Reviving SAARC to deal with ChinaDeeper regional economic integration will help India01/07/2020

As India-China border tensions continue to fester, a hegemonic China, as part of its global expansionism, is chipping away at India’s interests in South Asia. This should be a major cause for concern for New Delhi. China’s proximity to Pakistan is well known. Nepal is moving closer to China for ideational and material reasons. China is wooing Bangladesh by offering tariff exemption for 97% of Bangladeshi products, and has intensified its ties with Sri Lanka through massive investments. According to a Brookings India study, most South Asian nations are now largely dependent on China for imports despite geographical proximity to India.

Reinvigorating SAARC

Several foreign policy experts argue that India’s strategic dealing with China has to begin with South Asia. In this regard, it is important to reinvigorate SAARC, which has been in the doldrums since 2014. In the last few years, due to increasing animosity with Pakistan, India’s political interest in SAARC dipped significantly. India has been trying hard to isolate Pakistan internationally for its role in promoting terrorism in India. However, as Professor S.D. Muni argues, Pakistan is not facing any isolation internationally. India started investing in other regional instruments, such as BIMSTEC, as an alternative to SAARC. However, BIMSTEC cannot replace SAARC for reasons such as lack of a common identity and history among all BIMSTEC members. Moreover, BIMSTEC’s focus is on the Bay of Bengal region, thus making it an inappropriate forum to engage all South Asian nations.

One way to infuse life in SAARC is to revive the process of South Asian economic integration. South Asia is one of the least integrated regions in the world with intra-regional trade teetering at barely 5% of total South Asian trade, compared to 25% of intra-regional trade in the ASEAN region. While South Asian countries have signed trade treaties, the lack of political will and trust deficit has prevented any meaningful movement. According to the World Bank, trade in South Asia stands at $23 billion of an estimated value of $67 billion. India should take the lead and work with its neighbours to slash the tariff and non-tariff barriers. There’s a need to resuscitate the negotiations on a SAARC investment treaty, pending since 2007. According to the UN Conference on Trade and Development, intra-ASEAN investments constitute around 19% of the total investments in the region. The SAARC region can likewise benefit from higher intra-SAARC investment flows. Deeper regional economic integration will create greater interdependence with India acquiring the central role, which, in turn, would serve India’s strategic interests too.

Domestic challenges

There are two major domestic challenges that India faces in revitalising SAARC. First, to reap political dividends at home, and for ideological reasons, there has been an unrelenting top-dressing of anti-Pakistan rhetoric and Islamophobia on the Indian soil. There’s also a recurrent use of the ‘Bangladeshi migrant’ rhetoric. Such majoritarian politics influences foreign policy in undesirable ways. It dents India’s soft power of being a liberal and secular democracy, which gives moral legitimacy to India’s leadership in the region. This divisive domestic politics fuels an anti-India sentiment in India’s neighbourhood.

Second, the economic vision of the Modi government remains convoluted. It’s unclear what the slogans of atma nirbharta (self-reliance) and ‘vocal for local’ mean. The government’s economic advisers contend that this does not mean autarky. On the other hand, the Prime Minister and his Ministers are stating that India needs to cut down its dependence on imports, thus signalling a return to the obsolete economic philosophy of import substitution. If this marks sliding back to protectionism, one is unsure if India will be interested in deepening South Asian economic integration.

Prime Minister Narendra Modi did well by reaching out to SAARC leaders earlier this year, but such flash-in-the-pan moments won’t help without sustained engagement.

Prabhash Ranjan is Senior Assistant Professor of Law, South Asian University, New Delhi. Views are personal

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Utilise MGNREGA to the fullest capacityThe scheme should not be diluted in the name of the Garib Kalyan Rojgar Abhiyaan01/07/2020

“The government must ensure the release of funds on an emergency basis.” MGNREGA workers in Viluppuram district of Tamil Nadu. B. Jothi Ramalingam

The role of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) as a lifeline for the working poor in rural India has been proved once again with the experience of the lockdown. In April and part of May, it was the absence of MGNREGA which accentuated rural distress. The Central government revised lockdown guidelines to allow MGNREGA work only from April 20, nearly a month after the nationwide lockdown was imposed, and released funds for it belatedly.

But once the money reached the States, the results are evident. Whereas the number of households who got work in April 2020 was the lowest in several years at 95 lakh, in May the number went up to 3.05 crore. Till the third week of June, 2.84 crore households had got work, much higher when compared to the same months last year. With an average 23 days of work and a daily wage of ₹200, households who got work earned an average of ₹1,500 a month. Even though this is meagre, it shows the potential of MGNREGA to bring work and relief, provided it is further expanded.

The Central government released ₹38,000 crore for MGNREGA work, of which 70% has already been utilised. With the return of migrant workers to their home States and with substantial numbers having completed the quarantine period, the demand for work is bound to increase. The remaining ₹8,000 crore fund available to the States is clearly insufficient. It is therefore essential for the Central government to release the second tranche without delay.

Work provided to few

Even in these months where there has been a welcome increase in workers who got work, it is extremely disturbing that as many as 1.82 crore workers who demanded work were turned back. According to figures available on the Ministry’s website, in this fiscal year, 8.07 crore workers demanded work, but work was provided only to 6.25 crore workers. Recently we heard the Prime Minister and the Uttar Pradesh Chief Minister hardsell the record of employment provision in the State claiming that one crore jobs had been provided in a single day. This is certainly a novel interpretation of statistics. What is the nature of the work? Are they permanent jobs? Are they one-day jobs such as work on MGNREGA sites can be? In U.P., over one crore workers had applied for work under MGNREGA, but more than one third of them were turned back.

Similarly in Bihar, which also has a large number of returning migrant workers, 12 lakh workers of the 41 lakh workers who applied were turned back. In spite of a legal provision of unemployment allowance not a single rupee in compensation has been paid. Now that the monsoons have set in, this issue becomes all the more relevant. During the rainy season even though demand is high, work provision is low. It is therefore essential for the Central government to ensure that States are provided with the funds to pay unemployment allowance to all workers demanding work.

In this context of the need to strengthen MGNREGA, the announcement of the Central government’s “new” scheme, the Garib Kalyan Rojgar Abhiyaan, to provide work to migrant workers in 116 selected districts, raises several questions. First, what is the criteria for selection? Why, for example, should the States of West Bengal and Chhattisgarh be omitted when reverse migration is particularly high in these States? Of the ₹4,794 crore spent between June 20 and June 28, Bihar received more than 50% of the fund. As noted earlier, Bihar has had a poor record of implementation of MGNREGA. The Bihar elections are scheduled for later this year. It will be a terrible travesty of justice if this scheme is designed to serve a narrow political purpose.

Second, according to the list of 25 kinds of work available under this “scheme” it is clear that almost every single one of them is already covered under the convergence programmes of MGNREGA. What is the new “skill mapping” required for this since this work is already covered under MGNREGA? The nature of the work is manual work, mainly construction and earth work, including work to lay cables, ostensibly to take Internet connections to rural areas. It is unstated but clear that this will benefit private telecom companies.

Most importantly, how will this new scheme impact the MGNREGA work in these selected districts? There is no clarity on this critical issue in the set of guidelines issued by the Ministry of Rural Development, the nodal Ministry for this scheme. Last year, under MGNREGA, in these 116 districts taken together, an average of just 43.7 workdays were created, which was lower than the national average of 50 days. This poor record of provision of work may have been one of the reasons for the higher rates of migration from these districts. Instead of new schemes why should MGNREGA not be expanded to give work to all workers? This is a legal right, whereas the Garib Kalyan Rojgar Abhiyaan has no such legal binding on the administration.

The scheme is primarily meant for migrant workers in those districts where their numbers are 25,000 or more. That means in these selected districts women who comprise a smaller percentage of migrant workers will be largely excluded. However, women in these districts had a high demand for work reflected in the fact that the average of women working in MGNREGA in these districts last year was 53.5%, which was higher than the average for the rest of India. So unless this work in 116 districts is in addition to MGNREGA, women will suffer.

Potential for MGNREGA

MGNREGA should not be diluted in the name of the Garib Kalyan Rojgar Abhiyaan. The potential for MGNREGA to provide relief to the suffering of rural India should be utilised to its fullest capacity. This will also require a removal of the restriction of only one person per household to make every individual eligible. The cap of 100 days should be removed to expand it to at least 200 days. Unemployment allowance should be guaranteed for all those turned away from work. And importantly, the government must ensure the release of funds on an emergency basis.

Brinda Karat is a member of the Communist Party of India (Marxist) Polit Bureau and a former Rajya Sabha MP

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Control, not deleteDespite privacy issues with many apps, linking them to national security concerns is puerile01/07/2020

Citing concerns to both data security and national sovereignty, the Indian government on June 29 announced it would block 59 widely used apps, most linked to Chinese companies. These include the popular video-sharing social networking app TikTok, a mobile browser called UC Browser, and a file-sharing app called SHAREit. What is common to all three is their wide user base in India, with each claiming more than 100 million monthly active users, and their origins in China. Explaining the ban, the Ministry of Electronics and Information Technology cited “the emergent nature of threats” posed by the apps and “information available” that they are engaged in activities “prejudicial to sovereignty and integrity of India, defence of India, security of state and public order”. The apps, according to the Ministry, had been reported for “stealing and surreptitiously transmitting users’ data in an unauthorized manner to servers which have locations outside India”, which “impinges upon the sovereignty and integrity of India”. From the perspective of data security and privacy, there is indeed a strong case to be made to more strictly regulate apps that handle vast amounts of user data. Such a move was surely long overdue.

