya ers to be effective during a India. In the absence of mass ASeNtuD) toLeOnWablSe tracing and tracking crisis. There is no playbook for testing, India opted for a total Sstheinrnoiogurgahpprsiomnrcaeirptaplwhionintvheess.tiiLgtaisstaorNcogof, ntthh- ee leadership when the stakes are lockdown to flatten the curve tArgoenllceydfo, r Smcieentcice,uTleocuhnso,logaynadnd high, and there’s certainly none and gain time to build up med- fRoesceuarscsh’es dSingaporeapImpmrouanoclhog,y for how to face a 21st century ical defences. It does, however, oswsNehhfertivowcehwdpotrrahckese,apayssi“atnewarctdaerekeddea-nsuteiehtpdsasRctsa&l.SlD,dA” aeRbHnaSgdso-re2wewd0eeo0-rn3e pandemic. ‘Effective crisis need to increase its testing eeqvueipr,peidntothadeopftirasmt owreesetrkingoefnt leadership’ involves leaders capacity, up imports of PPE and Aappprroila,chtthoeCrOeVIwD-a19s. a sec- crafting a roadmap that helps ventilators. clarify the problem and unite oAnMdEAsSuUrRgEeD, AmPPoRsOtlAyCHfrom the population. Public healthcare systems have dDwenelslineg onmSiginrgaanpotre’swfaollrkfreorm withstood the challenge well, athcec‘goomld smtanoddaardt’iogrnacse.in teSrmins-of Many of the challenges of glob- especially in countries which gpeiScfera,fcieBcprpieooetoanarnrcreyayHotiunifcoihtonKhamenshdoMmtolhii,nneeSgiesntmtnhcriyeoeorpodmafDnHeediponetumsmttye- al governance are rooted in the had invested wisely upon them. tAhffeairWs iunhSaingafpeovree,r bwlaamsedreth-e tragedy of global commons, in Even Italy, while it may have vsheaarplesdecoinnd sDuregce etmo ebmeprl.oyiIntg that no country feels motivat- suffered huge fatalities, was imumnestmohpoehdidsstiiaacsatetealdydelbicboeengrtaaatcent-tcrharoceiicn-eg. ed to make sacrifices for the able to put up a gallant fight sSienagarpcohre, ianbcidreesabsyetdwobionhrdereernt common good. Healthcare is a against COVID-19 thanks to cproinnctirpolels:anpdresseruvrinvgeililnadnivciedu, - global common, a global good. its world-class public health aiaWenlqnhubpdeaornliuvoSanpiscnpdytgoaararptfnutoldeinrgeidtrhyiwgthaassnts.sdch, IircatteansbredeynegStioifAnvfRigian-lSlg,. system. In India, we have seen cthieerne twehreeaolnthlyc2a3r8ecassyesstaendm3,3 Russia’s strategy against the that private healthcare, has Pw“MfaBtPiiuanstEliie,sttitlreyhaysin.swTodtfheimelHvlpeeeeoalnaqlitrctuhoeiulihapcnaotpddno,ethrwadescelt,pwedtedriidtanthcnh-e’et. pandemic has been proactive. near-zero capacity to handle an aopbtlfeodr tietchtnoolsogaivesethtahtearleivmeosre Though saddled with an ageing epidemic of this nature. oinftrupsiavetibeencatsus,e ikteweaps ainngissuitesof and archaic public health mfporriovfairvcbeyitdaonistdiyxrdirgaahytsts,e.bWutleothwsah.tuwtTadshotweono system, the network of health- India could establish a national glaotev. eThrnatm’s tehnetpriceawlseohad toespa-y care facilities is widespread, command centre for disease tbaecbaluissehweeddiadnn’t ownanlitnteo bae ppper- providing one of the largest control. The National Disaster (csccaaeoayiukvsllleidMenddrha.tasKovaheoosootua.vTtererraaworcchweheTnirneogtAghpaeeotrwphooeeglrisrc-,e” per capita bed availability. Management Authority has yaSiSnegatpuo)retoalsoenparibdeles ittsrealfc-in proved ineffective, and creating itnregatiangndevterrayconkeinogn thitsrosuhgorhes There is hope that African a separate entity to deal with siedqmeunaatlslryt.aprBehootbhenifneogsre.giigvneLenrissfaraenedNtrergea,st-- countries, being more resilient, pandemics would be effective tmheentseinnitoher psarminecihpoaspliitnalvs,easn-d could avoid a rapid spread of in future. tgiegt aeqtouarl oacfcetshsetoAeqgueipnmceyntfoanrd medicine. P37 P21

ATION SYNERGIA FOUNDATION ceived as a state where the police could have overarching powers,” says Mr. Khoo. Singapore also prides itself in treating everyone on its shores equally. Both foreigners and residents are being given free treatment in the same hospitals, and cases hhaavsesCebhnueofreorwnrecnteimhtdaipnstotdCrrtiichectdiaen,traoSmrohsueatash- paTawwclloielectorsheeKstrpHwe’sheaeohhsdiosteinc.roaieenmeggoTarotip,syveneth,dcaairdolrbSonlnoysecAleahdefasefttnfienoeuminvftiaorimraohienlsngeotidregriladheca.as,Dl-nt,MiitientdtotnBihprisngmnaouepuevirqohestmeaSyurantslngriraphnSyecmrhlHadgeeaoiaornacusyfpcptfti---iioleisenrotsyes-mg, eetnetqaunadl access to equip- Korea