February 14, 2021 6:30:29 am
Authors: Chandrakant Lahariya, Gagandeep Kang, Randeep Guleria
Publisher: Penguin Books
Price: Rs 299
We have finished more than a year of living through an unprecedented global pandemic. As of February 9, 2021, there had been 106,125,682 confirmed cases of COVID-19, including 2,320,497 deaths, reported to the World Health Organization.
India, of course, has also faced the brunt of the pandemic. While we have been fortunate to see the number of cases and deaths associated with COVID-19 go down over the past few weeks, there are still pockets within the country where the situation remains worrying. Dealing with this public health crisis has also shown us the upsides and downsides of our health system — at various levels.
While we continue to learn and analyse the disease and how to respond to it, it’s important to document how we, as a country, responded to COVID-19 as it emerged and then spread nationally. The book by doctors Chandrakant Lahariya, Gagandeep Kang and Randeep Guleria, published in December 2020, is a welcome study of how we, as a nation, coped with the pandemic.
The authors — an infectious disease and clinical trials specialist and vaccinologist (Kang), a pulmonologist and medical administrator (Guleria) and a health systems and policy expert (Lahariya) — bring diverse expertise and insights to this book. Each of them was involved in some way in the national response, as a key leader and/or analyst.
They dedicate the book to the often under-recognised frontline health workers, especially women — Accredited Social Health Activists (ASHAs) and nurses — who are key to our health system, and contributed majorly to our COVID-19 response.
In the preface, the authors talk about how as the first case was reported in India on January 30, 2020, and as the cases started rising, it became apparent that it was going to be a challenge to respond to it, given the lack of quality laboratories, a surveillance network which could deal with a novel virus, limited hospital infrastructure and an almost complete lack of local production of essential items such as personal-protective-equipment (PPE) coveralls for health workers. Introducing and ensuring adherence to public-health measures, such as masking, physical distancing and hygiene, was certainly going to be difficult across the country’s diverse geography, with multiple high-density, low-resource settings.
The book is divided into four sections. The first section deals with the challenge posed by the spread of a novel infectious disease, with a focus on viruses. It also introduces the reader to the basics of outbreaks, epidemics and pandemics, and provides a historical overview of some major outbreaks, before going into more details about COVID-19 — the broader coronavirus family and specifically SARS-CoV-2 — how it spreads, how it can be identified, symptoms, treatment, etc.
The second section discusses (the inadequacy of) our preparedness, right from the first reported case in India — an Indian student in Wuhan, China who returned home — to the immediate steps taken at the state and national level and the uptake of approaches such as quarantine and isolation. This was followed by a stringent extended lockdown aimed at slowing the viral spread and allowing health systems to prepare for any spike in cases. A focus on Test, Trace, Isolate was a key aspect of the response from a planning perspective. A few case studies of local responses are presented, along with highlighting the key role of working through and with frontline health workers, and engaging communities.
The next section deals with the treatment aspect and presents easy-to-understand information about the various kinds of approaches used, and the (lack of) evidence around many of these. This is followed by an explainer on the role of vaccines and protective immunity, clinical trials, and the range of vaccines in the fray.
The final section talks about the key learning from a future-planning perspective, acknowledging the Thai health-policy phrase of the importance of the “Triangle Moving the Mountain” — the mountain being any major problem, and the triangle being knowledge, people’s participation, and political involvement. The authors provide a laundry list of changes and planning as part of health systems reform to equip and prepare us for public health challenges like a pandemic. It is good to see here the authors take an approach focused on universal health coverage and the need to enhance health systems’ capacity. The book ends with providing practical advice and information for the reader on how their personal and professional lives might intersect with the pandemic.
Overall, the book is an easy-to-read and well-written documentation of India’s initial tryst with COVID-19, and will be useful to any reader who wants to understand both the disease as well as what makes a pandemic and what we can learn from India’s early experiences with COVID-19. Hopefully, policymakers will heed some of their advice on what needs to change, especially the need for further health sector investment and foresight. While the authors try to take a neutral stance in their description, perhaps they do tend to shy away a bit from criticising some of the lacunae in our response — the impact of the lockdown on families and migrants, the delays in ramping up testing, the use of non-evidence-based therapies and guidance, and the role of some of our key national agencies, and the need for a broader social-determinants approach in health. Now, with vaccination underway across the nation, there is more that needs analysis and clarity. Perhaps, the authors could consider an updated version of the book in due course.
(Dr Anant Bhan is a researcher in global health, bioethics and health policy)
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