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19th April – Editorials/Opinions Analyses

Contents

  1. Is the lockdown helping India?
  2. The U.S. freeze on WHO
  3. Will convalescent plasma help COVID-19 patients?
  4. After the pandemic wave, what will happen to coronavirus?
  5. Explained: Ways and Means Advances

IS THE LOCKDOWN HELPING INDIA?

Focus: GS-III Disaster Management

What do the numbers reveal?

  • The lockdown has coincided with an increase in testing and the Indian Council of Medical Research (ICMR) has widened the pool of people of suspected cases who need to get tested.
  • Earlier, only those with a travel history and displaying symptoms were being tested.
  • Now, even those who show flu-like illnesses and are in a hotspot are likely to be tested and quarantined. Since the lockdown, confirmed cases have risen 23 times to around 14,000; deaths too have risen 40 times.
  • Every weekly rise in cases has seen an increase by a factor of 3.7, 2.5 and 2.0, respectively, until April 16.
  • Testing grew in those same weeks by a factor of 2.4, 2.1 and 1.1 times, respectively.
  • A slower growth in testing thus appears to be corresponding to a slower rise in confirmed cases.

Should India test more aggressively?

  • Increased testing does not necessarily mean a rise in cases, and could be explained by a fall in the speed of disease transmission.
  • However, to conclude so would be premature, caution health officials.
  • That is because India has still tested only a limited proportion of its population.
  • There is a pool, and we do not know how large, of asymptomatic people, that is those who have been infected but do not show symptoms, but can infect others.
  • Testing must be increased and contacts traced so that asymptomatics are also under the radar.

What is India doing about Testing?

  • Only this week India has effectively unveiled a new set of strategies — the use of rapid antibody tests and the concept of pooled testing to estimate the extent of undetected infections in hotspots which are places with a large number or large increase in cases.
  • These are useful but relatively crude measures and can still lead to several asymptomatic people going undetected, according to health officials.

Is the lockdown being followed?

  • While India’s lockdown has been among the harshest in the world, there have been several instances of people gathering in large numbers.
  • In fact, the makeshift relief camps that States have set up for migrant labour, the high average density of population are all aggravating factors for the spread of clusters as is seen in Mumbai.

Some States have managed to flatten the curve

  • New cases in Kerala, on a daily count, have dropped to single digits; the number of recoveries exceeds those being hospitalised in Tamil Nadu. Telangana and Andhra Pradesh are also showing signs of a dip.
  • These are signs that these States have been able to manage infections effectively through stringent contact tracing and curtailing asymptomatic persons from spreading infection.
  • They also reflect the importance of having moved early to stymie the spread.

THE U.S. FREEZE ON WHO

Focus: GS-II International Relations

When and why was the WHO set up?

  • It is important to understand the context in which WHO functions to understand the current situation around its funding.
  • WHO, a United Nations agency created in 1948, is headquartered in Geneva, and was founded to coordinate and direct the UN’s global health efforts.
  • It has no authority over its 194-member countries and, as is typical for UN agencies, depends on member contributions to carry out its work.
  • Also, as is often the case with UN agencies, WHO is not immune to political motivations and an inertia that often comes with large bureaucracies.
  • Yet, in this instance, critics and several public health academics have said that Mr. Trump’s attack of the organisation is misplaced.

Was WHO slow in alerting the world about COVID-19?

  • It took till about the middle of January for WHO to suggest human-to-human transmission of the virus, toeing the China line for the first few weeks of the year, as per reports.
  • Even then, in the first two weeks of the year and two weeks after it was notified of the virus, WHO had qualified its statement by saying there was “no clear evidence” of such transmission.
  • It took until January 30 for them to conclude deliberations and declare a global emergency.

How much does the U.S. give WHO?

  • The U.S. is the WHO’s largest contributor. The organisation’s funding is of two types — assessments or member dues and voluntary contributions. The total funds for the 2020-2021 biennium included $957 million in assessments and $4.9 billion in voluntary contributions.
  • Over the last decade, the U.S.’s assessed contributions have been in the $107-$119 million range while voluntary contributions have been in the $102-$402 million range, according to the Kaiser Family Foundation, a health-focused non-profit.

Will the U.S. stand affect WHO’s functioning?

The short answer is, yes, a funding freeze is highly likely to negatively impact WHO’s functioning for a short while at least, given the significant contribution the U.S. makes.

However, we do not yet know what the impact will be and for how long.

WILL CONVALESCENT PLASMA HELP COVID-19 PATIENTS?

Focus: GS-III Science and Technology

Introduction to use of Convalescent Plasma Therapy

  • Among the many scientific terms that seem to have entered common parlance with COVID-19 is convalescent plasma.
  • While we may be, in an optimistic scenario, a few weeks or months away from drugs or vaccines, clearly some front-runners have emerged, including remdesivir (originally designed to target the Ebola virus) and convalescent plasma.
  • Convalescent plasma is a time-tested strategy that has worked successfully with several other diseases, and doctors struggling to bring relief to COVID-19 patients have turned towards it — it is blood derived from patients who have recovered from COVID-19 — on the assumption that their body contains antibodies it used to fight the virus.

What is convalescent plasma? How does it work?

  • People who have recovered from COVID-19 have antibodies to the disease in their blood.
  • Doctors call this convalescent plasma. Researchers hope that convalescent plasma can be given to people with severe COVID-19 to boost their ability to fight the virus.
  • The blood — about 800 ml or so — is collected from the donor through the regular withdrawal process, tested for other pathogens, and if safe, the plasma component is extracted and subsequently used for transfusion on to patients.
  • Everyone who has suffered from a disease possibly carries what are called neutralising antibodies that when extracted via plasma and transfused on to others with the infection can help their immune system fight it off.
  • Whether it works or not depends on whether the disease produced a lot of antibodies in people or not.
  • Trials are also required to examine the effect of other anti-virals or anti-inflammatory drugs on convalescent plasma, and see if there is an additive effect or take-away from the benefits.

