Professor K. Srinath Reddy is the President, Public Health Foundation of India (PHFI) and formerly headed the Department of Cardiology at All India Institutes of Medical Sciences (AIIMS). Under his leadership, PHFI has established five Indian Institutes of Public Health (IIPHs) in different regions of India, to advance multi-disciplinary public health education, research and implementation support for strengthening health systems. He holds advisory positions in several national and international bodies and recently published a book Make Health in India: Reaching A Billion Plus. He speaks to The Hindu’s Bindu Shajan Perappadan on how India’s strategy will change if community transmission starts, stating that care will take over priority in containment.
What should be India’s specific plan if we slip into community transmission?
It depends on how localised or widespread the transmission is across the country, and the speed of spread from one location to another, especially the urban to rural spread.
At all times, care and containment will both be important but relative priorities will change depending on the extent of community spread. In early stages of a spread, there would be a need to test on the basis of well-defined clinical criteria, isolate and treat the cases based on severity, and trace their contacts, while energetically working to prevent spread to unaffected regions.
In later stages, if many cases arise in different parts of the country, the highest priority would be to save lives by focusing resources on providing the best hospital care possible to those who are severely affected.
After stratifying risk, based on composite clinical criteria, less severe cases can be treated at home or in health facilities which do not offer intensive care. At that time, care overtakes containment in priority. We should mobilise both public and private hospitals and strengthen the collective capacity to deliver the type of care needed to all affected persons.
How are we enhancing our lab capacity? Do we have enough ventilator beds to cater to community transmission? How will the private sector be involved in terms of testing and bed facilities?
Indian Council of Medical Research (ICMR) is expanding the laboratory capacity by accrediting medical colleges, research institutions and private laboratories which meet the required standards. The test kits needed are also being scaled up with domestic and imported components being made available for large-scale testing.
As for ventilators, it depends on how many persons will require intensive care. Recognising that there is presently a shortage compared to the anticipated need, if community spread occurs and numbers of persons with serious viral pneumonitis requiring ventilator care is large, efforts are being made to increase the procurement and availability of ventilators.
Dedicated intensive care areas are also being created in hospitals across the country. There is also an accompanying need for health personnel in intubation, efficiently operating the ventilators and providing respiratory care with efficiency and safety. That is also a gap that needs to be urgently filled.
The private sector has already been invited by the government to join hands in providing an accessible, effective and equitable response by participating in laboratory testing and in providing hospitalised care. It is up to the private sector to step up as a willing partner in a time of major national health emergency and use its institutional capacity and expertise as per agreed protocols. The specific modalities are being worked by the relevant governmental agencies at Central and State levels.
What is your advise to the general public, government and health care workers?
The public should, to the maximum extent possible, practice personal protection and social distancing to protect themselves. They should not be misled by incorrect messaging on social media and try to access authentic information from qualified sources. Xenophobia, of any kind, should be avoided. If there is an illness that arouses concern, they should report to a nearby health facility where they would be assessed. If found positive and advised home or hospital quarantine, they should accept that advice and not slip away to infect others.
The governments, at Central and State levels, should step up coordinated efforts to contain the epidemic and provide timely and appropriate care and counselling to all persons who need it. Healthcare workers should follow protocols for diagnosis and management at different levels of care and different clinical presentations. They should ensure that they themselves are well protected and not fall victim to infection or exhaustion.
What is the impact of people leaving isolation facilities and hospitals prior to discharge?
If quarantined persons leave the hospital during the infective period, they become a social menace. If they are ill, they do self-harm by depriving themselves of needed healthcare. This can have dangerous consequences and may end in avoidable fatality.