Looking at India’s role at containing COVID-19 outbreak and surge in new infection among denizens

Though India has made progress for preparing and migitating the impacts of pandemics still there is an uneven distribution towards International Health Regulations (IHR). The Global Health Security (GHS) Index 2019 assessment reported the fate of India which is shown below.

India over the last three decades has faced many novel diseases in epidemic proportion. For example, in 1984 Human Immunodeficiency Virus (HIV) that caused Acquired Immunodeficiency Syndrome (AIDS) arrived in India unnoticed. Nation’s health administrators upheld control measures by setting up the National AIDS Control Organization and executing preventive intervention. These measures were internationally acclaimed as they demonstrated numerous good practices through community-led efforts.Similarly the outbreak of Nipah virus(2001), the Chikunguya (2002), severe acute respiratory syndrome (SARS in early 2003), the pandemic H1N1(2009) and Crimean-Congo Haemorrhagic fever (2011) were contained without significant morbidity and mortality for the country.

In the case of COVID-19, this has striking resemblance with pandemic H1N1 that persisted as seasonal flu and SARS that caused severe bronchitis. Although this seasonal flu, spread rapidly but it’s deceased impact is less.

In the initial stage, these diseases like H1N1, SARS-Cov-2 or COVID-19 is undetected. Unlike the other diseases, COVID19 or Coronavirus is extremely contagious leading to death in maximum cases. The people who are in their advanced age i.e. above 60 years and those whose immunity is compromised due to certain health ailments are more prone to the fatal consequences of this virus.

Confronted with the current summons rising out of COVID-19 outbreak, it is fascinating to take note of India’s projection in the World Bank Group Pandemic Preparedness Funding Status Report of September 2019. India scores as IDA nations on readiness, research facility, reconnaissance and workforce which is anticipated in the figure underneath

India over the last three decades has faced many novel diseases in epidemic proportion. For example, in 1984 Human Immunodeficiency Virus (HIV) that caused Acquired Immunodeficiency Syndrome (AIDS) arrived in India.

In the initial stage, these diseases like H1N1, SARS-Cov-2 or COVID-19 is undetected. Unlike the other diseases, COVID-19 or Coronavirus is extremely contagious leading to death in maximum cases. The people who are in their advanced age i.e. above 60 years and those whose immunity is compromised due to certain health ailments are more prone to the fatal consequences of this virus.

Confronted with the current summons rising out of COVID-19 outbreak, it The states embraced ‘Custer Approach’ with distinguishing proof to trace the individuals who have interacted with COVID-19 infected individual as a group and afterward focusing on specific hotspots, door to door screening of people infected and those potential age group people likely to get infected. Certain areas were demarcated as “Containment Zones”. With the concurrence of the rapid testing facility for COVID-19 there were considerable increases in number of symptomatic as well as asymptomatic unnoticed. Nation’s health administrators upheld control measures by setting up the National AIDS Control Organization and executing preventive intervention. These measures were internationally acclaimed as they demonstrated numerous good practices through community-led efforts.Similarly the outbreak of Nipah virus(2001), the Chikunguya (2002), severe acute respiratory syndrome (SARS in early 2003), the pandemic H1N1(2009) and Crimean-Congo Haemorrhagic fever (2011) were contained without significant morbidity and mortality for the country.

In the case of COVID-19, this has striking resemblance with pandemic H1N1 that persisted as seasonal flu and SARS that caused severe bronchitis. Although this seasonal flu, spread rapidly but it’s deceased impact is less.is fascinating to take note of India’s projection in the World Bank Group Pandemic Preparedness Funding Status Report of September 2019. India scores as IDA nations on readiness, research facility, reconnaissance and workforce which is anticipated in the figure underneath-

The Government is well aware of its role and anticipation for widespread transmission,therefore the outbreak was declared in India as an epidemic and provisions of the Epidemic Diseases Act, 1897 were invoked. India’s reaction to the COVID-19 pandemic has been described as being the most stringent as per the Oxford COVID-19 Government Response Tracker. The nation faced prolonged lockdown since March 24. Given India’s deficient health infrastructure, a severe reaction had to be embraced on emergent basis to restrict the spread of the infection cases.

The migrant labourer from different states in the dire consequences has to take the ultimate judgemental step of returning back to their native states has spiked the spread of the disease. Majority of the migrant workers travelled from high risk areas to the rural native place, increasing the spread of the disease in rural areas which were earlier not exposed to the pandemic.

In response to the biggest economic crisis triggered by the Covid-19 pandemic after 1979 with a subsequent lockdown has led to the Nation Central government’s fiscal relief to just about 1.1% of GDP. It has, however, allowed states to increase their borrowing limit unconditionally by 0.5% of their Gross State Domestic Product (GSDP) or Rs. 1.07 lakh crore. A definite portion of the Centre’s fiscal relief i.e Rs 40,000 crore or 0.2 per cent of GDP with an additional allocation to MGNREGA has led to a budget estimate of Rs. 61,500 crore for the fifth and final tranche of the packages announced by Finance Minister.

