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Tuesday, June 02, 2020

NITI Aayog member Dr VK Paul: ‘Consider pandemic extinguished only when it subsides worldwide’

The effect of the first three weeks of lockdown is now clearly visible. India has succeeded in flattening the curve, says NITI Aayog member Dr V K Paul.

Written by Abantika Ghosh | New Delhi | Updated: April 22, 2020 11:23:11 am
Thermal screening in a queue for food for homeless people in Delhi. Express photo by Anil Sharma

Have the results of the first three weeks of lockdown been along the expected lines?

The effect of the first three weeks of lockdown is now clearly visible. India has succeeded in flattening the curve. If we look back, we started with a case doubling rate about every three days in mid-March when the government took several measures to contain the outbreak, including travel restrictions and campaigning for social distancing etc. The doubling rate of cases by the end of March slowed to every five days. Since the 5th/6th April, the effect of lockdown on flattening the outbreak curve has become consistently evident. The doubling time now is close to every 8 days, and there is more to come. We can expect it to drop to every 10 days in the next few days. Because the lockdown continues up to 3rd May, we also expect further dampening of the curve well into mid-May. The trajectory after May would depend on the pace of lockdown de-escalation. Since opening of the lockdown will be a phased and nuanced affair, we should not expect an abrupt increase in cases. Thus, in terms of outbreak control, lockdown has yielded the desired results. Cases have remained limited and deaths have been low. Compare it with any other country and you would notice how well we have done as a nation.

How do you see this panning out? What will happen in the next two weeks and beyond?

In the next two weeks, I visualise consistent and deep adherence to lockdown norms. Areas where phased relaxations would kick in would also respect the limits of activities allowed. We presently have a limited number of hotspots and clusters, and the situation is under control. The next two weeks should see our effective containment of these hotspots just as it was achieved earlier in Agra, Bhilwara and in Kerala. It is also notable that large and highly populated states like Uttar Pradesh and Bihar have succeeded in ensuring that the outbreak remains well-contained. Containment efforts should go hand-in-hand with efforts to strengthen the health system. De-escalation of lockdown is potentially an opportunity for the virus to resurface and spread, and this is bound to happen to an extent. There could be new clusters when life and activities become more normal. The magnitude of such spread is inversely proportional to our collective compliance with the best practices. We cannot afford to fritter away the lockdown gains made at a phenomenal economic cost and hardship. We have to keep the virus transmission under check and ensure that no new peaks appear. June and July months will test our resolve.

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Are we testing enough? Many experts seem to think we are missing the undercurrents of a much larger epidemic

India’s strategy of testing has been calibrated and pragmatic, making best use of the available resources. ICMR has scaled up our testing capability through a large laboratory network very rapidly, and engaged the private sector as well. Today, there are 201 government and 86 designated private laboratories in the country. In addition, 23 national science laboratory hubs are networked with 63 facilities in 16 cities for COVID-19 diagnostic services. There are some geographical areas that do need more access to testing systems. To address that, recently, all medical colleges have been requested to establish such laboratories. Our initial conservative testing guidelines were aligned to the then prevalent stage(s) of the disease. The guidelines have now been broadened, and we have tested as many as 3.6 lakh individuals so far. Even when our daily testing number has now reached 35,000, the proportion of those positive remains consistently around 4 per cent, indicating absence of any significant undercurrent of symptomatic cases. We will further refine and liberalise the testing strategy as the situation demands, and we will ensure adequate capacity to do so. Testing approach should be seen as a part and parcel of the overall strategy of pandemic control, and not in isolation.

What is the “new normal” after lockdown?

Life as we know has changed for now and the immediate future. The pandemic would be considered extinguished only when it subsides worldwide. Meanwhile, social distancing, wearing a mask and hand washing are the new normal. Protecting our elderly is the new normal. Likewise, the new normal would dictate us to avoid gatherings. We should get used to less crowded markets and shops. Virtual meetings will be the way forward in place of face to face meetings. We must be responsible enough to self-quarantine ourselves in case of flu-like symptoms. We must not attach stigma to a person who wants to be tested for COVID-19 or has been advised hospitalisation being positive.

