Strengthening of primary care services and of hospitals at district and sub-district levels should be given highest priority, says K. Srinath Reddy, president, Public Health Foundation of India
NEW DELHI :
The World Health Organization (WHO) has recently declared Covid-19 disease caused by a new coronavirus a “controllable pandemic". Countries across the globe are taking measures to contain the virus that has claimed nearly 6,000 lives and infected more than 150,000 people. India now has more than 107 confirmed cases and has recorded two deaths. K. Srinath Reddy, president of the Public Health Foundation of India (PHFI), spoke about the pandemic, its effect on India, treatment options, the country’s ability to tackle Covid-19 and the way forward. Edited excerpts:
There is a lot of panic, with the virus spreading to more than 145 countries. What did it take for WHO to declare it a pandemic?
For all practical purposes, it has been a pandemic for a while as many countries are affected, some with more intensity than others. ‘Pandemic’ and ‘panic’ share five letters. The word pandemic triggers a visceral fear among people and we could see serious disruption of normal life across the world.
The xenophobia, which has already manifested, could become more virulent than the virus itself and the global economy could teeter. This could even impede the capacity for organised, rational response to the epidemic. It is likely that WHO wanted to give more time to countries to ramp up their health systems to meet the challenge of a widespread community infection, without being initially unsettled by the panic that the term pandemic creates in the social media and the public mind.
How close are we to the vaccine or any effective treatment for the new strain of coronavirus, which causes Covid-19?
According to Anthony Fauci, a leading American infectious diseases scientist, it will take at least 12-28 months to have a vaccine with proven efficacy and safety. Potential vaccines are under development and clinical trials will be needed to evaluate them before a successful vaccine emerges for use.
Drug development and testing too are likely to take time, requiring clinical trials. Remdesivir, a drug developed for Ebola, is now being tested in a trial that has just started. The earliest we are likely to see Covid-specific proven vaccines or drugs available for large-scale use is around two years.
Is the Indian healthcare system prepared to handle the situation if the outbreak worsens?
In cricketing terms, we are playing with a new kind of ball that seams and speeds more disconcertingly. However, the essential cricketing skills are there to face it. More diagnostic kits will be needed, more isolation areas will be required in healthcare facilities across the country. More equipment for respiratory care, including ventilators, will be needed. Planning and preparation, for a scaled up response to meet a spreading epidemic, are on at the level of the Union health ministry, which is closely coordinating with the states.
The basic weaknesses of our health system, however, have to be addressed on a sustainable basis if we have to depend on a competent, countrywide response. The weakest link will be our undoing. Strengthening of primary care services and of hospitals at district and sub-district levels should be accorded the highest priority. Our health workforce needs to be augmented in scale and skills to provide the needed care at different levels of the health system. We cannot expect the required surge capacity to be suddenly created in weak healthcare systems which exist in some parts of the country. Again in cricketing terms, we need all those who wield the bat to hold their ground and guard the wicket.
India already has an overburdened healthcare system. How feasible would it be to set up new isolation facilities and quarantine centres?
It will be a tough challenge but the government can exercise powers, if need be, to demand that hospitals—both public and private — postpone elective hospital admissions for non-life threatening conditions and free up space and beds for isolation wards. Existing facilities and vacant buildings should be made use of. If necessary, even hotels can be commandeered for creating such facilities. It is unlikely that we will reach such a situation.
However, the challenge is not just space. It will be the need for trained healthcare personnel and equipment. It will be difficult to scale up those rapidly. Fortunately, most infected persons will experience only mild illness and can be quarantined and treated at home. Only the severe cases, which will be far fewer, will need hospitalization.
Basic hygiene is needed to keep the virus at bay, but when India has historically been an unhygienic country with little hand washing habits and open defecation. How easy would it be to contain this virus from spreading?
Poor personal hygiene is a challenge but needs to be altered through extensive health education. Water shortage too can be a challenge in water stressed parts of the country. This threat may provide an opportunity for advancing multi-sectoral public health programmes with greater intensity and impact. We should also ramp up our health messaging through mass media and enable our school children to become effective change agents in their homes and communities.
The government has temporarily included masks and sanitisers as essential commodities. What is the situation with regard to personal protective equipment (PPE) in India currently? How would you evaluate the situation?
Depending on the nature of the infective virus, PPE varies from standard surgical face masks and gloves to N-95 respirator face masks, surgical gowns and body suits. Despite panic buying, most people do not need masks or gloves to protect themselves against coronavirus. PPE for coronavirus will not be as elaborate as for Ebola where the mode of transmission is through different body fluids with deadlier consequences.
Personal hygiene of hand washing, avoiding physical contact or close proximity with infected persons and possibly contaminated surfaces and staying away from crowded locations will suffice to reduce the risk of acquiring infection. An infected person should wear a mask to prevent spread, apart from practising self-quarantine. Healthcare providers and elderly persons or ones with a chronic immunity lowering illness should be prioritized for use of PPE. The health ministry is evaluating scenarios of future need and is preparing for possible larger demand of PPE.
What is the possibility of Covid-19 becoming endemic and similar to H1N1 in the near future?
There are several influenza viruses that are endemic in different parts of the world and cause seasonal outbreaks. The novel coronavirus, which can cause a more serious respiratory problem in some of the infected persons who are vulnerable because of advanced age or co-existing medical problems, is a new virus which has gained foothold in several populations across the world. When it becomes a community infection, it has spreading power, staying power and can become an unwelcome visitor in the years ahead. American epidemiologists are predicting that more than half the global population will be infected, even as Africa which is presently least affected is trying to lock the virus out and stay safe. Attempts to curb transmission and stop it from becoming an established community infection are underway, with unprecedented worldwide intensity. Our ability to shackle it through these efforts will determine whether this virus will be a recurring part of our future. Anticipating that the virus will not ‘just go away’, efforts are also being made to develop effective vaccines.
What is the mechanism of coronavirus’s survival in humans and how are doctors treating the patients?
Treatment is mostly symptomatic and supportive. Antipyretics for fever, adequate hydration, nutritious food and rest suffice in most cases. Persons with severe respiratory illness need more intense care with ventilatory support till they start recovering. Anti- viral drugs used against other viruses (such as anti-HIV drugs) have been used in some cases but, without properly designed clinical trials, it is difficult to say if any of the existing anti-viral drugs are effective in curtailing the course of the illness.
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