But the government might have done the right thing for the wrong reasons. The timing of the move, coupled with the fact that it has chosen to block the apps outright, rather than ensure they were complying with the law, suggests the ban is less motivated by privacy concerns than about sending a message to China amid the tensions along the border. After all, privacy and data security concerns are not limited only to Chinese apps. Concerns about many of these apps are hardly new, and the move to block them comes after these apps had already amassed hundreds of millions of users in India. If sending a message about China is the motivation, the ban is more signalling than substance. It may help the government show the public it is taking China on, even if it will have no impact on deterring Chinese behaviour on the border, which will require a tough diplomatic and military response. The tensions on the border, as well as the COVID-19 pandemic, have ignited a much-needed debate on India’s economic dependencies on China. India remains reliant on Chinese products in several critical and strategically sensitive sectors, from semiconductors and active pharmaceutical ingredients to the telecom sector, where Chinese vendors are involved not only in India’s 4G network but in on-going 5G trials as well. India faces tough choices going forward in dealing with its deep economic embrace of China. Hitting the delete button on social media and gaming apps barely scratches the surface of the problem.

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In ending stand-off, magnanimity must prevailIndia’s border dispute with China calls for peaceful resolution, and has no place for moral outrage or military might01/07/2020

R. Sudarshan

AFPTAUSEEF MUSTAFA/AFP

India’s oft-quoted mantra when it comes to international relations has been vasudhaiva kutumbakam (the earth is our only family). It is not in India’s DNA, so to speak, to demonise any country in its neighbourhood, including China, South Asia and South East Asia, all the way to Indonesia; that is because of long-standing civilisational ties. When Prime Minister Narendra Modi spoke in Shanghai just five years ago, in 2015, he recounted to the Indian community living there how China’s President Xi Jinping took him to his native village in Xian province and showed him the book written by the seventh century Buddhist monk, Xuanzang, whose travels connected the birthplaces of both leaders. This was symbolic, he said of the bond between India and China in terms of aatmiata (soulful intimacy), nikatata (closeness) and bhaichaara (solidarity). There could not be more genuine and sincere affirmation of the spirit of friendship.

Keep a cool head

Presently, India is on the brink of regarding China as Enemy Number One. This has happened because of a bloody, hand-to-hand combat, without firearms, between Indian and Chinese soldiers in the Galwan Valley in Ladakh, which left 20 Indian soldiers dead and many more wounded. It may never be known how many Chinese soldiers died or were injured. These deaths on the frontier are a tragic break in an admirable record of avoiding casualties on both sides, despite face-offs on numerous occasions, along a long frontier between India and China. Both sides have accepted that the border between the two countries must be settled by agreement for the sake of peace.

China has refused to recognise the McMahon line and the demarcation of boundaries done by the British colonial power. Pending a final settlement of the boundary, India and China signed the Agreement on the Maintenance of Peace and Tranquillity along the Line of Actual Control in the India-China Border Areas, in 1993. Another similar agreement (Agreement on Confidence Building Measures in the Military Field along the Line of Actual Control in the India-China Border Areas), signed in 1996 contains a specific clause related to the use of firearms by both sides: “Neither side shall open fire, cause bio-degradation, use hazardous chemicals, conduct blast operations or hunt with guns or explosives within two kilometres from the Line of Actual Control. This prohibition shall not apply to routine firing activities in small arms firing ranges.”

Apparently, this provision was respected by both sides during the clash on June 15. Tragically, they fought much more barbarically, with nail-studded sticks, knives and stones, causing inhuman suffering. This incident threatens unofficial partition of territories that has stood the good test of time: Aksai Chin is claimed by India, but China, de facto, rules; China claims Arunachal Pradesh, but India, constitutionally, rules.

Will it ever be possible to resolve the boundary dispute, which is at the root of the conflict? And if so, how? The dispute cannot be resolved by going to war. No war has permanent winners. No losers can willingly accept defeat. The only way to resolve disputes, in post-nuclear times, is through negotiations, as equal powers, with mutual respect.

China’s record

During his visit to India in April 1960, China’s Foreign Minister Zhou Enlai made a proposal to settle the boundary dispute. It was rejected by Prime Minister Jawaharlal Nehru. In hindsight, history must record that as a lost opportunity which has had tragic consequences.

Today, China regards itself as a superpower in the making, which implies that negotiation will be condescending, tantamount to “my way or the highway”. The more China feels beleaguered, the more intransigent it is likely to be in negotiations to resolve the border dispute with India. China has flexed its muscle. It refused to recognise the authority of the Permanent Court of Arbitration (PCA), established under the United Nations Convention on the Law of the Sea (UNCLOS). The PCA rejected China’s legal claims. It ruled that China had breached its obligations under the Convention on the International Regulations for Preventing Collisions at Sea and Article 94 of UNCLOS concerning maritime safety, and that China violated international obligations. China has not paid any heed to international opinion that supports unimpeded commerce, freedom of navigation, overflights, and peaceful resolution of disputes in the South China Sea. The same hubris has made China more intolerant of infrastructure built by India, while it continues to build its own along that frontier.

Weighing in on the options

Should India counter China, tit for tat, by adopting a posture of aggression? Or should India redouble its diplomatic efforts to counter China’s intransigence with the support from Japan, Australia, the United States, Russia, and other countries, including those disputing China’s claims in the South China Sea?

What must matter to India is whatever is good for its people. Focusing on strengthening military might, when the economy is suffering and COVID-19 is taking its toll, will not be wise. Nor is it wise to call for a boycott of Chinese imports. Sanctions and boycotts are justifiable only when there is strong moral justification. Boycott of South Africa during the Apartheid period was justified and it served its purpose in hastening South Africa’s turn to equality and democratic governance. Arguably, there is moral justification for sanctions against Israel if it expands its illegal settlements in the West Bank and Palestine territories. Moral outrage has been triggered by actions of regimes in South Africa and Israel. But India’s border dispute with China calls for peaceful resolution, not moral outrage.

It is understandable, in the immediate aftermath of the sacrifice made by India’s soldiers, that nationalist ferment will come to fore. As has happened with other incidents when sovereignty seemed to have been transgressed, this one also will run its course. If India boycotts goods from China, it will hurt itself more and barely make a dent in China’s economic prospects. India is lauded as the pharmacy of the world because it is able to import essential raw materials from China. India’s sports goods exports are likewise dependent on imports from China. The world buys Chinese goods because their quality and price are compelling. It has been reported that Steve Jobs wanted to change the iPhone screen barely three days before its formal launch. China’s factory that assembled the phone for Apple mobilised its workforce to get the screens replaced in quick time. India should emulate China in its manufacturing practices and agility to adapt to international demand. There is little parity between India and China in trade terms; there is much more parity in military might, at present, compared to the 1960s.

The home watch

It is unfortunate that in many cities in India, people from the North-east, who have features resembling Chinese, have been ostracised. India must be on guard, in the aftermath of current tensions with China, not to unleash any kind of hostility against anyone, especially resident Chinese nationals. India must learn the hard lesson, which it did not in 1962, that warm and gushing expressions of friendship towards China will not stop hostilities; only pragmatic and shrewd diplomacy can do that. Oscillating to the opposite end and attacking China as the enemy is not wise.

R. Sudarshan is Dean of the School of Government and Public Policy, O.P. Jindal Global University, Sonipat, Haryana. Previously, he was a policy adviser for Governance and Justice in the United Nations Development Programme

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PCR testing is a double-edged swordIn order to avoid blind reliance on the result for COVID-19, clinical diagnosis by specific criteria should be popularised01/07/2020

K.R. DEEPAKK.R. DEEPAK

The government has allowed SARS-CoV-2 polymerase chain reaction (PCR) testing in many government and private laboratories. In January there was one laboratory (National Institute of Virology, Pune) but today there are 1,000. Test validity depends on laboratory quality. Mechanisms to ensure internal quality control and external quality assessment are urgently required.

The boon and bane of PCR testing are in its capacity to amplify even one viral gene segment in the sample to generate a detectable signal — a positive test; it is a boon because it accurately detects the presence of virus but a bane because it is prone to false negative and false positive results.

Follow protocol

When a laboratory handles several samples, cross-contamination must be avoided. During sample preparation for testing, if even one gene segment falls into the tube from the laboratory environment, it will be amplified and the test will be positive — but, false positive. It points to the lack of meticulous attention to protocol while processing samples, some with and others without the viral genes. A laboratory technician’s proficiency is integral to quality assurance. In reliable laboratories, a positive result means that the person whose sample was tested was indeed infected. For reliability, only laboratories under quality assurance should do testing.

Ensure quality

Here is an example. A conscientious professional in Vellore, Tamil Nadu, scrupulously practising personal protective procedures, had to get the mandatory PCR test to get an e-pass for an important meeting in a neighbouring city. The authorised laboratory for voluntary testing, a private laboratory in another town, sent a technician to his house to collect a nasopharyngeal swab. Two days later he gets a “positive for COVID-19” test report.

