K Sujatha Rao, former Union Secretary, Ministry of Health and Family Welfare, is an authority on Indian public health system. Her vastly detailed book on the subject, Do We Care? India’s Health System, covers communicable and lifestyle diseases and health and drug research in the country. Rao was also the chief of the National AIDS Control Organization. She had represented India on boards of the WHO, Global Fund and UNAIDS in the past. “This is not the time to believe and adopt non-scientific measures and promote belief over evidence,” she tells Open, emphasising that our health system should not choose between lifestyle and communicable diseases, and instead focus on both. Edited excerpts:
The Indian Council for Medical Research (ICMR) said before the lockdown that India was only in stage 2 and that we had not entered stage 3, or the community transmission stage, as regards Covid-19. Several doctors had disputed this claim, saying a large number of cases are unreported. What are your thoughts on this?
I do find the government figures far too low and would tend to believe that there could be a lot of under-reporting. For one thing the testing strategy does not give one the confidence that we have captured every infected case. The number of tests conducted is too low.
What are the lessons India has to learn from South Korea, Singapore and Hong Kong over the Covid-19 crisis?
To test and develop strategies to attack the virus from being transmitted. South Korea had a very aggressive testing strategy. Even if we didn’t want to go into the community, we could have tested every case showing symptoms of corona flu and coming for treatment to a facility – public or private. We have not done that. So, we might have missed out cases.
Pharmaceutical companies have invested big in lifestyle diseases treatment and have even shaped governmental priorities. Yet, infectious diseases continue to take a huge toll across the world. What are the lessons governments all over the world should learn from this experience?
Focus and continue keep vigil on infectious diseases and don’t make the health system choose between lifestyle or communicable diseases. If we have to then governments must always choose infectious diseases as they have a mandatory duty to protect population health and ensure health security.
How do you describe the central government’s response to the Covid-19 spread from early stages to now? Are there state governments that have acted promptly?
Quite good. Kerala has been the best so far.
What are the hurdles that public-health agencies face in launching a coordinated effort to suppress a viral disease outbreak in India apart from our propensity for superstitious assertions about the benefits of gaumutra, clapping, etc?
This is not the time to believe and adopt non-scientific measures and promote belief over evidence. If public health agencies have their strategy worked out, they should have no difficulties in ensuring a coordinated response. But then coordination with the large number of states at different levels of the epidemic can be a huge challenge. PM‘s review with the chief ministers, must, in that context, have had a salutary effect in getting states on board.
Why is it that we were not successful enough in the early stages in identifying potential Covid-19 cases who had arrived by flight to India and then enforce either home or hospital quarantine?
We have the capacity. There could have been a measure of carelessness or over-confidence. Secondly, many persons must have taken paracetamol … so the fever might have been suppressed and not captured in thermal screening. Third, the list of persons arriving and ultimate destination details may not have been provided to the states for them to take appropriate action. So, several factors may have contributed to missing out on cases.
How can India enhance its testing capabilities?
We have capabilities – both in public and private sectors. Point is to quickly identify them and ensure their equitable spread so as to enable easy access. Second is to ensure trained personnel and have them sensitised to the standardised protocols that need to be provided for quality purposes. Third is to get the testing kits and if they are being imported to incentivise Indian companies to manufacture them. They can. And to develop the logistics to have these testing kits supplied to all the facilities, public and private. Five, ensure all cases having symptoms of flu are tested and reported. If positive, the swabs can be sent for confirmatory test to National Institute of Virology, Pune, and other centres identified.