Leh Police faces allegation of brutality

During the nationwide lockdown, incidents of misconduct by police personnel have been reported from across the country. Videos have surfaced of police personnel beating people with sticks and publicly humiliating them to enforce lockdown measures. More recently, there have been protests around the world against police brutality after the death of American citizen George Floyd in the hands of a local policeman in Minneapolis, USA and subsequent heavy-handed responses to peace marches.

This trend of using disproportionate physical force by the police does not seem to have spared Ladakh either. District Police, Leh of Ladakh Police has come under public scrutiny after an audio message went viral on social media. In this audio message, a man accuses police officials of hitting and demeaning him while he was working as a volunteer with the Society for the Prevention of Cruelty to Animals (SPCA), Leh, a non-profit organisation working for animal welfare, during the lockdown to contain COVID-19.

In the recording, the SPCA volunteer has alleged that the police beat him and also accused him of kidnapping a policeman. Subsequently, SPCA, Leh wrote to Divisional Commissioner of UT Ladakh, Saugat Biswas, IAS to investigate the alleged misconduct by members of District Police, Leh against an SPCA volunteer.

The incident is said to have taken place on 21 April around noon when the SPCA volunteer was allegedly stopped by a team lead by an Additional Superintendent of Police (ASP) ranked officer [name withheld on purpose as the investigation is still underway] at Leh’s Petrol Pump Chowk. The volunteer, who is a student, was on his way to feed stray animals in the Choglamsar area.

In the audio message, the volunteer explains in Ladakhi, “I was on my way to feed stray dogs when I reached the Petrol Pump. The ASP and his team were checking cars. One of the policemen was speaking rudely with the public. Our car was also stopped and we were asked where we were going. I told them that we were SPCA volunteers and were on our way to feed stray animals. We were also asked to show the vehicle pass issued by District Magistrate, Leh, which we did.” Several media-persons in Leh district, including me, tried to get in touch with the SPCA volunteer to get his inputs but he has so far refused to speak to us.

Such voluntary activity is included in essential goods and services. District Magistrate, Leh, Sachin Kumar Vaishya, IAS had issued order no. DCL/PS/COVID-19/OO/2020/41-58 on 24 March which states “…there shall be no restrictions upon the movement of essential goods and services.”

On 23 March, 2020, Animal Welfare Board of India had issued order no. 9-16/2019-20/PCA, which said: “I would like to draw your kind attention that feed and fodder for large animals and food for companion and stray animals is an essential service and may be kept operational during lockdowns. District Administration, if need be, allot specific time during the morning and evening hours for individuals/volunteers to provide food and water for street animals and birds.”

Deskit Angmo, a member of SPCA, Leh, took to social media to highlight this incident. “One of our volunteers was mentally harassed, physically tortured and belittled in public for this, even though he had a lockdown vehicle permit to feed strays along with the other vehicle-related documents. I guess this letter needs to be well circulated among the public to make them aware of laws and rights during this vulnerable period. It’s really sad that all the hard work and respect of the 99% police fraternity is overshadowed by the 1% who misuse power and misbehave with the public. If the public is at fault, I can understand if the police tries to discipline us. However, if the public is harassed without proper reason, it’s civil society has the right to protest and make their voices heard,” she wrote.

In the letter written to the Divisional Commissioner of UT Ladakh, SPCA, Leh alleged, ‘…unacceptable behaviour” by the ASP and his team’ towards their volunteer. “We came to know about the incident on 23 April when the volunteer did not turn up for the service for three consecutive days. Upon calling him about his absence, we were told about the incident. We are writing for your kind intervention on behalf of SPCA, Leh because he was working as our volunteer at the moment of the incident,” they have written in the letter.

They have further added, “The vehicle of the volunteer namely [name and other details have been withheld on purpose as the investigation is still underway]…was stopped by ASP and his team at the Petrol Pump area on that unfortunate day despite having proper valid vehicle pass issued by the District Administration two days back under the movement of a vehicle under necessary goods (NGO) with the permission to feed stray dogs around the Leh-Choglamsar area.

Upon intervention, the following details came up:

1. The number was temporarily painted on the vehicle for display as his number plate was broken which he was unable to fix due to unavailability of such services under lockdown. He even showed the broken number plate which was inside the vehicle.

2. He was carrying a valid driving licence.

3. The photocopy of the vehicle registration certificate (RC) was presented as the original was at home.

4. The vehicle had official new vehicle permit issued by the Administration on the 19 of April with permission for three persons to carry, drive and distribute food articles to the stray dogs.

5. The volunteer was using a face mask at the moment

6. He was accompanied by another student at that moment.”

The letter also states, “The student volunteer requested them to allow him to bring the original papers quickly from his home which is in proximity to the petrol pump spot.”

According to the volunteer, the police constable informed him that his car had been seized and asked another constable to accompany him to the Housing Colony Police Post. “Since I was getting late to feed the stray animals and wanted to get out of this situation soon, I drove to my home to get the original RC so that I could show it to them. While we were coming out of my house, I was surprised to see that the ASP along with his team had already reached there. They beat me up and took me to the police station where I was beaten with a belt by five-six policemen,” alleged the volunteer.

The members of SPCA, Leh led by Deskit Angmo added that the volunteer was accused of kidnapping a policeman. “The team of officials also accused him of kidnapping their staff. Since Ladakh is a close-knit society, such behaviour by the police on the streets near his house not only harmed him physically but also caused mental anguish and publicly belittled the social service being done by the volunteer along with his family’s social position. We, the civil society as well as the whole team of SPCA, feel that such misconduct by any police official towards any social service provider in any field is unacceptable and discouraging in nature. SPCA is giving its heart and soul into avoiding problems that those hungry stray dogs can cause if not addressed during the vulnerable period. Our workforce consists of volunteers and members who give time, money and vehicles free-of-cost, the current student is one such contributor. We are saddened and worried by this misconduct and misuse of power by some police officials whose conduct erases the good services and efforts of rest of the police fraternity,” members of SPCA, Leh wrote in their letter.  

