Archive for ‘strategy’

31/05/2020

India coronavirus: Why is India reopening amid a spike in cases?

A rush of people and motorists in a marketplace area as shops start opening in the city under specific guidelines, on May 20, 2020 in Jammu, IndiaImage copyright GETTY IMAGES
Image caption Within a week of reopening, India has seen a sharp spike in cases

India is roaring – rather than inching – back to life amid a record spike in Covid-19 infections. The BBC’s Aparna Alluri finds out why.

On Saturday, India’s government announced plans to end a national lockdown that began on 25 March.

This was expected – the roads, and even the skies, have been busy for the last 10 days since restrictions started to ease for the first time in two months. Many businesses and workplaces are already open, construction has re-started, markets are crowded and parks are filling up. Soon, hotels, restaurants, malls, places of worship, schools and colleges will also reopen.

But the pandemic continues to rage. When India went into lockdown, it had reported 519 confirmed cases and 10 deaths. Now, its case tally has crossed 173,000, with 4,971 deaths. It added nearly 8,000 new cases on Saturday alone – the latest in a slew of record single-day spikes.

A worker cleans the mascot of fast-food company McDonald's for the reopening of the outlet in Hyderabad on May 20.Image copyright GETTY IMAGES
Image caption Fast food chains like McDonald’s have begun reopening outlets in parts of India.

So, why the rush to reopen?

The lockdown is simply unaffordable

“It’s certainly time to lift the lockdown,” says Gautam Menon, a professor and researcher on models of infectious diseases.

“Beyond a point, it’s hard to sustain a lockdown that has gone on for so long – economically, socially and psychologically.”

From day one, India’s lockdown came at a huge cost, especially since so many of its people live on a daily wage or close to it. It put food supply chains at risk, cost millions their livelihood, and throttled every kind of business – from car manufacturers to high-end fashion to the corner shop selling tobacco. As the economy sputtered and unemployment rose, India’s growth forecast tumbled to a 30-year-low.

Raghuram Rajan, an economist and former central bank governor, said at the end of April that the country needed to open up quickly, and any further lockdowns would be “devastating”.

The opinion is shared by global consultant Mckinsey, whose report from earlier this month said India’s economy must be “managed alongside persistent infection risks”.

Passengers maintaining social distance as they are on board in a DTC Bus after government eased lockdown restriction, at AIIMS on May 20, 2020 in New Delhi, India.Image copyright GETTY IMAGES
Image caption As restrictions ease, Indians are slowly getting used to the new normal

“The original purpose of the lockdowns was to delay the spike so we can put health services and systems in place, so we are able handle the spike [when it comes],” says Dr N Devadasan, a public health expert. “That objective, to a large extent, has been met.”

In the last two months, India has turned stadia, schools and even train coaches into quarantine centres, added and expanded Covid-19 wards in hospitals, and ramped up testing as well as production of protective gear. While grave challenges remain and shortages persist, the consensus seems to be that the government has bought as much time as possible.

“We have used the lockdown period to prepare ourselves… Now is the time to revive the economy,” Delhi Chief Minister Arvind Kejriwal said last week.

The silver lining

For weeks, India’s relatively low Covid-19 numbers baffled experts everywhere. Despite the dense population, disease burden and underfunded public hospitals, there was no deluge of infections or fatalities. Low testing rates explain the former, but not the latter.

In fact, India made global headlines not for its caseload but for its botched handling of the lockdown – millions of informal workers, largely migrants, were left jobless overnight. Scared and unsure, many tried to return home, often desperate enough to walk, cycle or hitchhike across hundreds of kilometres.

Perhaps the choice – between a virus that didn’t appear to be wreaking havoc yet, and a lockdown that certainly was – seemed obvious to the government.

But that is changing quickly as cases shoot up. “I suspect we will keep finding more and more cases, but they will mostly be asymptomatic or will have mild symptoms,” Dr Devadasan says.

The hope – which is also encouraging the government to reopen – is that most of India’s undetected infections are not severe enough to require hospitalisation. And so far, except in Mumbai city, there has been no dearth of hospital beds.

India’s Covid-19 data is spotty and sparse, but what it does have suggests that it hasn’t been as badly hit by the virus as some other countries.

The government, for instance, has been touting India’s mortality rate as a silver lining – at nearly 3%, it’s among the lowest in the world.

But some are unconvinced by that. Dr Jacob John, a prominent virologist, says India has never had, and still doesn’t have, a robust system for recording deaths – in his view, the government is certainly missing Covid-19 deaths because they have no way of knowing of every fatality.

