OPINION

Strategic shift

India is now forced to reserve its health-care facilities for those who need it the most

On March 28, only 130 districts of India’s 736 had reported COVID-19 cases. The Health Ministry’s strategy then, after the national lockdown, was to ensure State supervision of those who manifested symptoms — as well as their high-risk contacts — and who had a travel history. Suspected high-risk contacts or those likely to have been exposed to the infection were subjected to varying degrees of State quarantine. Those not showing signs of the disease or ‘mild’ manifestations, were put in care centres and those noticeably sicker, in hospitals. The idea always was that if the sick and their contacts were segregated from the community long enough, the transmission chain would be broken and the disease extinguished. As April ends, the number of affected districts stands at 401 and confirmed cases have risen by a 1,000 a day; the daily death count hovers between 50 and 60. In a containment strategy tweak, those with a mild form of the disease, or are presymptomatic, would have the option of home quarantining. But their homes ought to have self-isolation facilities, a full-time caregiver, and daily health-status reports given to the district surveillance officer.

The Health Ministry has not explained what prompted this relative relaxation. However, anecdotal evidence suggests doctors and health-care workers have been disproportionately vulnerable to the infection and a single case leads to entire hospitals being shut down. Unlike in the U.S. and western Europe, India’s hospitals are not yet clogged with seriously ill patients. It could be due to India’s relatively low case-count and also people not turning up fearing infection. Allowing home quarantine could be seen as health authorities inferring that quarantining in public facilities posed more risks. The presymptomatics (mild illness) and asymptomatics (no signs) did not benefit from treatment and were potent virus spreaders, and therefore endangered the staff and health workers. They also stretched State resources in maintenance. The Ministry also found that among those who tested positive, there were two presymptomatics or asymptomatics for every symptomatic. The disease spread, it appears, is now beyond the ability of the state to contain, by quarantine, and it was far more prudent to fortify health workers and hospitals with the best facilities available to handle patients. Officially, there is no community transmission in India but at this magnitude of cases, it does not practically matter. Gujarat, Maharashtra, Madhya Pradesh and Delhi are powering the spread of cases and only consistent declines here can broach discussion on the end of the pandemic. From a month ago, India, on paper, is equipped with better supply channels of personal protective equipment, infusion pumps (for oxygen), hospital beds, laboratories for testing and PCR kits. If the lockdown is lifted on May 3, the rationale behind the government’s containment strategy will be put to a stringent test.

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