medicine. sures. Shormt-taenrmagetrdavteollecrosnwtaitihn- DATAout a place othf erecsiodnentacegiaoren,alblouwtehdas to use the squeaernanatisneecfoacnidlitwy apvroe-. SHARINGvided by thTehgeovrerwnmereentmfoarnayfgeea.ps Routine upidnatitess sarterastteilgl yin, bpolathcei,n ing unsophisticated con- CRUCIALwith the KosrheaarCinengtroefs dfoartDaiasenadse JAPtAaNct-tracing methods as DURING AControl anednsPurreinvegntainonadiessquuinagte Duraindg ethliebeeraartlye sctahgoeisceo.f thSeinp-an- demgiac,pJoarpeaanbaidpepseabreydtwtoohianv-e a griphoenretnhtinpgrsin; ciinpfleecsti:opnreasnedrvm-or- talitiyngraitnedsiwviedrueallopwr.ivItacdyidannodt go daily statussubrpiepfliyngosf. Smmaasrktpshaonnde PANDEMICalerts are sesnatnoitnisinefrescted people’s movements. Testing has been free and those quarantined are treated for raigchotsm, plaented logcivkidnogwne.qPueaolple stocked suffi- weroepapdovristuednityo woarnkdfromcahreome INPUTS BY in hospitals that are Technology andandtostaaylli.ndoWorhse, nbuSt itnhgisapwoarsenot YE BAIXIN ciently. Science, DOCTOR AT Research’s Singapore Ims-tricwtlaysenhfiotrcbeyd. SBAusRiSne, sstheserweere RENMIN HOSPITAL OF WUHAN CHINA munology Network, stata-lsowkeerpet oopnelyn.2In38thceafsiresst waenedk of UNIVERSITY Current indeidcathoarst sShAoRwSt-h2a0t0C3hisnearvedApr3il3, a fsaetcaolnitdiewsa. veThcaempe,oslipcieking has manageadstao c“wonatkaein-utphecacoll,n” tbaa- sedinfehctaidonsh.elpInetdernthaetioMnailnisftlriyghts gion, but hoasn sweehnicahsethcoenydinwcarveea. sedweroefonHlyebaaltnhnecdoonntAacptrilt3ra. Acelo.ck- There wereRm&Danayngdapwseirne ietsqustiprapte-d todow“nBwuta,stfhinisaltliymime paoroseudn.d, we hina was the first country to be hit by Cegy, both inasdhoapritnagmofodraetastarnindgeenn-t ap- didn’t opt for technolo- the pandemic, and suring an adperqouaacthe tsoupCpOlyVoIDf m-1a9s.ks SINgGiAesPOthRaEt& HaIrGe HmSoAreNDinLtrOuW- S there is much to be learnt oaTTtaounnttAahhrddiIeweeWrsrratsaocnAenodssNiuoashteiynoasnntseAdAeDfrCtarfaiiwPhsreflhaMrli.oaPslecdis.HdnlElfRi’lleareAiioOonbnndgwSemigAcrshUetaoyCtvuucResoeHtgrteuEhrnep,DeiPrnpmniePnSlsu‘yaEguiminnostlnthuegblgsdfaraea.amnnrptcIsdosd-tos,tlraienon’gstomnsSaf-ihcfiecnocosuAsogSswtsswWswltpa.omioiuilncrpeexvyueoHaeimgeoslsfad,or,srhleoodpbeatoiwhdaddfhoaaetmuewdanerneycpivtettr’ds.iaritdsetecoi,tduhTervoownd,wfonsahmobesiawseaicta.cgpunesmnsyutrniat’ttemcssaeytaesonwfhtitsenonotgcheeodbahdtrrecafrseabedoftofrpnaiceiniiarlvpgrpttalsdnseeewpphrtwupdpirestacsiota,orwssuroeeserram--.rekepcgedeeahekr---wlFptft,,iohrgoaoiithnunmhdtengeoldCdhaDhCsotoriioGwnos..YntehetT(idhinQsheBiucbsytaooyaitomixleskSpi)nayeasnnrItoaneahtmrgitgigoaehheidnnae-- has not closed its borders, although rations the moment the Wuhan fe- quarantining of travellers is still on. ver was revealed in December. It im- SARS taught thePm38to be better pre- mediately began research, increased pared with a national health com- border control and surveillance, and mand centre, stockpile of supplies, started screening inbound flights. and restricting the price of masks. Its efficient healthcare system,

COVID-19 COMPENDIUM THE LEGITIMACY OF OUR THINK TANK IS IN THE POWER OF OUR IDEAS interview, he says, “Hav- CONTAINING THE by the coronavirus, which ing gone through all the SPREAD IN CHINA then went to other prov- hardships and eventually The COVID-19 pandemic inces and cities to super- conquered the epidemic, originated as a cluster of vise the control of the ep- Wuhan doctors are like an unidentifiable pneumonia idemic. The mainland also internationally recognised cases in Wuhan, the cap- stepped up its production brand name to overseas ital of Hubei province. As of masks from 10 million health workers. We can- the number of cases grew, per day to 116 million not only provide them with the potential for an out- daily. Delivery drones, AI, experience but also boost break was discovered by and facial recognition sys- their confidence.” the National Health Com- tems were used to keep mission (NHC) in Beijing the check the epidemic. In the panel, he stated after sending experts to Makeshift hospitals were three things that worked Wuhan. On the same day, also built that resembled for them, which were the authorities notified the those made for the 2003 namely the containment World Health Organisa- SARS