The COVID-19 pandemic is continuing to rage across the world. Europe is trying to tackle the second wave of cases and deaths. Its worried leaders are implementing frantic measures to prevent the spread of the disease and reduce the mortality rate.
India’s COVID-19 spread
India is caught in the first wave. It is slowly inching towards beating the U.S. in terms of cases and assuming the no. 1 position in the world, despite the amateurish way in which the U.S. is handling the pandemic. Why has India been unable to achieve what China or other East Asian countries have been able to achieve? One view is that India is not an authoritarian state like China. But India did impose a stringent lockdown in March when the country had just over 600 recorded cases. But now, to save the economy, it has been forced to open up despite having over 75 lakh cases.
Many experts say the lockdown was premature, and the way it was implemented led to the spread of COVID-19 from major urban centres like Mumbai and Chennai to rural pockets in Uttar Pradesh, Bihar, etc. Another view is that it did not prevent the spread much but only delayed the peak. Also, with movement restrictions imposed between States and districts, the virus was seen spreading at different rates in different districts and peaking at different times. As a result, India saw an increase in the number of cases and reached the peak in September. Hopefully, the decline in cases will continue. Unlike in Spain, Italy, France, etc., India did not reach the peak rapidly perhaps because districts were compartmentalised. We must now be prepared for the second wave if a vaccine or a proven cure is not found in the near future.
Fortunately, India’s mortality rate is not as alarming as in the Western countries; with 1,08,000 COVID-19 deaths till October 10, India’s deaths per million is 78, against the world average of 138. The country’s younger age profile is cited as one reason. Natural immunity to the virus thanks to large-scale use of malarial drugs and the BCG vaccine might be another. Fortunately, India has suffered low mortality despite poor tertiary healthcare facilities in most States. Whatever may be the reasons, we hope that this holds up till the end. The main issue for policymakers is what can be done at this stage to keep cases and deaths under check.
The Tamil Nadu picture
Let me attempt to answer this question with reference to Tamil Nadu, a State with which I am familiar. The number of deaths due to COVID-19 in Tamil Nadu crossed 10,000 recently. Although the accuracy of this number is questionable, as it is with other States, this is the official figure, and we have to accept it for want of any independent survey. The question is whether the State has done better than others and whether anything more can be done to reduce mortality.
In view of data inaccuracies, a useful measure of mortality is deaths per million/lakh of the population. The data for a few States are furnished in the table above. Surprisingly, Tamil Nadu has not done that well despite excellent tertiary healthcare infrastructure. Tamil Nadu has seen 14 deaths per lakh of the population against the national average of 7.8. This is far higher than Kerala’s figure of 3 deaths per lakh of the population. The State must attempt to reduce it to about 6 per lakh or 7 per lakh, below the national average.
It is time to spell out what can be done to contain mortality, given the possibility of a second wave hitting us with no credible vaccine in place in time. Here are some suggestions. The State government along with many task forces and the best medical brains is already implementing some or many of these ideas.
Suggestions to contain mortality
We have handled the pandemic mostly as a law and order problem, whereas it is primarily a public health issue. Therefore, public health professionals must lead the fight against the virus.
The primary responsibility to prevent the spread lies with the public, most of whom do not seem to care. They must follow the guidelines strictly.
However, the government also has a duty to properly educate them. It could launch an effective media campaign to bring high awareness among the public. My interactions with the public reveal considerable deficiency of information. Printed handouts must be given to every household along with media advertisements. In addition to well-known measures such as wearing masks and physical distancing, the public must be warned of the danger of being in a closed environment. They must be told how to seek timely medical assistance. An independent survey on public awareness should be conducted to create better awareness.
Saving lives is the primary responsibility of the government. It is not that the government is unaware or has not done anything, but it must set a goal so that the number of deaths per lakh is reduced further. This is achievable if there is a coordinated effort by the State Health Department. A helpline for fever for every city, which is run by medical professionals, would be useful to detect early cases of fever. Doctors may guide patients with fever symptoms through telemedicine. Private medical personnel may also be roped in. Most are now familiar with WhatsApp and can therefore access telemedicine services. This will enhance confidence in the public of handling an episode of fever. Reporting will be better in this arrangement.
Patients could be guided for testing for COVID-19 wherever necessary. In case of a positive result, the patient may be given an option of quarantining at home or a government facility. A trained doctor must take over at this stage and guide the home-quarantined patients towards recovery through telemedicine.
Whenever any patient needs hospital care, he must be able to get immediate admission, with help from government online data on bed availability in public and private hospitals. This bed management requires some effort. The private sector must be persuaded to come on board — the government must avoid any attempt to fix the price. The online system must be accessible to the public and managed by the Health Department to ensure data accuracy. A public health professional may be posted in each hospital to assist patients in admission.
Another important task is to publish standard treatment guidelines. Given the innumerable research findings pouring from across the world, these guidelines cannot be static but modified regularly. This would help all medical professionals to know the latest treatment protocol.
To protect senior citizens who are at high risk, the government could delay renewal of their driving licence, ration cards, etc.
Smooth running of an efficient mechanism is difficult and requires many administrative leaders at different levels. The day a common man can immediately get a free bed in a government hospital or a paid bed in a private hospital is the beginning of our effective control of deaths per lakh of the population. We hope that this day will come soon.
R. Poornalingam is former Health Secretary, Government of Tamil Nadu