Post COVID-19: Challenges, Opportunities and Ethics of Care

The paper presented at the following conference:

“Post COVID-19: Challenges, Opportunities and Ethics of Care”

Two Day's National Webinar, 13 and 14 June 2020

Nirmala College, Department of Philosophy, Ranchi.

Organized By Dr. Ranju Kumari PhD

Post Covid-19: The Ethical Challenge of Care and Cure

Dr. Fr. Raju Felix Crasta  MA, PhD

Professor of Indian Philosophy, Specialized in Vedāntic Traditions

1. COVID-19: Origin Causes, Symptoms and Spread 

Corona Virus Disease 2019, known commonly as Covid-19 is a pandemic caused by a virus. It is classified under the Severe Acute Respiratory Syndrome (SARS) and named as Corona Virus Disease or SARS-CoV-2.[1] Its first outbreak was observed in Wuhan, China in December 2019. Therefore, it is also known as Wuhan Virus[2] among common people. When the person infected leaves germs around upon sneezing, coughing, or even when the infected body parts come in contact with the healthy person, place and things the disease gets spread. Globally, it is reported in more than 188 countries and territories resulting in over 406,000 deaths so far. The World Health Organization has declared the outbreak a Public Health Emergency of International Concern on 30th of January, 2020 and a pandemic on 11 March.[3]

The most common symptoms are fever, cough, fatigue, shortness of breath and loss of smell. There could be pneumonia and acute respiratory distress. Since the virus is new and no vaccine or medicine is being discovered so far, the only solution till the remedy is found is as the dictum goes, “Prevention is better than cure.’ The recommended preventive measures include a thorough sanitization of the parts most likely get infected. Hand washing, covering one’s mouth and nose while sneezing, maintaining a social distance from others, wearing a face mask in public places, monitoring and self-isolation of the suspected people, implementing travel restrictions, lockdowns, workplace hazard controls, facilities of closure, etc. Equally important is to break the viral chain. For this, navigating the places the infected person has moved, identifying possible people contacted and isolating (quarantine) the people for about two weeks are the effective measures to combat the virus. 

The pandemic has raised several ethical questions ever since it started spreading its tentacles. The questions in all the fields from medical to biomedical, social to political, human to ecological and philosophy and theology and so on. Here we deal with some concerns pertaining to the ethical domain. 

Ethics is basically concerned with human rights, and the most fundamental of these are right to life, health care, education and dignified social living. Therefore, we try to understand the challenges the Covid has brought at present and in the near future. This will be followed the concerning ethical issues that we come across. 

2. The COVID Challenge 

2.1 Dual Nature of Viruses 

The first and foremost challenge of any viruses, apart from the complications of invisibility to the naked eyes, come from their dual nature. They exhibit two kinds of behaviors: intra-cell and extra-cell. When the virus gets into a live cell, it acts swiftly and multiplies, while outside the cell remains dormant for quite some time. This is also a reason for the delay in the vaccine preparation. A patient, upon sneezing, coughing or talking emits thousands of germs and creates a hotspot around. Thus, the virus finds another body or surface and the atmosphere gets ready to multiply. Human beings have tendencies to regularly contact their mouth, eyes, ears, nose and scratch body parts and if the hands are infected by contact, then the person becomes a victim of the virus, often unintentionally. Depending on the immunity of the person, the virus may take three to fourteen days to surface onset of symptoms. 

2.2 Facts and Myths on Soaps and Sanitizers as Effective Barriers 

Ever since the pandemic broke out, the experts have suggested use of soaps and sanitizers as protective measures against the virus. However, soaps should be one’s first choice and then the sanitizers. The reason is, the virus has a peculiar protein which can melt the cell membrane and penetrate into the cytoplasm through a process called phagocytosis or adsorption. The soap molecules too have a dual nature called “amphiphiles”[4] wherein one side it attracts water and repel protein and fats, and the other side attracts protein and fat and repel water. In the process, the dirt or the unwanted thing is dissolved and removed. In the same way, the viral protein takes some time to get dissolved in soap molecule and therefore it is advised to wash the hand for 20 seconds. The alcohol present in the sanitizers often is less concentrated and therefore the effect is lesser. 