The laboratory informed the health authorities who wanted him admitted in a COVID-19 quarantine centre, despite pleas for home isolation. With great difficulty he bought time for two days to get admitted in a reputed hospital for two tests on consecutive days, in the hospital’s nationally accredited lab. You can imagine his personal anxiety and his family’s anguish, apart from the expenses incurred. Both tests were negative; he returned home, missed his meeting, and lost faith in the epidemic management system. Had he been admitted in a COVID-19 quarantine centre, he might have been exposed to infected persons, the story turning tragic for no fault of his.

The first test result was false positive, which should not occur in any quality-assured laboratory. The selection of private laboratories has not been careful. There have been newspaper reports recently of a private laboratory in Amritsar turning out four false positive PCR results in as many days. After selection, quality checks of laboratories have been found to be woefully inadequate.

We wonder how many laboratories produce similar false positive results. How many of reported positive tests in asymptomatic subjects nationwide are false positives? And how many lead to a misfortune similar to that experienced by the gentleman in Vellore? There is urgent need to ensure quality assurance from all laboratories testing for the coronavirus infection. Erring laboratories must be disqualified at least until quality assurance is certified.

A false negative PCR means that a person with infection was missed by the test, but that is in the very nature of PCR. The viral load is lower in the throat than in the nasopharynx. Hence throat swabs are falsely negative in 60% of tests and nasopharyngeal swabs in 30%, according to published studies. An incorrectly taken nasal swab may miss the virus altogether and lead to a false negative test.

The relatively high frequency of false negative results leads to gross underestimation of the epidemic’s magnitude. Moreover, traced contacts with false negative tests will not be quarantined but allowed to spread the virus, augmenting the epidemic.

Doctors should not be misled by false negative tests when COVID-19 is clinically diagnosed with specific criteria. The patient must be treated as COVID-19, and the PCR repeated. Globally, many patients with COVID-19 pneumonia who are PCR negative on the first swab have typical appearances of COVID-19 in a chest x-ray or CT scan. They turn PCR positive on repeat testing. Missing a diagnosis of COVID pneumonia just because of a negative PCR test is medical negligence.

Terms and differences

Contrary to the pervasive misconception that PCR alone diagnoses COVID-19, it detects only virus infection, not the disease. Most of the media report PCR positive persons incorrectly as cases. In medical parlance, case is “patient with disease”. PCR positive but asymptomatic subjects during contact tracing are infections, not cases.

False PCR results highlight that blind faith in the laboratory test misleads the government, underestimates the real extent of spread and, at the individual level, it is a recipe for personal tragedy.

When a false positive result is suspected, the doctor should alert the authorities, who in turn should get the subject re-tested in an accredited laboratory. In case of discrepancy, the laboratory concerned must be closed and checked for compliance with protocols and record-keeping.

In order to avoid blind reliance on the PCR test result, clinical diagnosis by specific criteria, which is the only way to diagnose COVID, (D for disease), should be popularised among doctors. Whether or not a confirmatory PCR test is done depends on circumstances. During the rural wave of the epidemic, doctors should be confident to diagnose COVID-19 even without a PCR. If we fail to implement these correctly, we are rendering disservice to unsuspecting society and its members.

M.S. Seshadri is retired Professor of Medical Endocrinology, Christian Medical College (CMC), Vellore and now Medical Director, Thirumalai Mission Hospital, Ranipet, Tamil Nadu. T. Jacob John is retired Professor of Clinical Virology, CMC, Vellore and past President of the Indian Academy of Pediatrics

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Separatist leader Geelani quits Hurriyat ConferenceAiling hardliner cites ‘current situation’ to exit the grouping30/06/2020

Crowd puller: A file photo of Syed Ali Geelani in Srinagar.

Hurriyat chairman Syed Ali Geelani, 90, on Monday decided to quit the conglomerate, without divulging his future course of action.

“I have decided to distance myself from the Hurriyat given the current situation [in the amalgamate],” an ailing Mr. Geelani said in an audio message. He said all the constituents of his faction of the Hurriyat had been informed, in a detailed letter, about the decision.

Mostly under house arrest since 2013 at his Srinagar residence, Mr. Geelani, a crowd-puller, was associated with the Jamaat-e-Islami but left it to float his own political organisation, the Tehreek-e-Hurriyat. He also split from the Mirwaiz Umar Farooq faction of the Hurriyat over the approaches adopted to resolve the Kashmir problem.

Mr. Geelani, known for his hardline ideology, advocated accession of J&K to Pakistan.

He, however, did not clarify if he had resigned from the Tehreek-e-Hurriyat.

In the past two years, his health had deteriorated significantly, a family member said. “No one outside the family is allowed to see him.”

Sources said Mr. Geelani’s resignation was due to the internal feud in the Hurriyat. It is likely to pave the way for a new leadership in the Hurriyat, which faced a massive clampdown in the run-up to the abrogation of J&K’s special status last year. Mr. Geelani had opposed the move and asked the Centre to work on a political resolution through dialogue with the Hurriyat and Pakistan.

BJP national general secretary Ram Madhav also tweeted about Mr. Geelani’s resignation.

BJP leader Aijaz Hussian said, “Other Hurriyat leaders should call it a day and realise their mistakes. India is the only way forward for all those who believed otherwise”.

Senior party leader Avinash Rai Khana described the resignation of Mr. Geelani as “a biggest benefit of the removal of Article 370”.

There has been no reaction from the other constituents of the Hurriyat.

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KausalyaThe woman who livedThe anti-caste activist vows to continue the legal battle against her parents28/06/2020

March 13, 2016. It was a lazy Sunday afternoon, until a CCTV footage of an unknown couple hacked by mercenaries in broad daylight in the town of Udumalpet in Tiruppur district started to make the rounds. Soon, it would emerge as a spine-chilling case of “honour” killing carried out by the family of a Caste Hindu girl for marrying a Dalit man. The victims Shankar, and his wife of 10 months, Kausalya, were in a pool of blood. While Shankar died on the spot, Ms. Kausalya survived. Udumalpet killing would become the first case from Tamil Nadu to make it to the National Crime Records Bureau’s crime listed as an ‘honour’ killing that year.

In December 2017, a Tiruppur sessions Court handed down a landmark judgement that came down on the blight of murder in the name of honour by sentencing the main accused Chinnasamy, father of Ms. Kausalya, along with five others to death. Two others were given double life terms and a five-year term, respectively. Ms. Kausalya’s mother Annalakshmi and three others were acquitted.

However, on June 22, the Madras High Court overturned the sessions court verdict and acquitted Chinnasamy and two others. The death sentences of the hired killers was commuted to 25 years in jail. The High Court had faulted the Prosecution for failing to prove conspiracy.

Ms. Kausalya, from the Thevar community, had met Shankar when they were in college. Their friendship blossomed into love by the time Shankar was in final year. When her family got wind of their friendship, they prepared to marry her off, forcing the couple to elope in 2015. The tranquillity of her 10-month-long marriage to Shankar was punctuated by kidnap attempts, threats, unsolicited visits by her family members and culminating in the killing of Shankar in March 2016. That summer Sunday afternoon, Ms. Kausalya had taken Shankar to the store to buy him a shirt for his college annual day the following day.

In the earliest testimony in 2016, Ms. Kausalya recorded the rabid caste pride that ran in her family. Her mother’s first query was, “what was his caste?” and “how it was blasphemous to bear the seed of a Dalit man”. In the four years since, from a victim of a caste-hate killing, Ms. Kausalya reinvented herself into an activist pledged to subvert caste supremacy. She founded a foundation in Shankar’s name to teach neighbourhood children, read up on Ambedkar and Periyar, gave speeches, learnt the art form of parai, once condemned a profane art form; found love and married a parai artist, incidentally a caste Hindu, in a self-respect ceremony.

Vile criticism

This last act of hers subjected her to vile criticism. Of this, she would ask, “how was this patriarchy different from the caste Hindu patriarchy that dictated who I should marry? It was something as basic as wanting someone to care for you, when you’re sick.” On June 22 morning, Ms. Kausalya had called Shankar’s father Velusamy, whom she calls Appa (father), and sobbed over the phone over the High Court’s acquittal of her father Chinnasamy. The verdict also increased her resolve to make it her life’s mission to secure justice for Shankar.

After Monday's verdict that exonerated the family's role in the killing, A. Kathir, executive director at Evidence, an organisation that works with victims of caste-hate crimes, who had led Ms. Kausalya’s legal fight, remembers late Justice Krishna Iyer's observations on the guiding principle of courts in rendering justice. “Krishna Iyer said court has a conscience and it will always know the facts. In some cases, victims will have a disadvantage, and the accused an advantage. But the courts will have to prod through that advantage enjoyed by the accused and walk that extra mile to mitigate the disadvantage of the victim to consciously render justice.”

“I haven’t fought for any case like this. There are Thevar Facebook pages that crowdsourced funds for the accused,” said Mr. Kathir, who had a bounty on his head in Usilampatti after the sessions court verdict in 2017. While the High Court said the prosecution could not prove conspiracy, the question flagged by Ms. Kausalya and Mr. Kathir was what was the motive for the hired killers to kill. “I will continue to fight till Shankar gets justice,” Ms. Kausalya said after the verdict.

