COVID-19 has made nearly 1.6 million people sick and claimed over 96,000 lives to date. Barely anyone alive has seen a health crisis of this scale and magnitude. To fight this coronavirus infection, we will need to take a public health approach: a quantitative, as well as qualitative, approach to fight an infection so new that we learn something more about it every day.
True, we have had our share of scares in the 21st century – SARS in 2002-03, Swine Flu in 2009-10, Ebola in 2013-14 and Zika in 2015-16. Yet COVID-19 has affected more people in more parts of the world in a shorter time period than any of these epidemics and pandemics that came before it.
The government has taken steps to limit the spread already, by quickly sealing international borders and ensuring physical distancing. This shows that there is an openness to seeing COVID-19 not just as a medical problem but a public health problem. This is heartening, to say the least.
From Explained: Tracking the coronavirus curve in India
We in the community — whether we are public health experts, doctors, community workers, RWA leaders and even social media influencers — can assist in this effort, too. Happily, there are public health tools and ideas that could give India another leg-up in its fight against COVID-19. Here’s a look at four such ideas:
1. Let’s think about the most vulnerable first
This comprises people over 60 years of age as well as people with chronic illnesses, especially diabetes and/or heart disease. This is because when these people get COVID-19 infection, they are more likely to fall very sick. They are also more likely to need hospitalisation and prolonged ventilator use. And they are more likely to die. Keeping them in strict physical isolation – but with a lot of social engagement from a safe distance – over the next several months should be a top priority. Doing this will save lives. Additionally, it will also reduce the pressure on our healthcare services.
2. Let’s unlock every avenue we have for healthcare
Experiences in other countries and regions have shown us that depending solely on big hospitals in a situation like this simply doesn’t work. It didn’t work in Italy, and it probably won’t work here as the number of COVID-19 positive cases rise.
Consider also that only a small percentage of patients actually need to go to a hospital for COVID-19 treatment – for everyone else, we can leverage our primary healthcare workers, community workers, retired doctors, nurses, medical interns, AYUSH doctors, skilled and semi-skilled health workers – in short, anyone capable of addressing the COVID-19 challenge efficiently in their different capacities and regions. These workers will give us the numbers and reach we need to fight the infection in every home of India.
To build this army of healthcare workers in the fight against SARS-CoV-2 infection, we will need to train them, guide them on SOPs (standard operating procedures), equip them with tools from personal protective equipment to medicines and oxygen masks. In return, this army will give us the much-needed reach into every last block, village and home of India. It will give us the numbers we need to wage war on this infection on multiple fronts.
Here, too, our Ministry of Health and Family Welfare has taken progressive steps, by working with top doctors at AIIMS to make training videos for healthcare providers like medical interns and ASHA workers (the videos are available on the ministry website for anyone to download and watch). The community’s role here could be to support the government in this gigantic war effort. (More on how to do this in a subsequent article of this five-part series.)
3. Let’s leverage more ways to manage this disease, while we work on our wish list of vaccine, medicines, more ventilators
Scientists are turning every stone – seeing if existing antivirals and antiparasitic medicines will work against this new virus. Researchers are also working against the clock to develop a vaccine. But any vaccine for COVID-19 may still be months away.
In the meantime, we need to think on our feet and become more flexible, too. For example, ventilators aren’t the only solution for the management of severe COVID-19. There’s oxygen therapy, which can be cheaper and more widely available – the government has already stipulated that a supply of oxygen be maintained at all designated COVID-Care Centres.
The World Health Organization has added oxygen therapy in its guidelines for the management of acute respiratory distress in severe COVID-19 cases. Indeed, medical practitioners and researchers have found that high-flow nasal oxygen can prevent or delay the need for intubation (invasive ventilator use).
4. Let’s put mathematical models to work here
Evidence from the US, which has the highest incidence of COVID-19 in the world currently, shows that what we do today will take about two weeks to have a visible impact on curtailing this infectious disease. So, it is crucial that every step we take is informed by as much research and data as we can muster. To do this, we need to prioritise some things over others, we need to break things down, place them in grids, use algorithms to rationalise the use of existing resources while we develop or source more.
An example of this is cluster-testing: given that there is a shortage of tests in the country, we could test up to 64 swab samples for COVID-19 in one RT-PCR test. If it comes back positive, we could test more clusters in that community until we can arrive at an informed decision on whether to send more medical resources to this area or direct the resources to another place that needs them more.
Another thing that is possible to do (possible but not easy) is to map what health infrastructure we have: this would include our primary care providers, transport mechanisms (ambulances, including those with oxygen support), and nearest hospitals. Only when we have done this, would we be able to map each member of the community to a particular primary care provider and ensure that every primary care provider is clear on the next steps to be taken.
To be sure, feeding this information into machine algorithms would only give us a direction – not a solution – but it will be something to go on. We have never faced a challenge of this scale before, yes. But we also have more big data tools than ever before to deal with scale. Figuring out what might happen next through models and projections could help us build preparedness for every plausible scenario. This could help us in better allocation of resources, and potentially greater success in managing the stress on our healthcare systems.
There are some among us who are doing this work in the community already. An example that comes to mind is Ambuja Cement Foundation, which is taking stock of critical health resources such as testing, isolation, and treatment centers in the areas where it operates, especially in Gujarat.
COVID-19, or corona as it is colloquially called, may seem like a war without an end. But if the community works with the government on this, and we can rope in some of the best public health thinking and tools for it, this war will end sooner rather than later.
This is the first article in a five-part series, supported by myUpchar. Nachiket Mor, PhD, is Visiting Scientist, The Banyan Academy of Leadership in Mental Health. Manuj Garg, PhD is Cofounder of myUpchar. In the next article, they will talk about safeguarding the most vulnerable people in this health crisis: the elderly.
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