To make the thing worse, often we find spurious sanitizers at the exorbitant rates. There are various companies advertising their products as best sanitizers and soaps. The fact is any detergent cake or soap is sufficient and effective due to the nature of soap molecule. Therefore, one need not purchase a costly sanitizer or soap. 

2.3 Business and Travel 

The velocity at which the virus spread across the globe is a matter of great concern than the other viral and bacterial pandemics the world has faced. For example, Antonine Plague (165 AD), thought to be smallpox affected mostly in Asia Minor, Egypt, Greece and Italy. Justinian Plague also is known as Bubonic Plague that killed half of the European population of that time (541-542 Ad) affected the Byzantine Empire and Mediterranean port cities. The third Cholera pandemic affected mainly Asia, Europe, North America and Africa in the 19th century lasted from 1852 to 1860.[5] The fact of the matter is that the spread of the disease became pan-global due to the wide range of travel facility. Though the physical distance between places hasn’t decreased, the travel facilities have decreased the distance. Add to this, over the last two decades China is extending its business over every country. The highly developed countries are accommodating millions of people from developing countries. This mutual exchange, trade and travel have triggered the spread of the virus in lightning speed. 

It is not possible to totally avoid trade and travel, for it is the matter of sustenance. Obviously, people have to travel for various reasons: medical emergency, jobs, care and protection, for law and order and various other reasons. There is a danger in travel also. Therefore, the traveller has to take necessary precaution. 

2.4 The Chain Reaction 

This Covid-19 virus transmits via a person. The infected person emits virus through tiny water droplets in the atmosphere while sneezing and coughing. It remains in the atmosphere for a certain duration. When the person infected touches the places and things they again get contaminated. When a healthy person comes in contact with these, becomes the victim of the virus. To make things worse, it takes several days to exhibit the symptoms. Humans cannot but relate with fellow humans in society. The asymptomatic person might meet several persons and places during this period and potentially all those who come to contact with, one’s surroundings and places will be affected. And the chain continues, from one person to two or three and from them several hundred. Thus, identifying the probable contacts, places and isolating them is the greatest challenge for society. 

The severity should be understood from three stages. The first stage is the person infected from a known patient. The Second stage of spread is the person’s contact with the person and places the infected person travelled, where navigation is possible. But, the third stage is the most dangerous wherein one cannot trace the contact from where the person received the germs. Therefore, protective measures and effective quarantine are very much needed. This is indeed challenging to both public and people involved in care and law and order. 

2.5 The Social Set-up 

Humans are social beings and in particular, the Indian society is communitarian. They live together, relate each other closely as compared to the individualistic life in most developed countries. This is the reason the migrant workers in Kerala were eager to return to their homes in spite of the best care and protection the government and the local people offered.[6] If this the case of the migrant workers in Kerala, one can imagine the situation in those states where basic facilities are not given, but also treated them merely as means. Treating people as means is against the fundamental the right. Add to this, in the Indian context, isolating and treating without human dignity is nothing but imprisonment. Thus, the unprepared social distancing and quarantine lower public patience. The result is in front of us today. 

2.6. Literacy and Education 

Though directly literacy has nothing to do with the infection of virus, it serves as a great challenge to the spread of the disease. The States where the literacy rate is high like Kerala and Delhi the number of deaths reported from Covid is relatively lesser than those States having poor literacy rate. The fact of the matter is that there is a growing awareness among people about health, hygiene and other nitty-gritty of the situation among the literate people than those without it. Places like Kerala, the common people understand the gravity and themselves take initiative for social distancing and other precautions than the people of other states. 

Illiteracy leads to superstitious practices and unreasonable workouts. Many of Indian educated people are illiterates. Illiterates in the sense they cannot independently reason out and act. They act according to other’s directions. Such are educated illiterates. Illiteracy leads to Superstition and hero-worship which plays another major role in curbing the disease. In India, many have a herd mentality and follow the ideals of certain people. Though many are learned people, yet they are imprisoned by their psychological conditioning. This is the reason when the Prime Minister symbolically urged people to encourage the corona warriors with “tali and thali bajavo” (beating plates and claps) and light a candle in from their balconies, the people took it literally and entered into the streets as if it is a victory march of the king. Even many educated people do not understand the symbolic language and the direct language, and their intended meaning. Many began to propitiate ‘the corona māta’ (Corona Mother Deity) with puja and a solemn marches. This is not to downgrade religious pious practices, but the reality that we see amidst us. Equally, there were people who questioned the closure of religious and places of worship. If the religious places can be closed for two months why not for another two months? Religion by its definition ‘religare’ is ‘to bind,’ ‘to uphold’ (dhr in dharma in the Sanskrit language), to unite. It is to cater to the spirituality of people and not the economy. There are countries who were infected by this virus, and are able to arrest the spread at a phenomenal rate due to the effective measures they have taken. They rose above their religious practices, social culture and norms. If they can, why can’t we? 