A woman jogs at Lodhi Garden after the local government eased restrictions imposed as a preventive measure against the spread of the COVID-19 coronavirus in New Delhi on May 21, 2020.Image copyright GETTY IMAGES
Image caption Indians are venturing out again but it’s unclear how many of them are asymptomatic.

And, he says, “what we must aim for is flattening the mortality curve, not necessarily the epidemic curve”.

Dr John, like several other experts, also predicts a peak in July or August, and believes the country is reopening so quickly because the “government realised the futility of such leaky lockdowns”.

A shift in strategy

So is the government gearing up for another lockdown when the peak comes?

While Dr Menon believes the lockdown was well-timed, he says it was too focused on cases coming from abroad.

“There was a hope that by controlling that, we could prevent epidemic spread, but how effective was our screening [at airports]?”

Now, he adds, is the time for “localised lockdowns”.

Media caption Coronavirus: Death and despair for migrants on Indian roads

The federal government has left it to states to decide where, how and to what extent to lift the lockdown as the virus’ progression varies wildly across India.

Maharashtra alone accounts for more than a third of India’s active cases. Add Tamil Nadu, Gujarat and Delhi, and that makes up 67% of the national total.

But other states – such as Bihar – are already seeing a sharp uptick as migrant workers return home.

“Initially, most of your cases were in the cities,” Dr Devadasan says. “But we kept the migrant workers in cities and didn’t allow them to go home. Now, we are sending them back. We have facilitated transporting the virus from urban areas to rural areas.”

While the government has said how many infections have been avoided – up to 300,000 – and lives saved – up to 71,000 – by the lockdown, there is no indication of what lies ahead.

There is only advice: The day the government began to ease restrictions, Mr Kejriwal tweeted, urging people to “follow discipline and control the coronavirus disease” as it was their “responsibility”.

The famous Paranthe wali gali (bylane of fried bread) in Chandni Chowk, on August 20, 2014 in New Delhi, India.Image copyright GETTY IMAGES
Image caption Social distancing will prove to be India’s biggest post-lockdown challenge

Because the alternative – of curfews and constant policing – is unsustainable.

“My worry is more the circumstances of people – it’s not as though they have an option to practise social distancing,” Dr Menon says.

And they don’t – not in joint family homes or one-room hovels packed together in slums, not in crowded markets or busy streets where jostling is second nature, or in temples, mosques, weddings or religious processions where more is always merrier.

The overwhelming message is that the virus is here to stay, and we have to learn to live with it – and the only way to do that, it appears, is to let people live with it.

Source: The BBC

28/05/2020

India coronavirus: Trouble ahead for India’s fight against infections

Coronavirus in IndiaImage copyright GETTY IMAGES
Image caption India has more than 150,000 reported infections

On the face of it, things may not look bad.

Since the first case of coronavirus at the end of January, India has reported more than 150,000 Covid-19 infections. More than 4,000 people have died of the infection.

To put this in some context, as of 22 May, India’s testing positivity rate was around 4%, the death rate from the infection around 3% and the doubling rate of infection – or the amount of time it takes for the number of coronavirus cases to double – was 13 days. The recovery rate of infected patients was around 40%.

All this is markedly lower than in the countries badly hit by the pandemic.

Like elsewhere in the world, there are hotspots and clusters of infection.

More than 80% of the active cases are in five states – Maharashtra, Tamil Nadu, Delhi, Gujarat and Madhya Pradesh – and more than 60% of the cases in five cities, including Mumbai, Delhi and Ahmedabad, according to official data.

More than half of people who have died of the disease have been aged 60 and older and many have underlying conditions, hewing to the international data about elderly people being more vulnerable to the disease.

The more than two-month-long grinding lockdown, official data suggests, has prevented the loss of between 37,000 and 78,000 lives. A paper published in Harvard Data Science Review appears to support that – it shows an eight-week lockdown can prevent about two million cases and, at a 3% fatality rate, prevent some 60,000 deaths.

“Infection has remained limited to certain areas. This also gives us confidence to open up other areas. It is so far an urban disease,” says VK Paul, who heads the medical emergency management plan on Covid-19.

This is where such claims enter uncertain territory.

India testingImage copyright GETTY IMAGES
Image caption India has conducted some 180,000 tests so far

India is now among the top 10 countries worldwide in terms of total reported infections, and among the top five in the number of new cases.

Infections are rising sharply, up from 536 cases on 25 March when the first phase of the world’s harshest lockdown was imposed. The growth of infections is outpacing growth in testing – tests have doubled since April but cases have leapt fourfold.

Epidemiologists say the increase in reported infections is possibly because of increased testing. India has been testing up to 100,000 samples a day in the past week. Testing criteria has been expanded to include asymptomatic contacts of positive patients.