Divisional Commissioner, Ladakh, Saugat Biswas responded by writing letter bearing No. DivComL/UTL/2020/3847 to Inspector General of Police (IGP) of UT Ladakh, Satish Khandare, IPS on 25 April. In his letter, he wrote, “The bearer of this letter (Ms Deskit Angmo) has come up with a complaint of misconduct by police against SPCA volunteers. The Divisional Commissioner has heard them and is of the view that your office may examine the matter urgently. In case there has been misconduct/misbehaviour or over action on the issue, such officer who has misbehaved must be reprimanded. I am directed to request you to look into the matter and hear out the bearer of this letter.”

I was unable to speak the ASP who led the team despite multiple attempts as he remained busy with tasks related to the lockdown. Then on 18 May, 2020 the UT Ladakh administration issued an order transferring him to UT of J&K. I checked with several officials to determine if the transfer was related to the incident involving the SPCA volunteer. However, most officials claimed that it was not related to any case. A police office spoke on the condition of anonymity and explained, “The transfer was long overdue and it had nothing to do with the incident.”

I then approached others in District Police, Leh for their account of the events of 21 April, which turned out to be significantly different from the one described by SPCA, Leh in its letter and by the volunteer in the recording. A police officer—who was not involved in the case and spoke to me on the condition of anonymity—explained, “On that day, the police stopped the car of the student and asked where he was going. The ASP was also present there. The student was asked to show the RC and other documents, but they were not with him at that time. Contrary to what the student and SPCA members are alleging, it was the student who misbehaved with the police team and talked rudely to them. He was trying to control the police even though he was clearly at fault. Peeved with his conduct, the ASP ordered his team to seize the car. A constable was asked to accompany him to the Housing Colony Police Post. Instead of going to the Police Station, he went straight to his home. He had disobeyed the order of the police.”

Meanwhile, taking note of the letter from the Divisional Commissioner of UT Ladakh, IGP, Satish Khandare tweeted on 27 April, “Apropos to the posts on social media by a prominent artist of Ladakh and the voice message of a volunteer of SPCA, it is to reiterate that both the matters are in notice of the higher ups of the Department. Senior level officers are enquiring into the matter separately.”

In this regard, Commandant of Indian Reserve Police, 25th Battalion, Stanzin Nurboo, was appointed to lead a departmental enquiry into this incident. He has already called the volunteer and police personnel for questioning. SPCA member Deskit Angmo said, “We were called by Ka Stanzin Nurboo to the Housing Colony Police Post in May. The policemen who were present when the volunteer was beaten were also asked to come there. The ASP’s team comprising of a driver and guards apologised for beating the volunteer. However, they said that they had left after dropping the volunteer at the Housing Colony Police Post and do not know what happened at the Police Post after their departure. Others at the Police Post said that it was the ASP and his team who beat the volunteer. Even though the policemen were wearing masks at the time, the volunteer was able to identify one of the people who had beaten him at the Police Post. It was clear that they were trying to escape responsibility. Ka Stanzin Nurboo assured us that he would investigate the matter and inform us of its progress.” 

I also spoke with Stanzin Nurboo, who is heading the departmental enquiry, about this case. He confirmed that he had spoken with the representatives of SPCA, Leh, the volunteer and the policemen accused of beating him, including a face-to-face meeting between them. “One of the things that has emerged from the inquiry is that the SPCA volunteer had violated police orders as he did not take his car to the Housing Colony Police Post as directed by the ASP. In addition, the police have also accused him of kidnapping a policeman. On the other hand, the volunteer is alleging that he was beaten by a few policemen, which the police are denying. Therefore, I asked the volunteer to provide proof that he was beaten up by the police. The volunteer alleged that a fellow volunteer was also present in the car when the incident took place. We are going to cross-examine the statement of that person too. We cannot initiate action on the basis of an allegation alone. We have to probe deeper and find out the facts of the case. Only after I have had a look at these issues will I be able to present a report to the IGP. Unfortunately, everyone is currently busy tackling the COVID-19 pandemic.”

By Tashi Lundup

Tashi Lundup is part of the editorial team at Stawa

Image source: Wikipedia

The lessons of COVID-19

World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus announced that the disease caused by the new coronavirus (SARS-CoV-2) was being named as COVID-19. The ‘co’ stands for ‘corona’, ‘vi’ for ‘virus’ and ‘d’ for ‘disease; and ‘19’ marks the year when the outbreak was first identified (31 December, 2019). WHO declared the novel coronavirus outbreak (2019-nCov) a Public Health Emergency of International Concern (PHEIC) on 30 January, 2020 when there were 7,818 confirmed cases worldwide with a majority in China and 82 in 18 other countries. WHO declared COVID-19 as a Global Pandemic on 11 March after it spread rapidly to 114 countries at the time.

As a 77-year-old physician, I have witnessed the last epidemic of smallpox in India, including the one in Ladakh in 1972, and the first cholera epidemic in Ladakh in 1991. I was part of the team that treated and contained these two epidemics. I have also followed global epidemics like SARS in 2003 and Ebola in 2014. I was not surprised with the emergence of COVID-19 in Wuhan, China. In fact, I had written an article in the March 2015 issue (Vol. 2, Issue 3) of stawa on ‘Ebola response and preparedness’ where I warned public health authorities to prepare for such an epidemic. I am surprised by the lack of institutional memory and callousness of the Chinese government, especially in the context of the SARS epidemic that also originated in China. The SARS epidemic had many lessons for the world community, which were conveniently forgotten. This reminds me of 19th century Danish Philosopher Soren Kierkegaard’s words, “Life must be lived forwards but it can only be understood backwards.”