Amidst the lockdown, the Prime Minister of India addressed the nation on May12, 2020 where he allocated Rs. 20 lakh crore for “Atmanirbhar” package, stating it to be liquidity driven with little burden on the exchequer. The government reinforced new revenue options from different sector such as agriculture, public sector enterprises.

Looking at India’s role at containing COVID-19 outbreak and surge in new infection among denizens!

In the area of healthcare, 17 states reportedly have hospitals dedicated for the treatment of Covid-19 patients with separate areas for suspected and confirmed cases, but these facilities in all likelyhood are to be overwhelmed with the current surge in new infection. Utilizing the available information from National Health Profile–2019, it is noticeable that there are 7,13,986 government hospital beds available in India. This adds up to 0.55 beds per 1000 populace. The older populace (matured 60 or more) is particularly vulnerable for the disease. The accessibility of beds for older populace in India is 5.18 beds per 1000 populace.

Once more, there are between-the-states variations in the number of beds accessible per patient, isolation beds, intensive care units and ventilator facility availability. It very well seen that numerous states i.e Bihar, Jharkhand, Gujarat, Uttar Pradesh, Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Haryana, Maharashtra, Odisha, Assam and Manipur lie below the national level figure (0.55 beds per 1000 populace). These 12 states together recorded for nearly 70% of total population in India. Bihar has an intense lack of government hospital beds, with simply 0.11 beds accessible per 1000 populace. A few states improve on this metric, for example, West Bengal (2.25 government beds per 1000) and Sikkim (2.34 government beds per 1000). The capital city of Delhi has 1.05 beds per 1000 populace and the southern conditions of Kerala (1.05 beds per 1000) and Tamil Nadu (1.1 beds per 1000) likewise have better accessibility of beds.

The situation is quite comparable when the examination is accomplished for simply the older populace: North-eastern states show improvement over others; southern states likewise have higher number of beds accessible for elderly population — for instance, Kerala (7.4), Tamil Nadu (7.8), Karnataka (8.6) — while northern and central states have moderately low accessibility of government beds for senior citizen category of people. It is certain that availability of government beds is wretchedly low in India, and a scourge like coronavirus can rapidly convolute the issue much further. An expected 5-10% of all patients require critical care in form of ventilator support.

Presently, Indian Council of Medical Research (ICMR), the apex body, has endorsed private clinics to treat COVID-19 patients. Thus with the inclusion of private hospital in the drive, the bed capacity for COVID-19 patient might see improvement but the situation can be inadequate if there is a surge in patients requiring indoor-based care facility. The infrastructure stress will be especially acute in few high-burden states like Gujarat, Maharashtra and Delhi. Already, as per media reports, two of the highest prevalent states for Covid-19 are Delhi and Tamil Nadu. Due to increasing contagion rate there is an alarm for the requirement of government hospital beds. The Union government instructed health authorities of all major states to reserve at least 20 per cent bed for COVID-19 patients in this scenario.

Looking at India’s role at containing COVID-19 outbreak and surge in new infection among denizens1

Despite the COVID-19 trackers updates, there is still less transparency in the amount of cases reported and treated. Health experts augmented that the nonavailability of detailed information, precluding the scientific, clinical and public health community from making any definite estimation about the viral spread. Testing criteria has changed with testing of certain symptomatic patients and their contacts along with asymptomatic patients, migrants workers, and some healthcare workers.

The reports varied from district to district in every state. Any robust calculation would require information on the qualities of the testing denominator to make reasonable extrapolations for the remainder of the populace. Health specialists additionally express that the vulnerability profile of at-risk populace in India will be one of a kind, with its blend of malnutrition, stunting, non-communicable diseases and respiratory diseases, as will be the demography a more youthful populace. As observed, most local jurisdictions do not collect data on the age groups and disease profile of hospitalized patients, the length of stay of hospital admissions, the numbers transferred from one level of care to another, all of which hospital administrators would need to plan bed capacity.

Notably, Indian Council of Medical Research (ICMR) recently undertook the first population-based serosurvey in India, to assess the extent of exposure to SARS Cov-2 – the pathogen behind COVID-19. The preliminary findings shared revealed that several containment areas has high caseload districts, 15-30 per cent of the population has been exposed to the infection and quietly recovered. Scientists ascribed the phenomenon as ‘Nature’s own way of immunization’ that may lead to reaching herd immunity.

Notwithstanding, simultaneously efforts at this stage required is to generate the state and district-wise tally to conclude the number of patients treated, their analysed test reports and data about their segment, socioeconomic and health status, with the goal that state administration can find a way to adjust lives and livelihood. The declaration that generally safe patients can self-confine at home will give some reprieve, yet this may pose potential danger of transmission in the community, as health experts opined stressing that given the conditions, nation’s health systems need to bend over endeavours to contain case growth and enlarge health infrastructure as much possible.

Composed by: Dr. Gautam Kr Ghosh

Dr. Gautam Kr Ghosh, the writer is Ph.D. (sociology) and presently working as a research scientist at ICMR National Institute of Cholera and Enteric Diseases, Kolkata, India.
InnoHEALTH magazine digital team

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