India learns a bitter lesson for disregarding crucial warnings and recommendations on Covid-19
In the month of April this year, there has been an unprecedented upsurge in daily new cases and daily new deaths in the country due to Covid-19. States, which reported large increases in daily new cases and daily new deaths, are Maharashtra, Kerala, Karnataka, Delhi and Uttar Pradesh, to name but a few.
The Parliamentary Standing Committee report on the outbreak of pandemic Covid-19 and its management, which was presented to the Chairman of Rajya Sabha on 21st November, 2020 and forwarded to the Speaker of Lok Sabha on 25th November, 2020, among other things, made the following recommendations and statements:
* The 'Strengths' of the Government's contingent and mitigation plans pertaining to Covid-19 have been identified as: (i) Coordinated national response and proactive surveillance; (ii) Early impact of lockdown on virus dissemination and deaths; (iii) Step up in National capacity for manufacture of medical equipment, test kits and drugs; (iv) Increase in healthcare facility for quarantine, isolation, treatment and intensive care; (v) Increase in testing labs and testing rates; (vi) Diligent contact tracing to identify primary and secondary contacts of cases; (vii) Capacity Building of all levels of workers through tailor made modules; (viii) Risk communication through various means and campaigns like ‘Break the Chain’; (ix) Digital healthcare modals like tele-medicine, e-ICU etc. enabling access to quality healthcare; (x) Delegation of powers to local administration under Disaster Management Act facilitated inter-institutional coordination (health, police, municipal, local govt. etc.) planning and response at district level; (xi) Convergence among the Department of Health, WCD Education, Rural Development Panchayat Raj and others for Food distribution, IEC, local surveillance, availability of masks, sanitisers, screening and vigilance and awareness etc.; and (xii) ASHAs and Angandwadi workers playing a critical role in community outreach.
* The 'Weaknesses' of the Government's contingent and mitigation plans pertaining to Covid-19 have been identified as: (i) Inadequate healthcare spending with no focused budget for Covid; (ii) Inadequate primary and secondary healthcare infrastructure and staffing in many areas. Absence of organised urban primary healthcare has been a major weakness; (iii) Although health infrastructure was massively upgraded but the scale and speed was not commensurate to the population size and demand for services for the peak transmission season; (iv) Districts and states with already fragile health infrastructure unable to cope with demand for testing, tracing and treatment during peak transmission; (v) Gaps in implementation strategies and measures by some states especially in initial months; (vi) Delays in coordination between the Centre and states; (vii) Inadequate contact tracing in many areas leading to high rates of viral spread despite increased testing; (viii) Lack of public health expertise at various levels of the health system; (ix) Reverse migration during lockdown and the inability of the system to cope up with the huge migrating population; (x) Excessive dependence on Rapid Antigen Tests which have low sensitivity; (xi) Data collection system not providing complete, timely and accurate data on newly tested persons, ratio of RT-PCR to other tests, Covid-19 related deaths, co-morbidities, antibody surveillance studies and hospital bed availability; (xii) Multiple guideline with differences in interpretations; (xiii) Although first lockdown was appropriate to identify and locate the active Covid-19 transmission zones and facilitated source reduction and containment of the disease especially in metros but further lockdown could have had a more nuanced and tailored approach incorporating risk of infection and disease transmission; and (xiv) Economic slowdown precipitated by global pandemic and restrictions of travel and trade to prevent the spread of the virus also impacted the country. Poor and vulnerable populations (elderly, women, children and infants) were disproportionately affected.
* The 'Opportunities' of the Government's contingent and mitigation plans pertaining to Covid-19 have been identified as: (i) Covid-19 pandemic has exposed the broken links of the economic system and linkages of health to economic progress. This provides an opportunity to increase investments in the health sector significantly (3.0 percent of GDP); (ii) Enhanced investment in health should have both a short and medium term perspective. In the short term, opportunities should be utilised to upscale the current size of human resources for health particularly in smaller towns and rural areas. With a medium to long term perspective, increased investment should be undertaken for creating health infrastructure with a decentralised approach; (iii) Provides an opportunity to develop an integrated healthcare system where service provisioning can be by both public and private sector and individual patients may have choice. Eligibility criteria of Ayushman Bharat maybe expended to other vulnerable population groups and expanding the package of services by including outpatient care for women, children, elderly and NCDs and empanelling more hospitals from rural and remote districts; (iv) R&D research and innovation can be harnessed by creating a network of labs and institutions engaged in fundamental research and transnational research, linking them with the industry to develop self-reliance in healthcare technology pharmaceuticals and diagnostics; (v) Making ‘AtmaNirbhar Bharat’ and stress on “Vocal for Local”; (vi) India’s manufacturing capacities for PPEs, Masks, ventilators, testing kits etc. have been immensely augmented; (vii) To maintain and expedite digital healthcare models with inbuilt safeguards; (viii) Increased testing capacities; and (ix) Mortality kept low due to focus on systems and manpower.