Why is there a stress on randomised controlled trials?What due process must be followed in the appraisal of any drug, especially those for COVID-19?28/06/2020

The story so far: On June 23, the claim by Patanjali Ayurved [Haridwar, Uttarakhand] that its preparations, ‘Coronil’ and ‘Swasari’, would cure COVID-19 in only seven days, was met with robust disbelief in some quarters, even as it hogged media space soon after the announcement. Ramdev, the yoga guru, and who is associated with the company, claimed that a randomised controlled trial (RCT) among COVID-19 positive patients had proved favourable results. The government, through the Ministry of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) responding a short while later, told the company to stop advertising the drug as a cure for COVID-19, pointing out that it would attract provisions of Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954

What has the government said?

The Ministry, in a statement (https://bit.ly/2Zgbfco), said the details of the study were not known to it and it has asked Patanjali Ayurved “to provide at the earliest details of the name and composition of the medicines being claimed for COVID treatment; site(s)/hospital(s), where the research study was conducted for COVID-19; protocol, sample size, Institutional Ethics Committee clearance, CTRI registration and results data of the study (ies) and stop advertising/publicizing such claims till the issue is duly examined”. The Ministry has also “requested the State Licensing Authority of the Uttarakhand government to provide copies of the licence and product approval details of the Ayurvedic medicines being claimed for the treatment of COVID-19”.

It is learnt from media reports on the yet-to-be published RCT conducted on behalf of the company, that 100 patients who had tested positive were given the medicine (five dropped out midway). The clinical trial tested the drug on 45 people and another 50 were given a placebo. The claim was that 69% (31 persons) of those on the drug tested negative on the third day, and 25 of those on the placebo arm of the trial had also tested negative.

What is the place of RCTs place in clinical trials?

As per definition, a randomised controlled trial, or RCT, is a study in which people are allocated at random, entirely by chance, to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be standard practice/treatment options, a placebo (a drug without an active substance, or a ‘sugar pill’), or no intervention at all. The idea is to measure and compare the outcomes against the control after the participants receive the treatment.

Prof. Madhukar Pai, director, McGill Global Health Programs, McGill University, Canada, teaching an online course on epidemiology for journalists with Suno India portal, explains that RCTs are based on multiple factors, including type of interventions being evaluated, and number of participants. In single-blind trials, the participants, or the investigators do not know who is assigned what; in double-blind trials, both participants and investigators do not know; and triple and quadruple-blind trials, where three or four of the relevant groups are not aware of the treatment assignment.

Is an RCT a good tool to employ during the throes of an epidemic? Why do we need RCTs?

“No other design can get us close to the ‘counterfactual’ comparison we need to see if an intervention is causally linked to a particular outcome,” says Prof. Pai.

Nancy Cartwright, writing in one of the Springer journals, in October 2009 (https://rdcu.be/b5hbx), argues that RCTs are widely taken as the gold standard for establishing causal conclusions.

S.P. Kalantri, professor of medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, answers this question with a resounding yes. He says, “We need studies that get data that we can trust.” This means, clear and robust evidence about benefits and risks. A good RCT (for COVID-19) should enrol enough numbers, define clinical endpoints, including mortality and morbidity, also whether intubation was needed and days of stay in hospital. He adds: The hurry, hype and marketing for drugs (Ayurveda and Favipiravir) even before results were published were ‘just not science’.

“The priority is to have safe, efficacious drugs that can be used in the real world setting,” he explains. “We get the best evidence from an RCT, while other strategies have huge limitations. The problem with simple descriptive studies, for instance, is that there are no comparisons.”

In well-designed RCTs, researchers, after random assignment of participants, assess whether randomisation was done sufficiently to eliminate the influence of confounding factors, and avoid selection bias. Researchers follow the groups over days, weeks, years and observe major clinical end points. In the end, all other things being equal, it will be possible to measure what benefit a particular group X got, in comparison to Y group. It is possible to estimate if there were any differences between the two groups, say, in mortality, and if this was because of strategic effect of the cause, or due to pure chance. RCTs remove the impact of chance in cause and effect relationships, says Dr. Kalantri.

But ethically, an RCT can only be employed when researchers think/hope that the interventions will offer benefits. Participants can be enrolled in a randomised controlled trial that is expected to leave them better off. The dexamethasone study where mortality was reduced by a third, is a classic example here.

The Solidarity and RECOVERY (or Randomised Evaluation of COVid-19 thERapY) trials are examples of large-scale RCTs done with multiple partners at many locations, bang in the middle of an epidemic. They have already been instrumental in setting the standard of care — for instance, hydroxychloroquine was hyped up as a drug but studies conclusively proved no ameliorative effect in using it. The Remdesivir study, on the other hand, showed some improvement in reducing intensive care unit stay, while there was no great impact on mortality, says Dr. Kalantri.

What is the future?

Strident science should be the basis of any interventions in therapeutics or vaccinology, experts emphasise. The over 200 projects in the pipeline, listed in the Clinical Trials Registry of India, might produce results over time, but as in the case of Patanjali Ayurved, the regulator’s immediate and scientific response to unpublished claims will be essential, they urge.

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How will the U.S. visa ban impact India?Why was the White House proclamation made? Will the Trump administration’s move affect the IT services industry adversely?28/06/2020

The story so far: On June 22, the White House made a proclamation halting the processing and issuance of non-immigrant work visas of several types, with the stated aim of this sweeping policy being to stop foreign workers snagging American jobs, especially at a time of deep economic distress brought on by the COVID-19 pandemic. The order by the Donald Trump administration includes the H-1B visa for skilled workers, a large proportion of which goes to Indian nationals, dependents of the H-1B who are seeking the H4 visa, the H-2B visa issued to seasonal workers in the landscaping and hospitality industries, the L-1 visa for intra-company transfers and their dependents on the L-2 visa, and the J-1 visa for students on work-study summer programmes and related occupations. The important questions on this latest policy shift by Mr. Trump on immigration relate to whether it will muddy the waters of the U.S.-India relationship by adversely impacting Indian IT services exported to the U.S., and whether it has the potential to shore up the flagging U.S. economy and open up more jobs for U.S. persons, or whether it will fail in that goal and yet yield dividends in terms of campaign strategy for the U.S. presidential election on November 3, 2020.

Why is the Trump administration tightening the screws on its immigration policy?

It had earlier instituted a ban on visitors from certain Muslim-majority countries and periodically engaged in rhetoric on building a wall to stop undocumented workers from entering the U.S. from across its southern border. On April 21, the White House announced a 60-day halt in legal migration — effectively a ban on “green card” issuance. The gaping hole in this policy was the fact that the number of jobs purportedly saved from immigrants for U.S. persons was relatively small compared to the number of jobs going to foreign nationals who enter the U.S. on non-immigrant visas. Unemployment claims filed since the novel coronavirus pandemic hit the U.S. economy in March have crossed 40 million. Analysts argued that out of the million or so green cards that the U.S. issues annually, approximately only 358,000 would likely be impacted by the pause in immigration processing.

It appears that the Trump administration has been seized of this fallacy in its immigration policy in this regard, and the proclamation of June 22 is likely to have been a remedial measure to bring non-immigrant work visas under the purview of the ban. The reasoning offered by the White House is that the ongoing COVID-19 pandemic has “significantly disrupted Americans’ livelihoods”, to the extent that the overall unemployment rate in the country nearly quadrupled between February and May 2020 to a little over 13%.

To what extent is the motive behind the visa ban political?

Despite the stated reasoning for the work visa ban, which is to protect U.S. persons from loss of livelihoods to foreign nationals, it is still unclear that tangible economic benefits of this sort can be achieved at this juncture. The reason is that the latest restrictions do not apply to visa-holders who are already within the U.S., or those who are outside the country and have already been issued valid visas. Given that the ban will remain in force until the end of the 2020 calendar year, this implies that U.S. firms or others with U.S. operations who rely on skilled foreign nationals working in the U.S. will be unable to make new hires as long as the ban stands. How many firms are likely to do any hiring at this economically depressed time? How many will do so before the end of the calendar year? If we assume, as we safely can, that the answer is “negligibly few”, then it is hard to see the Trump White House’s policy as anything other than a campaign tactic.

What further policies do we expect on the \visa ban?

If indeed these moves have been made keeping in mind the imperatives of the 2020 Republican presidential campaign, then that would be signalled by Mr. Trump seeking, in the months ahead, to build political capital in the name of the “America First” mantra — a foregone conclusion given his outspokenness on the subject to date.

The proclamation supplies hints on the likely tenor of this policy plank of Mr. Trump’s administration. It noted that between February and April of 2020, “more than 20 million U.S. workers lost their jobs in key industries where employers are currently requesting H-1B and L workers to fill positions”, noting that similar or higher numbers could be found in the other visa categories included in the proclamation.

Yet, in the first instance, it is not his Democratic rival in the election, former Vice-President Joe Biden, who will play spoiler to Mr. Trump’s visa ban plans. It is the backlash from America Inc., the employers of likely millions of non-immigrant foreign workers, from Wall Street to Silicon Valley, that could bring his dreams crashing to the ground, and fast.

