‘Crisis will end depending on how the virus and we behave’

With India in the grip of a massive Covid health crisis, K SRINATH REDDY, president, Public Health Foundation of India, and former head of cardiology, All India Institute of Medical Sciences, speaks to Nivedita Mookerji on why the country was ill-prepared and what can be done now to tackle the situation. Edited excerpts:

Why did India get caught in the kind of healthcare crisis we are witnessing?

We did not anticipate the second wave, which we should have. We took it for granted that we had herd immunity and that there would be no second wave. That’s why we have been caught under-prepared and we are now beginning to provide the response, but it’s taking time.

Can you elaborate on why we were under-prepared?

Last year, while there was a fair amount of strain on the health system, the numbers were low when we announced a national lockdown. The country went for partial unlocking in phases; the public was adhering to the Covid protocol advisories; and we restricted travel as well as large gatherings. But by early January, when the daily case and death count came down, we committed the error of believing that the pandemic had ended for us. We believed in the rather attractive theory that we had all acquired herd immunity. People want to hear what they want to hear — economists wanted the country’s growth to revive; small traders wanted to get back to business; the ordinary person wanted to get back to daily life and travel; and politicians wanted to be in election rallies and so on. The view that we had put the whole thing behind us was widely prevalent and the preparations ceased. We sort of turned our back on the virus whereas the virus didn’t turn its back on us.

What is the way forward?

We should try and contain the transmission by ensuring that we go out wearing a mask and keep away from ill-ventilated places. People must not go to crowded areas. This means that even the public administration must ensure such crowded events, particularly super-spreader events, don’t take place. Also, people should not undertake unnecessary travel. We must understand that virus clouds do form in closed rooms and they don’t disperse easily.

The next step is that vaccination must speed up and everyone should have access to it. Access barriers in vaccination should be removed for poor people and those who are not literate enough. Home care support is also very important so that the pressure on hospitals is greatly diminished. And there should be reasonable assurance for hospitalisation along with transportation when required. And, of course, all the shortages — drugs and oxygen — should be addressed. These are steps to be executed with efficiency and equity. This has gone on for more than a year and is likely to continue for some more time. Therefore, the fundamental weakness in the health system must be addressed not just because there may be a third wave but also because there could be a first wave of a new virus.

Do you agree that lockdown helps?

Lockdown helps when the transmission rates are high and the system is not geared to provide a full-scale response. So, to prepare for resources while bringing the curtain down on transmission, it helps. But it cannot be a long-term and a countrywide solution because the situation varies from one part of the country to the other.

You’ve been familiar with the workings of the government. Why do you think the budgetary allocation for healthcare has remained low over the years?

Yes, I’m very familiar. I was chair of the high-level expert group that presented the report on universal health coverage for the Planning Commission in 2011…. I think health allocation hasn’t gone up because health was never accorded importance in political decision making. There were other priorities for public spending and other areas of economic activities were considered important. For several years, health was not seen as an economically productive investment and it was considered more as a necessary social sector support despite the fact that health is a very important investment, both because it protects productivity of people and also helps prevent poverty.

Do you see the crisis ending anytime soon?

Well, that does not depend only on how the virus behaves but also on how we behave. If everybody decides not to be a part of any crowd, everybody puts on a mask, everybody stops travelling unnecessarily, then it is possible that in two to three weeks we will see the cases going down. And after another two weeks, the deaths would go down. The virus may get exhausted for some time and may step off on its own, but we can’t leave things entirely to that.