Updated: March 24, 2020 1:40:33 am
A B R Ambedkar Centenary Award winner for Excellence in Biomedical Research, NITI Aayog member Dr V K Paul is co-chairman of an empowered committee coordinating among agencies, scientists and regulatory bodies to fight coronavirus. As in-charge of health-related issues at NITI Aayog, the former AIIMS heads of paediatrics formulated the Centre’s POSHAN Abhiyaan to fight malnutrition and the Ayushman Bharat initiative. Paul speaks to HARIKISHAN SHARMA on the government’s strategy, the stage India is in, and Janata Curfew. Excerpts:
Are we under-reporting cases? We have screened over 1.5 million in-bound passengers and tested less then 20,000.
When we are reporting this number, it is based on a well-known methodology. And, that methodology is, you have a traveller, and you track that traveller. Then, there are symptomatic cases, a cluster of people who are tracked systematically. In addition, the ICMR (Indian Council of Medical Research) has mounted another screening system, of a few thousand random samples. We are also looking at how deaths of serious pneumonia, respiratory diseases are happening… What does it mean? It tells us, first, that there was no excess increase in admissions for respiratory failure and serious conditions that may mimic COVID-19 till yesterday.
You can’t make the entire country suffer… Based on this, we are getting this 400-odd number. The ICMR system also shows that even by random numbers, the spread is very limited. There is no major outbreak in the community.
Why is strategic testing needed? Because it is a very complex, two-stage test. So, based on the stage of the outbreak then, the earlier strategy was thought to be good, efficient, feasible and doable in a way that we understood the disease… Kul milaakar ham kah sakte hain ki serious death wali, serious disease wali mahamari ki stage abhi dikhti nahin hai (All in all, we can say that we haven’t reached the stage of large-scale deaths, disease).
Now that there are more numbers, we have changed our testing strategy. If you say, what is the absolute number in the US, who can say this? The number of people who went for testing, it is only that number. Not everybody is going for tests. Who is going for tests? The one who has symptoms. Understand that… So, we have adopted a balanced approach.
It is being said the reason we chose this strategy is that we don’t have enough test kits.
We chose that strategy given our overall resources and to make sure we don’t miss anything. Maybe in the beginning we didn’t have test kits, but now there is no dearth. As the disease progressed, availability was not an issue at all.
Why did we not let private players do tests till now?
Please understand, there are two things. One, you do surveillance to find out how big the disease is. No one can collect samples of all people… That is where the private sector comes in. The private sector is not part of our surveillance system, that is only the NCDC (National Centre for Disease Control) and ICMR. This is because it is not the private sector’s job to catch people at the airport. Second, I am a patient with cough and fever, that is a different thing.
Why delay even private labs?
There is no delay, this is the right time. When the numbers were limited and we were in the entry phase, it was not needed. Now we are seeing a possibility that we could have a much larger outbreak, we could enter Stage 3. Then, the whole mobilisation, resources have to be stepped up.
What happens when we reach Stage 3? How does the strategy change?
The strategy changes then to mitigation. Surveillance goes on, but individual patients then become more important. Then this issue of tracing every contact becomes non-effective. When it is limited, you do tracing and containment. When there are too many infected people, your whole strategy is mitigation, which means you look after the patient. Avoid any problem with health workers, doctors, nurses… and then avoid serious disease and deaths, that becomes your main strategy. But continue to ensure that spread is controlled. Abhi local transmission hee hai (till now, it remains local transmission).
There appear to be at least three cases of no history of travel or contact…
After investigation and tests are done in these cases, we will have no problem making a statement that we are in community transmission stage. Doosri baat yeh hai ki iske anticipation mein, aapne kal bhi suna ki community transmission nahin hai, lekin change kahan hua, change 10 din pehle hua jab pradhan mantriji ne aahwan de diya, maan lijiye uss point se le lijiye, ki bhai containment bhi karo aur yahan tak to theek hai lekin desh ko agle stage ke liye taiyyar karo (You heard yesterday too that there is no community transmission, but there has been a change in strategy. When did the change take place? The change happened 10 days ago, consider it the point the PM called upon people, that take containment measures but also prepare the country for the next stage).
God forbid, if we reach the next stage, the efforts we are making now are against that. But jo bhi data abhi tak hai aur officially aapko bataye gaye hain, main manta hoon ki theek hain (But whatever data is there till now and has been conveyed to you, that is correct).
Is it in preparation for Stage 3?
Today you can say, as of now, yes, it’s preparation for Stage 3 and intensification of containment to the best possible extent.
However, it can be argued that the government introduced lockdown, as Stage 3 has already arrived.
There is no harm over-reacting. Stage 3 will happen. That’s a scientific fact based on the data available to us through multiple sources… That is why, we have to be prepared, and to ready the people for the fullest mitigation strategy. In fact, the preparation began even earlier, when talk started of social distancing.
Prime Minister Narendra Modi’s addess to the nation… was Janata Curfew a desi tareeka to sensitise people, or was it done on the advice of medical professionals?
Unka jo faisla hai, unko jo saare input aayen hain, sab taraf se jo aayen hain, scientific community se aayen hain, microbiology experts se aaye hain, unke apne system se aayen hai, sarkaaron se aaye hain (Whatever he has decided, it’s based on all inputs, from everywhere, scientific community, biology experts, his own system, different governments). He has other advisers, across sectors, because such decisions are not related just to health. They are related to other sectors. It is based on a holistic assessment.
What will be the benchmark when we start relaxing the measures? Will it be the number of new cases or patients?
It is too early, I cannot say anything.
What do you find reassuring and what worries you?
That India’s response has been robust, that people have cooperated, they have faith. The nation is prepared for the worst scenario and people have come together to make it happen. Both these are reassuring. However, because it’s a new disease, it’s a new virus, a new animal in the zoo, we do not know the overall extent and the consequences.
Here’s a quick coronavirus guide for you to stay updated: Who all should be tested for Covid-19 and when? | How should you quarantine yourself? | How often (and how) should you clean your home? | What is the Janata Curfew announced by PM Modi? | Who are restricted from coming to India, and from when? | How long can the virus live on surfaces or in air around you? | Still more Coronavirus Q&A Explained news here
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