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In the rural areas, health facilities are fewer and far between. How will tracking and tracing happen there once lockdown is over ?

By and large, the rural areas have been free of the disease so far. The outbreak is largely urban and peri-urban. However, this cannot be taken for granted. Fortunately, the rural communities are taking proactive measures. These include wearing masks, washing hands, maintaining social distance and conforming to containment norms. There is no doubt that awareness about disease-prevention and life-saving practices in the rural heartland is huge. Access to healthcare and referral linkages are being strengthened. Participation of self-help groups and Panchayati Raj Institutions in this regard is laudable.

Is it true that a lot of PPEs from China have failed tests?

One donated lot of PPEs from China had to be returned due to quality issues.

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Give an Idea about how the health sector was prepared (in terms of beds availability, testing kits, PPEs) between January 8 when India’s first COVID meeting happened and March 22 when lockdown started in many areas

The lockdown has provided the country a precious time window to mount optimum health system preparation. It is expected that among symptomatic cases, 80% would have mild disease, about 20% moderate and about 5% severe disease. The country has developed a comprehensive plan to face the onslaught of COVID-19 outbreak of a large scale should that eventuality arise despite all efforts. The preparedness approach taken aims to be ready for a very large potential surge of new cases of COVID-19. Three types of COVID-specific facilities have been envisaged. At the most sophisticated level, there will be dedicated COVID hospitals for severe cases with intensive care facilities. Then there are dedicated COVID health centres meant for moderately sick and high-risk cases who require oxygen and supportive care, but no intensive care. At the third rung, COVID care centres provide isolation facilities for COVID cases with mild disease and for those suspect cases to be kept in isolation till their tests confirm or refute the disease. It is also important to highlight here that COVID care centres would actually not be located in hospital facilities, but in quarantine-like systems such as hostels, schools, stadia, even hotels etc. The rationale is to make sure that hospital beds are utilised for the moderate and severe cases, and importantly, also for patients with other illnesses. The battle against COVID-19 will be fought together with the private sector. Private sector has almost the same number of beds as the government facilities. In particular, their strength in critical care is better than that of the government sector. There is also an initiative to convert train coaches into mobile COVID facilities. The government is ensuring optimum supplies of oxygen, medicines, PPEs, N95 masks etc. The requirements for PPEs will be taken care of fully very soon with increased local production and large imports.

A lot of routine health activities have halted, TB reporting is down to a fraction. Are we going to pay a long term price of COVID too in terms of other health problems?

With intense focus on COVID-19, it is possible that other key activities have been diluted to an extent. However, this was unavoidable given the dire circumstances. It is important now that our preparations for COVID-19 are in advanced stages, we should focus also on our national programmes and priority health problems. In particular, immunisation, maternal and child health, nutrition and TB care should be intensified. We should be ready for the usual diarrhea, malaria and dengue rise in coming months. Our health and wellness centre activities should also gather momentum even as our vigil for COVID–19 would continue unabated even after phased de-escalation of the lockdown.

READ | After complaints, ICMR tells states not to use rapid tests for two days

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Where are we in terms of vaccine, drugs etc.?

An effective vaccine is our decisive and ultimate defence against COVID-19. At least four firms in India are collaborating with overseas partners for research and development for SARS-Cov-2 vaccines. Likewise, at least four of our national laboratories have identified potential vaccine candidates. A BCG vaccine trial is on the anvil. An empowered Task Force is making sure that all efforts are made to develop an indigenous vaccine in the near future. India will not miss any opportunity to be the global hub for vaccine development and manufacturing. ICMR has created a clinical research network and a registry to serve as a platform for trials on various therapeutic modalities. These include studying the use of convalescent plasma, plasma exchange and other drugs such as Redemsivir etc. when available. ICMR laboratories are also examining the potential of novel drug molecules for their effect on the virus. An effort is also being undertaken to evaluate the efficacy of Ayurveda formulations on COVID-19 disease prevention and treatment. Prime Minister’s clarion call to the scientific community to develop a vaccine and other science solutions for COVID-19 has galvanised the research teams, the industry and the research organisations of the country.

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