Google CEO Sundar Pichai wasted little time in responding to Mr. Trump’s latest visa proclamation tweeting, “Immigration has contributed immensely to America’s economic success, making it a global leader in tech, and also Google the company it is today. Disappointed by today’s proclamation — we’ll continue to stand with immigrants and work to expand opportunity for all.”

Elon Musk, SpaceX founder and Tesla CEO, and Apple CEO Tim Cook, posted similar messages on social media.

As more captains of industry chime in, the momentum of lobbying behind closed doors, and lawsuits filed by civil liberties groups, to either get the ban revoked or to strengthen Mr. Biden’s hand will likely build up fast. Corporate America, already hit by the economic downturn since the pandemic struck, can hardly afford to accept even more losses as the President undermines the base of their work force.

Will Indian corporations be hit?

The prospects of Indian IT majors building up their order books as they limp back through an economic recovery in India are, in the interim, likely to be seriously undermined by this move. What is more, this may come at a crucial inflection point for the Indian economy, even as restrictions on the movement of people and goods slowly lift after India passes its peak viral case numbers, thus leading to a knock-on effect from IT to other sectors.

India’s IT services exports to the U.S., which depend significantly on the H-1B visa, have been an important constituent element of bilateral economic trade. U.S. imports of services from India were an estimated $29.6 billion in 2018, 4.9% more than in 2017, and 134% greater than 2008 levels, according to the U.S. Trade Representative. The major services exports from India to the U.S. are in the telecommunications, computer and information services, research and development, and travel sectors.

Until now, the U.S. issued 85,000 H-1B visas annually, of which 20,000 went to graduate students and 65,000 to private sector applicants, and Indian nationals would garner approximately 70% of these. Now the Migration Policy Institute has been cited predicting that up to 219,000 workers would be blocked as a result of Mr. Trump’s proclamation.

What is the Indian government saying?

Its response has so far been muted, limited to highlighting the importance of highly-skilled Indian professionals to imparting a competitive edge to the U.S. economy.

Nevertheless, that the high-skilled non-immigrant visa ban is a double-edged sword is amply demonstrated by the fact that the unemployment rate in the “Professional and Business Services” super-sector, which includes IT services, unemployment actually dropped between April and May 2020, and there remained almost 950,000 job openings in this sector nationwide despite the sharp hike in overall unemployment filings.

If there is one assumption of the Trump administration’s immigration policies that is most likely to fail, it is that there are sufficient numbers of U.S. persons with the requisite skill set to perform the jobs that Mr. Trump is “protecting” for them.

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1921 and the Malabar RebellionWhy is there a controversy in Kerala over a new film project on the protagonist of an uprising against the British?28/06/2020

The story so far: Malayalam film director Aashiq Abu, on June 22, announced a new film project, ‘Variyamkunnan’, on Variyamkunnath Kunhamed Haji, the main protagonist of the Malabar Rebellion of 1921 who was executed by the British. Soon, three more directors, Ibrahim Vengara, P.T. Kunju Muhammed and Ali Akbar, announced their own films on the same historic figure. The announcement of Abu, a Left supporter, sparked a controversy, with Sangh Parivar outfits calling on actor Prithviraj Sukumaran, who is playing the role of Haji, not to accept the role in the film, ‘Variyamkunnan’. Akbar, a supporter of the Sangh Parivar, has declared that he will portray the ‘real face’ of the rebellion. A historical event that occurred a century ago suddenly seems to have acquired contemporary relevance.

Why has Aashiq Abu’s film project announcement led to protests?

Unlike in 1988 when the late I.V. Sasi directed ‘1921’, a Malayalam movie based on the rebellion, political and communal polarisation in Kerala today has led to protests on social media. Amid criticism of Sangh Parivar leaders and attacks in the social media, Prithviraj wrote on his Facebook page that Haji “stood up against an empire that ruled a quarter of the world”. The Hindu Aikya Vedi announced a year-long campaign to counter attempts to “glorify” Haji and other leaders who it said were responsible for atrocities against Hindus in southern parts of the erstwhile Malabar district of Kerala.

Why does the rebellion still stoke passions?

The Malabar Rebellion (also called the Mappila or Moplah Rebellion by the British) broke out in the southern taluks of Malabar in August 1921. By the time the government troops captured Haji in January 1922, the rebellion had fizzled out. It largely took the shape of guerrilla-type attacks on janmis (feudal landlords, who were mostly upper caste Hindus) and the police and troops.

Mappilas had been among the victims of oppressive agrarian relations protected by the British. But the political mobilisation of Muslims in the region in the aftermath of the launch of the Khilafat agitation and Gandhi’s non-cooperation struggle served as an opportunity for an extremist section to invoke a religious idiom to express their suffering, while working for a change in the oppressive system of administration. There were excesses on both sides — rebels and government troops. Incidents of murder, looting and forced conversion led many to discredit the uprising as a manifestation of religious bigotry. Moderate Khilafat leaders lamented that the rebellion had alienated the Hindu sympathy.

How did Kunhamed Haji emerge as the leader?

Haji, who was one of the three most important rebel leaders, was the face of the rebellion. British officers viewed him as the “most murderous”. Born in 1866 in a family with relatives involved in one of the Mappila “outbreaks” or “outrages” in the 19th century, he was familiar with the commemoration of shaheeds (martyrs) who fought against the tyranny of landlords and their helpers, mostly upper caste Hindus in the region. There were several such outbreaks in the region during the 19th and early 20th centuries. The main actors of the outbreaks were individuals on suicide missions. The Khilafat movement launched in 1919 provided a fresh stimulus to the grievances of Mappilas. Now their sense of local injustice was sought to be linked with the pan-Islamic sentiments created in the aftermath of the collapse of the Ottoman Empire that rendered the Ottoman caliphate irrelevant. Haji was among those in the Malabar region inspired by the zeal of the agitation. During the rebellion, he led many attacks on individuals, including Muslims, who had been loyal to the British. Some contemporary accounts, however, deny that he favoured conversion of Hindus.

What was the impact of the protests?

The rebellion of Mappilas inspired by religious ideology and a conception of an alternative system of administration — a Khilafat government — dealt a blow to the nationalist movement in Malabar. The fanaticism of rebels, foregrounded by the British, fostered communal rift and enmity towards the Congress.

The exaggerated accounts of the rebellion engendered a counter campaign in other parts of the country against ‘fanaticism’ of Muslims. That said, the traumatic experience of the uprising also persuaded educated sections of the Muslim community in Malabar to chalk out ways to save the community from what they saw as a pathetic situation. The community’s stagnation was attributed to religious orthodoxy and ignorance. The thrust of the post-rebellion Muslim reform movement in Malabar was a rigorous campaign against orthodoxy.

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To wear or not to wear a mask: a public health message disaster28/06/2020

Vital: Measures to cut the spread even minimally should have been encouraged.Getty ImagesArtistGNDphotography

If there is a single message delivered by leading institutions that can be considered as a disaster in public health messaging especially during a pandemic, then it is the advice to people not to wear a face mask. Especially during a pandemic, any non-pharmaceutical measure that cuts the transmission risk even by only a small percentage should have still been encouraged.

If acute shortage of masks for healthcare workers was the reason why the U.S. Surgeon General did not want the public to use a mask, the lack of community spread in the U.S. prompted the Centre for Disease Control (CDC) to discourage people from wearing it. For the World Health Organization, it was the lack of scientific evidence that masks can prevent coronavirus spread which prompted it to dissuade people from wearing a mask.

Messages urging people not to wear a mask started in early February when the CDC Director Robert R. Redfield in a tweet on February 5 said: “CDC does not currently recommend the use of face-masks to help prevent novel coronavirus. 2019nCoV is not spreading in communities in the US...”

CDC and WHO

On February 28, CDC tweeted: “CDC does not currently recommend the use of face-masks to help prevent novel coronavirus.

Take everyday preventive actions… to help slow the spread of illness.”

On February 29, the very next day after CDC’s tweet, the U.S. Surgeon General Dr. Jerome Adams weighed in on the issue. His message was largely unhelpful. He tweeted: “Seriously people – stop buying masks! They are not effective in preventing general public from catching coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!”

In its interim guidelines, the WHO had on January 29 stated that in community settings, a “medical mask is not required by individuals without respiratory symptoms as no evidence is available on its usefulness to protect non-sick persons”.

In the guidelines updated on April 6, the WHO continued to discourage people from wearing a face mask. It was only as recently as June 5 that the WHO reversed its position saying masks protect individuals from coronavirus infection.

Unscientific approach

A paper published on June 11 in the Proceedings of the National Academy of Sciences (PNAS) tried to overcompensate by espousing the goodness of mask wearing through a completely unscientific approach. While the world media amplified the advantages of wearing a mask as projected by the paper, scientists were tearing up the study. Now, 35 scientists have written to the journal demanding the paper to be retracted.

The study had supposedly analysed the effects of mitigation measures in Wuhan, Italy and New York City. Besides a few factually wrong data and assumptions used to support their work, the paper has “serious methodological errors”. From the fact that Italy made face-mask compulsory on April 6 and New York City on April 17, the authors conclude that it reduced the number of cases by over 78,000 between April 6 and May 9 in Italy and over 66,000 in New York City from April 17 to May 9.

