A mantra for India: Test-isolate-treat-trace | Opinion – analysis
The coronavirus pandemic (Covid-19) may or may not be a viral flu. It is infectious, but only a third as deadly as SARS. In the recent past, the world has witnessed more deadly epidemics: SARS, MERS, Ebola, and H5N1. However, the coronavirus has been overwhelming because of the speed with which it has spread, infected people, and taken lives.
The virus crossed the borders of India on January 30 through the 1.5 million Indians who returned to India since then until the international travel ban. We do not know how many of them were active and passive carriers of the infection due to our abysmal testing status.
Two months later, we have more than 2,000 infected and more than 50 dead. These figures are not worrying compared to other countries, except that the curve moves upward and flattens horizontally: today, more than twice as many districts are affected than they were a week ago.
Due to bad tests, we have no idea who the virus is stalking and in which direction it is spreading. Fighting a war blindfolded has its risks. One hope is the beginning of the scorching summer and if, as they say, this epidemic follows the same path as the 2009-10 swine flu, we can end up with a more reasonable count of those infected.
The response has had no heartbreaking consequences for the poor, the homeless and the marginalized. I have not found any compelling evidence in the public domain to give the country less than four hours to close. Surely not based on a model prepared by some people based in the United States that estimates that 300 million people will get the flu and that other experts questioned it?
In any case, India has to take strong preventive measures. There were two models: the Chinese model of social distancing by prohibiting all movement except the essential elements; and the South Korean model of mass testing.
Both strategies seek to isolate the virus and interrupt transmission. Of the two, South Korea was more sensible, but not possible, as we had messed up our testing policy and we don’t have enough test kits.
On the other hand, social distancing through blockades gave the government time to gather its scarce resources to fight in the next phase of the battle (treatment) and obtain the related requirements: doctors, nurses, personal protective equipment, beds intensive care units, equipment, medications. and trained personnel on site.
Given our wicked health system, it is vital to establish such infrastructure in the event of a sudden increase, if we want to minimize deaths.
However, the abruptness of the unprepared blockade has created another battlefront. In the best administrative system, it takes at least three days for a balanced response system to implement such an order: framing guidelines for clarity, understanding, and operationalization to reach the last mile. But the sudden shutdown caused misunderstandings and panic, forcing migrant workers to flee the cities.
However, the chaos that followed has diverted attention from what caused it, in addition to creating additional concern about the possible spread of the infection within. It reminds me of the spread of HIV in Surat. The sudden dismantling of a 400-year-old brothel by an enthusiastic police chief forced sex workers to flee, making it difficult to contain the infection.
But now, India has a window of opportunity, provided it acts quickly and decisively. The lock itself is of limited value. Even if the 1.3 billion stayed home for 21 days, the virus will decrease, but it won’t go away.
For optimal results, blocking should be accompanied by an extension of the tests ten times higher than current levels and rigorous implementation of the mantra: test-isolate-treat-trace. And for such escalation, tests must be free and accessible.
With several manufacturers of test kits now licensed, prices will drop with volume. This will be much cheaper than what India is paying in terms of economic and social costs. Eliminating price and distance deterrence is critical these days.
The second measure is to relax restrictions on the movement of goods necessary for the manufacture and delivery of all health-related items (medical devices, consumables, drugs, and instruments) and to ensure the operation of outpatient departments in hospitals. The Chhattisgarh government is reportedly organizing five additional vehicles per block to ensure the constant supply of medicines for tuberculosis and chronic patients, in addition to 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 medications and surgeries, without creating another health crisis. Closing patient units outdoors could also mean losing potential carriers of the virus.
It must be remembered that money cannot buy all the essentials necessary to deal with a wave of cases, but rapid decision making can. The Center has established working groups to deal with different aspects of the pandemic. This is a positive step, provided they are trained and responsible for delays. Indian companies have also introduced themselves, making all their resources available: knowledge, experience, infrastructure. This is inspiring
Working together can generate innovation with the long-term activation of more independent and less dependent policies. As Prime Minister Narendra Modi said: It is a battle that we have to win.
Sujatha Rao is former Union Health Secretary
The opinions expressed are personal.