India needs to correct its course by adopting a technology- and protocol-led approach to the pandemic before it gets any worse
The first covid-19 case in Karnataka was reported on 9 March. Strict measures ensured that the total number of cases was contained at about 3,200, with 1,950 active cases and just over 50 deaths till 31 May, when the nationwide lockdown started to be eased. Since then, the situation has exploded. Karnataka’s total case count crossed 44,000, with about 26,000 active cases and over 840 deaths by 15 July. Within a span of 45 days, the state has, on an average, added over 900 cases a day. In the first two weeks of July, it witnessed a jump of 2,000 cases daily. Covid-19 cases in Karnataka are growing at the fastest pace compared to other states. The doubling time of cases is less than 10 days for the state versus more than 21 days for India as a whole.
Simultaneously, the state’s fatality rate at 1.82% is inching towards the national level of 2.64%. The test positivity rate for Bengaluru, the state capital, surpassed India’s average rate of 9.8% for the week of 6-12 July.
From a safe haven in May to becoming the state with the fourth-highest caseload of covid-19 in India, Karnataka’s situation seems to be spiralling out of control. Yet, this state has important lessons for the rest of India.
To prevent the covid-19 situation in India as well as in the states from worsening, the top three priorities should now be to contain the spread of the virus, control the mortality rate, and cascade responsibility.
Contain spread: With several parts of India, including Bengaluru, imposing a second lockdown, the 5T model of “test, trace, track, triage and treat" needs to be strictly enforced.
India needs to relook its testing guidelines, given the Indian Council of Medical Research’s (ICMR’s) estimate that 70-80% of coronavirus patients are asymptomatic. Everyone should be able to get a test done, as India is now producing enough testing kits. Companies should be allowed to test employees who report for work on site.
The plan to conduct a nationwide sero-surveillance should be quickly implemented.
Comprehensive contact-tracing is key to slowing the spread of covid-19. Up until May, Karnataka was doing a thorough job of tracing and quarantining. For every positive case, Bengaluru was tracing 47 contacts, compared to Mumbai’s ratio of 1:3. With the easing of the lockdown, complacency seeped in, contact-tracing reduced to immediate family members, and cases started multiplying.
Active clusters should be completely sealed-off and the Dharavi pattern of “chase the virus", which helped bring down the incidence of covid-19 in Asia’s largest slum, should be emulated throughout the country.
Containment through increased testing, efficient contact-tracing and proper quarantining is only one part of the story. The government also needs to be able to predict where the next outbreak is likely to take place through data mining and analysis, so that the authorities are prepared to nip the problem in its bud.
Control the mortality rate: The mortality rate is a good indicator of a country’s ability to prevent covid-related deaths. While it is heartening that this has dropped from 3.28% at the beginning of May to 2.64% now, we need to reduce it below 1%.
An alarming shortage of hospital beds across the country is putting at risk the lives of patients with serious covid-19 complications. To prevent hospital infrastructure from getting overwhelmed, the government will need to triage covid-19 cases into mild, moderate and severe categories. Patients with mild symptoms should be home-quarantined, while moderate cases should be treated in government quarantine centres or paid hotel quarantine facilities. The staff at hotel-turned-quarantine centres should be equipped with proper personal protective equipment and trained to provide contactless services to ensure their safety.
Only severe cases with complaints of breathlessness, blood oxygen saturation levels of less than 90% and other complications should be admitted to designated covid-19 hospitals.
The government should aim to bring down the number of covid-19 patients seeking hospitalization to less than 5% from the current 15%.
To bring mortality down, the ICMR should update clinical management guidelines for the use of available treatment options along the continuum of care. For example, hydroxychloroquine and favipiravir can be used in the initial asymptomatic and mild treatment stage, while remdesivir and methylprednisolone can be administered immediately after hospitalization. Immunomodulatory drugs like tocilizumab and itolizumab can be used to treat moderate to severe patients, so as to address a brewing cytokine storm and prevent patients from needing critical ventilator support. Protocols for convalescent plasma therapy and corticosteroid medication such as dexamethasone should also be specified. Metrics that show a reduction in ventilator need will bear a direct correlation with the effectiveness of the care delivered.
Cascade responsibility: A decentralized approach is critical to tackle public health emergencies like covid-19. Responsibility needs to be cascaded down to the smallest administrative unit. Ward councillors and sarpanches of gram panchayats should be tasked with preventing any resurgence in infections in the areas they administer through greater testing, quarantining, zoning and sero-surveillance.
Time is running out, and India will need to adopt a technology- and protocol-led approach, with stakeholder collaboration and administrative accountability. to avert a worsening of this crisis.
Kiran Mazumdar-Shaw is executive chairperson, Biocon.
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