Call for retraction

The scientists calling for the retraction say that the authors have not factored in the “lag between changes in disease transmission and changes in reported case counts”. With the incubation period lasting for five-seven days, and at times up to 14 days, and another five to 10 days for symptoms to show up and testing to be carried out, the effect of mask in reducing the cases can be discerned only after a couple of weeks, thus completely weakening the study results.

The authors have wrongly used the dates of policy implementation as a proxy for actual mask use. Also, the policy mandating mask use was accompanied by other changes across the society, thus making it extremely difficult to tease out the effect of mask alone in reducing cases. The scientists also say only simple linear regression models have been used and no “measures of statistical uncertainty are measured or presented”. This becomes particularly egregious as the analysis is based on only three regions.

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TB during COVID-19Public TB services must be resumed to find missed patients28/06/2020

Digital resource: A digital chest x-ray could be deployed along with AI-based tools for both TB and COVID-19 detection. Getty Imagesx-reflexnaja

India has the highest burden of tuberculosis (TB) in the world. Even as the government was pushing to end TB by 2025, the COVID-19 pandemic has caused a massive disruption in TB services. TB case notifications across India have dropped by over 50% since March, with an estimated 3,00,000 missed case notifications (until May 30). This is worrisome, since undiagnosed TB can worsen patient outcomes and increase transmission in the community.

As the lockdown ends, we will see a big surge in people seeking care with TB and COVID-19 symptoms. However, people will struggle to get care because the public sector is still dealing with the pandemic, while the private sector is not functioning at normal capacity or is reluctant to manage people with fever and cough.

To find the missed TB patients, we will need to find ways to rapidly resume public TB services, integrate TB and Covid-19 testing and be creative about engaging the private health sector to augment public TB services.

It is critical for the National TB Elimination Programme to resume routine TB services, which include diagnostic services, such as microscopy and rapid molecular testing, as well as drug-susceptibility testing.

Dual testing

Since fever and cough are symptoms of both TB and COVID-19, simultaneous screening and testing can be encouraged. Thankfully, India has access to three existing technologies that permit dual testing for both infections.

The first is the digital chest x-ray (CXR), which could be deployed along with artificial intelligence (AI) based tools for both TB and COVID-19. AI-based algorithms are now available that obviate the need for trained radiologists to read the x-rays. If a CXR is suggestive for TB on the AI algorithm, then a confirmatory test such as GeneXpert can be done to confirm TB and also detect drug-resistance. One such AI-enabled screening tool is called qXR, developed by Qure.ai, an Indian company. Several studies show accuracy that is comparable or better than human radiologists.

The screening tool, qXR, has now added the capability of detecting signs of COVID-19 from the x-rays images. It is being deployed in some sites in Mumbai with promising preliminary results. It is important to validate the use of qXR for simultaneous screening for both diseases for wider use.

Based on an estimated 3,00,000 missed cases during the national lockdown, around 10,50,000 CXR (assuming 70% of these are pulmonary TB cases and 5 CXRs are needed to detect one patient with pulmonary TB) will be required for detecting TB cases. This is an overwhelming figure for any health system especially during a pandemic. However, a dynamic partnership with 80,000 licensed diagnostic radiology facilities will help combat this.

CXR screening will require confirmatory testing for both diseases, and molecular testing is the most accurate and rapid option. There are two technologies already in use in India that could be leveraged for simultaneous testing of sputum samples for both infections.

One is called GeneXpert. India has over 1,100 of these systems in use. A large number of private labs, too, have this technology. On this platform, TB can be detected using a cartridge called Xpert MTB/RIF and COVID-19 by using the Xpress SARS-CoV2 cartridge.

The second molecular platform is called TrueLab, developed by an Indian company – Molbio Diagnostics. This technology is already being used in some states and in private labs to test for TB using a chip called Truenat MTB. Molbio now has a chip called Truenat Beta CoV that can be used for COVID-19. This chip, along with Xpress SARS-CoV2 cartridge, has been approved by ICMR for emergency use for COVID-19 testing.

Typically, TB testing requires sputum sample. Now, SARS-CoV-2 testing is done using nasopharyngeal swabs, but there is no reason why sputum samples cannot be used, since sputum is generated deeper in the lungs. However, it is important to validate both test molecular platforms for simultaneous testing using the same sputum sample.

All hands on the deck

To detect the missed thousands of TB patients, we need to leverage our best technologies and find ways to integrate testing for both respiratory infections. We need to integrate our public and private health sectors. India needs all hands on the deck, to battle an existing as well as a new killer disease.

With most TB patients seeking diagnosis and treatment in the private sector, the integration of the private sector in the TB care cascade has shown good results. This is evident in the success of the Private Provider Interface Agency (PPIA) model launched in Mumbai by the Government of India, WHO and PATH and the subsequent large scale, pan-India version of it called the JEET (Joint Effort for Elimination of Tuberculosis) project. We need to use the lessons from public–private partnerships in TB to address the growing challenge of providing adequate care for COVID-19.

(Shibu Vijayan is a physician and Global TB Technical Director at PATH, Mumbai, India.

Madhukar Pai is a physician and Director of the McGill International TB Centre, Montreal, Canada.)

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When the Indian Ocean’s ancient climate patterns returnFormations like the El Niño of the Pacific Ocean could emerge28/06/2020

Global warming: If current trends continue, the new Indian Ocean El Niño could emerge as early as 2050, the study says.scanned in chennai

About 19,000-21,000 years ago, ice-sheets covered North America and Eurasia, and sea-levels were much lower. This period, the peak of ice age conditions, is called the Last Glacial Maximum. Researchers analysed simulations of this past climate and predicted that the ongoing climate change could reawaken an ancient climate pattern of the Indian Ocean.

They find that this could be similar to the El Niño phenomenon of the Pacific Ocean bringing more frequent and devastating floods and drought to several densely-populated countries around the Indian Ocean region. If current warming trends continue, this new Indian Ocean El Niño could emerge as early as 2050. The results were published in Science Advances.

Study on shells

By studying microscopic zooplankton called foraminifera, the team had published a paper in 2019 which first found evidence from the past of an Indian Ocean El Niño. Foraminifera build a calcium carbonate shell, and studying these can tell us about the properties of the water. The team measured multiple individual shells of foraminifera from ocean sediment cores and reconstructed the sea surface temperature conditions of the past.

“In the previous paper, we argued for the existence of an ‘Indian Ocean El Niño’ during the Last Glacial Maximum. We suggest that the Indian Ocean has the capacity to harbour much larger climate variability than observed during the last few decades or a century,” writes co-author Kaustubh Thirumalai, from the Department of Geosciences at the University of Arizona in an email to The Hindu. “In this paper, we argue that this climate variability in the Indian Ocean can arise under increased greenhouse gas forcing of global climate change.”

Lessons to learn

He explains that there are many lessons to be learnt from this cooler period about our warmer future, “even though the Last Glacial Maximum consisted of vastly different conditions compared to where the world is headed.”

Prof. Thirumalai adds: “As it is, under present-day conditions, changes in the Indian Ocean Dipole and the El Niño–Southern Oscillation strongly affect Indian Monsoon variability from year to year. If the hypothesised ‘equatorial mode’ emerges in the near future, it will pose another source of uncertainty in rainfall prediction and will likely amplify swings in monsoon rainfall.”

The paper adds that it could bring more frequent droughts to East Africa and southern India and increased rainfall over Indonesia. The team warns that further work is needed to accurately assess this new mode, particularly under lower-emission scenarios and taking into account past climatic states other than the Last Glacial Maximum.

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Novel coronavirus infection might trigger type-1 diabetesIn type-1 diabetes, the body’s immune system destroys the beta cells that produce insulin28/06/2020

Growing evidence: The novel coronavirus might actually be triggering diabetes in some people who have so far remained free of it. Getty Imagescelsopupo

Diabetes poses one of the key risk factors for developing severe COVID-19, and chances of dying are elevated in people with diabetes. Now, there is growing evidence that novel coronavirus might actually be triggering diabetes in some people who have so far remained free of it. These patients typically develop type-1 diabetes. The virus seems to be causing diabetes spontaneously in people.

These patients typically develop type-1 diabetes, which is caused when the body’s immune system plays rogue and begins to attack and destroy the beta cells, which produce the hormone insulin in the pancreas. With the destruction of beta cells, the amount of insulin produced is reduced, and hence, the ability of the body to control blood sugar is compromised leading to type-1 diabetes.

The 2002 SARS coronavirus, too, caused acute-onset diabetes in patients. Like the 2002 SARS coronavirus, the SARS-CoV-2 virus, too, binds to ACE2 receptors that are found on many organs involved in controlling blood sugar, including the liver and pancreatic beta cells, and subsequently infects the cells in the organs.

Two-way relationship

In a letter published in The New England Journal of Medicine, the researchers write: “There is a bidirectional relationship between COVID-19 and diabetes. On the one hand, diabetes is associated with an increased risk of severe COVID-19. On the other hand, new-onset diabetes and severe metabolic complications of preexisting diabetes… have been observed in patients with COVID-19.”

