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Saturday, 06 June 2020 7.30 AM IST

How India performs on six steps to flatten coronavirus curve

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NEW DELHI: The respected New England Journal of Medicine, in an editorial titled Ten Weeks to Crush the Curve, on managing Covid-19, listed six steps needed to fight the pandemic. At the core of these steps is science, according to US public policy expert and physician Dr Harvey V. Fineberg who authored the editorial. “And with enough intelligence about the enemy — where the virus lurks, how quickly it is moving, where it is most threatening, and what its vulnerabilities are we can begin to re-energize the economy without putting additional lives at risk,” he wrote in the piece published on April 1.

So, how does India perform on each of the six steps?

1. Inspire and mobilise the public India has done reasonably well on this, as evident in the response to Prime Minister Narendra Modi’s call to cheer health care workers for five minutes (at 5 pm) on March 22, and light a lamp or shine a torch (after switching of all lights), for nine minutes at 9 pm on April 5. A collective action such as this connects people, said an expert. “Asking people to light diyas and candles helped them reconnect with society and break the monotony of being locked down for three weeks. It’s used in therapy to build resilience to help people cope with adversity,” said Dr Rajesh Sagar, professor, department of psychiatry, All India Institute of Medical Sciences New Delhi.

And for a country such as India, where people have trouble with queues, the kind of discipline shown in terms of adhering to the lockdown and social distancing when shopping for essentials is remarkable, although there have been some exceptions.

“You beat a pandemic by collectivism, not individualism, and what we saw on Sunday night is remarkable. The lights-out on Sunday was a remarkable display of the power of messaging, the power of social connectedness, the sense of community, and of camaraderie and togetherness across socio-economic groups,” said Dr Samir Parikh, director, Fortis Mental Health Programme.

But mobilisation must be taken beyond society to include research, technology, manufacturing and academia to develop vaccines, drug therapies, diagnostics kits and personal protection equipment, the NEJM article adds. “This epidemic has to be stopped by intelligence and speedy action. For that, we need to use the best and more appropriate technology to empower all people. Aarogya setu is the bridge that connects you, in this epidemic, to our health system... The more users, the more effective our pushback will be,” tweeted Dr K VijayRaghavan, principal scientific advisor to the government of India, referring to the app launched by the government.

2. Establish unified command India has done well on this too. It was quick to enforce the provisions of the Disaster Management Act, ensuring a unified response to the pandemic. There is a central command, with technical experts advising the government, but the decisions are still enforced by the states, customising them to the needs of each neighbourhood and district, all of which are at various stages of the epidemic. “Target responses to specific places and times, deploy and redeploy limited national supplies where they can do the most good, and learn from experience as we go,” NEJM said.

3. Make millions of diagnostic tests available
India hasn’t done well on this. It must scale up tests to identify and isolate the infection. Mass testing worked for South Korea and Germany. Rapid antibody tests for population screening should be expanded from outbreak areas to identify those who have had mild disease, recovered and developed immunity (and who can, therefore, return to work). This will be a game-changer in restarting parts of the economy quickly and safely, esperts say. This is why the antibody tests India will start using later this week are important. The protocol for their use, and the fact that some state governments have procured their own kits, will help widen testing.

4. Supply health workers with personal protective element (PPE) and equip hospitals to care of the severely ill India’s performance on this is patchy. It has ordered 7.5 million PPEs, of which 1.75 lakh have arrived from China, but they need to reach health workers urgently, many who are infected at very early stages of the pandemic. “All staff, including health care providers and hospital administrators, need urgent training in infection-control and biomedical waste-disposal disposal. With several health staff getting infected across hospitals in several states, contamination because of poor infection-control is often as big a problem as shortage of PPEs,” said a public health specialist, requesting anonymity.

In addition, India has sought to mobile 48,000 ventilators too.

Ample supplies of PPE (personal protective equipment) should be standard issue to every health worker who is in the front lines caring for patients and testing for infection. “We wouldn’t send soldiers into battle without ballistic vests; health workers on the front lines of this war deserve no less,” said the editorial in NEJM.

5. Differentiate the population into five groups and treat accordingly

While the number of infected in India isn’t high enough to warrant this, there has been some level of differentiation. Testing and quarantine policies have to be different for those at high risk of infection, those presumed to be infected (persons with symptoms who initially test negative), those who have been exposed, those who is not known to have been exposed, and those who have recovered from infection and are immune.

Quarantining people with symptoms till results come and hospitalising those with severe illness till they test negative at least thrice is happening in India, but there needs to be a clearer home-quarantining policy for people with mild symptoms and wider antibody testing for those who have recovered and are now protected. Some states have identified dedicated Covid hospitals and hotels to board health workers, but the implementation remains inconsistent.

6. Learn while doing real-time, fundamental research

India was quick to set up a highly qualified technical committee to advise it on its approach to combating the virus, but it hasn’t listened to all its recommendations, although it is understood that the initial idea for a lockdown did come from the committee.

Decisions to shape the public health response and to restart the economy should be guided by science, including when people can start working, and when schools, airlines, hotels, restaurants, and entertainment venues be reopened, said the NEJM editorial. But India needs to partner more closely with academia to build accurate predictive models for the emerging infection to improve preparedness.

“If we persist with half-measures against the coronavirus, we risk saddling the economy with a long-term and avoidable burden of anxious consumers, illness, higher medical costs, and constricted business activity,” said Dr Fineberg.

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