In the backdrop of COVID-19 pandemic, I made a sudden travel on 15th March 2020 from Glasgow (transiting through London Heathrow) to reach India on 16th morning (Chennai, then onto Trivandrum). Jim O'Neill, British economist and former Goldman Sachs chief economist, couple of days back said "Thank God coronavirus didn't start in India", taking a jibe at India's quality of governance system comparing with Chinese response. India's governance system has its share of complexities, I agree, but at least on the COVID-19 response front, though it is still very early days (fingers-crossed), my experience from first day (16th March 2020), suggests a contrary view or at least an attempt for making a contrary view true. I am penning down this post (from advisory self-isolation at home), because my first-hand observations, conversations and experiences revealed a striking difference in response to COVID-19 between India and UK. My aim is not to criticize or glorify one approach, rather just a presentation of facts I experienced (I might well be a minority on this). Given the management academic that I am, I am calling this the 5Ps approach of India's COVID-19 response.

Major disclaimer: I need to acknowledge that this is based predominantly on my experience from Trivandrum (capital of state of Kerala) and partly from the transit at Chennai airport (capital of state of Tamil Nadu). I don't know how generalizable this is to all parts of India, I hope it is same or atleast should aim to be.

1. Preparedness

There is a distinctive difference in the preparedness levels. In London and Glasgow airport, I just walked through with no specific health checks or clearances or contact tracing attempts. However, on the flight to India itself, I was given two copies of a self-declaration form, which asked for personal address and contact details, along side specific information like seat number on the flight, which are aimed at developing an efficient contact tracing database if any passenger on board is to show symptoms of the virus. The moment I landed in Chennai airport, even before immigration, there was a health clearance desk. It was super quick, just a quick temperatature check on the forehead and a seal each on the two copies of self-declaration forms (one retained with them for their record, another to be given at immigration counter). Moving on to immigration, there was a careful look at the visa stamps in the passport to check for travel history to majorly affected virus areas. Given I had no travel history to that end, it was straightforward. Also, at immigration, the details on the self-declaration form are digitised to help with quick contact tracing.

In Glasgow, all shops in the city and even airport shops were out-of-stock on hand sanitizers and face masks. Consequently, there was hardly anyone at airport wearing face masks. I thought London Heathrow, being the hub it is, would definitely have stock of it, but the shops I asked (ones where you would expect to find like Boots) where out-of-stock on it. A marginally higher proportion of people at Heathrow where using face masks or at least covering the nose and mouth using scarf/cloth. However, in Chennai airport, there was a sanitizer dispensing machine at various points in airport (one right at the arrival gate) with an automated instruction guiding its usage for 20 seconds. Face masks are also easily accessible, and all airport staff were wearing masks and hand gloves.

I thought this level of preparedness will be restricted to the international airport, given the largely "imported" nature of this virus. But, I was happy to be proved wrong, as the Chennai domestic airport seemed closely mirroring the health standards of the international one. Though I did not see any hand sanitizer dispensing machines with automated instructions at the domestic terminal, in front of most shops (especially the food ones), they had a bottle of hand sanitizer accessible to the customer next to the payment counter.

Upon reaching Trivandum domestic airport, given it was just a domestic flight from Chennai, I was expecting a walk-through. Well, no. There is a repeat of the same temperature test on the forehead at the arrival gate itself. The health staff were also consistently repeating the message to inform them of any international travel in last 14 days. Given, my international travel, I informed them, so I was directed to another health desk. Here, I was asked to fill out the same self-declaration form once more so that they have my details for contact tracing. It was then duly summarized in a larger written register (not digital). In the past week, the Kerala government had already made use of such data to create extensive contact tracing flowcharts which contained the transfer of virus in central Kerala.