Permanent or transient

However, more evidence is needed to conclusively prove that COVID-19 indeed causes type-1 diabetes. It is also not clear if the acute-onset diabetes in COVID-19 patients will be permanent or transient. The is no clarity whether people who are borderline type-2 develop the disease.

The COVID-19 patients who develop diabetes have extremely high levels of blood sugar and ketones. When there is insufficient insulin produced, breaking down the sugar present in the blood is compromised leading to high levels of sugar. At the same time, the body begins to turn to alternative sources of fuel, which in this case are ketones. A study found 42 of 658 patients presented with ketosis on admission. Patients with ketosis were younger (median age 47). Ketosis increased the length of hospital stay and mortality, the researchers found.

Using human pluripotent stem cells, researchers grew miniature liver and pancreas and found that both the organs were permissive to SARS-CoV-2 infection. In particular, they found the pancreatic beta cells were infected by coronavirus. ACE2 is expressed in human adult alpha and beta cells. While the beta cells produce insulin which reduces the sugar level in the blood, the alpha cells produce glucagon, which increases the blood sugar. A fine balance between the two helps maintain the blood sugar level.

Tested in mice

The researchers transplanted the miniature pancreatic endocrine cells produced using human stem cells into mice. Two months later, they examined the xenografted pancreas and found ACE2 receptors on beta and alpha cells. When the mice were infected with coronavirus, they found the beta cells were infected by the virus. Thus the virus is capable of damaging the cells that control blood sugar thus triggering acute-onset of type-1 diabetes.

According to Nature News, a global database to collect information on people with COVID-19 and high blood-sugar levels who previously do not have a history of elevated blood sugar levels has been initiated. “The researchers hope to use the cases to understand whether SARS-CoV-2 can induce type 1 diabetes or a new form of the disease,” Nature News says. Researchers want to use the database to understand if the acute-onset diabetes is permanent and people who are borderline type-2 develop the disease.

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treaty: ASEANBloc strengthens assertions vis-a-vis China’s claims28/06/2020

S. China Sea rights should be rooted in UN 

Vietnamese Prime Minister Nguyen Xuan Phuc speaking at the summit on Friday.APHau Dinh

Southeast Asian leaders said a 1982 UN oceans treaty should be the basis of sovereign rights and entitlements in the South China Sea, in one of their strongest remarks opposing China’s claim to virtually the entire disputed waters on historical grounds.

The leaders of the Association of Southeast Asian Nations took the position in a statement issued by Vietnam on Saturday on behalf of the 10-nation bloc. ASEAN leaders held their annual summit by video on Friday, with the COVID-19 pandemic and the long-raging territorial disputes high on the agenda. “We reaffirmed that the 1982 UNCLOS is the basis for determining maritime entitlements, sovereign rights, jurisdiction and legitimate interests over maritime zones,” the ASEAN statement said.

The leaders were referring to the United Nations Convention on the Law of the Sea, a 1982 international agreement that defines the rights of nations to the world’s oceans.

Three Southeast Asian diplomats told that it marked a significant strengthening of the regional bloc’s assertion of the rule of law in a disputed region that has long been regarded as an Asian flashpoint. While it has criticised aggressive behaviour in the disputed waters, ASEAN has never castigated China by name in its post-summit communiques.

As ASEAN’s leader this year, Vietnam oversaw the drafting of the “chairman’s statement”. Vietnam has been one of the most vocal critics of China’s actions in the disputed waters.

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Russia secretly helped Afghan militants kill coalition troops’U.S. intel agencies say a Russian spy unit offered bounties to Islamist militants28/06/2020

Shrinking footprint: American troops at Camp Shorabak in Helmand province, Afghanistan, last year.NYTJIM HUYLEBROEK

American intelligence officials have concluded that a Russian military intelligence unit secretly offered bounties to Taliban-linked militants for killing coalition forces in Afghanistan — including targeting American troops — amid the peace talks to end the long-running war there, according to officials briefed on the matter.

The U.S. concluded months ago that the Russian unit, which has been linked to assassination attempts and other covert operations in Europe intended to destabilise the West or take revenge on turncoats, had covertly offered rewards for successful attacks last year.

Islamist militants, or armed criminal elements closely associated with them, are believed to have collected some bounty money, the officials said. Twenty Americans were killed in combat in Afghanistan in 2019, but it was not clear which killings were under suspicion.

The intelligence finding was briefed to President Donald Trump, and the White House’s National Security Council discussed the problem at an inter-agency meeting in late March, the officials said. Officials developed a menu of potential options — starting with making a diplomatic complaint to Moscow and a demand that it stop, along with an escalating series of sanctions and other possible responses, but the White House has yet to authorise any step, the officials said.

An operation to incentivise the killing of American and other NATO troops would be a significant and provocative escalation of what American and Afghan officials have said is Russian support for the Taliban, and it would be the first time the Russian spy unit was known to have orchestrated attacks on Western troops.

Hybrid war

Any involvement with the Taliban that resulted in the deaths of American troops would also be a huge escalation of Russia’s so-called hybrid war against the U.S., a strategy of destabilising adversaries through a combination of such tactics as cyberattacks, the spread of fake news, and covert and deniable military operations.

The Kremlin had not been made aware of the accusations, said Dmitry Peskov, press secretary for President Vladimir Putin of Russia. “If someone makes them, we’ll respond,” Mr. Peskov said. A Taliban spokesman did not respond to messages seeking comment. Spokespeople at the National Security Council, the Pentagon, the State Department and the CIA declined to comment.

The officials familiar with the intelligence did not explain the White House delay in deciding how to respond to the intelligence about Russia. While some of his closest advisers, like Secretary of State Mike Pompeo, have counselled more hawkish policies toward Russia, Mr. Trump has adopted an accommodating stance toward Moscow.

At a summit in Helsinki in 2018, Mr. Trump strongly suggested that he believed Mr. Putin’s denial that the Kremlin interfered in the 2016 presidential election, despite broad agreement within the U.S. intelligence establishment that it did. Mr. Trump criticised a bill imposing sanctions on Russia when he signed it into law after Congress passed it by veto-proof majorities. And he has repeatedly made statements that undermined the NATO alliance as a bulwark against Russian aggression in Europe.

The officials spoke on the condition of anonymity to describe the delicate intelligence and internal deliberations. They said the intelligence has been treated as a closely held secret, but the administration expanded briefings about it this week — including sharing information about it with the British government, whose forces are among those said to have been targeted.

The intelligence assessment is said to be based at least in part on interrogations of captured Afghan militants and criminals. The officials did not describe the mechanics of the Russian operation, such as how targets were picked or how money changed hands.

It is also not clear whether Russian operatives had deployed inside Afghanistan or met with their Taliban counterparts elsewhere. The revelations came into focus inside the Trump administration at a delicate time. Although officials collected the intelligence earlier in the year, the inter-agency meeting at the White House took place as the COVID-19 pandemic was becoming a crisis and parts of the country were shutting down. Moreover, as Mr. Trump seeks reelection in November, he wants to strike a peace deal with the Taliban to end the Afghanistan war. NY Times

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26.9 crore people used drugs in 2018: UN reportOpioid use jumps fivefold; youth account for major share28/06/2020

An awareness march held in Bikaner on FridayPTI

About 26.9 crore people used drugs in 2018, which was 30% more than the 2009 figure, with adolescents and young adults accounting for the largest share of users, according to the latest United Nations Office on Drugs and Crime (UNODC) World Drug Report.

Compared with earlier estimates from a survey done in 2004, overall opioid use in India is estimated to have increased fivefold.

Seizures of amphetamines across the world quadrupled between 2009 and 2018. The stimulant scene is dominated by cocaine and methamphetamine, and use of both the substances is rising in their main markets. Production of heroin and cocaine remains among the highest levels recorded in modern times.

While about 19 million people used cocaine in 2018, fuelled by the drug’s popularity in North America and Western Europe, close to 27 million people used amphetamines the same year, the latter being the most used amphetamine-type stimulants in Southeast Asia, it said. “Use of methamphetamine in these two subregions has been expanding for two decades, according to most available indicators. Cocaine and methamphetamine can coexist in some markets by acting as substitutes for each other, so that use of one drug rises when the other goes down.”

Expanding markets

A number of indicators suggest that the global market of ATS, particularly meth, is expanding. “Quantities of seized methamphetamine... reached a new record high, at 228 tonne-equivalents, in 2018,” says the report.

Observing that rapid market changes were being noticed, the report said synthetics were replacing opiates in Central Asia and the Russian Federation.

Crystalline meth market has grown in Afghanistan and Iraq. In Afghanistan, meth seizures have steadily risen since 2014. The amount seized in the first six months of 2019 — 657 kg — signalled a huge leap over the previous year.

The study found that traffickers and manufacturers were using “designer chemicals” as an alternative to synthesise amphetamine, meth and ecstasy.

The report expressed concern about fewer countries taking part in joint drug operations, apparently due to budgetary problems.

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In debt crisis, Sri Lanka turns to ChinaBeijing nod for $500 million loan as pandemic hits tourism revenue28/06/2020

Mahinda Rajapaksa sought India’s help this February.

The Sri Lankan government is likely to once again turn to China for help with debt repayment, as it did in 2014, even as its request to India for a postponement of its debt repayment has been hanging fire for the last four months. After a conversation between Chinese President Xi Jinping and President Rajapaksa on May 13, Beijing has already approved an additional $500 million loan from its development bank to help counter the impact of the pandemic.

