Covid-19: This is what India needs to do now: analysis
The Indian government’s decision to impose a 21-day blockade to combat the coronavirus pandemic (Covid-19) was a bold one. But now more remedies are needed to help citizens whose lives have been damaged by the blockade. It is worth reiterating the main objective of the blockade: to prevent a sharp increase in Covid-19 cases that could overwhelm the health care system and cause economic and social damage. Global evidence, including from Asia and Europe, points to three priorities in the coming weeks: testing, protecting health workers, and producing better and open scientific data.
First, India’s test rates, although better than 10 days ago, are still too low. India can use innovations like driving tests to achieve an unprecedented rapid expansion of free tests through public and private laboratories (a ~ 5,000 bill will deter many of the tests, so it should be free). The Indian Council of Medical Research aims to increase the testing capacity to 10.00.00 per day in the coming months. But this should be done faster.
Thousands of mobile testing sites located outside of healthcare facilities must be created, along with limited randomized testing from communities. The National AIDS Control Program offers replicable lessons to ensure the quality of evidence and reporting. All positive samples must be filed in national bio-repositories, along with basic and confidential information for each person.
For those who test positive, self-isolation effectively means quarantining (and testing) your entire family. Therefore, all those who test positive and need it should receive immediate cash or credit to organize self-care and compensate for the loss of family wages. Each case should also be assigned a community companion to help meet basic needs. Most cases are mild and can be managed at home. To care for those who are too sick to be home, the Indian army can build temporary field hospitals, as the Chinese did. India’s innovative information technology companies can connect people to local testing and treatment sites and community support workers, including letting patients rate their care. Reinfection of Covid-19 seems unlikely. Positive patients, after isolation and a second negative test, can go to work (even as chaperones). These steps would also reduce the stigma of a positive test.
Second, Covid-19 transmission should not occur in crowded hospitals and clinics. Hospitals must focus on treatment, not testing. Physical partitions and separate computers must handle suspected or potential Covid-19 cases, apart from non-cases. Health workers were infected too often in Italy, Spain, and the United States (USA). Sick nurses, doctors, and other health workers reduce valuable human resources. In addition, symptom-free providers may infect older patients or those with existing conditions who are at increased risk for Covid-19 death. A major industrial push is required to ensure that the World Health Organization-recommended list of personal protective equipment is available to all front-line healthcare workers. Excess stocks in private hospitals must be purchased or recruited. Indian industries must be assigned millions of masks, gloves, disinfectants and thousands of fans. Anything not used in India can be sold or donated worldwide.
Third, India must emphasize better data science and transparency. Collecting basic demographic and risk details (age, sex, travel, contact with other Covid-19 patients, existing chronic conditions, current smoking) is a priority. Singapore is a model of exemplary reporting and contact tracking. A three-week follow-up phone call can establish whether the infected person is alive, dead, or hospitalized. Antibody tests in random populations and among health workers can establish the true proportion of infected, but they must start very soon before immunity decreases. This, together with tests in morgues, can provide a plausible estimate of the infection death rate, a key parameter that is not adequately documented worldwide.
If Covid-19 deaths are to increase sharply, daily reports of total death counts by age and sex by each municipality would help track whether there is an increase in alleged Covid-19 deaths. Registrar-General Verbal Autopsy studies are helpful, but should be reactivated to review deaths in 2020, as the latest published results are from 2013. Collectively, the simple denominators of infected and death rates would help provide a true ” GPS “to control the epidemic. Unfortunately, mathematical models make too many assumptions. We need real data.
Admittedly, Prime Minister Narendra Modi, Health Minister Harsh Vardhan and most of the top ministers have begun to speak as one. Honest, calm and daily communication of science can explain the role of each citizen to flatten the path of the epidemic and generate public confidence in a stronger response.
Prabhat Jha is a university professor at the University of Toronto and leads the Study of Millions of Deaths in India.
The opinions expressed are personal.