As the state hit the one lakh mark for Covid-19 cases on Friday, Dr Satyajit Rath, retired scientist from Delhi-based National Institute of Immunology, and currently adjunct professor at the Indian Institute of Science Education and Research, Pune, spoke on factors behind the rise in Covid-19 cases, states handling of the outbreak and public health care system. Excerpts:

What are the factors responsible for the large number of Covid-19 cases in Maharashtra and Mumbai?

Globally, much of Sars-CoV-2 transmission seems to be direct, meaning from being in close proximity to an infected person. Since the entry of the infection into India is from overseas, it is quite unsurprising that the high-volume international entry points, Mumbai and Delhi, have had most seeding of local outbreaks. When that is coupled with crowded urban conditions, especially in Mumbai, again, the number and size of local outbreaks are unsurprising, as also the outcome that infection has spread to surrounding areas (western Maharashtra, Gurgaon) from these initial seeding points. These are not really huge numbers, given the numbers some other countries with early high-volume outbreaks have had and continue to have. The pandemic is going to be with us in fits and starts for a long time.

Has the state done enough to contain the epidemic?

The state (the Centre and Maharashtra government) is trying hard, and with good intentions, and acknowledges and tries to act on evidence-based directions and approaches needed (unlike the government leaderships in the two countries ahead of India Brazil and the USA). It also acknowledges some of its own limitations and shortcomings.

And the inadequacies?

The state has failed to address the core issue, which is to build a community partnership in which there is clarity about the fact that the pandemic is not so much an individually lethal risk as a community risk. The result is stigmatisation, ostracisation, fear and concealment, disruption of non-Covid-related health services and their usage (childrens vaccinations, other non-pandemic illness handling, et cetera), and the like. The state has not built robust and generous public support structures for the underprivileged anywhere near the extent needed.

What is your assessment of the public health infrastructure?

The state (the Centre and Maharashtra government), most directly, have not yet acknowledged the sad state of public health care systems, especially at community level. It is a contributor to the quantitatively inadequate pandemic response. As a simple example, the general consensus globally is that for efficient community-based Covid-19 case identification and contact tracing, one skilled and trained health worker will be needed per three thousand people. This kind and level of manpower in neighbourhoods, backed up with infrastructure, data handling, and testing-technical capacity, was not available before the pandemic, has not been aimed at so far, and is not being built for the future.

Data shows that the state has been carrying out about 14,000 tests everyday as against the testing capacity of 38,000. Its a similar case with Mumbai too. Should we be testing more?

Given these numbers, it is quite likely that larger numbers of testing would help; more tests will still likely identify more cases. However, a major issue has come to be; how easy is it to get tested, and how clear, supportive and unthreatening are the practical decision streams for what is to be done if the test comes positive and how it is to be done?

What has been the consequence of constant changes in testing criteria by Indian Council for Medical Research (ICMR)?

The major consequence is that it becomes difficult if not impossible to compare data from testing under one set of criteria with data from testing under another set. This makes it hard to say anything much about the trajectory of the epidemic in the country. However, it is also true that ICMR has had to work in practical constraints of test and related resource (swabs, transport) availability, and of changing case numbers.

How do you gauge the potential impact following the easing of lockdown restrictions in Maharashtra/Mumbai?

It is quite likely that numbers will go up with a delay of a week or two, especially because there is no cultural assimilation in the community of the need for physical distancing (not social distancing; we need social solidarity). Case numbers are most likely to go up, not in some orderly and well-distributed fashion, but as increasing numbers of local, scattered outbreaks.

Suggestions to control further spread of the infection and revive the economy range from a ban on gathering of more than two or five people, enforcement of a stringent containment strategy and cyclical lockdown. Your comments.

A single strategy wont work everywhere, all the time. All of these and more are likely to be invoked and used, in reactive fashion, in different local situations at different times. It would be helpful if some systematic analytical thought has been given to identifying which local circumstances would warrant which of these containment approaches; I do not know if governments are doing this kind of planning.

What is the takeaway, three months into the pandemic?

Unless we persuade ourselves, culturally, as a community, that physical distancing and social solidarity need to become the new normal, and unless we re-commit ourselves, as a representative government, to the idea of major, long-term, durable investment in comprehensive public health systems as a core responsibility of governance, the outcomes of the pandemic are likely to be bleak for us.

See the article here:
State and Centre trying hard, but didnt spread awareness about community risk - Hindustan Times