outbreak in Caidian, of spread and disease ac- tion. Wuhan. China was also tion, good procedures for the first country to go into disease management and By the first week of Jan- a full lockdown - on Janu- avoiding medical resource uary, the genetic sequence ary 23rd - by its own and wastage (all of which was of the virus was published not on the suggestion of free to people in China), on an open-access data- the WHO. A lockdown of and using highly scientific base. The Wuhan seafood this scale had never been technology. He also em- market was closed down seen before. Caught off- phasised on the need to by Jianghan District’s guard by the epidemic, set up resources to allow Health Agency and Admin- China received help inter- for the sharing of informa- istration for Market Regu- nationally, from places like tion across borders be- lation on January 1st. On Japan, Guinea, and even tween medical profession- January 20th, the NHC the Bill Gates Foundation. als, as he has managed to set up a group to deal achieve from China. with pneumonia caused Many cities limited the number of people going out per household, with only one person permitted for purchasing necessities every 1-3 days in Febru- ary. Temperature checks are now necessary and commonplace at each entrance. There is round the clock surveillance P39

SYNERGIA FOUNDATION through contact tracing effort put in by the doctors tains roughly 40,000 pa- apps, CCTV usage, and on the ground cannot be tients in the Beth Israel check-in by doctors. Dr Ye negated in controlling the Deaconess Medical Cen- also stated that what they spread of the virus. ter (BIDMC). It offers in- learnt from their battle sights into a critical care with COVID was that even THE CASE OF INFOR- cohort, allowing clinicians though they asked sus- MATION SHARING and computer scientists pected cases to stay at Some databases offer to address research ques- home, the number of cas- data on COVID-19 through tions and build predictive es still increased, which public-private partner- models. then had to be controlled ships such as databases through community con- by Dawex, Parexel, and the Much of what is known tainment. EU’s ERA vs Corona Action about COVID-19 comes Plan. But this kind of da- from how it has spread in The lockdown was lift- ta-sharing is done only in different countries, based ed in May after 76 days, certain circles, with no one on which doctors make and an ambitious testing governmental organisa- their assumptions. Creat- regime was introduced in tion having taken the lead. ing large scale COVID-19 Wuhan after new cases Patient-level COVID-19 Real World Evidence emerged, raising fears of data is also not publicly (RWE) studies that take a second wave. Wuhan available. The data avail- in data from a variety of states that it has now test- able is said to “lack com- real-world sources — like ed nearly seven million prehensive information patients being treated in people in 12 days. beyond typical registry the hospital — could help resolution.” To deal with accelerate the develop- China’s prompt re- the virus, there is the need ment of treatments in a sponse and efficient mon- to create a unifying mul- more patient-centric and itoring can be credited tinational COVID-19 elec- patient-friendly way. with curtailing the spread tronic health record which of the virus, along with the can be accessed by re- The need for open-source willingness of citizens to searchers globally. hardware and software that adhere to protocol. Chi- allows for national and na now has sent medi- The non-existence of sub-national health sys- cal equipment and PPE this is not due to the ab- tems to collect and share all over the world to help sence of technology. One live and updated data in a other countries still work- such example of a public- timely manner, while being ing on slowing down their ly-available, anonymous, mindful of privacy laws has cases. While there have electronic health record never been more topical. been issues raised about is the MIMIC-III (Medi- This would allow already the quality of the PPE and cal Information Mart for overburdened healthcare the chance that China Intensive Care III), pres- systems around the world could have hidden the ex- ent since 1996. It con- to quickly adjust in their act number of cases, the fight against COVID-19. P3404