There are obvious parallels between the SARS epidemic and COVID-19. Both began in winter and originated in China’s unregulated wet markets. The genetic data of SARS-CoV-2 is similar to the one responsible for SARS (SARS-CoV) as they both have spike protein with adaptation to bind with a specific protein in human cells called Angiotensin-converting enzyme (ACE2).

There are uncanny parallels in the roles of Dr Carlo Urbani during the SARS epidemic and Dr Li Wenliang during the COVID-19 epidemic. Dr Carlo Urbani was an infectious disease specialist at WHO’s Hanoi office. He volunteered to work at the Hanoi French Hospital where he identified SARS as a new viral disease. This led to the introduction of infection control and a global alert that helped contain the epidemic. By dealing with the outbreak openly and decisively, Vietnam and Hong Kong risked damage to their economy. This was a story where things went right when public health was prioritised over politics. Dr Urbani died of SARS on 29 March, 2003 in Bangkok. Dr Li Wenliang, a 33-year-old doctor in Wuhan, had warned colleagues and authorities in December 2019 of a possible outbreak of a SARS-like disease. He was reprimanded by the local police for “spreading rumours”. Li died of COVID-19 on 7 February, 2020. His voice was silenced in a system that prioritised politics over public health. The result is there for all of us to see.

Healthcare workers have a duty to care for their patient and often work in less-than-ideal circumstances and with depleted resources. The important lessons to be learnt from SARS and Ebola is the role of astute clinicians who can alert the world about impending epidemics.

Chronology of Covid-19

The first case of COVID-19 appeared in early December 2019 in Wuhan, Hubei Province, China. It is assumed to have emerged from an unregulated wet market that sold wildlife. In December 2019, hospitals in Wuhan started witnessing a growing number of atypical viral pneumonia cases. This is when Dr Li Wenliang warned colleagues and authorities about the possibility of an outbreak resembling SARS. His warning was ignored and he was reprimanded. On 31 December, 2019, China informed WHO about cases of ‘pneumonia of an unknown sort’ detected in Wuhan linked to human exposure to a wholesale wet market. On 5 January, 2020, Chinese scientists sequenced the genome of the virus and made it publically available on 7 January, 2020. On 14 January, Maria Ven Kerkhoe, acting head of WHO’s Emerging Disease Unit gave a mixed assessment of the situation, which included, “…no sustained human-to-human transmission.” However, on 19 January, Chinese authorities confirmed human-to-human transmission. On 22 January, three days before the Chinese New Year, the authorities suspended all rail and air-links from Wuhan and imposed a complete lockdown in the city of 11 million people and other urban centres in the province. By then, the new virus had already reached other countries. The first case of the novel corona virus outside China was reported in Thailand on 13 January: A 61-year-old Chinese lady with travel history to Wuhan who had never visited the wet market. This provides evidence of human-to-human transfer. India reported its first case in Kerala on 30 January from a batch of 72 medical and nursing students who had returned from Wuhan for the Lunar New Year holiday. By this time, the virus had already spread to 18 countries including South Korea, Iran, Italy, Spain, France and United States.

On 7 March, two people in Ladakh tested positive after they returned from Iran. The chain of human-to-human transmission progressed in similar manner across the world. India started screening international passengers on 6 March. The first confirmed death in India from COVID-19 was reported on 12 March. As of 18 June, 2020, WHO reported 8,242,999 cases worldwide with 445,535 deaths with other sources estimating around 4,100,000 recoveries in this period. For India; WHO reports 366,946 with 12,237 deaths for this period and other sources estimate that around 204,000 people have recovered so far.

Perhaps the most important lesson from COVID-19 is the Chinese failure to disclose the emergence of the virus in December and the failure to suspend air and rail links in early December 2019 that has resulted in the current global pandemic. The Prime Minister of India announced a Janata Curfew on 22 March and then enforced a 21-day nationwide lockdown from 24 March that was later extended to 31 May. While migrant labourers faced many problems in this period, the lockdown seems to have helped curb the pandemic by increasing the doubling time, rate of recovery, rate of testing facilitates and availability of PPE, ventilators, isolation beds and administrative quarantine facilities.

Virology: Corona viruses are enveloped single-stranded RNA viruses that are zoonotic (transmitted from animals to humans) in nature and cause symptoms ranging from those similar to a common cold to severe respiratory symptoms and rarely symptoms related to intestine, colon, liver, blood vessels and nervous system. There are six other coronaviruses, in addition to the present one, which infect humans. Coronaviruses have already caused three pandemics in the last two decades: SARS, MERS, and now, COVID-19.

Chinese researchers collected 585 environmental samples from Huanan Seafood Market in Wuhan between 1 and 12 January 2020. Of these, 33 samples contained SARS-CoV-2, which indicates that it originated from wild animals sold at the market. The researchers also collected lung fluids, blood and throat swab samples from 15 patients, which revealed that virus-specific nucleic acid sequences in the samples were different from known human coronaviruses but was similar to beta corona virus genera found in bats. They then conducted next-generation sequencing from Bronchoalveolar lavage fluids and cultured isolates from nine patients in Wuhan with viral pneumonia who tested negative for common respiratory pathogens. They found that the match for SARS-CoV-2 was 79% for SARS-CoV and 50% for MERS-CoV while it had a 87.9% and 87.2% sequence match with two bat-derived coronaviruses. Studies also reported that COVID- 19 S-protein supported strong interaction with human ACE2 molecules despite its dissimilarity with SARS-CoV. A study titled ‘The proximal origin of SARS-CoV-2’ in the journal Nature Medicine published in March 2020, used bio-informatics tools to compare publically-available genomic data for several coronaviruses. They focussed on the parts of the coronavirus genomes that encode the spike protein that gives this virus family a distinctive crown-like appearance. (‘corona’ is Latin for crown). All coronaviruses rely on spike proteins to infect other cells and each virus fashions this protein slightly differently overtime. The genomic data of SARS-CoV-2 show that its spike protein contains some unique adaptations. One adaptation it provides enables it to bind to a specific protein in human cells called ACE2. The coronavirus that causes SARS in humans also seeks out ACE2. Computer models had predicted that SARS-CoV-2 would not bind to ACE2 as well as SARS-CoV but the inverse has turned out to be true. This is probably due to genetic adaptations that enabled SARS-CoV-2 to take advantage of a previously unidentified alternate binding site. This is being cited asevidence that SARS-CoV-2 was not developed in a laboratory as no bioengineer could have chosen the particular configuration for the spike protein. Furthermore, SARS-CoV-2 genome closely resembles a bat coronavirus though the part that binds ACE2 resembles a virus found in pangolins (scaly anteaters). The origins of the virus remain unclear as of now. One probable explanation is that SARS-CoV-2 evolved in its natural host, possibly bats or pangolins, where the spike proteins mutated to bind to molecules similar to human cells. Another explanation is that SARS-CoV-2 developed this capacity after it crossed from animals to humans.

