What Next? Experts on India’s Future Coronavirus Graph
As India crosses the 1 million mark in Coronavirus cases as of 16 July, its graph continues to rise, with little sign of the elusive flattening of the curve. What strategies should India adopt today, to contain the spread across the country in the future? Joining us for a conversation are Dr Shahid Jameel, virologist and CEO, Welcome Trust, DBT India Alliance and Dr Mathew Varghese, public health expert who led India's efforts against Polio, currently works as an orthopaedic surgeon at St Stephen's Hospital, Delhi.
1 Million: Just a Number? Or a Indicator of What's to Come?
I started by asking that while media is criticised on its obsession with numbers, what does one million coronavirus cases mean in India's context, given our population size and geographical spread.
Prof Jameel was of the opinion, 1 million is just a number, when the spread is as wide as it is. The concern is - rate at which daily infections are being added to the country. We are adding nearly 30,000 cases. But it's important to remember that this is country-wide number. However, these 10 lakh numbers have been added in last 6 months - a short period of time, and that is worrisome as it overwhelms the healthcare system.
Prof Jameel drew our attention to India's case fatality rate of 2.5%, 18 deaths per million, which is a really low number. And this is not just true for India, but also for large parts of South Asia and South-east Asia - all these populations have a death rate in single digits. Compared to western Europe and the US, where deaths were in the range of 300 to 800 per million. He attributed this to perhaps a biological factor, something in our biology that offers us protection.
Low Fatality Rate: Biology? Or Missing Deaths?
Dr Mathew Varghese was of the opinion that it is very difficult to hide a death. While certification in cause of death is a certainly a concern, India for example lags behind by nearly 3 years when it comes to certification and registration. So he is not of the opinion, and Prof Jameel agrees, that the deaths are being fudged.
He agrees there is something beyond the recording of deaths, that is giving South Asians and South-East Asian and even African countries some protection. We have to investigate the biological factor.
Lockdowns Then and Now: How Effective Are They as a Strategy?
Lockdown certainly slowed down the doubling rate of the virus, says Prof Jameel. But what we should have done was to prepare ourselves better. And what we didn't see was the social and economic dimensions of the lockdown.
He says India needs a more coordinated strategies towards the lockdowns - else it is giving diminishing returns.
If your social structure is not congenial and if you don't have a robust primary, secondary and tertiary health care, you are not going to see better outcomes. The virus has exposed the weakness.
How Do We Prevent Our Next Vulnerable Cities/Districts From Getting Worse?
We know of the situation of the urban centers and that's because we are testing more here. There are states with abysmal testing rates and we are not testing in rural areas, said Prof Jameel. If you test 20 people of whole 1 tests positive, even the WHO agrees, that's a good situation. But overall in India, we are finding 1 case in every 13 tests, in Delhi it is 1 out of 10 and in Mumbai it is 1 out of 5. Prof Jameel says we need to increase our testing capacity, and the prescription is test, contact, isolate. Data-driven, science-driven strategies is what is needed.
Dr Mathew is of the opinion that we've delayed our preparation - what should have happened in March has been achieved today. And we needed to have done this without disrupting other health services that has lead to misery and hardship for the sick and for the disabled.
Today lockdowns are meaning less. When we went into lockdown we were at around 500 cases, today we have a million. What we need to do is protect the vulnerable.
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