What Went Wrong

Epidemiologists suggest a midcourse   correction in war against coronavirus

Three eminent experts representing professional associations of doctors have concluded that the central government’s handling of the coronavirus pandemic had major drawbacks from the very beginning. These experts, who represent the Indian Public Health Association, the Indian Association of Preventive and Social Medicine and the Indian Association of Epidemiologists, include former advisors to the Union health ministry, current and former professors at the All India Institute for Medical Sciences, Benaras Hindu University, Jawaharlal Nehru University and Postgraduate Institute of Medical Education and Research. According to them, if the central government had consulted epidemiologists, who had a better grasp of disease transmission dynamics compared to modellers, it would have been successful in combating the pandemic. They lamented that the central government was primarily advised by clinicians and academic epidemiologists who had limited field training and skills. The central government also erred in relying overwhelmingly on general administrative bureaucrats and having a limited engagement with expert technocrats in the areas of epidemiology, public health, preventive medicine and social scientists.

The pandemic, which has affected more than 2 lakh Indians and taken more than six thousand lives as of June 4, was a public health emergency which was not handled with success. For a poor country like India it was not only a health emergency but also a humanitarian crisis, with crores of people deprived of livelihood due to prolonged nationwide lockdown. According to the experts, the response of the Narendra Modi government after the first case of the coronavirus was detected in the country on January 30, 2020 blunted the rapid progress of the infection and the nation accepted near-total disruption of all facets of daily living. However, the stringent nationwide lockdown from March 25, 2020 failed to contain the spread of Covid-19, with cases increasing exponentially. Dubbing the lockdown as draconian, the experts have said that lockdown was presumably in response to a modelling exercise from an influential institution, which was a ‘worst-case simulation’ as it had estimated 2.2 million deaths globally and which has proved to be wrong.

India is paying a heavy price both in terms of humanitarian problem and disease spread because of lack of professional approach in dealing with the crisis. The government’s draconian lockdown came as an afterthought to catch up with what the governments of other countries were doing, rather than a well thought-out and coherent strategy drawn up with an epidemiological basis. The delay on the part of government in sending back migrants to their homes is proving to be a curse. They should have been given a window to leave the cities of their work to go to their native states before the announcement of the total lockdown on March 25. At that time the disease spread was very low. The current catastrophe could have been avoided, as several migrants got infected in the cities during the lockdown and carried the virus to their villages. In the beginning the virus was limited to the cities. Had the migrants been allowed to leave in the beginning, the virus would not have spread in the villages. It is now emerging that the more the number of the migrants reaching home, the more the number of them detected to be carrying the virus. According to reports, migrants account for 60 percent of new cases in Uttar Pradesh and 25 percent of cases in Bihar.

The experts have opined that India and mankind will have to “live with the virus” and the policy makers have to prepare themselves to meet this challenge, rather than taking haphazard steps on the basis of information of the modellers. As most Covid-19 infected persons are asymptomatic or with mild symptoms which are not life threatening they would not require hospitalisation and can be treated at domiciliary level with a modified “enforced social distancing” imposed on the household. The health authorities must recalibrate operational strategies rapidly from containment to mitigation. The central government should pay heed to the advice of the epidemiologists and redesign the strategy of fighting the virus. The authorities must not hesitate to make midcourse corrections to prevent a catastrophic situation in future. Let us hope the central government engages epidemiologists as an important stakeholder in the country’s fight against coronavirus.