What should India’s Covid-19 strategy look like?

Before the end of March, India was in the strictest of lockdown anywhere in the world.

Screening of all incoming persons was being done at the airports, leading to longer times in exiting the premises. And India’s COVID-19 strategy was praised by experts across the world. Back then contact tracing was rigorous and testing precisely guided.

Six months later (time really flies, doesn’t it), India’s strategy to tackle COVID-19 is suspect. Looking at this through three aspects : understanding the infectivity of coronavirus, treatment of those testing positive without stressing the existing public health service and planning the strategy

Initially, the sudden restrictions on mobility led to panic and violations of lockdown, particularly by migrant workers, daily wagers and people stranded away from home, which rendered the lockdown pretty ineffective. Many of these people were housed in camps, often poorly run, by government agencies or cash-strapped, ill-equipped NGOs.

For weeks COVID-19 testing was limited to authorized government laboratories, and available conditional on pre-determined criteria. The government took a cautious approach, most likely to protect scarce testing resources. In light of this fact, it definitely seemed that imposing strict lockdowns was the best way to slow down the virus, despite the economic repercussions. And it all would have made sense had the authorities utilized the time for preparing their testing infrastructure. After all, it’s about planning everything for the time that’s coming.

Having granular numbers is important

Even if we consider the information, we have right now, we would require access to data in a granular form to understand beyond the existing big numbers that have been provided by the government i.e., no of tests done, no. of cased identified, no of deaths, no of recoveries.

Questions including

• What are all the tests that have been done ?
• In all of the tests done, what is the breakdown of rapid antigen tests and RT-PCR tests?
• What are the results of these tests?
• Why were these tests done in a particular place ?
• What was the profile of the person on whom this test was performed ? (To understand whether the person was a traveler, a healthcare worker, was asymptomatic or not etc.)

Some locations in the country do report these numbers, but all of this data is not collated at a single place, and one has to go through each state in order to obtain this information. What it means is, when we talk about testing it becomes difficult to trust the numbers on face value. RT-PCR tests are considered the gold standard for testing, due to its accuracy. For antigen testing, the chances of a false negative is much higher. You understand where I am going with this ? More information is needed! In order to make sense of the testing data, and to use it for prediction, all of this information is necessary.

Let’s look at another number — the no. of recoveries happening.

What does a daily recovery rate mean ?

I am no expert, but even I understand that if the mortality rate, as being told by the media, is 2% it implies that the recovery rate is 98%. So does the number of recoveries in a day mean anything and what is the criteria for calculating it?

What does “recovery” even mean?

In my understanding, it means when a person contracted the virus and then got better after a certain number of days. (maybe 14, but I am unsure) So again, what’s the official criteria here for calculating these numbers?

Does it mean the patient has tested negative ?

Does it mean that the patient was released from hospital or quarantine ?

Were the patient’s symptoms gone when they were let go ?

There’s no clarity on that.

And also on how states decide on making that distinction, because there is a difference in choosing how to report.

India is facing criticism for it’s reporting methodologies and its relatively low death rate has come under question especially since India doesn’t have a robust database on the cause of deaths.

Moving on from the data, let’s talk about the treatment that people are receiving. We know now, the risk the virus possesses for people with comorbid conditions, people who can get really sick.

If we know the proportion of the population who get very sick, with any degree of accuracy, it becomes easier to predict the demand on healthcare services. To ensure there’s a consistent supply of healthcare services to serve these people who are severely affected, while ensuring it’s not stressing out the system.

Since we’re talking about patients suffering from comorbid conditions, there’s a key factor to look into here that normally doesn’t get attention — preventive service in public health. A large chunk of people who suffer from heart ailments, diabetes etc. can get tested earlier to reduce the risk of the disease, but it simply doesn’t happen. Partly because insurance services do not cover such treatments or tests. Preventive care is not incentivised so no one cares about it, it’s only when procedures are being done, that can help the hospitals earn money.

The problem with data is there are many methods of collecting data. Some of them are collected through labs, some are distinct, but very few are joint up together.

Having a coordinated data system is a pre-requisite for handling diseases.

There should be an organization that is an integrated program that handles all the data from the country and then integrates it all together at one place. This information will also be useful if/when India comes up with a vaccine. Whenever that happens, a vaccine strategy would be required to decide where vaccine programs can be set up and how much supply will be required.

India is still developing its vaccine distribution strategy. While it stands united in saying that the frontline health workers directly interacting with COVID-19 patients will be the first recipients of the vaccine, there seems to be no clarity on who will come next.

Saving the economy

In the debate, between economy and healthcare, we know that it is in the best interest of public health to keep our economic health strong.

Quoting the infamous phrase from Bill Clinton’s presidential campaign -

“It’s the economy, stupid!”

As the disease started spreading, it is becoming more apparent that the virus is extremely transmissive and we cannot control it.

This is the general belief that when any nation enters the community transmission phase, there’s no point in trying to contain the disease. Despite having such high numbers, the government has never acknowledged that there is community transmission in the country.

Following what developed nations did, and enforcing a complete lockdown was simply impossible to do in India. People had to go to work, because a majority of the population relied on daily wages. Thousands of migrants had travelled back to their villages, at a time when the government was asking people not to get out of their homes. The decision to reverse it should have happened much earlier. And due to this negligence, many people lost their livelihoods.

There shouldn’t have been a delay in relaxing restrictions.

There would have been casualties, just like it is right now. But the industries would have been going on, and the economy would have been in a slightly better position. And the real tragedy of this whole ordeal is that the downward trend we’re seeing in the economy is not something that will affect people who are well-settled, people like you and me, but it will affect a large chunk of people who are used to poverty.

Instead of preparing for restrictions, we should have been focused on preparing for adequate healthcare for those who were going to be severely affected.

India’s response to detecting the COVID-19 outbreak was reactive, not proactive.

The world imported the lockdown strategy from China much like the coronavirus itself. But while China backed its lockdown strategy with door-to-door service delivery — aided well by a population trained to obey its government — the rest of the world including India failed to meet the basic needs of the most vulnerable and the poor.

Originally published at https://catwomaniya.io on October 08, 2020.