Based on virus genome sample data collected between 24 December, 2019 and 4 March, 2020, researchers in the UK and Germany have identified three distinct ‘variants’ of SARS-CoV-2. The original human virus genome (type A) seen in Wuhan includes variants that were later seen in Chinese and Americans who lived in Wuhan and in patients in the USA and Australia. Type B was the major type found in Wuhan and patients in East Asia. Type C is the variant found in Europe, especially early patients from France, Italy, Sweden, and England. It was not found in samples taken in mainland China but was seen in Singapore, Hong Kong, and South Korea. This study did not look at samples from India.

Researchers Parta Majumdar and Nirdhan Biswas at the National Institute of Biomedical Genomics, West Bengal studied more than 3,600 samples of the SARS-CoV-2 genome collected from around 55 countries and found 11 strains of SARS-CoV-2. They found that the strain A2a was dominant in 1,848 global and Indian samples. Thus, vaccine development must focus on this strain. Indian researchers are now increasing the sample size and trying to understand how the A2a strain became more efficient at infecting human as compared to other strains. It is important to study such mutations as a virus can acquire new functions to become more infectious or virulent. This will help identify and target processes important for the survival of the virus and assist in the development of a vaccine and cure.

Transmission patterns: Many domestic and wild animals like bats, camel, cats, and pangolins serve as hosts for coronaviruses. Generally, animal coronaviruses do not spread to humans though there are exceptions such as SARS and MERS. In the case of COVID-19, initial patients are believed to have some links with Huanan Seafood Market in Wuhan suggesting that these infections were due to animal-to-person transmission. Later cases were reported among medical staff and others with no links to the market or Wuhan, which indicates human-to-human transmission. Three main transmission channels for COVID-19 are through droplets, contact and aerosol.

Droplet transmission occurs when respiratory droplets produced when an infected person coughs or sneezes are ingested or inhaled by someone standing in close proximity. This is why it is important to cover one’s mouth and nose with a tissue or handkerchief while coughing or sneezing and discarding the tissue in covered containers. Similarly, wearing face masks will probably become a normal practice now.

Contact transmission occurs when a person touches a surface contaminated with the virus and then touches his/her mouth, nose and eyes. Studies have shown that SARS-CoV-2 stays viable for over 72 hours on surfaces like plastic and steel, for four to six hours on surfaces such as garments and for shorter periods in air. This is why health advisories recommend frequent hand washing with soap and water for about 20 seconds and warn against touching the mouth, nose and eyes without washing one’s hands. Alcohol-based sanitisers are an alternative when water is not readily available.

Aerosol transmission occurs when respiratory droplets mixed with air form aerosols and cause infection when inhaled in high doses in a relatively closed environment. While SARS-CoV infects the lower respiratory tract, SARS-CoV-2 also infects the upper respiratory passage. Studies report that SARS-CoV-2 remains viable in aerosol for a considerable period, which is why social distancing is a crucial strategy to contain COVID-19. Corona and influenza viruses are going to stay with us for a long time and such preventive measures will help us contain them. A fourth mode of transmission, though less important, is through the gastrointestinal tract i.e. faecal transmission. Such transmission has been reported by Chinese researchers and was also reported during the 2003 SARS epidemic.

Symptoms: COVID-19 causes a respiratory infection with a highly variable course depending on the host’s health. Mild cases observed in 81% of patients in the initial Wuhan report were manifest as self-limited respiratory symptoms typical of viral pneumonia including fever, dry cough, breathlessness, fatigue, muscle pain, headache and sore throat and interestingly, loss of smell and taste. One study found that 39.6% of 140 COVID-19 patients had gastrointestinal symptoms. The incubation period for COVID-19 ranges from two to 14 days in human-to-human transmission. The spectrum of the disease severity includes asymptomatic, symptomatic with mild or severe symptoms, requiring hospitalisation, and fatal. The fatality rate for SARS and MERS were higher though COVID-19 is more contagious.

Chest Tomography (CT) images of COVID-19 patients include ground glass opacity, bi-hilar patchy shadows and segmental areas of consolidation, sometimes with a rounded morphology and a peripheral lung distribution. Lung abnormalities were most severe about 10 days after the onset of symptoms. However, CT manifestation of COVID-19 has been diverse and changing fast. A normal chest CT image cannot rule out COVID-19. RT-PCR is a diagnostic test that uses nasal swab, tracheal aspirate, or brochoalveolar lavage specimens. The preferred method for diagnosis is to collect upper respiratory samples via nasopharyngeal and oro-pharyngeal swabs. The specificity of RT-PCR seems to be very high and it is able to detect RNA viruses like SARS-CoV-2. However, the patent-holders have included royalties in the cost of the enzyme, which has caused resentment amongst scientists especially during a global pandemic.

