One mantra for India: Test-isolate-treat-trace
Even if all Indians stay home for 21 days, the virus will only be down, not out. Increase testing tenfold
The coronavirus pandemic (Covid-19) may or may not be a viral flu. It is infectious, but only a third as lethal as SARS. In the recent past, the world has witnessed more deadly epidemics: SARS, MERS, Ebola, and H5N1. Yet, the coronavirus has been overwhelming due to the speed with which it has spread, infected people, and claimed lives.
The virus breached India’s borders on January 30 through the 1.5 million Indians returning to India since then till the ban on international travel. We do not know how many among them were active and passive carriers of the infection due to our abysmal state of testing.
Two months down the line, we have over 2,000 infected, and over 50 dead. These figures are not worrisome when compared to other countries, except that the curve is moving upwards and flattening horizontally: Today, more than double the districts are affected than a week ago.
Due to poor testing, we have no idea among whom the virus is lurking, and in which direction it is spreading. Fighting a war blindfolded has its risks. One hope is the onset of the searing summer and if, as is being said, this epidemic follows the same trajectory as the 2009-10 swine flu, we may end up with a more reasonable count of the infected.
The response has been unprecedented with heartbreaking consequences for the poor, homeless and marginalised. I have not found any compelling evidence in the public domain to give the nation less than four hours to lock down. Surely it is not based on a model prepared by some individuals based in the United States that estimates that 300 million people will get the flu, and since questioned by other experts?
Regardless, India has to take strong preventive measures. There were two models: The China model of social distancing by banning all movement, except for essentials; and the South Korean model of mass testing.
Both strategies seek to isolate the virus and disrupt transmission. Of the two, South Korea’s was more sensible, but not possible as we messed up our testing policy and do not have enough testing kits.
On the other hand, social distancing through lockdowns gave the government time to marshal its scarce resources to fight the next phase of the battle (treatment) and getting related requirements — doctors, nurses, personal protective equipment, intensive care unit beds, equipment, drugs, and trained personnel — in place.
Given our iniquitous health system, putting in place such infrastructure in the event of a surge is vital, if we want to minimise fatalities.
The suddenness of the lockdown without preparation, however, has created another battlefront. In the best administrative system, at least three days are required for a balanced response system to implement such an order: Framing guidelines for clarity, understanding and operationalising them to reach the last mile. But the sudden lockdown led to misunderstanding and panic, forcing migrant workers to flee cities.
The chaos that followed has, however, diverted attention from what caused it, besides creating the added worry of the potential spread of the infection to the hinterland. It reminds me of the spread of HIV in Surat. The sudden dismantling of a 400year-old brothel, by an enthusiastic police chief, forced sex workers to flee, making containment of the infection difficult.
But now, India has a window of opportunity, provided it acts quickly and decisively. The lockdown itself has limited value. Even if all 1.3 billion stayed home for 21 days, the virus will only be down, but not out.
For optimal results, the lockdown has to be accompanied by scaling up testing tenfold from the current levels, and rigorously implementing the mantra — test-isolate-treat-trace. And for such a scale-up, testing has to be free and accessible.
With several manufacturers of test-kits now authorised, prices will fall with volume. This will be much cheaper than what India is paying in terms of economic and social costs. Removing the deterrence of price and distance is critical in these times.
The second measure is relaxing movement restrictions for goods required for the manufacture and delivery of all health-related items — medical devices, consumables, drugs and instruments — and ensuring the running of the out-patient departments in hospitals. The Chhattisgarh government is reportedly organising five additional vehicles per block to ensure the steady supply of drugs for tuberculosis and chronic patients, besides transporting patients to and from hospitals.
We cannot allow the tap to run dry for the essential care of millions of sick people who need their medicines and surgeries, without creating another health crisis. Closing down outdoor patient units could also mean missing out potential carriers of the virus.
It must be remembered that money cannot buy all the essentials needed to cope with a surge of cases, but quick decisionmaking can. The Centre has now constituted working groups to deal with different aspects of the pandemic. This is a positive step, provided they are empowered and held accountable for delays. Indian companies have also come forward, making available all their resources — knowledge, expertise, infrastructure. This is inspiring.
Working together may give rise to innovation with the long-term triggering of more self-reliant and less dependent policies.
As Prime Minister Narendra Modi said: It’s a battle we have to win.