2.7 Leadership 

A leader is the one who walks the talk, gives a vision and direction. An able leader does not hide one’s light under the bushel, rather is the light oneself. The leader motivates people. One of the greatest challenges in addressing a situation is the leadership. India does not lack able leaders, but what she lacks is ‘the right people at the right place.’ If this is missing then, whatsoever superior medical care and facility that may be available are as if not there. India can boast of superior medical research institutes, virology departments, scientific technology and medical experts. What we fail is the top leadership that directs them. The direction is not an extempore practice but should have been built over the years. When the real worth of the person and trade is not recognized, the product obtained will be of substandard. The salaries of teachers, medical experts and scientists should have been the highest after the President of the Country. Because it is they who build and direct the country. Sad to say, some of these people mentioned above not even get what the present ministers get as their medical allowance. Health, science and agriculture should have been our top priority with better incentives. Alas! We are a few centuries behind the development. 

2.8 Financial Situation 

The kind of leadership exhibited at the hierarchy decides the financial self-dependency (ātmanirbharata) of an institution. Financial well-being leads to prosperity and growth. Over the decade the GDP has dropped considerably. The self-sustaining units like home products, handlooms, small industries are being seen the doors shut. Increase in farmer suicides cases, loss of income-generating schemes have made the ordinary people look towards posh buildings and Industries in the towns. Over a few decades, we have witnessed a growing number of migrant workers in search of their daily bread. One could see their plight if one stands at any town square of major cities in the early hours of the day. The leadership has failed to address the situation. The result is the growing number of Covid cases even in the remote villages. Covid-19 born as a sickness of the elite, spread by affluent category and the poor are in death pangs. Only questions can be raised at this level. Once these people are back in their homes (many are back already), what would be their situation? How long will be this pandemic go on? Will there be an end? Where will the people earn their daily bread? Where will they find their shelter during the monsoon? More importantly, the lion part of India’s economy is supported by these daily wage earners. The lack of vision and the unplanned lockdown has only doubled the severity. When the worse has happened, the only way out is to bear with it. Still, as an optimist, I feel there is an idealistic hope: share the economy and bread of the rich with the poor; cut off all facilities of ministers and give it to the Corona warriors; stop new projects and use that money for village self-reliance and job creation. 

2.9 Health and hygiene 

The good news is that the immunity of Indians is far better than the most developed countries.[7] Yet they are vulnerable to such pandemics. It is due to the malnutrition the country is facing. There is an irony here. India has enough food in its barns than what actually need, yet people go hungry and are malnutrition. The mortality rate of hunger death is so much that it hardly becomes headlines in the media, for it has become a common feature. That which is common is seldom given heed. 

Comparing to other pandemics that India faced, the mortality rate of Covid-19 is very low. This should not make us happy, rather should be a great matter of concern. It will affect the whole economy and integrity of the country, if not checked. One step to avoid it in the longer run and simultaneously arrest untimely death due to various other reasons (death of farmers, deaths due to loss of job and industries, malnutrition, poverty, certain diseases, etc) is to boost the immunity. It can be done by providing good health care, setting up hospitals and dispensaries at strategic locations, encouraging farming and herbal medicine, etc. 

General behaviour of Indians is another hurdle like a mountain stands on the way: awareness of health and hygiene. People are so comfortable that even on the billboard written ‘do not spit’ will do exactly opposite over that is written. Government places are treated as one’s private washrooms, even by educated people. Will they do such things in countries like New Zealand, Belgium, Australia and places like Singapore? Though there is the penalty for such public indecency in India,[8] hardly they get punished except in one or two instances. There are cases where hardly action is being taken when health workers spat on their face,[9] if so, what will be the situation in general public? 