Pulmonary fibrosis and consolidation in lung biopsy specimens were less severe in COVID-19 than SARS and MERS but exudation was more obvious. However, we need more research to understand the pathogenesis of COVID-19 and develop therapeutic strategies. An Italian pathologist at a hospital in Bergamo performed 50 autopsies on patients who died of COVID-19 and found Disseminated Intravascular Coagulation (DIC) rather than pneumonia. This implies that the virus not only kills pneumocytes (a kind of cells in the lung) but also uses an inflammatory storm to create an endothelial vascular thrombosis (clots in blood vessels). As in DIC, the lung is the most affected as it is inflamed but it can also cause heart attacks and strokes. However, more research is needed in this matter. If these finding are true, then the strategy to fight COVID-19 will change dramatically to treat patients with antibiotics, anti-virals, anti-inflamatosis and anti-coagulants. We currently do not have a holistic understanding of SARS-CoV-2. Data from different parts of the world will continue trickling in and it will take scientists time to understand the virus. Till then, we must practice social distancing, use a face mask, wash hands frequently, and protect elderly citizens, children, pregnant women and those with other health conditions and on immunosuppressant drugs. A balanced approach between a lockdown and freedom to carry out everyday activities with proper precaution is the way ahead.

WHO has reported that a number of treatments for COVID-19 are under clinical trials but none have been approved so far. It has launched the Solidarity Trial to carry out clinical trials for specific drugs for COVID-19. More than 2,500 patients have enrolled in this multi-site clinical trial. The Indian Council of Medical Research (ICMR) has approved nine hospitals in India under WHO’s Solidarity Trial.

Plasma therapy: When a person is infected by a virus or bacteria, the body responds by creating antibodies. When a virus or bacteria attacks us for the first time, we do not have antibodies for it. However, once created, the antibodies protect us from subsequent infections. Vaccines employ this mechanism by introducing an attenuated virus or bacteria that is not strong enough to cause the disease and yet trigger the production of antibodies. It is assumed that people who have recovered from COVID-19 have antibodies against the virus. Plasma therapy entails taking specific components of blood from such patients and giving it to patients suffering from COVID-19 in the hope that the antibodies will protect them. This sounds good in theory but trials are underway to test its efficiency.

Hydroxycholroquine: ICMRrecommended chemoprophylaxis with hydroxychloroquine for asymptomatic health workers treating COVID-19 patients, and for asymptomatic contact individuals. This endorsement along with that of US President, Donald Trump may lead to widespread self-medication. In the current chaos, it is difficult to screen people for potential risks to prevent adverse side-effects or to prevent shortage of hydroxichloroquine for patients of malaria, rheumatoid arthritis etc. So far, clinical trials have not found any significant impact of this course of treatment.

Remdesivir: This is aninvestigational broad-spectrum antiviral treatment developed by Gilead Science and administered by daily infusion for 10 days. Initial results from clinical trials suggest that Remdesivir does have some impact in treating COVID-19 though more detailed studies are required. Remdesivir is a nucleotide analogue, in the same drug class as HIV and Hepatitis B medication. If it works, we must ensure sufficient supply of the drug and correct pricing to ensure that it is affordable by everyone.

COVID-19 in UT Ladakh: As on 18 June, 2020, UT Administration has reported 687 COVID-19 cases for Ladakh and one death. So far, 95 patients have made an uneventful and timely recovery despite coming from an area where environmental silicosis is prevalent and impairs lung defence mechanisms. Researchers investigated the epidemiology of COVID-19 in high altitude regions in Tibet, Bolivia and Ecuador. In all cases, the number of COVID-19 cases has been low (134 in Tibet, 54 and 722 cases in high altitude regions of Bolivia and Ecuador). In Tibet, about 10% developed severe medical condition, some of whom had co-morbid conditions like chronic respiratory and cardiovascular problems. According to the paper published in the journal Respiratory Physiology & Neurobiology, all the patients recovered fully with medical treatment. It appears that the pathogenesis of COVID-19 differs in populations that live in high altitude regions and are three to four-fold less than areas below altitudes of 2,500m above mean seal level.

These findings probably reflect physiological and environmental factors. High altitude areas are characterised by a dry climate, drastic changes in temperature between day and night, and high level of ultraviolet (UV) radiation that is capable of altering DNA and RNA—UV radiations probably act as ‘sanitisers’ in high altitude areas. All these factors may dramatically reduce the ‘survival’ of SARS-CoV-2 in such regions and reduce its virulence. Furthermore, lower air density and greater distance between molecules at high altitudes probably reduces the size of airborne virus inoculum than at sea level. In addition, hypoxia-mediated respiratory regulation leads to a decreased expression of ACE2 in pulmonary epithelia among high altitude inhabitants. This may provide some protections against severe, and often lethal, pulmonary oedema as ACE2 is the main binding site for SARS-Cov and SARS-CoV-2. These findings vindicate my belief that studies of high altitude natives, their environment and adaptation can give us insights to understand and treat many diseases afflicting people the world over. This is probably the most opportune time for Ladakh to establish a state-of-the-art molecular biology laboratory with support from ICMR and links with national institutes. Ladakh has at least two senior genetic scientists working at renowned university laboratories in the USA. They can be approached to guide the UT administration to establish this laboratory.

Overall,the UT administration in Ladakh has done a commendable job by proactively preparing for COVID-19. This includes screening of incoming travellers, establishing isolation beds for COVID-19 patients, quarantine facilities, outsourcing sample testing to accredited laboratories, sourcing adequate quantities of PPEs and ventilators, providing essential services in containment zones, establishing an efficient surveillance system, contact-tracing and testing, proactive engagement with the media to provide COVID-19 updates and propagate health advisories.