Yet, India’s testing remains one of the lowest in the world per head of population – 2,198 tests per million people.

The bungled lockdown at the end of March triggered an exodus of millions of informal workers who lost their jobs in the cities and began returning home in droves, first on foot and then by train. Some four million workers have travelled by rail from cities to their villages in more than half a dozen states in the past three weeks.

There is mounting evidence that this has already led to the spread of infection from the cities to the villages. And with the messy easing of the lockdown earlier this month, there are growing fears of infections spreading further in the cities.

Rising infections and a still-low fatality rate possibly points to milder infection in a younger population and a large number of asymptomatic cases. The focus, says Amitabh Kant, CEO of the government think-tank NITI Aayog, should be “bringing down fatalities and improving the recovery rate”.

But if the infection rate continues to grow, “things are going to get pretty grim in a few weeks time,” a leading virologist told me.

India lockdownImage copyright GETTY IMAGES
Image caption Millions of workers have fled the cities and returned to their villages after the lockdown

Doctors in the capital, Delhi, and the western city of Mumbai tell me they are already seeing a steady surge in Covid-19 admissions and worry about a looming shortage of hospital beds, including in critical care.

When the infection peaks in July, as is expected, a spike in infections could easily lead to many avoidable deaths as hospitals run out of beds for, or delay treatment to, infected patients who need timely oxygen support and clinical care to recover.

“That is the real worry. A critical-care bed needs an oxygen line, a ventilator, doctors, nursing staff. Everything will be under pressure,” Dr Ravi Dosi, who is heading a Covid-19 ward at a hospital in Indore, told me. His 50-bed ICU is already full of patients battling the infection.

With the lockdown easing, doctors are feeling jittery. “It’s a tactical nightmare because some people have begun going to work but there is a lot of fear”, says Dr Dosi.

“One co-worker sneezed in the office and 10-15 of his colleagues panicked and came to the hospital and demanded they get tested. These are the pressures that are building up.”

One reason for the confusion is the lack of – or the opacity of – adequate data on the pandemic to help frame a strategic and granular response.

Most experts say a one-size-fits-all strategy to contain the pandemic and impose and lift lockdowns will not work in India where different states will see infection peaks at different times. The reported infection rate – the number of infections for every 100 tests – in Maharashtra state, for example, is three times the national average.

“The infection is not spreading uniformly. India will see staggered waves,” a leading virologist, who insisted on anonymity, told me.

The lack of data means questions abound.

What about some 3,000 cases, which are not being assigned to any state because these people were found infected in places where they don’t live? (To put this into context, nine states in India have more than 3,000 cases.) How many of these cases have died or recovered?

Also, it is not clear whether the current data – sparse, and sporadic – is sufficient to map the future trajectory of the disease.

There is, for example, no robust estimate of carriers of the virus who have no symptoms – last month a senior government scientist said at least “80 out of every 100 Covid-19 patients may be asymptomatic or could be showing mild symptoms”.

coronavirus victim burial in IndiaImage copyright GETTY IMAGES
Image caption More than 4,000 people have died of Covid-19 in India

If that is indeed true, then India’s fatality rate is bound to be lower. Atanu Biswas, a professor of statistics, says the predicted trajectory could change “with the huge inclusion of asymptomatic cases”. But, in the absence of data, India cannot be sure.

Also, epidemiologists say, measures like the doubling time of the infections and the reproduction number or R0 have their limitations. R0, or simply the R value, is a way of rating a disease’s ability to spread. The new coronavirus, Sars-CoV-2, has a reproduction number of about three, but estimates vary.

“These measures are good when we are in the middle of a pandemic, less robust with fewer cases. You do need forecasting models for at least a month’s projection to anticipate healthcare needs. We should always evaluate an aggregate of evidence, not just one measure, but a cascade of measures,” Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, told me.

Others say even calculating the number of recorded infections every day is “not always a good indicator of how an infection is spreading”.

A better option would be to look at the number of new tests and new cases every day that would provide a “degree of standardisation”, K Srinath Reddy, president of the Public Health Foundation of India, told me.

Likewise, he believes, a measure of how many Covid-19 deaths have occurred compared with the size of a country’s population – the numbers of deaths per million people – is a better indicator of the fatality rate. Reason: the denominator – the country’s population – remains stable.

In the absence of robust and expansive data, India appears to be struggling to predict the future trajectory of the infection.

It is not clear yet how many deaths are not being reported, although there is no evidence of large scale “hidden deaths”.

Coronavirus isolation ward in KolkataImage copyright GETTY IMAGES
Image caption A Covid-19 isolation ward in India

Epidemiologists say they would like to see clearer data on deaths due to pneumonia and influenza-like illnesses at this time over the past few years to quantify excess deaths and help with accurate reporting of Covid-19 deaths.