Even prior to the coronavirus pandemic, Prime Minister Mahinda Rajapaksa had asked India for a debt deferment during a visit to Delhi in February, as he had confirmed in an interview to The Hindu. In April, the Central Bank of Sri Lanka sought a $400 million currency swap with the RBI under the SAARC facility and again in May, President Gotabaya Rajapaksa sought a “special” $1.1 billion currency swap facility from Prime Minister Narendra Modi, who had called him to discuss the responses to the pandemic and bilateral cooperation.

The situation could get more difficult for Colombo, as Japan’s International Cooperation Agency (JICA) has put on hold funding for a proposed light rail transit system, local media reported, because of concerns over the island nation’s rising debt. Sri Lanka’s total foreign debt is approximately $55 billion, which accounts for nearly 80% of its GDP, according to last year’s official figures. Of that, China and the Asian Development bank each hold about 14%, Japan accounts for 12%, the World Bank holds 11%, while India holds about 2%.

When asked about talks on the moratorium, Chinese Embassy officials in Colombo confirmed that the two countries are working together on the financial cooperation “via different channels and mechanisms”.

“More practical progress will be drawn in coming weeks,” spokesperson at the Chinese Embassy Luo Chong told The Hindu.

Regional distress

Other countries in the region are also now seeking debt repayments. On Friday, Pakistan Prime Minister Imran Khan spoke to President Rajapaksa about joining a ‘Global Initiative on Debt Relief” to mitigate the economic impact of the pandemic, a press release from the Pakistani High Commission in Colombo said.

In the Maldives, President Solih’s government is talking to all its bilateral partners and international agencies. “ We would also be seeking help from India, one of our closest friends,” Presidential spokesperson Ibrahim Hood told The Hindu.

According to government sources, Maldives has very “small loans” from India, which prefers a more project-driven, development aid programme. In comparison the Maldives owes China a sum of nearly $1.5 billion, including $600 million from government-to-government, which could necessitate a shift from the Solih government’s earlier tough stand on what it called the Chinese “debt trap” due to the Belt and Road Initiative projects. Reports suggest that China has now agreed to a partial repayment, to reduce the dues this year from $100 million to $75 million, a development New Delhi will watch closely.

Colombo’s request to India for freeze on debt hangs fireNo decision despite a personal request to Modi

28/06/2020 

Sri Lanka’s request to India for a postponement of its debt repayment amid the current economic crisis is “under consideration”, say officials, though no decision has been taken, more than four months after the request was made personally by Sri Lankan Prime Minister Mahinda Rajapaksa to Prime Minister Narendra Modi.

On Saturday, Mr. Rajapaksa “renewed calls for international monetary organisations to provide debt relief for developing countries” during an interaction with United Nations officials, the Prime Minister’s office said, repeating earlier appeals to all its debt partners, including India. According to officials in Delhi and Colombo, the two sides have been discussing holding the loan repayment on the total $960 million that Sri Lanka owes India, as well as two separate Sri Lankan requests for a currency swap facility.

Meet proposed

Ministry of External Affairs officials say they have now proposed a virtual meeting between Delhi and Colombo on the issue, to take talks further, but did not explain why the request has not been cleared thus far.

“The Sri Lankan side hasn’t yet responded on when to do the talks,” an Indian official told The Hindu.

Last week, President Gothabaya Rajapaksa told a group of European Union ambassadors that the country needs “new investments instead of further debt” and asked for a deferment on loans. In March and April as the coronavirus pandemic spread, he had called on international donor agencies to do the same.

Sri Lanka's foreign reserves, already in peril due to economic troubles and last year’s Easter Sunday terror attacks, are being further drained after the pandemic, as its main earners — exports (tea and garments), labour remittances and tourism sectors — are all badly hit. Sri Lanka is scheduled to repay $2.9 billion of its total external debt this year.

Even prior to the coronavirus pandemic, Prime Minister Mahinda Rajapaksa had asked India for a debt deferment during a visit to Delhi in February. In April, the Central Bank of Sri Lanka sought a $400 million currency swap with the RBI under the SAARC facility and again in May, President Gotabaya Rajapaksa sought a “special” $1.1 billion currency swap facility from Prime Minister Modi, who had called him to discuss the responses to the pandemic and bilateral cooperation.

BJP Versus Congress on Cina relation

BJP steps up attack on Cong. over China fundsThe Gandhi family should answer for their sins, says Nadda

28/06/2020 

J.P. Nadda

The BJP on Saturday continued its attack on the Congress and the Gandhi family over the alleged links between the Rajiv Gandhi Foundation (RGF) and China, with party president J.P. Nadda saying they had sacrificed the national interest by accepting donations from the foreign power.

At a press conference here, Mr. Nadda posed 10 questions to Congress president Sonia Gandhi about the foundation’s working. “The Gandhi family should answer for their sins,” he said.

Mr. Nadda had this week raised the issue of the RGF accepting donations from the Chinese Embassy, to which former Finance Minister P. Chidambaram responded by asking would Prime Minister Narendra Modi assure the country that China would vacate Indian territory if the RGF returned the ₹20-lakh donation.

Mr. Nadda said China had donated to the foundation every year from 2005 to 2009 and donations from the “tax haven” of Luxembourg were made from 2006 to 2009.

“Why did the Rajiv Gandhi Foundation, headed by Sonia Gandhi, accept money from the Chinese government and Chinese Embassy? Isn’t it a shame, sacrificing national interest by accepting money from foreign powers for personal trusts,” he asked. He raised concern over the UPA government’s “haste” with regard to the East Asia Free Trade Agreement. “India’s trade deficit with China was allowed to increase from an almost negligible $1.1 billion in 2003-04 to as much as $36.2 billion in 2013-14. Why did the Congress weaken the economic position?”

He alleged that funds had been ‘diverted’ from the Prime Minister’s National Relief Fund to the RGF from 2005 to 2008, and the company founded by Congress leader Rameshwar Thakur had been appointed the auditor of the PMNRF. Mr. Nadda also hit out at former PM Manmohan Singh, saying he had allocated ₹100 crore to the private charitable trust when he was Finance Minister in 1991. “Since then, it has regularly received donations from the government of India Ministries. Yet, the RGF refuses to be audited by the Comptroller and Auditor-General or even come under the Right to Information Act. Why,” he asked.

Cong. releases travel list of BJP leadersParty says many ruling party leaders had been to China on invitation

28/06/2020 

The Congress on Saturday said the BJP president has made making sensational claims his favourite pastime after J.P. Nadda launched a fresh offensive against the Congress and the Gandhi family.

In a statement, Congress chief spokesperson Randeep Surjewala gave a detailed account of the visit of BJP leaders to China at the invitation of the Chinese Communist Party (CCP) when the BJP was in the opposition.

“Why did the then BJP president Nitin Gadkari go to China on a five-day visit on January 19, 2011, at the invitation of the CCP? Why did former BJP president Amit Shah send a delegation of MPs/MLAs in November 2014 to China for a week-long study in the Party School of the CCP? Why did Narendra Modi visit China on four occasions as Gujarat Chief Minister and on five occasions as Prime Minister, besides hosting the Chinese Premier on three occasions in India? Isn’t he the only Prime Minister to have had 18 meetings with the Chinese Premier in six years,” Mr. Surjewala asked.

He also dared the RSS and the Vivekananda Foundation to make public the list of all their donors, including foreign sources. “Will the BJP disclose the source of funding, amounts received, the names of donors (including of Chinese origin) for Overseas Friends of BJP (OF-BJP)? How much amount has been received by OF-BJP from Overseas Friends of BJP-China and Hong Kong and when? What is the connection of Shri Rajkumar Naraindas Sabnani alias Raju Sabnani to OF-BJP,” he asked.

Earlier in the day, former Finance Minister P. Chidambaram accused Mr. Nadda of “specialising” in speaking half-truths regarding the Rajiv Gandhi Foundation (RGF) receiving money from the Prime Minister’s National Relief Fund (PMNRF) for tsunami relief work.

On Friday, Mr. Nadda targeted Congress president Sonia Gandhi as the head of the RGF and called the PMNRF’s grant to a “family-run foundation” as fraud.

“BJP President Mr. Nadda specialises in speaking half-truths. My colleague Randeep Surjewala exposed his half truths yesterday. Why is the BJP hiding the fact that the Rs. 20 lakh received by RGF from PM National Relief Fund in 2005 was for tsunami relief work in Andaman & Nicobar? And that every rupee was spent for the purpose and accounted for?” Mr. Chidambaram wrote on Twitter.

“Suppose RGF returns the Rs. 20 lakh, will PM Modi assure the country that China will vacate its transgression and restore status quo ante? Mr Nadda, come to terms with reality, don’t live in the past that is distorted by your half-truths,” he said.

‘Diplomatic failure’

Prime Minister Narendra Modi should publicly condemn China for brazen intrusions into Indian territory and his government should take “strong and quick action” to resolve the LAC issue, the Congress said on Saturday.

At a virtual press conference, former Law Minister Kapil Sibal said the last six years of the Modi government had seen the biggest diplomatic failure and no major global power was standing with India now.