In my opinion, such viruses are going to become a normal part of our lives. It is thus important for us to adopt practices such as frequent hand-washing, use of face mask in public places, and maintaining social distancing. We also need to strengthen our healthcare system with adequate funding for a separate infectious disease hospital for each district and increase ICU capacity. Our community health centres, and primary health centres need to be upgraded and integrate district surveillance programmes that must include Behaviour Risk Factor Surveillance Systems.

I hope that the UT administration in Ladakh will learn from this experience of dealing with a pandemic and implement a progressive healthcare strategy that includes a medical college, a state-of-the-art tertiary-level care facility and a critical academic environment; a dedicated cancer institute, a separate infectious disease hospital in each district, a public health institute and a molecular biology laboratory. It also needs to upgrade healthcare facilities at every level with an integrated disease surveillance programme. Investing in these centres will be very rewarding as they will attract qualified healthcare providers and improve the system by reducing the burden on tertiary-level hospitals that can focus on providing quality care to serious patients.

By Dr. Tsering Norboo

Dr. Tsering Norboo is founding member and honorary secretary of Ladakh Institute of Prevention

Chadar Trek: A lifeline or a leisure sport?

One cold winter morning, I stepped onto a footpath in Skalzangling. I saw five men with heavy rucksacks and wooden sleds standing by the roadside. I asked, “Where are you all heading?” They replied without hesitation, “To the Chadar.”

Three words were enough to help understand the context of their journey. They were waiting for a taxi to reach the famous Chadar Trek. The trail head is a 60-km drive from Leh. The start of the trek has been moving deeper into the gorge as the motorable road progresses further. In the winter of 2019-20, the trail head was approximately 11 kms after Chilling village.

The men were of different ages and all of them hailed from Zangskar. I wondered if they were heading home or working with trekking groups. Trekking in Ladakh during the summer entails walking along high mountain trails and crossing passes. In winter, it entails walking on the frozen Zangskar river i.e. the Chadar. The trekking season for Chadar generally lasts around 45 days and is limited to the peak winter months of January and February.

The popularity of Chadar

Chadar is an Urdu word that means a ‘sheet or broad piece of cloth’. In the context of the trek, it refers to the sheet of ice on the frozen Zangskar river that is thick enough to allow a person to walk over it. In Ladakhi, the word is ‘tar’. Though Ladakh has several rivers such as the Indus, Zangskar and Shayok along with numerous streams, the term ‘Chadar’ is generally used for Zangskar river after it freezes in the winter.

As I spoke with Zangskari trekkers I heard many stories, legends and myths about the Chadar. According to one legend, the Chadar was used as a sacred pathway by female deities who travelled through this gorge over the frozen river. Some believe that one of the spots along the Chadar called Tsomo is connected with the Ganges.

They also narrated a folk-story about King Kyaltsey who was travelling along with some companions and a cook. All of them were stranded in a cave for a few days after the ice on the river started to break. They remained stuck for many days and they started running out of food supplies. The king and his companions started eating their leather bags. As they exhausted its supply of leather, they started to make plans to eat the cook. The cook feared for his life and prayed to the gods to save him. At night, he took his waistcloth and a stick and put them in the icy water. Within a few hours, the water froze to create a rock-solid path. The cook was able to leave the cave using this path and managed to survive. There are some people who claim that it was this story that led to people calling the tar as Chadar as the cook had used a piece of cloth.

Historically, this route has been used by the residents of Zangskar valley and neighbouring villages such as Lingshed, Chilling, Nyerags, etc during the winters. This route provides the only physical connectivity with the outside world for these areas in the winter.

Historian Janet Rizvi mentions this winter trail in her book, Trans-Himalayan Caravans: Merchants, Princes and Peasant Traders of Ladakh. She writes “This route [Chadar] must have been in occasional use from time immemorial; but according to Sonam Stobdan, it is only relatively recently that Zanskar butter has been so sought-after in Leh as to make it worth the time and effort of a few Zanskaris to undertake the Chadar trek regularly.”

James Crowden, who trekked this route in February, 1977, has written about the hardship that he and Zangskaris endured during their journey in his paper titled Butter trading down the Zangskar gorge: The winter journey (1994). Similarly, Olivier Föllmi (1981) has documented the Chadar through his photography, which has been published in his book, Where Heaven and Mountains Meet: Zanskar and the Himalayas (1999).

Some of the more experienced Zangskari trekkers say that the route has become popular with tourists fairly recently. This popularity is fuelled by a craze for taking selfies. The popularity of the trek has led to negative impacts and necessitated regulation.

The duration of the trek varies from five to seven days depending on the intended destination. Many tourists prefer to return from the Nyerags waterfall (about five days) while others prefer to travel all the way to Zangskar (seven days or more).

Interestingly, the people from Zangskar do not regard the Chadar as a fancy adventurous trek but as a necessary journey to be undertaken to travel in and out of the valley in the winter. I managed to reach Tundup Dorjay, a 29-year-old man from Lungnak village in Zangskar, over the phone. He mentioned that there are many songs about Chadar. He mentioned a song that was sung during his grandfather’s time, then sung by his father and now by him. The first line of the song goes, “Chadar road po dub na, tey sang skitpoi Zangskar” (If the Chadar road is made, what a blessing it will be for Zangskar!). This route is an essential pathway for the people of Zangskar valley.

Twenty eight-year-old Stanzin tells me that local men and women from Zangskar walk on the tar for 10 hours each day to reach their respective villages within five days. Their stamina and endurance is incomparable and they are an essential component of the commercial Chadar treks.

Chadar and Zangskar

Zangskari trekkers in their 50s still remember walking on the Zangskar river till its confluence with the Indus. This is no longer the case. The trek now ends and starts from a point called Dar, which is approximately 11 kms from Chilling village. This is the point till which the motorable road constructed by the Border Road Organisation (BRO) has reached so far.