One might say that it is not possible to reach out to the extreme villages due to the fact of the geographical conditions and connectivity. Frankly speaking, was it the case during the general elections? Even villages where electricity and telephone was the distant dream, there were political parties with their vendetta: LCD monitors airing the speeches of their leaders, distributing pamphlets and seeking votes. How was this possible? Are the elections superior to the life of people? If there are people today, then only can be parties tomorrow. 

3. Post-Covid-19 Ethical Questions and Concerns of the People 

From the above-noted challenges of the Covid-19 we can deduce certain ethical concerns the people are undergoing at present and will continue in the near future. It is clear that whether people are affected by the disease or not, the world is in anxiety and fear. The frequent questions that come from the ordinary people are: “When will this epidemic end? How long are we to stay locked in? How safe are we? What is the future of our children? How do we survive if it continues another few months?” People are sad, frightened and angry. 

Obviously, when it is the question of survival and if there is no cure for a certain illness people get panic and many end up in depression and even suicide[10]. This has been the case for many people. Many have lost their job and also financial security. A research conducted by the Caritas India on the migrant workers in India during this epidemic showed that as much as 95.2 per cent have lost their means of livelihood. Among them, around 10.6 per cent have lost a family member in the pandemic.[11] Many workers have not received their wages for the work done. Many private institutions are facing a financial crisis due to the closure and are unable to pay their workers. 

The worst-hit areas are agriculture and education. Nonetheless, we cannot avoid talking on the consequences of reverse migration too. Both these are the backbone of the economy and development. The farmers who cultivate are not able to market their products and thus are not able to get money. Though the permission to carry the essential commodity is given, only limited vehicles are operating and are not reaching to every farmer. Some business people are making use of this situation to manipulate the poor. To add the worry, people are not ready to work in their fields for three reasons: a. Fear of getting viral infection and lockdown menace; b. no guarantee of receiving payment; c. Why work when the essential commodity is freely being distributed? 

If the agricultural sector is facing this trouble, the educational sector is still in a pathetic mode. 98.5% of world education sector is worst hit by the pandemic.[12] Schools, colleges and places of learning are shut. Private schools and colleges have another worry. Since the school is closed, some parents have the opinion of not paying the tuition fee, in spite of the virtual classes the teachers give. We need to understand the trouble teachers take to give those online classes. They have to learn the technology, get gadgets (already managing with meagre salary), struggle with electricity and internet and then deliver. But on the other hand, the behaviour of some parents is different. I have literally witnessed the scene the parents create at the school office during this lockdown for fee payment. Many studious children feel the fear of losing the academic year even. If this is the case with teachers, one can imagine the children. Parents already struggle with money during this period. Only a few people can afford to buy needed gadgets and internet connection. Recent news from Kerala is alarming, “Kerala Girl Climbs Rooftop For Better Connectivity To Attend Online Classes.”[13] Do we have better connectivity in villages? If the situation in Kerala is like this, what about in other states of the country? Only towns and urban areas can have fair connectivity. Thus there is tremendous anxiety and fear among the people. 

Now that the migrant workers are back to their homeland, what is their future? How long the government and organizations can feed? Already complaints are coming from the people. A certain farmer Ramesh Mahato tells me with tears that his farm produce is stolen overnight. There was a theft in another village another day. These are not for big amount, but to fulfil the most basic need, the food. One may say that the government is distributing free grains. The reality is, not all the needy get this benefit. There are primitive and most vulnerable people who do not have any official records like ration card, adhaar card or election Id. Among the migrants, many do not have any proofs in government records. Are they not the citizens of our country, our brothers and sisters? Therefore, it is not a surprise to see the increased number of theft, murder, suicide and other such incidents. 

4. Ethical Dilemma and the Philosophy of care 

One of the important dilemmas the Covid warriors faced in countries like Italy, UK and America is triage dilemma. Triage is “the process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care. Triage is done in emergency rooms, disasters, and wars when limited medical resources must be allocated to maximize the number of survivors.”[14] In other words, it is sorting the patients in three categories: those can survive without medical care, those will die even with medical care, and those will survive with care. India has not reached this stage, however, the kind of covid data is coming into the picture, cannot be taken lightly. 

