We have three models in front of us:
1.The South Korea model with no lockdown (but with good cough etiquettes, social distancing) and doing extensive testing - it has done well.
2.The Indian model with severe lockdown (but with some poor adherence to social distancing, cough etiquettes) and lesser tests being done - doing good so far.
3.The Euro-US model with no early strict lockdown and no extensive initial testing - doing bad.
South Korea can continue to test without worrying about lockdown if things go well, but India can't afford to continue being locked down perpetually. The need of the hour is to make more testing being made available. It could be through community ‘Fever clinics’ or ‘Flu corners’ ready with doctors trained to identify potential COVID-19 patients. Through this it is possible to identify community spread, isolate and treat early so there is no further spread. The current hospitals should continue to treat Non-COVID patients, particularly the ones needing urgent attention so that they do not suffer. For hospitals to decide upfront whether to admit and treat a certain patient or send him to dedicated Covid centres, rapid tests are crucial. Many patients presenting with atypical symptoms for COVID may harbour Covid without being symptomatic for it. So without rapid initial testing it becomes difficult for doctors to decide.
The problems of super spreaders of Delhi who have spread far and wide are:
1.Lack of awareness/motivation/responsibility towards society in curtailing the spread
The government should invest energy into taking people into confidence so that they come forward and get themselves tested. When community spread starts, it will be difficult to trace everyone. In a country like India with a huge population, people are resources and should be utilised well. If community spread starts, doctors will not be the sole frontline warriors, people will also be. We need the trust of people at large.
2.The stigma of contracting a virus
The concept of 'Herd Immunity' should be propagated. The concept of Sama, beda, Danda (in the Indian context) may have to be followed in reverse for a change. The time to beat up people will be soon over. We have to incentivise now. Individuals who are found to be symptomatic or who have been in contact with symptomatic individuals and coming forward for testing must be appreciated and set as an example.
The Way Forward
More flu corners should be made available with extensive testing capacity and tests should be free. Doctors and nurses working at these clinics should be adequately protected with PPE etc.
A very well integrated war room is needed to coordinate all these clinics in real time. If anybody tests positive they should be isolated, treated and tracked properly. The government may need more hands and funds for these. This system can form a platform for future integration of healthcare upto the community level using technology.
Once the system for the flu clinics and extensive testing is in place, the lockdown should be released in phases. People should be made aware that it's a dynamic process. If any area gets an increasing number of cases it may go under lockdown. Even though the lockdown is relaxed, social distancing and cough etiquettes should be strongly propagated. These days of lockdown should be utilised to flatten the curve, slow the spread of virus and most importantly to buy time. People need to be educated - the virus wont move around until we take it around.
What do we do with the borrowed time of lockdown ?
1.It is time we put the Make in India mission to work in healthcare. Promote the production of Ventilators, PPE, masks, drugs in India. It's the ideal time to scale up our production capabilities and sustain it into the post COVID phase also so that we become independent and with more job opportunities.
2.Establish community clinics(flu clinics) with extensive testing capabilities
3.Educate people better and win their confidence.
4.Prepare for post lockdown period.
5.Invest and increase our research capabilities into medical science. The era of winning wars with nukes are impractical and financially unviable. We have bigger challenges in new frontiers.
Lessons for the future
1. With the increasing frequency of outbreaks being seen, its time India prepares itself for more such scenarios in the future.
2. Interdisciplinary research and collaboration is the need of the hour. The technological advancements happening elsewhere should be adopted into the medical field for a swifter and more coordinated response.
3. India needs newer laws to deal with the current situation where humans can become potential healthcare hazards and push the nation into crisis. We need to be prepared for bioterrorism possibilities.
4. The media should differentiate between news and opinions. The government should pass laws that government provided or only verifiable authentic information should be considered as news and everything else as opinions. Media should always quote the difference.
5. Healthcare communities are no less than soldiers manning the borders. They need to be adequately protected and provided a safer environment to work in. They don't carry guns for their protection so the government should bring stricter laws to prevent any abuse or ill-treatment, which this community is fed up with. If we don't treat our heros well, we only deserve the villains.
6. The present health infrastructure needs some serious attention. More budgetary and resource allocations have become mandatory.This pandemic has laid bare the vulnerabilities of our healthcare system, poor infrastructure, overdependence on other countries for our health equipment needs.
7. India has unique problems like personal beliefs and biases. Non disclosure of contact or travel history has put doctors and nurses at grave risk and are being quarantined in large numbers leading to wasted precious resources. We need to decide where our freedom of speech or expression ends and duty to the nation begins. Social media has made every person an internet warrior, a potential anarchist who can put a question mark in front of every statement issued by govt authorities. We need cool heads which does not bring politics and religion into everything.
8. The law enforcement agencies need priming to handle a crisis like a pandemic. We need laws to bring private, government, research institutions into a unified well coordinated system capable of handling national health emergencies on a war footing at short notice. The rules of engagement have changed.
9. As a measure of immense forethought India needs a world class advanced disease control centre at national level with global appeal, bringing together researchers, epidemiologists, virologists etc needing unhindered budgetary allocation. So next time there is a medical emergency of such proportions we know who is calling all the shots.
Authored by Dr.Pavan Yadav MD,FCCP