The main stopping points on the trek are Bakula Cave, Shingra Yogma, Bukta, Shingra Gongma, Tsomo, Tibb, Nyerags and several small pullus (human-made stone shelters). In 2020, bad weather limited the number of camps and the days for trekking. The main camps in 2020 were Shingra Gongma, Tibb and Nyerags along with caves and smaller camps used by local trekkers. The main camps had basic facilities such as medical facilities with a doctor, garbage bins, toilets, satellite phones, and a rescue team deployed by District Magistrate, Leh. The rescue team was manned by members of Ladakh Mountain Guides Association (LMGA) and functioning under the aegis of All Ladakh Tour Operators Association (ALTOA) and State Disaster Response Force Component (SDRF). The Indian Army was initially stationed at the starting point in Dar. After 14 January, they were deployed to other camps too as weather conditions became rather unpredictable.

Prior to the starting of the 2020 trekking season, District Magistrate, Leh released the Standard Operating Procedure (SOP) for the trek through order no. JC/169 (P) 2018 (903) dated 22/10/2019. The main objective of the SOP was to ensure safety during the Chadar trek. The SOP made it mandatory for all trekkers to buy a medical Insurance and undergo a medical check before being allowed to undertake the trek. The insurance covered hospitalisation expenses for injuries and illness, repatriation of mortal remains, medical evacuation, personal accidents, trip cancellation and interruption, etc.

The SOP also made it mandatory for trekkers to rest for two days after arriving in Ladakh to allow their bodies to acclimatise to the altitude. All the checks and necessary paperwork was centralised at the Tourist Information Centre in Leh.

The SOP also included safety instructions for the trek and stated that the trek can only be carried out through registered travel companies. ALTOA was given the responsibility of carrying out daily checks and implementing safety procedures. ALTOA created register of porters and guides and issued them with identity cards. It was also given the responsibility of providing communication facilities at each camp. In case of an emergency, every group was instructed to contact the nearest Camp Director of the Mountain Rescue Team (MRT).The Department of Wildlife Protection, Leh was given the responsibility of providing each group with garbage bags and collecting the bags when the group returned.

When asked about this system, President of ALTOA, Tsetan Angchuk explained, “The Wildlife Department and ALTOA initiated a system in 2019. It was mandatory for trekking guides to provide the lists of all items being taken on Chadar, especially food, along with a security deposit of INR 500 at the check post near Phyang village. The deposit would be returned when all the non-biodegradable items and waste were handed over at the check post on their return. This system was very effective and successful. It helped reduce trash at different sites on the Chadar.”

This system was implemented again in 2020. Leh-based travel agent, Tsering Angchuk (Serthi Paeyok) explained, “Most travel agencies followed the zero-waste policy, which translated to minimum waste be it shopping for non-packaged products for the trek, reuse of items and recycling and minimal use of plastic. We still had to make sure that we bring back all the waste generated during the trek as part of our social responsibility towards the environment.”

I collected data for the number of trekkers from the Department of Wildlife Protection, Leh and ALTOA. According to Department of Wildlife Protection data in 2020, the Chadar trek season lasted from 6 January to 10 February. A total of 2,287 trekkers participated in the trek of which 2,160 were domestic trekkers and 127 were international trekkers. ALTOA provided the data for the previous years, which showed a marked increase: 3,144 (2019) , 2,529 (2018), 1,735 (2017), 1,545 (2016) and 1,043 (2015).

However, these numbers do not include the support staff members that accompany each group. On an average each group includes a guide, a cook and a helper along with two porters for each person in the group. In addition, each camp also has officials posted there by the administration. Thus, the actual footfall on Chadar is probably twice to thrice the number of registered trekkers.

The political economy of Chadar

Based on my conversations and observations about Chadar, I found that porters who work on the trek work under the most unfair conditions. In 2019, the daily wage for a porter on the Chadar was approximately INR 1,200. In 2020, this figure reduced to an average wage of INR 800. When asked why the rate had reduced, some porters claimed that the first few porters who worked this season opted for lower wages, which then became fixed as the minimum wage for all porters till the end of the season. I checked this with travel agents who claimed that the wages sometimes vary depending on factors such as average market rate that the porters fix for a season. It is surprising that local porters did not have a representative body to negotiate crucial issues such as wages.

In addition to getting registered with ALTOA, each porter was also supposed to buy an insurance premium of INR 50. However, many of them were not aware of their entitlements under the insurance scheme.

Furthermore, the porters have the toughest jobs on the trek. They have to carry or pull all essential camping materials from kitchen supplies to bedding for their clients for the duration of the trek. These loads generally weigh 40 kgs or more. For most part, the porters pull the load on sleds. At times, they have to physically haul the load over rocky outcrops and through the freezing water. There is constant danger of falling into the river and other grave risks. Despite these challenges, these men work their way back and forth on the frozen river for the whole season year after year, They also earn the least of all the people who are involved with the Chadar trek. However, ALTOA does provide training to porters and other support staff on life skills to survive such treks.

Lobzang Odzer, a guide from Zangskar, mentioned the Chadar has become much safer nowadays. “We have been walking the Chadar for several generations. These days we have rescue teams and medical facilities. In my opinion, Chadar has become safer since the government started regulating the trek.”

The guide is the leader of the group and is responsible for everyone in it. They generally have vast experience, have to tackle every challenge, and make decisions to ensure that the group remains safe. They earn anywhere between INR 1,300 and INR 1,800 per day but the rates are known to vary based on various factors.

Only about 40 travel agents in Leh, i.e. about 10% of the total, operate in the winter and offer Chadar trek. The main challenge they faced is the cut-throat pricing prevalent in the sector. For instance, there are agencies outside Ladakh that are selling Chadar trek packages for INR 16,999 per person, while others are selling it for over INR 24,500 per person. These prices include food, accommodation, local transportation and the actual trek. Travel agents in Leh explained that these rates depend on the number of people in each group, which incentivises larger groups. Furthermore, this sort of pricing has a detrimental impact on local businesses that provide logistical support and relevant services in Ladakh with minimal earnings.