From the ethical point of view, the right to life is a fundamental ethical value. This may be debatable in the cases of euthanasia, capital punishment and in such cases. One must accept, more so as Indians who are by nature spiritual, that there is ‘sanctity of life’, more so, of human life. It is the image and likeness of God, the essence of Brahman, tattvamasi. So, care for life should be the utmost need. But how do we care? If I am weaponless, how will I fight the war? 

This takes us to the question of our preparedness to fight the disease. Already there are a shortage of testing labs, protective measures and medical equipment. If a person is deeply religious, the doctrine would tell, ‘with all the mind, heart and soul protect the other.’ Covid is upsetting this dictum. Given the situation and with limited medical experts, the doctors and nurses have to protect themselves first before protecting the other. Secondly, whom are we going to save first: the elderly, children, vulnerable, youngsters or any other prominent people? This is the toughest choice a medical expert has to make in a given situation if there is a shortage of equipment, like ICUs, ventilators and serums. Imagine the trauma the medical experts will face at the moment when a person is dying and the doctor knowing what to be done is not able to save the person, precisely because there is no facility available. 

If the medical experts are facing such a crisis, the woes of the patients and their loved ones is deplorable. Any dying person would like to have their loved ones to bid the last farewell, to fulfil the last wish, and do the final rites suiting to one’s religious belief. According to the medical experts, half of the sickness gets cured maybe with the placebo effect, with sheer love and care poured in by the loved ones. Today Covid has threatened this kind of thinking. While the patients fear to contract the sickness to others, the visitors are more frightened of their own survival. Even to perform the last rites there is fear. 

There is another psychological dilemma between the patients and their parents or loved ones. Covid affects irrespective of age and gender. When a person is infected, say, a child is admitted in a Covid ward and not its parents or loved ones. They are kept in separate isolation places. Imagine the psychological condition or trauma between the parent and the child. If the child is an infant can/should we separate the mother with it? Separation may lead to more complications in the child, if not separated the healthy mother may be at the risk of getting positive or may be more vulnerable if has a very bad medical history. 

5. Undoing the Phobia and the Ethics of Care 

5.1 Acceptance 

One of the important aspects at this hour is to feel belonged. The experience that we have someone to care for, someone has a concern for us. Someone is loving us. Society should accept both the patients and the caretakers. Each one should make me feel the other at home. 

People need to accept the Covid warriors, especially the doctors and nurses with special care. I have a short advise to all the doctors and nurses treating Covid patients. Do not get dejected. Do not allow depression to ride on you. You are an important person. Ayurveda tells us, “vaidyo narayano hariḥ,” “Doctor is indeed God.” You are our saviours. If you show your sad face, how can the already frightened and depressed people overcome theirs? Whatsoever be the situation, even if you see people dying in front of you knowing what could have been done and yet not able to do (let this situation not reach India), do not worry. We are with you. Do what the present moment tells you. Follow your conscience. This is my message to all the Covid Warriors and health workers, accept people as they are in the present situation. Already they are under tremendous stress, fear and anxiety. Let us not overburden them. 

Here we need to pay attention to the formation of our conscience in India, because it has something to offer concretely. In India, we form our conscience largely on the basis of our rich religious, and in some cases, tribal heritage. This is an added advantage for us. Therefore, triage dilemma may not work in India. The need to understand the religious and tribal belief systems correctly is essential. Religion and culture have to be understood from its original meaning, ‘that which is good, valuable and that which builds the world, lokasangrahartha. The Mahopaniṣad refers to such a concept as ‘vasudaivaka kutumbakam,’ the whole world as a family. It says, “ayam nijaḥ, param veti, gaṇanām laghu cetasām. Udāra caritānām tu vasudaiva kutumbakam” “I am right and others are wrong to think those who are small-hearted. For the liberals, the whole world is their family.” The Bhagavadgita echoes with a similar tone and says that the one who accepts others, treats everyone and everything equanimously (samadarśina or samatabhāva) is a sthitaprajña, the person of steady wisdom. Jainism and Buddhism call such people as Arhant and Buddha respectively. The Gita says, “vidyā vinaya sampanne, brāhmaṇe gavi hasthini. śuni caiva śvapāke ca paṇḍitāḥ samadarśnaḥ” (5:18). This gives us a sense of distributive justice, equality, right to life, the right to love. If our scriptures are forming and endorsing this kind of conscience, why are we not promoting such ideals amongst us? Why should we do polity out of it? 

