Wisdom and intuition can see us through routine situations in our lives, but they are unproductive for public health programs.
These are scientific evidence that must guide decisions that ultimately save lives in a public health crisis.
India entered a national blockade last year when there were 500 cases. In retrospect, the public health response was a sensible decision, as the effective reproductive number (RT) – the number of people infected by infected people – was the highest (3.75) on 23 March 2020.
A year later, despite a lower RT of 1.65, numerous super-spread events and poor compliance have led to the ongoing devastation we see around us ̵
I want to think that the decision to block in 2020 is based on evidence. Even though he was intuitive, he really helped prevent a major national health crisis.
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Limited until February 2021: there was a red flag on the rising RT quite early in the month.
Although cases rose sharply in Kerala and Maharashtra, the country failed to prevent mass rallies when it had to go to war.
This inability to use data at this crucial time has led us to ruin our chances of limiting newer versions of the virus to a few areas.
India has some of the best minds and research laboratories to study genomic sequencing and discover new variants of Covid-19.
When the Indian Genomics Consortium SARS-CoV-2 (INSACOG) – a group of 10 national laboratories – was set up by the Ministry of Health and Family Care, on 25 December 2020 it was mandated to test 5% of positive samples from all states and 100% of positive samples from international travelers.
However, the government’s March 24 press release said only 10,878 samples were shared by the states and UT in three months, the same day the country officially saw more than 50,000 positive cases.
Today, India ranks 102nd when it comes to genomic sequencing of Covid (see table), even lagging behind smaller countries such as Australia and Denmark when it comes to the absolute number of positive sequenced samples.
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This is mainly due to the poor allocation of resources by the government and the lack of priority in determining the role of newer options in the earlier outbreak in Maharashtra. Much of the crucial time was lost when the state was going through a wave of cases. As a result of the delay, the options may have spread to other areas.
Since March 27, the positive sample rate in India has jumped four times, from 5% to 21%.
Similarly, there has been a 12-fold increase in daily deaths per million population, from 0.2 on 28 March to current levels of 2.7.
Based on what we know about RT and the capacity of the health care system, some cities, districts and states need to stop the rate at which the virus is spreading through focused blocking and aggressive restraint.
Instead, we ignore scientific data when it comes to developing a response to the second wave.
The National Center for Disease Control (NCDC) is a powerful force for field epidemiologists; The National Institute of Epidemiology (NIE) in Chennai is the core of laboratory surveillance and training of health professionals in epidemiology.
Ideally, the country would benefit from our own Anthony Fauci, one of the ICMR or NCDC, by gaining the autonomy to lead a combined response against Covid-19.
But any attempt to review the state of the country using data is hampered by tacit or poor figures.
Countries that test at higher prices and have better reporting systems can also attract the attention needed to obtain more resources.
Countries such as Kerala, Punjab, Karnataka, Haryana and Gujarat have seen an increase in RT compared to the previous week. By the way, these countries also have the highest tests per million (TPM> 1600).
In contrast, countries such as Uttar Pradesh and Bihar, which show a decrease in RT, are directly related to the presence of a relatively lower TPM than earlier in the week.
Using a data-based approach promotes fairness, as detecting more cases through a better testing strategy ensures that many vulnerable people fall within the scope of services.
And this lack of an evidence-based approach is not only found in the public health response. Current clinical guidelines also contain hydroxychloroquine, which has no evidence that it is useful as a prophylaxis against Covid-19.
In contrast, it was extremely confusing to see Coronil’s approval of COVID. Also, some of the drugs in the Ministry of Health’s management protocol require evidence to be cited from a randomized controlled trial or published studies. Combining non-factual guidelines as part of clinical management only confuses the provision of quality care.
The country can also benefit from a data-based approach when it comes to vaccination.
The rate at which India launched the vaccination program even before the Phase 3 results of Covaxin and Covieshield without a binding study did not match the rate of coverage subsequently.
The results of phase 3 of Covaxin were recently announced with a vaccine efficacy of 78% (95% CI: 61-88) against mild, moderate and severe Covid-19 disease. The best time to fight the virus was when transmission was low in India, while other countries witnessed a second and third wave.
Instead of accelerating the pace of vaccination, the country has not taken emergency measures to make it easier for foreign companies to cooperate with Indian producers.
While supply restrictions still exist, more confusion is created by expanding the age group of younger people, without setting a clear date by which the process can begin.
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Indians are prone to cardiovascular disease at least a decade earlier than patients in the West. Young people with comorbidities should be included in the vulnerable vaccination group. The government had to give priority to vaccinating them along with the existing 45 and more years.
India’s response to the pandemic relies on an unscientific approach, relying on a system that was never built to meet the health needs of its citizens.
For example, every third adult has hypertension. However, ignoring detection and treatment, the focus is on increasing government spending to recover from complications arising from high blood pressure.
Similarly, over 60% of health care needs are met by the private sector. However, no effort is being made to change the patient base by building reliable and healthier public health systems.
Ignoring all the data suggesting an increase in the cost and costs of treatment in private hospitals, treatment services are mostly transferred to private health systems.
In emergency medical care such as Covid-19, the private health care system is demonized, while the government’s inability to prioritize public health is rarely questioned.
The way forward
To begin with, the country failed to use the full potential of those from the NCDC and NIE in managing the Covid response. Scientists and public health experts must be given full autonomy to manage the pandemic.
The chief scientific adviser’s office only granted access to data yesterday (May 1st). NCDC and ICMR data, when provided to Indian researchers, can provide useful analysis and valid conclusions to guide our Covid policy.
India boasts computing skills, data analysis and is home to some of the best scientists in the world. Epidemiological evidence must be aligned with the results of genomic sequencing to stop the virus from attacking and to prevent the spread of newer variants of concern.
India is a world leader in vaccination due to its strengths in micro-planning and mobilization efforts. The experience of WHO-NPSP and UNICEF, which is used to combat polio, measles and rubella, should be used as part of a coalition to rapidly expand vaccination coverage.
We can have specialists in every unit in India and set up fully functional intensive care units with enough oxygen beds in each hospital at the unit level.
Isn’t it time to turn all hospitals at the block level into 250-500 beds depending on the population and to hire all the necessary qualified and trained staff permanently? Besides, isn’t it time to provide them with conveniences and salaries for the private sector or what is comparable to the West?
The use of evidence-based guidelines and guidelines and the availability of well-trained workers are not a luxury but a necessity in meeting the country’s public health needs.
(Giridhara R. Babu is Professor of Epidemiology at the Indian Institute of Public Health, PHFI, Bengaluru)