On the Chadar I met several trekkers. One trekker I met was being pulled on a sled by a young porter on their way back from Nyerags. The trekker said that for the amount they paid for the package, they should be provided with central-heating facilities in hotels. When I mentioned this to some travel agents, they countered that if trekkers do not acclimatise and learn to endure the cold, they would have a tough time adjusting to the conditions on the trek. One of them said, “What is the use of coming all the way to Ladakh if one wants to sit comfortably in a centrally-heated room?”

Four first-time trekkers I met on the Chadar, Druv Pariwal (20 years ), Gaurav Pariwal (31 years), Ashutosh Pariwal (34 years) and Dr. Jitendra (33 years) from Jaipur were very positive about the trek. They said, “Everything was very systematic. We did find the cold nights very challenging but food was very nutritious. The trek was comfortable except the few times we had to go off route where the ice had broken. The camps were generally clean with medical and toilet facilities.”

I also met 25-year-old adventure enthusiast, Kartik Kolipaka from Hyderabad. We met at Nimmoling as they were preparing to leave for the trek. He explained that they were forced to change their schedule due to the weather but that he was looking forward to the challenge of the trek and hoped to reach the last camp. “I have been training for this trek for the last five years. I look forward to enjoying nature. The trek is more about being mentally fit to endure hardships in such conditions,” he added.

Managing Chadar

In 2020, the office of District Magistrate reports that Chadar trek was officially suspended only for two days (13 and 14 January). The decision to re-open the trek was taken after field assessment. However, bad weather and the lack of ice formation led to the trek remaining suspended for seven to 10 days. The bad weather also forced the District Magistrate and the Administration of the Union Territory of Ladakh to request Indian Air Force for support to airlift 70 porters and one rescue personnel from Nyerags. This was done through order no DCL/PS/Airlift/2020 dated 17/01/2020. The rescue operation became necessary after two groups of trekkers, which included 41 people, were stuck between Tibb and Nyerags camps after water started to flow over the ice. They were rescued and temporarily accommodated at Nyerags village, where the villagers took care of them.

When asked about the management of Chadar, President of ALTOA, Tsetan Angchuk stated that most regulations were implemented in 2018-19 by the then District Magistrate, Leh, Avny Lavasa, IAS, to regulate the trek and manage its ecological impact. As part of this, the number of trekkers allowed per day was capped at 100. “All other measures such as medical insurance, communication infrastructure, rescue teams, mandatory medical checks etc. were implemented at the same time. This has improved the trek and the biggest accomplishment of 2020 is that we did not have a single casualty,” he added.

In an effort to promote winter tourism, Chang Chub Stan and Strung Junu Tsogspa Nyerags in collaboration with Ladakh Tourism Department and ALTOA organised a Chadar Festival at Nyerags Ice Fall on 6 and 7 February, 2020. The festival was called ‘The Grand Canyon of Himalaya’. The 8-9 ft-tall frozen waterfall is one of the main attractions for many trekkers and marks the point where many groups turn around. Unfortunately, I was not able to meet any of the trekkers who participated in this festival to understand their experience. President of ALTOA, Tsetan Angchuk said that around 50 to 60 tourists had participated in the festival. This festival was also a way to exploring potential trekking and rafting routes around Nyerags and neighbouring villages in the summer. Assistant Director of Tourism, Leh, Tsering Angmo added “The festival was an initiative to focus on better livelihood options in the tourism sector for local communities.”

Looking forward

Tsering Angchuk (Serthi Paeyok) said, “While we all focus on the ecological impact of the Chadar trek, we also need to consider how road building affects the Chadar. The road being built by BRO will cover the Chadar and soon there will be no Chadar trek. This will impact the livelihoods of local communities. At the same time, the road is necessary to provide all-weather connectivity to Zangskar and address many of its problems.” When asked about this, President of ALTOA, Tsetan Angchuk said that alternate options for winter sports needs to be explored. “We can explore places like Wanla river and other places in Sham and Drass that freeze in the winter.”

I was curious to know how local residents of Zangskar viewed the Chadar trek and the impact of the road on their lives. Zangskar resident Tundup Dorjay asserted the need for an all-weather road to connect Zangskar with the outside world. He added, “Padum, the main headquarter of Zangskar, is 230 kms from the district headquarter of Kargil while the Nyemo-Padum will barely be 150 kms.”

According to the 2011 Census, Zangskar is home to around 12,000 people and connectivity remains the main challenge for the area. There are numerous stories of people from Zangskar using the Chadar to access better healthcare facilities as the whole valley has one Community Health Centre in Padum with one or two doctors, one Men Tse Khang (traditional Tibetan medicine), and Medical Aid Centres in each village. Tundup Dorjay explained that this is far from sufficient and the Nyemo-Padum road will help people access better healthcare facilities more easily.

He further added that it will probably take another five to six years for the road to be completed. “In the meantime, the government could make alternative routes such as pony trails, especially in places where one has to climb the rocky cliffs. This will ensure that when people from Zangskar walk the Chadar, they do not get trapped anywhere for several days. This would be a big relief for local Zangskaris who are otherwise at the mercy of the weather and the frozen river.”

When asked how the road would impact the livelihoods of the people of Zangskar, Tundup Dorjey was pragmatic. He explained, “The road will actually provide more livelihood opportunities for the people of Zangskar, especially in the tourism sector. However, it will have a negative impact on the social lifestyle of the people of Zangskar. I hope that the transition period is gradual and planned. This will help Zangskar develop in a sustainable way.”

By Rigzin Chodon

Photograph by Jigmat Lundup

Rigzin Chodon is Research Associate at Ladakh Arts and Media Organisation (LAMO), Leh

Jigmat Lundup is an avid photographer based in Leh.