It is praiseworthy that many organizations came forward to assist the migrant workers to reach them home safe. But, every village and homeland did not accept them. Many shut their entry into the village, even after completion of self-isolation. So too was the case within many cured Covid patients. Kudos to those people who welcomed the cured with garlands and honour. We have also witnessed people thrashing and beating and chasing from the roads. Where will the people living in slums and footpath go? Where will the homeless go? They are rejected by the officials, rejected by the loved ones and rejected by the village. Therefore, the first and foremost priority of the citizens as of now should be accepting the person as they are. There may be few people taking advantage, let us overlook it. 

5.2 Plan, Safeguard and Guide 

Duties of health care leaders during a public health emergency should be to plan, to safeguard, and to guide. Every hospital and health care institutes should have a detailed guideline. There must be an ethical consultation service and committee to support clinicians, doctors, nurses who care the patients in different situations. So be prepared. 

The government should leave aside their political views and work for a common cause. Already, the Covid has taught us the significance of relationship and bonding both at the family level and at the social level. Some states are working together without a feeling of ruling or opposition party. Together can plan, draw policies, and work as a unit to build a safe India. 

COVID-19 caught us napping as regards our health infrastructure. India has one of the poorest health infrastructures in the world. Access to basic health care is still a distant dream in our country. We should have been prepared all the time for any health emergency like COVID-19. Why do we spend so much on arms and ammunitions and so little on hospitals and primary health care centres? 

5.3 Online Engagements 

Deviating mind is an effective method to get rid of fear, loneliness and depression. Direct the education institutes, organizations to conduct various programmes and courses to deviate the minds of tensed people. Encourage online learning. Give enough incentives to perform and participate in such an endeavor. Direct the telephone companies to increase the broadband speed and make it free till the covid gets under control. This will ease the burden of children and researchers. Encourage online marketing: of both buying and selling. Let the merchants who buy from the village farmers online be given an extra incentive. 

With regard to education, not all States are using the free DD channels for online education in so far as the State Board education is concerned. Yet, using DD channel for online teaching is accessible to most Indians. The drawback of online teaching in India today is that it is leaving out a large number of poor students. The classes like ZOOM, Google classrooms, etc. are reaching up to the privileged classes of our country only. The poor, back in the villages are still with old Nokia black and white mobiles are unaware of such technology. 

5.4 Equality in Times of the COVID-19 Pandemic 

The COVID-19 has affected all people alike. However, as we saw earlier, this sickness came from the rich. But why should the poor suffer when the rich are affected? Lockdowns have caused misery mainly to the poor and not to the rich. When the poor fall sick, there are no lockdowns. When the rich fall ill, the whole world is locked down. The poor have helped the rich and the society as a whole not to get infected by COVID-19. What have we given these poor people in return? Hence, the State and the rich people need to come to the aid of the poor during these times. This is the right time to bridge the gap between the poor and rich. 

Conclusion 

There is general feeling and may be right to a greater extent that this pandemic is a gift of the gory of the human relationship with the fellow humans and nature. Though it is traced back to Wuhan, somehow we are part of this social sin. Protection and care is the call for us today. Let me conclude along with Pope Francis who in his Laudato Si’ (Encyclical Letter On Care For Our Common Home, 24 May 2015), tells us. 

“Each organism, as a creature of God, is good and admirable in itself; the same is true of the harmonious ensemble of organisms existing in a defined space and functioning as a system. Although we are often not aware of it, we depend on these larger systems for our own existence. We need only recall how ecosystems interact in dispersing carbon dioxide, purifying water, controlling illnesses and epidemics, forming soil, breaking down waste, and in many other ways which we overlook or simply do not know about (no. 140). Doomsday predictions can no longer be met with irony or disdain. We may well be leaving to coming generations debris, desolation and filth. The pace of consumption, waste and environmental change has so stretched the planet’s capacity that our contemporary lifestyle, unsustainable as it is, can only precipitate catastrophes, such as those which even now periodically occur in different areas of the world. The effects of the present imbalance can only be reduced by our decisive action, here and now. We need to reflect on our accountability before those who will have to endure the dire consequences (no. 161). Obsession with a consumerist lifestyle, above all when few people are capable of maintaining it, can only lead to violence and mutual destruction (no. 204).” 

