COVID-19 should be considered a watershed moment and governments should invest heavily in public health skills and services because preventing deaths by providing adequate supportive care is the primary responsibility, says Indian Institute of Public Health (IIPH)-Hyderabad director G.V.S. Murthy.
Clinical evidence shows only a minority of patients needs ventilation while 15-20% need oxygen supplementation. Efforts should be made to provide oxygen-supported beds spread across a distance of every 30-50 km so that patients requiring such facilities do not need to travel too far, asserts the public health specialist.
“Providing such facilities only at a few hospitals will be counter-productive as the risk of hospital transmitted infections will be higher. We see that most of the clustering of cases is urban-centric and therefore, a proper geographical spread of services is critical so that low-risk populations risk is not increased,” he warns.
Considering 80% of all infected are asymptomatic and evidence shows that the risk of transmission is low from them yet it will be impossible to trace such persons except those who are in very close contact of an infected person. So, a high level of preparedness is essential both at the individual and government level, he affirms.
Dr. Murthy calls for strict norms of “physical distancing, hand sanitisation, coughing and sneezing etiquettes, universal mask use and increased personal and family hygiene to be ensured by all individuals”. Most important measure is there should be no congregation of people with partying and religious congregations be strictly avoided as all the major outbreaks in the country have been linked to clustering of people, he adds.
Testing is crucial to improve performance but no country has taken up universal testing for all people, hence a targeted testing approach yields better results. It means testing those at high risk of COVID-19 and their immediate contacts. Using a severe respiratory illness surveillance or an influenza-like illness surveillance as the first step and then doing an antigen test on those who have these symptoms is a better use of resources than testing blindly, he advocates.
Antibody testing helps to identify what proportion of the population has already been infected to help classify the stage of the pandemic only but will not directly help in controlling the pandemic. A targeted testing approach is the optimal solution and for it to succeed, robust symptom surveillance mechanism is vital.
If people are identified early in the disease they can be prevented from dying or from serious complications. “We can see this in our country where number of COVID-19 deaths among those identified as positive has decreased to 2.3% from 3.4%. This is because more RT-PCR tests are being done compared to the early stages,” Dr. Murthy points out.
Governments should also initiate a public health cadre to tackle outbreaks for surveillance, rapid response and containment. They can act as community physicians to manage outbreaks and advise governments, he adds.