They would also like to see what racial disparities in infections and deaths there are to help improve containment in specific community areas. (In Louisiana, for example, African Americans accounted for 70% of Covid-19 deaths, while comprising 33% of the population.)

What is clear, say epidemiologists, is that India is as yet unable to get a grip on the extent of the spread of infection because of the still limited testing.

“We need reliable forecasting models with projection for the next few weeks for the country and the states,” says Dr Mukherjee.

Epidemiologists say India needs more testing and contact-tracing for both asymptomatic and symptomatic infections, as well as isolation and quarantine.

There’s also the need to test based on the “contact network” to stop super-spreader events – frontline workers, delivery workers, essential workers, practically anybody who interacts with a large group of people.

“We have to learn how to manage and minimise risk in our daily lives as the virus is going to be with us,” says Dr Mukherjee.

Without knowing the true number of infected cases India is, in the words of an epidemiologist, “flying blindfolded”.

That can seriously jeopardise India’s fight against the virus and hobble its response in reviving the broken economy.

Source: The BBC

17/05/2020

Lufthansa Cargo adds more flights to mainland China, ferrying urgent supplies to Europe

  • There has been strong demand for air freight services since April, when Chinese factories got back to work
  • Cargo flights have become critical in moving protective health equipment across the globe
Planes of German air carrier Lufthansa at the country’s largest airport in Frankfurt. Photo: Reuters
Planes of German air carrier Lufthansa at the country’s largest airport in Frankfurt. Photo: Reuters

German freight carrier Lufthansa Cargo is expanding in China, surpassing 100 weekly flights for the first time, and adding new flights to Shenzhen.

Peter Gerber, CEO of Europe’s largest cargo airline, said there had been heavy demand for its services, though this might cool by the peak of summer.

“At the moment, cargo demand is very, very strong,” he told the Post. “It started to get strong in April, when Chinese industries got back to work, and after that we have seen a constant, heavy demand, a real peak.”

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Global air freight capacity has been squeezed as two-thirds of the world’s aircraft have been grounded by the Covid-19 pandemic.
The collapse of air travel has practically put a stop to passenger flights, which typically carry half of all air cargo.

Since the pandemic, cargo flights have been critical in moving protective health equipment across the globe. From sending masks and other supplies to China in February, the German carrier is now taking urgent supplies from the mainland back to Europe.

Peter Gerber says Lufthansa Cargo has a high responsibility in maintaining supply chains, for both global health and world trade. Photo: Handout
Peter Gerber says Lufthansa Cargo has a high responsibility in maintaining supply chains, for both global health and world trade. Photo: Handout
“We have a high responsibility in maintaining supply chains in these unprecedented times for both global health and world trade,” Gerber said.

With the addition of Shenzhen, Lufthansa Cargo will fly to five destinations in China. It serves more than 300 destinations in 100 countries.

The cargo carrier is part of the Lufthansa Group and coordinates all the freight that goes into the passenger planes of its sibling brands, including Lufthansa, Swiss and Austrian.

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By next week, Lufthansa Cargo will be running more freight flights to China than the 72 passenger flights the group flew weekly before the pandemic to Beijing, Shanghai, Shenyang, Nanjing and Qingdao.

Lufthansa Cargo has a fleet of seven Boeing 777 Freighters (777Fs), with two new 777Fs arriving this year as part of its strategy to operate a fleet with a single aircraft type.

It also has six McDonnell Douglas-11Fs that Gerber said would still be retired as planned at the end of 2020, despite the extra demand for cargo capacity.

Its additional flights to China will make use of “preighters” – passenger aircraft flying cargo only. Gerber felt the trend of using empty passenger planes as “preighters” had peaked, pointing out that they cost the same to operate as freighters but carry only a fraction of the cargo.

Although he did not rule out future expansion, he said: “Demand will gradually come down in the next two or three months because a lot of equipment would have been shipped by then and some shipments will go on rail or ocean shipping.”

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He said some uncertainty remained over continued demand for airfreighted cargo, given the battered state of the world economy. Airlines would have to consider longer-term demand before deciding to invest more in cargo aircraft. “It depends how it looks beyond the next year,” he said.

Gerber said no decision had been taken yet on whether to convert some of the group’s orders for Boeing’s newest widebody 777X passenger aircraft into cargo planes.

He added that future plane orders would be balanced against the wider needs and spending decisions at Lufthansa Group, which is currently negotiating a government pandemic bailout package in the region of 9 billion (US$9.7 billion).

Source:SCMP

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