Stay Home, Stay Safe.

Notes and references
[1] “COVID‐19 breakthroughs: separating fact from fiction”, ”https://febs.onlinelibrary.wiley.com/doi/ epdf/10.1111/ febs.15442, doi https://doi.org/10.1111/febs.15442.
[2] human-to-human transmission of Wuhan virus outside of China, confirmed in Germany, Japan and Vietnam - The Online Citizen, Jan. 29, 2020.
[3] WHO Director-General's opening remarks at the media briefing on COVID-19—11 March 2020". World Health Organization. 11 March 2020.
[4] https://www.advisory.com/daily-briefing/2020/03/16/soap.
[5] For more details see, https://www.mphonline.org/worst-pandemics-in-history/?__cf_chl_captcha_tk__=c2b2ae 84262fa4e4b4cf4c5ccb70c15336105d2e-1591705986-0-Afqnq2kQ4d0uYT-hXMQHKmBNwgx5p1uMy ARDSRYyoaZeg77Pib7W8Cjwl4-9iZDbC60YMkBCGv3mnAcGaKhSYfUXKkDFQV3ZoRj6yX9TPbu5JFt6K 0pEVHzdDtrTh4GKWkiDBSUeWaQ6VGpksiRNCxxDeRQ0ReMjRpXNOUwGeYpMHRs-aBJz4OHAUes4l663YBn57y0pyLhg5HRWZL aq7OCWzAzrNRhWgMc1f6zx4VcfzhPf CMf6Ws8AHKsVD2CJx 2spmFC5kfkahgPwREsMdtONAId0wL-3EPLAch0OUpWA7jASxuk0YpALdaFgo5qTq JMqF3NXRk 3nVRnNWl XKYuQkPU3ihN4Oq5EXDmBZNzX4_GXNUX7gfeMxfclwUORCJwKsJSoYbni3VT-mICKr8Wia jqjJFzTp506LqoowxNqBYo-Do-nAiICak_M0dZPLoPd_HS2H82BontwE4-nhHQYrrJv4ZYBT 8IBzOJkyxZ9MFviTMC9ex0pAk3z53SUES_E1CeVqw_eVLyhS5eS29whfwlqbHgtWSa5KsFuleS7P2o Yb7JQ5DBkFYNkfHA5yWEd6XxEpJciChugprI1Uaag.
[6] “Amid lockdown, migrant workers a content lot in Kerala,” Economics Times. April 20, 2020. https://economictimes.indiatimes.com/news/politics-and-nation/amid-lockdown-migrant-workers-a-content-lot-in-kerala/articleshow/75243908.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst.
[7] Vibha Varshney, “COVID-19: Do Indians have higher immunity to novel coronavirus” DownToEarth. Also see, https://www.immunopaedia.org.za/breaking-news/indian-population-could-have-intrinsic-immunity-to-resist-covid-19-challenge/. https://www.downtoearth.org.in/news/health/covid-19-do-indians-have-higher-immunity-to-novel-coronavirus-70322.
[8] https://untobaccocontrol.org/kh/smokeless-tobacco/wp-content/uploads/sites/6/2017/08/factsheet_8.pdf.
[9] https://www.bbc.com/news/world-asia-india-52151141. https://www.ndtv.com/india-news/tamil-nadu-coronavirus-news-case-against-covid-19-patient-for-misbehaving-with-hospital-staff-in-tam-2210604.
[10] https://twitter.com/shetty_kc/status/1271158105158508545?s=08&fbclid=IwAR0jtVSSW1unq BOTM2BdidZma oTjRTcYmJe3YHJDxAhs1DwVzaqP34R_guY
[11] https://catholicmasses.org/caritas-india-lockdown-hits-income-of-80-of-migrants-small-farmers/.
[12] "COVID-19 Educational Disruption and Response". UNESCO. April 3, 2020.
[13] https://www.outlookindia.com/website/story/india-news-kerala-girl-climbs-rooftop-for-better-connectivity-to-attend-online-classes/354189.
[14] https://www.medicinenet.com/script/main/art.asp?articlekey=16736.