“Had the migrant persons been allowed to go home at the beginning of the epidemic, when the disease spread was very low, the current situation could have been avoided,” three medical professional associations highlighted in a joint statement to Prime Minister Narendra Modi.
Public health experts of the Joint Task Force from the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and the Indian Association of Epidemiologists (IAE) have compiled a report, criticising the Modi government’s handling of the pandemic in its initial stage.
The 16 signatories — advisors to the health ministry, present and former professors of the All India Institute for Medical Sciences (AIIMS), Benaras Hindu University and Jawaharlal Nehru University, among others — also listed out recommendations for the future in the report submitted it to the Prime Minister on May 25.
'India paying heavy price'
According to the signatories, the Indian government failed to consult epidemiologists who had a better grasp of disease transmission dynamics, and that the lockdown was based on modelling of infectious diseases by popular institutions. As a result, “India is paying a heavy price both in terms of humanitarian crisis and disease spread,” said the signatories, calling it a “draconian lockdown”.
India's nationwide lockdown from March 25 till May 31 has been one of the most "stringent" and yet COVID-19 cases have increased exponentially through this phase — 606 cases (March 25) to 138,845 (May 24) — said the Joint Task Force, which was constituted to help the Indian government to contain COVID-19 pandemic in the country.
"This draconian lockdown is presumably in response to a modelling exercise from an influential institution which presented a 'worst-case simulation'. The model had come up with an estimated 2.2 million deaths globally. Subsequent events have proved that the predictions of this model were way off the mark,” read the statement.
"The incoherent and often rapidly shifting strategies and policies, especially at the national level, are more a reflection of an afterthought and catching up phenomenon on part of the policymakers rather than a well thought cogent strategy with an epidemiologic basis," said the signatories.
The experts also hinted at community transmission as a result of the returning of migrants across the country - “mostly to rural and peri-urban areas, in districts which had minimal cases and have relatively weak public health systems (including clinical care) - triggered by the lockdown.
“It is unrealistic to expect that COVID-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country,” read the statement.
The experts concurred that the benefits of the nationwide lockdown has been achieved, although after the fourth phase of the lockdown: “to spread out the disease over an extended period of time and effectively plan and manage so that the healthcare delivery system is not overwhelmed… The case fatality rate in India has been relatively on the lower side, and mostly limited to the high-risk groups (elderly population, those with pre-existing co-morbidities etc)”.
However, this lockdown cannot be enforced indefinitely, “as the mortality attributable to the lockdown itself… may overtake lives saved due to lockdown mediated slowing of COVID-19 progression”.
The experts also pointed out that the opaqueness in terms of data maintained by the Union and state governments so far “has been a serious impediment to independent research and appropriate response to the pandemic”.
The 11-point action plan
1. Constitute a panel of interdisciplinary public health and preventive health experts and social scientists at central, state and district levels to address both public health and humanitarian crises.
2. Make all data, including test results, available on public domain for the research community, who can access, analyse and provide real-time context-specific solutions to control the pandemic. A Public Health Commission with task-specific Working Groups, too, maybe urgently constituted to provide real-time technical inputs to the governments.
3. Lift the ongoing lockdown and replace it with cluster specified restrictions, based on epidemiological assessment.
4. Resume all the routine health services (primary, secondary and tertiary) while ensuring the protection of health care workers, as “the brunt of disruption of health services may even be higher in days to come”.
5. Ensure source reduction measures through public awareness and practice of preventive measures (use of face mask, hand hygiene and cough etiquette), with special focus on the high-risk population.
6. Ensure physical distancing while promoting social bonding to address mental health concerns. Avoid social stigma by creating awareness among people and treating them with empathy and respect.
7. Extensive surveillance for patients with Severe Acute Respiratory Illness (SARI) and Influenza-like Illnesses (ILI) through clinical institutions (including private hospitals) and testing, tracing, tracking, and isolating with marked scaling up of diagnostic facilities. Existing HIV serological surveillance platform could be a cost-effective way to do the serological surveillance and also provide an estimate of the burden and trend, needs of vaccine, and the impact of other preventive strategies.
8. Test, track and isolate with marked scaling up of diagnostic facilities. Governments need to support free testing in private laboratories, too. Home quarantine needs to be promoted and protocols followed with active participation and support from frontline health workers and local communities.
9. Strengthen the Intensive Care capacity and be given only by the well-trained adequately protected health care providers. Makeshift hospitals are already being established in Mumbai, Maharashtra, and the same may be built in other cities of India.
10. Ramp up production of personal protective equipment (PPE) and for frontline workers to instil confidence. Alternate teams must be identified to take care of attrition due to fatigue, exposure and quarantine.
11. Rapid scaling up of public health (including medical care) – both services and research – should be done on a war footing with an allocation of 5% of GDP (gross domestic production) to health expenditure at the centre and state level.
Calling for fundamental changes to our lifestyles and in policymaking, especially in health policymaking, the experts said, “Evidence-based scientific and humanistic policies will help us in overcoming this calamity with minimal loss to human life, social structures and economies.”