What is the future?

  • Trials will conclude in a few weeks/months for definitive conclusions to emerge. The Indian Council of Medical Research has approved Delhi and Kerala to undertake clinical trials, and Tamil Nadu has also applied for permission to conduct trials in the State.
  • If trials clear convalescent plasma and approvals are given for a clinical rollout, it can be employed in hospital settings widely to help patients.
  • If that were to come to pass, the government would also do well to bring in regulations to ensure that plasma donors are not exploited under any circumstances.

AFTER THE PANDEMIC WAVE, WHAT WILL HAPPEN TO CORONAVIRUS?

Focus: GS-III Science and Technology

The post pandemic possibilities: What the research states

  • Researchers have noted two possibilities. The SARS-CoV-2 virus could be eradicated through public health measures, just as its closest genetic relative SARS-CoV-1 was. Public health authorities, however, do not consider this a likely outcome.
  • Alternatively, the transmission of the virus could be similar to the influenza pandemic, which circulated seasonally after the initial global wave of infections.
  • Researchers have reason to believe there could be recurrent wintertime outbreaks of COVID-19.

What factors will influence post pandemic transmission of SARS-CoV-2?

  • The post pandemic transmission of SARS-CoV-2 could depend on various factors. First, it will depend on the whether the transmission of coronavirus changes with seasons.
  • Second, it remains uncertain as to whether immunity from the virus is permanent. Which is to say, for how long a person can remain immune to SARS-CoV-2 without contracting the disease again. If the immunity is short term (40 weeks), such as in the case of HCoV-OC43 and HCoV-HKU1, researchers project that the virus will cause annual outbreaks. On the other hand, if the immunity is for a longer period (about two years), the virus may lead to biennial outbreaks.
  • Third, researchers are studying the degree of cross-immunity between SARS-CoV-2 and other coronaviruses. Cross-immunity means if getting infected by one type of coronavirus can protect against the other.
  • When compared with other coronaviruses, SARS-CoV-2 may appear to be milder than SARS-CoV-1 and MERS, but more severe than HCoV-OC43 and HCoV-HKU1. What makes SARS-CoV-2 difficult to control is its high infectiousness at the start of onset of mild symptoms.          
  • Last, the intensity and timing of mitigation measures will determine the future spread of the disease.
  • Serological testing is required to determine and understand the extent and duration of immunity to SARS-CoV-2, which in turn will influence what the post-pandemic scenario looks like.

EXPLAINED: WAYS AND MEANS ADVANCES

Focus: GS-III Indian Economy

Why in news?

The Reserve Bank of India (RBI), on Friday, announced a 60% increase in the Ways and Means Advances (WMA) limit of state governments over and above the level as on March 31, with a view to enabling them “to undertake COVID-19 containment and mitigation efforts” and “to better plan their market borrowings”.

What exactly is Ways and Means Advances (WMA)?

Simply put, it is a facility for both the Centre and states to borrow from the RBI. These borrowings are meant purely to help them to tide over temporary mismatches in cash flows of their receipts and expenditures. In that sense, they aren’t a source of finance per se. Section 17(5) of the RBI Act, 1934 authorises the central bank to lend to the Centre and state governments subject to their being repayable “not later than three months from the date of the making of the advance”.

How much does the RBI charge on these advances?

  • The interest rate on WMA is the RBI’s repo rate, which is basically the rate at which it lends short-term money to banks.
  • That rate is currently 4.4%. The governments are, however, allowed to draw amounts in excess of their WMA limits.
  • The interest on such overdraft is 2 percentage points above the repo rate, which now works out to 6.4%.
  • Further, no state can run an overdraft with the RBI for more than a certain period.

Why have all these relaxations been made?

  • The reason is simple. Government finances are in a mess today. The lockdown has resulted in revenues drying up, and it is the states that are actually feeling the heat.
  • With economic activity at a near standstill, there is hardly any money coming in from GST, petroleum products, liquor, motor vehicles, stamp duty or registration fee.
  • At the same time, the states are also incurring the bulk of the on-the-ground expenditures for combating the novel coronavirus.
  • These extend not only to purchases of testing kits, personal protective equipment and ventilators or deployment of healthcare and police personnel, but even to providing food, shelter and other relief measures to those worst hit by the lockdown.
  • In a scenario where their expenses are real, mounting and cannot be deferred, even as revenues are collapsing and uncertain, the states are facing an unprecedented cash crunch.
  • Most of them have resorted to slashing expenditures of other departments in order to meet COVID-19 exigencies, with some even deferring or cutting salaries of employees. But all these measures haven’t really addressed the underlying problem of liquidity and cash flow mismatches.

Will the increase in the WMA limits help?

  • The WMA window, as already pointed out, is intended only to tide over temporary mismatches in cash flow of receipts and payments.
  • Given the likelihood of total government borrowings crossing Rs 20 lakh crore – a conservative underestimate – a WMA limit of Rs 120,000 crore for the Centre and Rs 51,560 crore for states may prove grossly insufficient.
  • At some point, the Centre, at least, might have to invoke Section 5(3) of its Fiscal Responsibility and Budget Management Act, 2003.
  • That overriding provision in the Act – which otherwise bars the RBI from lending to the government, except for meeting temporary cash flow mismatches – allows the central bank to “subscribe to the primary issues of Central Government securities” under very specified grounds.
  • Those cover, among other things, “act of war” and “national calamity”.
  • Apart from monetisation of deficits – which is what this provision effectively entails – the RBI may, in the coming day, also have to undertake increased secondary market purchases and sales of Central as well as state government securities.
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