Unlocking The Lockdown

Our community’s leading medical luminary, Dr. Keki Edulji Turel commands 47 years of expertise in neurosurgery and is a Consultant Neurosurgeon, Prof. Emeritus, Dept of Neurosurgery at the Bombay Hospital Institute of Medical Sciences. Known for his compassionate outlook towards his patients, Dr. Keki Turel is the Managing Trustee at Mumbai Institute of Neurosciences and the Chairman, WFNS Committee on `Complications in Neurosurgery’. He has held leading positions in several prestigious medical associations including the Neurological Society of India, Academia Eurasiana Neurochirurgica, Epilepsy Association of India, Indian Medical Association, Associations of Surgeons of India, etc. In this article for Parsi Times, he ponders on the human tendency of waiting for the worst times to bring out our best!

The lockdown has produced many unusual repercussions. The environment, which during the past decades has been a universal concern, and appeared to be progressively and irreparably damaged, has had a natural respite, and is on its way to getting mended. Man must seize this opportunity to allow it to heal, and remain healthy. We now hear birds chirping all around all the time. Not knowing their language, I wonder if it’s a call of freedom or of hunger, as littering by man has reduced significantly. Vehicles have started to ply and the liberty to speed has already started to break the silence of the city streets, which are now treated by some as autobahns, as also by our inherent habit of pointless honking; and by occasional car crashes, which instantly draw hordes of people, throwing social distancing to the winds. True, old habits die hard!

In the past, every time our PM gave a clarion call to address the nation with the now familiar ‘Mitro’, everyone got anxious and restless! Now we have new, unpredictable, contradictory and unsettling announcements being made by leaders every day to implement, modify or withdraw the regulations;  we are put to wonder if some of these knee-jerk reactions are based on any analysis, logic or simply emotional, yielding to the mounting pressure of human inconvenience and suffering, or to the vote-bank. Typical politicians will take a long time to don the ‘avatar’ of Diplomats, and will need a new ‘janam’ or formal training, first to unlearn old habits, and then to acquire attitude and skills of prioritising public good before their own.

The pandemic has seriously thrown everyone out of gear because none expected it to be so universally spread, nor was anyone prepared, despite some warnings that surfaced during December itself.  Professionally, ignoring the warning symptoms reminds me of patients who disregard the tingling and numbness occurring on one side of the body as something trivial in the limb, (especially, as it disappears even without treatment within minutes or hours) when, in reality, these are Transient Ischemic Attacks (TIAs) or warning symptoms heralding a catastrophic brain stroke that would result in permanent damage to one’s function of movement, speech, cognition etc. So, having overlooked the warning signs, we are currently witnessing the stroke effect and with COVID positive cases and deaths mounting everyday at a frenetic pace, the process of recovery and rehabilitation from this pandemic, I am afraid, will last an entire generation, if not more! 

The lockdown has also produced colossal economic suffering. Industries are in coma, MSMEs (Medium and Small Scale Enterprises) will suffer the most. So, following the lockdown and industries closing down, we are witnessing the movement of suffering humans (migrant workers); of course, nothing yet in comparison to the unbelievable and unforeseen tragedies one witnessed after Aug ’47 when India lost part of its body with one deadly ‘stroke’. This has changed and scarred the face of the subcontinent, if not the entire world, not just transiently, but permanently, and subsequent generations are still paying a huge price of this man-made disaster. Isn’t it true that wars take a far heavier toll and perpetuate more suffering than any naturally occurring cyclone, earthquake or volcanic eruption?  But, while the genesis of this tiny virus is still in question, the abysmal human response (of the government and its people) has provided it a truly monstrous proportion. 

Instead of caution, India should rapidly consider easing the COVID shutdown to revive the economy otherwise it may suffer the worst of both worlds. Economic collapse, without checking the virus. China was the epicenter of the pandemic, but it contained its spread with ferocious speed and action sparing no time, efforts and money doing so. Even now, fearing a backlash, Wuhan has tested 7 million of its people in less than a fortnight.  But in poor countries with weak administrative and medical capacity, shutdowns would not check the disease. Social distancing would be impossible in densely populated urban slums (like Dharavi), crowded bazars and huts where several people slept. If virus testing capacity was weak, detection, isolation and treatment would be highly incomplete and the disease would spread despite shutdowns. 

India is better than African countries, but it’s administrative capacity…?? If just one percent of India’s population gets infected, that means 13 million people getting affected. Our facilities look pathetically inadequate for that. Enforcing social distancing despite police and paramilitary forces appears impossible. We have witnessed massive crowds of migrant workers demanding assistance and even looting. Farmers growing perishables have lost their entire crops due to curbs on transport, and now to parasitic infestation. 

The IMF predicts India’s GDP growth will drop to 1.9% – as bad as in 1991, when India went bust. If social distancing does not work and the economy fails to revive in the second half of 2020, the IMF says growth will be deeply negative, the worst performance in the independent India. This economic disaster will create massive misery that will exacerbate illness and deaths. So, a prolonged shut down may kill and make more people miserable than it saves. Gradual easing of the shutdown to check the disease, would cause more miseries than a rapid revival of economy. Rapid easing will check the economic disaster but could of course worsen deaths. But gradual easing may give India worse of both worlds. The best mode of control of disease or mode of lifting of shutdown may only be realised in hindsight, but we must learn from the history of past pandemics, where no shut downs were imposed and death rates and economies both remained unaffected in the long term.

So we are now witnessing the mass exodus of poor migrant workers, who had flocked to the ‘City  of Dreams’, some a few months ago, some even decades ago, and whilst most were still struggling to have a decent human living and barely surviving, had the cheek to pull their families from their tranquil rural habitats to this unforgiving, shark-like megapolis with a seemingly infinite capacity to accommodate all kinds of elements. They traded their clean environment and traditional lives for a breathtaking (literally) pace and suboptimal survival with no clear plan or aim. With the scorching summer and no jobs, money or amenities, they are belatedly let loose to return to their rural homes carrying the deadly combination of empty pockets, hungry bellies, frustrated brains and an unknown load of the virus. Some have died on the way in very curious circumstances, run over by trains, vehicles or just by hunger and fatigue in this unforgiving weather and unfortunate conditions. 

Mumbai may have seem to have become lighter and cleaner. One hopes this will allow its remaining decades-old settlers with a calmer life. As the migrants have appeared to relocate themselves to their respective states, Mumbaikars will have to brace themselves to do without them (to become ‘Atmanirbhar’ as suggested by our PM), or accept those from the interior of our state, who in turn will have the onerous task to match the hard work and ruggedness shown by the erstwhile migrants. The latter may be well-advised to remain where they came from, and by exhibiting the same zeal and efforts may easily develop their own villages and small towns into prosperous lands of agriculture and industry. 

To make this happen the government will have to step in strongly and invest a part of the lakhs of crores promised for other avenues to enable these migrants with jobs, skills and entrepreneurial opportunities. Offering fish to the hungry will only solve the hunger for one day; but by teaching and providing opportunity to fish you will solve it for a lifetime. Thus ‘Make in India’ will truly ‘make India’ – shining like the ‘Sone ki Chidiya’ it used to be! 

As even for rest of the world, life will never be the same… at least not in the foreseeable future.

Prof. Dr. Keki E. Turel

Emeritus Chairman Department of Neurosurgery

Bombay Hospital Institute of Medical Sciences

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