Preparing to live with COVID is India’s best hope

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Published: May 15, 2020 4:01 AM

Apart from a lot more hospitals, masks etc, it means more planning; RT-PCR tests for air/rail travel, for instance.

While the lockdown gave India breathing space to bolster its creaky healthcare system as the spread of the infection was delayed by 6-7 weeks, there is a long way to go.While the lockdown gave India breathing space to bolster its creaky healthcare system as the spread of the infection was delayed by 6-7 weeks, there is a long way to go.

While India managing to ‘flatten the curve’ is good news, the fact is that unlike many other countries, even after the series of lockdowns, the number of infections continues to rise, even if at a declining rate. Not surprisingly, the government is now talking of living with the virus, of taking precautions like ‘do gaz ki doori’ while trying to restart economic activity. While the lockdown gave India breathing space to bolster its creaky healthcare system—set up more hospital beds, isolation areas, ventilators, etc—as the spread of the infection was delayed by 6-7 weeks, there is a long way to go.

The prime minister spoke of how, from not producing anything at the time Covid-19 struck us, India is now producing two lakh N-95 masks and PPE suits a day. This is good news, but there is a long way to go when you consider that the country has 12 lakh doctors and 30 lakh nurses, each of whom requires one suit and one mask a day. It is true that not all the doctors and nurses are treating Covid-19 cases, but till India has a much wider testing protocol—and this requires adequate stocks of working testing kits, including the rapid antibody ones—doctors and nurses have to assume that anyone they are treating is potentially an infected person.

And, as the infection spreads, the shortages will multiply manifold. That is why, for instance, so many hospitals in cities like Delhi and Mumbai are complaining that they don’t have adequate protective gear. Sadly, there are few databases—at even a city-level, leave alone a national one—on this. But, for Pune, databases created by the Pune Municipal Corporation and state government showed that the Sahyadri Hospital in Kothrud, Pune has 30 doctors and only 15 PPEs and 25 N95 masks; another Sahyadri Hospital in Bibwewadi has 37 doctors, only 25 PPEs and 35 N95 masks. How under-provided the country’s hospitals are, as this newspaper detailed (bit.ly/35WbHPY), is best illustrated by the fact that Mumbai has a fifth of the country’s infected people and a fiftieth of its medical infrastructure.

Inducing behavioural change regarding usage of masks at all public places, washing hands frequently with soap, etc, will not only mean intensification of awareness drives—apart from measures to enforce these—but, crucially, access to key resources (masks, even water). Similarly, while opening up travel will be a big part of opening up the economy, there has to be a uniform protocol on this. It is unacceptable that the Railways restarted special trains and there was no information on whether those travelling would be quarantined at their destination.

It is even more shocking that this happened while the government has not even opened up intra-city bus transport for fear of contagion. Theoretically, passengers were scanned at the departing station, but when 70-80% of the infected are asymptomatic, the screening is largely ineffective. So, for air and rail travel, why not insist on mandatory RT-PCR tests of passengers before travel? This requires ramping up the testing facilities, but it needs to be done.

States must agree upon a quarantining strategy to minimise spread. Ganjam district in Odisha saw cases rise from zero on May 1 to 249 right now, but the state was able to nail each of these—all cases were migrant workers who had returned from Surat—by insisting that people coming from outside only be allowed to enter the state if they had registered on a state-run portal, or had key details provided to the local authorities by friends/family.

The rigorous, but incentivised, quarantining of 28 days that the state follows could help keep transmission in check. And, clearly, there needs to be a much greater focus on cities like Mumbai, Delhi, Ahmedabad, Surat, Chennai, etc, that have reported a high incidence, for intervention in terms of propping healthcare, greater screening through pooled antigen testing/random antibody testing, and tailoring restrictions as per demographic and local economy.

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