* The 'Threats' of the Government's contingent and mitigation plans pertaining to Covid-19 have been identified as: (i) Spikes in Covid cases still being seen in affected regions and India yet to reach its peak; (ii) Unpredictable pandemic with possibility of second wave like in Europe; (iii) Inability to stop or slow down transmission to rural areas and small towns; (iv) Lack of threat perception in sections of the people; (v) Crowd density in urban areas especially slums, areas of indoor employment and in public transport; (vi) Unaddressed issues of communicable, non-communicable diseases, maternal and child health issues, rampant malnutrition; (vii) Loss of livelihood of many leading to various concuss; (viii) Closure of schools and administrative institutions led to suboptimal performance and anxiety; (ix) Lack of firm action by administration to prevent large gatherings; (x) Non-adherence by people to public health measures like physical (social) distancing, masks and hand-washings; (xi) Population density, high public morbidity; (xii) Violence on healthcare workers; (xiii) Psycho-social impact on the people; (xiv) Poor risk perception at the individual level and stigma associated with the disease; (xv) Dependency on global economic and supply chain systems; (xvi) Violence against women and children; and (xvii) Adverse impact on reproductive health care services such as clean and safe deliveries, contraceptives and pre and post natal care.
National Health Policy 2017, Ministry of Health and Family Welfare, please click here to access
The Covid-19 hospital in India so bad patients want to get out -Sandi Sidhu, Julia Hollingsworth, Clarissa Ward, Rishabh Pratap, Elizabeth Joseph and Tanya Jain, CNN, 4 May, 2021, please click here to access
Dr. Rakesh Mishra, member of the Indian SARS-CoV-2 Genome Sequencing Consortia (INSACOG), interviewed by Karan Thapar, TheWire.in, 4 May, 2021, please click here to access
EXCLUSIVE: Scientists say India government ignored warnings amid coronavirus surge -Devjyot Ghoshal and Krishna Das, Reuters, 3 May, 2021, please click here to access
Bhopal COVID-19 deaths mismatch: Government says 104, crematoriums say 2,557, PTI, The New Indian Express, 2 May, 2021, please click here to access
‘We’re burning pyres all day’: India accused of undercounting deaths -Hannah Ellis-Petersen and Mohammad Sartaj Alam, The Guardian, 1 May, 2021, please click here to access
‘We are not special’: how triumphalism led India to Covid-19 disaster -Michael Safi, The Guardian, 29 April, 2021, please click here to access
Data can play an important role in helping India recover from COVID-19 -Harsh Vardhan Pachisia and Sriram Gutta, World Economic Forum, 29 April, 2021, please click here to access
Citizens Are Plugging India’s Gaping, Governance Gaps In Covid Care -Salik Ahmad, Article-14.com, 29 April, 2021, please click here to access
Parliamentary panel predicted second Covid wave in November -Meghnad S, Newslaundry.com, 28 April, 2021, please click here to access
At Delhi crematoriums, corpses wait in 20-hour queues to burn, PTI, Hindustan Times, 27 April, 2021, please click here to access
April, November last year: Officials, House panel flagged oxygen need, shortage -Harikishan Sharma, The Indian Express, 23 April, 2021, please click here to access
Officers, Parl. Committee Had Flagged Oxygen Supply as an Issue in April, November 2020, Report Says, Newsclick.in, 23 April, 2021, please click here to access
MHA orders closure of 2 special COVID centres in Delhi as cases decline, Business Today, PTI, 23 February, 2021, please click here to access
Image Courtesy: ICMR, please click here to access
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