In all this talk of bed strengths and ventilators, no one is asking what is happening in small-town and rural India, points out former Health Secretary Keshav Desiraju while speaking exclusively with The Hindu’s Bindu Shajan Perappadan.
As insider to the Indian and international health care systems do you think India is doing enough to contain and prepare for COVID-19?
One is never doing enough when faced with an epidemic, but if we had systematically invested in strengthening primary health care, and across States, we would be better equipped today to collect samples, and to deploy health workers. Both the Central and State governments have made some investment, especially after the National Rural Health Mission (NRHM) and later the National Health Mission (NHM), starting 2005, but investing in public health is not a one-time measure. We should also be doing a great deal more of testing, through the kind of massive drive that was undertaken in 2009 with swine flu.
Can the Indian health system take on the burden of a community outbreak (bed strength/ ventilators support/ manpower/ testing kits)?
I don’t think we have the option; we have to take on the burden.
Urgent expenditures will have to be made. I saw a report which says that Delhi has 1,400 quarantine beds, 2,200 ICU beds and 10,059 beds in tertiary care facilities, and a minimal number of ventilators. Not every city or town will need isolation facilities or beds. The big public hospitals like the six new AIIMS (All India Institute of Medical Sciences) should turn over their wards. Actually, in all this talk of bed strengths and ventilators, no one is asking what is happening in small-town and rural India. How long will it be before persons exposed to the virus in the cities will return to their village homes? They will do, especially if they are thrown out of work.
What should be our focus right now when the government is asking people to stay indoors and delay community transmission?
Staying indoors is good and essential advice but Indian lifestyles and work habits do not make this easy. We need a strict ban on social gatherings, of the kind that the Food Control orders enforced in the old days, or the blackouts during the 1965 war. But who is to protect street vendors, daily wage workers, construction workers and others whose existence is hand-to-mouth at the best of times? It will be intolerable if they are thrown out of work, at a time when they face increased risk of illness.
Municipalities and Corporations must make arrangements in shelters and the like, while also recognising that people cannot be made to stay in close proximity. Free PDS (Public Distribution System) supplies should be given to some categories of persons, or food packets, as were distributed after the Chennai floods of 2015. But our most important focus has to be on testing of persons with one or more symptoms, even if there has been no international travel.
Is it time for the India government to take extreme steps like nationalising private labs and hospitals for a specific period of time?
I am not sure ‘nationalisation’ is called for. Government can, and has, invoked Section 2 of the Epidemic Diseases Act, 1897. This is more than enough to get private labs to test samples, or to take over beds for isolating patients. Of course, government will need to cap the rates charged for testing, and also pay for the private beds. Apparently, the Mumbai Corporation has capped it at ₹4,000 per test.
Where are we as a global community in controlling a) treatment b) vaccine and c) containing the virus?
I cannot answer this, but the Indian Council of Medical Research (ICMR) has such fine institutions as the National Institute of Virology, Pune and the National Institute of Epidemiology, Chennai, and I am sure they are working on containing the virus and developing a vaccine. But all this is for the future. We have to manage today’s crisis with what we have.
