India’s corona strategy is very amoebic

The government took charge of the fight against Covid-19 right from the beginning — the first week of February. The first port of virus entry happened to be Kerala. Infection coming through individuals flying in from affected communities was blocked. Travellers at risk were identified, quarantined, tested, contacts traced and quarantined. The Centre was involved from day one. Kudos to the Centre for staying well ahead of the invisible enemy and blocking its lateral spread.

What cannot escape the virologists, epidemiologists and healthcare professionals’ notice is that the government’s strategy is not based on sound principles of science or management. These fears are being aired only in bits and pieces through some of the media; but who should the people believe?

On March 19, the Prime Minister addressed the citizens for the first time regarding the coronavirus, reassured that the battle was going well and called fora 14-hour janata curfew (stay-at-home campaign), for the whole of India on Sunday, March 22. It was a success. And now, the Prime Minister has announced a more severe 21-day lockdown, starting March 25.

That said, dig a little deeper and we see flaws. What cannot escape the virologists, epidemiologists and healthcare professionals’ notice is that the government’s strategy is not based on sound principles of science or management. These fears are being aired only in bits and pieces through some of the media; but who should the people believe?

Reacting to the virus

The first flaw is hubris on the part of the government, which has led to epidemiological intelligence being placed on the backburner. The government’s battle strategy is not science-based and proactive but reactive, confronting the enemy wherever it chooses to appear and fighting a thousand battles simultaneously. This enemy tactic was seen in many countries. India has no war-room thinking, just heroic fighting.

If there has been proactive planning, its details have not been divulged to the public: exactly how much personal protective equipment for healthcare workers, ventilators for patient-care, and diagnostic test kits are on order for manufacture and stockpiling? What are the plans for rapid erection of temporary hospitals? Surely the army has been alerted to be ready, but why keep that a secret? What sites are being prepared for erecting hospitals in tents? Are beds, linen, sanitary and disinfecting liquids on stockpile? Hubris is anathema in war; it has consequences.

The second flaw has been a complete reliance on government health management infrastructure, shunning the age-old wisdom of public-private participation. Private healthcare institutions, with their hardware and software capacities, were not invited to join in the battle from the beginning. They will become essential very soon, but they also needed time to prepare for the deluge of patients.

Testing protocol

Testing for infection has two basic reasons — identifying infected people to prevent further transmission (public health testing); and for diagnosing infected persons with symptoms, for their own personal benefit (healthcare testing). Hospital admission and isolation of symptomatic people has been part of the battle early on; but only government hospitals were authorised to undertake this. These interventions are for preventing further transmission, ie to protect public health. And there is no doubt that public health testing belongs to the government.

But what about testing for healthcare? Assigning all healthcare testing also exclusively to government institutions is neither fair nor just nor ethical. Prevention of diseases and protecting people’s health is the government’s purview. Healthcare, on the other hand, is a human right. Confronted with this dilemma, the government’s solution was to invoke a law the British had enacted in 1897 (the Epidemic Diseases Act), by which ethics and rights could also be put on the backburner.

Just over a week ago, a friend in Chennai called to check if there was some safe and convenient place to get himself tested as he had returned from a foreign country that was not on the government watch-list. When asked, a renowned institution with a virology lab said that it had been asked not to do any testing. So, there were only two places in Chennai — King Institute of Preventive Medicine and Research and Rajiv Gandhi Government General Hospital — where the concerned man could present himself.

But will there not be others there for tests, and may not some of them truly infected? Will that not pose a risk for the gentleman? Yes, indeed; so he decided not to get tested.

Now, there is also a third centre in Chennai, a city with a population of 11 million. If the government wants to prevent mass transmission of the infection, why is public health testing made so people-unfriendly? Everyone has to obey the rule that testing should be related to government-notified travel and contact — therefore, testing is exclusively for preventing further transmission, rather than for an individual’s health.

There is one government specimen collection lab that insists that anyone who requests testing must stay under isolation for 3-4 days until test results are back from the National Institute of Virology in Pune. If negative, you go home; if positive, undergo 14 days of isolation in the ward. This requirement has deterred several people from getting tested. Less the infections detected, better the statistics.

Undermining healthcare

The third flaw is the neglect of healthcare as an essential element of battle strategy andcomplete reliance on public health. This is a chronic problem that India has lived with for many decades. For controlling some diseases, healthcare methods were given primacy. But with Covid-19, focus is on public health. Science and management principles demand that both public health and healthcare go hand in hand.

The government itself has encouraged — even unfairly, some people feel — the private sector to invest heavily in healthcare. Now, when there in an urgent need and people are anxious and scared, why were the doors of private hospitals closed? The battle strategy is becoming clearer — this is the government’s showcase of public health prowess. The brahmastra has been thrown into battle. Is the neglect of healthcare in the battle against Covid-19 by design or by default? If this is a battle strategy, it must be by design.

The fourth and fatal flaw is, surely, not making the public an ally in the battle. The government had not addressed us directly earlier — we have not been given authoritative information. That vacuum was filled by a flood of unauthenticated information. This is a newly emerged virus. We do not yet fully understand its behaviour. Its transmission is highly contagious. The most ordinary social contact is sufficient for its spread. The infected may infect others without even realising. The virus may last several days, a week and even longer.

The more authentic information people have, the better prepared they will be to reduce transmission. The more informed people are, the more allies the government has — and the less will they transmit. The government did not take us into confidence, but just told to obey simple orders and respect the Sunday curfew.

The curfew was presented as the ‘transmission-breaker’. But shockingly the very next day, in spite of assurances that this was a one-day affair, 80 districts were placed under lockdown. So was the janata curfew a damp squib? Our confidence in the war strategy and machinery is dented; let’s be aware that the way things are going, the spread of the virus will not be dented easily.

Through The Billion Press. The writer is the former head of the Indian Council for Medical Research’s Centre for Advanced Research in Virology and serves as a professor emeritus at Christian Medical College, Vellore