Virus control: What India should do next

NEW DELHI: For Brigadier Lokesh Sharma (name changed), biking is a passion. On one early morning biking session in June, a wasp stung him and Sharma lost balance, fell off the bike and suffered multiple fractures. He was rushed to the army base hospital and operated upon. His commandant and senior officers visited him in hospital. Sharma was discharged two days later and after he reached home, the hospital staff called to say his Covid-19 test was positive. Within a day, at least 10 senior officers and 50 juniors had to quarantine themselves on the base.Bizarre stories like what happened to Sharma, of people who haven’t ventured out of their homes in four months getting infected by the virus and of young adults suddenly feeling breathless and passing away within 24 hours are all a part of India’s journey in combating Covid-19. As India surges past the 1 million mark, Covid-19 cases in the big cities are plateauing, the virus is following a wave-like pattern, shifting geographical location to the south and east of India and scientists are working overtime to develop a vaccine. ET takes a look at what India should do next and the long road ahead:DRIVE SLOW: SHARP TURNSHealth experts say India has successfully enhanced its testing capacity, added adequate number of oxygen-support beds, achieved self-reliance in production of testing kits and personal protective equipment, and added to its repertoire scientific innovations that would help in getting cheaper and faster options to imported medical equipment. However, what remains a big challenge is to ensure that there is no sudden spurt in cases that could overwhelm the already-overburdened healthcare system.“This epidemic has multiple calendars as it advances from region to region, across the world and within each large country,” said K Srinath Reddy, president of the Public Health Foundation of India. “Where we are gaining control, as in some of the large metros, we should not slacken but must continue to maintain vigil through symptom-based syndromic surveillance at the household level and micro-containment measures as needed.”In syndromic surveillance, healthcare workers monitor disease indicators with the help of automated data acquisition and statistical alerts. This is different from traditional public health methods like door-to-door physical surveys.As Uttar Pradesh, Telangana and Bihar – states with the poorest testing numbers so far – begin widespread tests, newer hotspots are emerging.“In places which are becoming newly affected with rising numbers, case finding through household surveillance must be accompanied by extensive contact tracing, testing and isolation. Containment zones may expand if numbers continue to grow,” Reddy said.Former Delhi chief secretary Shailaja Chandra, who was the medical and public health secretary in the Delhi administration in 1991 and served for over a decade in the health ministry, said governments need to follow the Bhilwara model in the rural areas. The Bhilwara district magistrate had cordoned off the entire district in late March, sealed the borders and conducted door-to-door surveillance of every home to contain the spread of the virus. Calls were made to homes in quarantine three times a day.“Every district must be mapped down to the village level with an SOP that the community understands to identify suspect cases, people who are risk-prone like the elderly, and pregnant women. Micro-level mapping should not be restricted to only government facilities,” Chandra said. “Private doctors and community leaders need to be involved. In urban areas, making containment zones and tracking the cases day to day with the help of the RWAs or cooperatives has proved successful.”77028871CAUTION: UNLOCK AHEADIndia was one of the countries that imposed a lockdown as early as March 25, when the total number of reported cases was 468. As states began the unlock process, doctors and administrators emphasized on following strict protocols.“We are witnessing a downward trend in big cities like Delhi and Mumbai where more people are recovering and getting discharged than the number reporting to hospitals,” said Sandeep Budhiraja, group medical director, Max Healthcare. “In India, the virus has followed the same pattern as other countries – it stays for 3.5-4 months and then cases start plateauing. By mid-August in cities like Delhi, we will be down to the level of cases reported at the end of April. But we need to realise that the virus is not going anywhere. We need to learn to live with it.”Budhiraja compared this to the outbreaks of SARS in 2003 and MERS in 2012.“SARS, for reasons unknown, disappeared. But this highly infectious, maybe less fatal, disease (Covid-19) is here to stay. How do we deal with it? We as a community need to prepare to restrict transmission before a vaccine is developed,” he said.The internal medicine expert stressed on the need to involve people and the corporate sector to ensure that hand hygiene, wearing of masks and social distancing become the norm.“Infection control has to become a part of life. We need to accept that virtual meetings, telemedicine, e-learning are the new normal for some time,” Budhiraja said.Private companies need to start using technological innovations as they open up, he said. There is technology that can regulate the number of people in a conference room.“We need to deploy these,” he said.Chandra said the onus in the private sector should be on companies.“The health ministry has issued guidelines but there are bodies like CII, Ficci and Assocham that can be involved to ensure these guidelines are implemented. Employees should be given a break to wash their hands. Awareness campaigns need to be run to tell people that even if you are inside office with colleagues or at home with relatives, masks need to be in place. You cannot sit across and share your lunch,” she said.THE LONG ROADExperts said there are long-term lessons in the pandemic. India needs to increase its healthcare budget as a percentage of GDP, change the medical curriculum to ensure that more doctors take up infectious diseases as a super-speciality, train more nurses and change hospital designs to handle infectious diseases.“In the last decade, we have seen the frequency of infectious diseases increasing across the world. India needs to now focus not only on infrastructure but invest in training of healthcare workers,” said Budhiraja.“A lesson that has registered strongly is that India needs to become fully self-reliant in the production of medical equipment, pharmaceutical products, vaccines and protective gear,” said Reddy of PHFI. “Depending on global supply chains makes us vulnerable to disruptions. We need a strong public sector as a dependable resource for readily responsive healthcare.”

from Economic Times https://ift.tt/2WxlMzh