Next, I was trying to get an airport taxi. Here again, the preparedeness surprised me. At the taxi counter, I was asked for contact details to be digitized for contact tracing. Casual chatting with the taxi driver on the ride, was a mini-health tutorial. Given the warm temperature (I was transitioning from 8 degrees in Glasgow to 32 degrees here), I asked the driver to turn on the A/C. He responded saying, airport drivers had a class yesterday from the state health team, and have been adviced to not turn on A/C, as heat is a natural killer of the virus. On the contrary, closed A/C environment, is likely to spread the virus if either of us cough/sneeze. On being curious about these classes from health team, he revealed details on the class content - washing hands in a comprehensive manner and not just the inner palms, clean seats after every passenger, use sanitizers after each ride, recommend to passengers (wherever possible) to use back seat to allow one metre distance.

2. Precaution

Though I hadn't travelled to any majorly affected virus areas, at immigration I was given the general advisory of self-isolation at home for 14 days (incubation period of the virus). Upon reaching home, on news I was told that, health staff are regularly contacting people who come from abroad during the 14 days period using the contact mobile number to check on their health condition. There is also easy availability of face masks at local shops in the city. In contrast, in UK, the press address from the PM last Thursday (12th March 2020) was sending quite a different message.

3. Public awareness

On every phone call I made after reaching India, as a caller tune, I got an automated health message about the COVID-19 precautions to take. This caller tune is not just on mobile phones, but also on landlines. These messages are conveyed in English and in different vernacular languages to ensure it reaches everyone. I thought this was a very powerful public awareness mechanism that gets repeated naturally within day-to-day life. I was also provided pamphlets on arrival at Trivandrum airport with contact numbers of relevant health staff and symptoms to watch-out for. In UK, except for the public address of the PM, one SMS from the NHS and some banners at airports, unless I went seeking for it, I saw little consistent communication strategy of public awareness building.

4. People attitude

Last Thursday, while shopping at Aldi, for the first time since being in UK, I saw all counters having very long queues and people stocking large volume of goods. This panic buying behaviour had called for supermarkets' rationing the purchase. In Trivandrum, however I see a different picture. There is explicit acknowledgement of the gravity of situation with people wearing masks and there are less people on the road. But there is definitely no hysteria, and run-on-the-supermarkets. People are definitely stocking slightly higher than normal for contingencies, but are being more rational.

5. Policy

As I was browsing through the newspaper cover pages (Scottish Sun, Sunday Times) I picked up at Glasgow Airport yesterday (March 15th) - the message was one of limited clarity or furthering panic behaviour (e.g., Queen being asked to move to quarantine). Switching to cover page of an Indian daily I picked up today (March 16th) morning at Chennai airport, the focus was on SAARC leaders discussing virus fightback and creation of a cross-country medical research platform.

Why I think there is this striking difference in the responses to COVID-19 between UK and India?

I am no expert on pandemics. But my sense is, the answer probably lies in the comparison of temporality to institutional responses and people's expectations of it. For a rule-based UK society, when exposed to major exogenous events like COVID-19, given the structured nature of rules and people’s expectations from it, it is likely to take a much longer time to adjust to a new-normal. In contrast, for an emerging market context like India, given the more fluid nature of its institutions, it is just another day at the office with a slightly higher chaos level. Hence, the institutional response to adjust to the new-normal is likely to take much lesser time.

Second, Indian government machinery and its people have recent institutional memory of successes in combating other epidemics such as SARS and Nipah virus. Given the prior experience, the health staff and government leadership, are better prepared to anticipate the needs and responses of handling another virus epidemic. For instance, in Kerala, it is the same health minister, Smt. K. K. Shailaja Teacher and her team, who were in the forefront of containing the Nipah virus epidemic couple of years back. So the moment initial reports of COVID-19 cases began to be reported from Wuhan, her team started preparations for contact tracing and other related actions.

Another social behaviour helping contain the spread of virus in India is its non-touch greeting styles like Namaste (folded hands) rather than shaking of hands. Such practices are natural social distancing mechanisms which ensures a healthier society.

I am sure we all will stay strong and recover from the pandemic soon. A big shout out to the health staff who are at the forefront of this battle across the world, thank you for your service.

#COVIDー19 #covid19UK #COVID19india

Stay Strong, Stay Healthy!!!

Catch IT! Bin IT! Kill IT!





Hoping for a quick move back to normalcy

Dr. Sreevas Sahasranamam