Why the 21-day Lockdown?

What is the reasoning behind the 21-day lockdown?

We have to prevent person-to-person spread for a period that overlaps with the incubation period of the virus and extends beyond its observed upper limit of 14 days. During that period, already infected cases will become symptomatic, coming to attention, or be asymptomatic, becoming virus-free over two weeks. If we can prevent transmission in the three-week period, we would have stopped the virus in its tracks as it cannot replicate or live long outside the human body. Hence, the 21-day shutdown.

What is the extent of the shortfall we face in terms of medical professionals—doctors, nurses, primary care workers—as we prepare for a surge? Can students in the final years of their medical/nursing training be recruited to plug some of the gap temporarily?

There are substantial shortfalls in most categories of health workers: basic and specialist doctors; basic and specialist nurses; allied health professionals of different disciplines; community health workers and public health professionals. The shortages range from 30 per cent to 50 per cent in many of these categories. That is at the aggregate national level. Some states, especially the southern and western states, are better positioned than others.

Certainly, final-year medical and nursing students should be recruited to perform a supportive role in providing care to quarantined persons, tracking contacts and similar functions. That will give them a great learning opportunity, apart from filling some gaps in the availability of the health workforce. During the small pox eradication programme, medical students played a laudable role in the community coverage of vaccination.

What have been the biggest lessons from the Nipah outbreak in Kerala? Has it had any positive impact on public health infrastructure?

Kerala showed remarkable health system leadership, inter-agency coordination, community engagement and strong technical partnerships in responding with vigour to the Nipah outbreak. It gave the rest of India many valuable lessons in public health management. Kerala has also greatly strengthened the primary healthcare infrastructure and the public health system over the last few years.

States that are the worst equipped to handle a Covid-19 outbreak, such as Uttar Pradesh and Bihar, are also testing the least. Does this not increase the chances of community transmission in these states?

Testing is being done by the criteria prescribed and these are periodically revised by ICMR. It is likely that testing will soon pick up with the use of revised criteria. However, the fact remains that weak health systems will not perform as well as better functioning health systems—whether it is child immunisation or infectious disease testing. It is important that all elements of the public health response—from testing and contact tracing to effective quarantine and supportive care—are efficiently delivered by all states. Otherwise, the risk of community transmission increases and poses a serious threat to the state and the country.

Italian physicians have warned that hospitals are a major source of transmission, and have urged other countries to decentralise care. Is India equipped to treat people at home?

Most mild cases should be home-managed. Primary health services are critical for that, both in terms of availability and quality. Again, states like Kerala and Tamil Nadu will do well in this area because they have invested in strong primary healthcare.

Migrant labourers, out of work and stranded in cities under the countrywide lockdown, are at high risk of contracting the coronavirus. How can the public health net be extended to them without requiring them to visit hospitals?

Urban primary healthcare has been a neglected area. This will tell on our response in cities. Whatever services are there must reach out to these vulnerable groups. They need to be supported for healthcare as well as shelter and food supplies. Social distancing will be difficult if they live in the cramped conditions of insanitary tenements. They need to be protected so that they do not pose a risk to themselves and to the rest of society.

What do you expect will be the human cost of postponing elective procedures like chemotherapy?

Which procedures are postponed is discretionary, based on hospital and physician judgement. Life-saving medical therapies should not be discontinued. All of them may not need hospital admission. Special facilities may be set up for such treatments.

Considering that 80 per cent of healthcare in India is private, how much compliance can the Government expect when all hospitals are likely to be overburdened?

If private hospitals don’t cooperate, they face a twin danger. If the epidemic goes beyond control, the staff and management of private hospitals as well as their families will face dangers to their own health—they don’t live on another planet. If public anger is directed at non-cooperating private hospitals, there will be a clamour for their nationalisation as in Spain. Will they want that?

Most Indian drugmakers, aside from Cipla and Zydus, haven’t shown interest in developing treatments for COVID-19. Can we expect a homegrown treatment anytime soon?

Drug companies, in India and elsewhere in the world, are evaluating several available drugs. The WHO too is mounting a global trial. Beyond testing of existing anti-viral drugs, development of new drugs will take time.

India, in the early days of the pandemic, seemed to underestimate the need for face masks, overalls and other protective gear and allowed exports. What other equipment, besides ventilators, are we running out of?

Every health system in the world, including the US, UK and EU members, are struggling with such shortages. Attempts are being made to meet the projected requirements through domestic production as well as imports.

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V Shoba

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