On May 25, three medical professional associations submitted a joint statement to Prime Minister Narendra Modi, criticising India’s response to the coronavirus pandemic, and, in particular, the lockdown. The statement also contained several recommendations for course correction.
Two of these associations had submitted a similar statement, albeit less elaborate and gentler in tone and tenor, in April too.
Among a range of serving and retired government scientists and physicians, one of the signatories to the statement is DCS Reddy, who heads the research group on epidemiology and surveillance constituted by the Indian government’s National Task Force for Covid-19 headed by Niti Aayog member, Vinod Paul.
The priority task assigned by the task force to the group at the time of its formation on April 6 was to study the “basis for lockdown/partial lockdown”. The nationwide lockdown, initially put in place on March 25 for three weeks, was extended several times. But Reddy said: “We were not consulted for extending or modifying the lockdown. Those decisions were taken by the National Task Force headed by Dr Vinod Paul.”
Reddy, a former professor and head of community medicine at the Institute of Medical Sciences at Banaras Hindu University, was a signatory to the previous statement too – he is a member of the Indian Public Health Association and the Indian Association of Preventive and Social Medicine that issued it.
Scroll.in spoke to Reddy who lives in Lucknow. Here are edited excerpts from the interview.
You were signatory to a similar statement on April 11. What prompted you to put out another statement?
This is an explosive outbreak. The nature of explosive outbreaks is that first it starts going up and up, then it plateaus and then it will start dipping. So, this requires continuous monitoring and adaptation of your strategy according to the changing dynamics of the epidemic.
We prepared the first statement during the first phase of the lockdown and expressed our reservations, etc. Now we have gone through different stages of lockdown with varying levels of restriction.
Also, at that time, we did anticipate some problems in terms of movement of migrants, etc. but did not know the magnitude and scale of it. Now, we have quantitative data of that.
Also, this is a stronger reminder to the government to share data so that all the talent that we have in the country can analyse it.
Then this time, we have suggested immediate surveillance for influenza like illnesses using the HIV serological surveillance platform.
Basically, the idea was to bring all of this attention to the people in positions of power…those who can actually do something.
Speaking of positions of power, you head the government research group on epidemiology and surveillance whose priority was to study the basis for lockdown/partial lockdown. On April 11, you signed a statement that called for the lockdown to be reviewed in favour of restrictions in certain clusters on the basis of epidemiological surveillance. Yet, days later the government extended the lockdown – and its terms were almost as stringent as the first one. How does that square up?
I am not the appropriate person to answer that.
There are several ways to do interventions. One is cluster-based approach and another total lockdown. What I would suggest is targeted and graded. Anyway, what we feel about the issue, we have said in our two statements.
So were you and your research group consulted at all as the government kept extending the lockdown?
No. This group is probably not considered big enough to be consulted. This group’s role is seen as designing surveys and studies. We were not consulted for extending or modifying the lockdown. Those decisions were taken by the National Task Force headed by Dr Vinod Paul.
So what exactly is the role of the group?
We have done several things. One of the things we attempted was a population-based survey based on the cases being detected in the labs. To know how we are moving, one of the immediately available data is the number of people being tested and the number of people testing positive, their clinical and demographic features. Based on that we can form some ideas [about] the way the epidemic is behaving. So, we immediately identified a group to collect that data and analyse it. That data has come out as a paper [Read a summary of the study here].
Parallelly, we started designing a population-based surveillance programme. It was initially designed for 80 randomly selected districts. On April 15, we received the antibody kits for that. April 16 and 17, we took the kits to the field to test them. Subsequently, what happened you know [the kits failed].
Thereafter, we had to wait for new kits. Now it has been done in all the states using the kits, except West Bengal where we couldn’t do because of the cyclone.
Third thing we put in place is we have already designed and started a study to identify the risk factors for severe cases and mortality.
Fourth, we have designed a health facility-based surveillance that the government can do – we are only an advisory body. That will soon be notified.
How many times has this committee met?
Initially, we used to meet two-three days when we designed and finalised the studies. Now we are meeting once a week.
So what are the recommendations you have made so far to the ICMR?
We can play an advisory role when there is data. So, we are trying to generate data that is dependable. That is why we have created one population-based surveillance. But one round of survey is not enough, we have to have an ongoing process. So, we have designed the facility-based surveillance which will generate new data every month. The recommendations will be made once we analyse the data. I don’t want to make recommendations in vacuum, or based on perception. You have seen the outcome of perception-based recommendations.
In the statement, you have called for more data transparency. Could you please point out a specific instance where you or the committee may have not had access to the data that would have helped your research?
The NCDC [National Centre for Disease Control], as the very name suggests, is the main player for disease control. They have to be at the centre of things. I don’t know about control anymore since all control is now at a higher level, but they do have an ongoing ILI [influenza like illness] surveillance program in place.
Though they are doing such good work, is there timely analysis and sharing? How much of that information is going into our policy? People are doing a lot of things but all of it seems to be happening in silos. If there is free flowing data, all of that can be stringed together to obtain useful information.
What is that one thing that India did not do that we should have?
I already used the term targeted and graded. But anybody can say that it is easy for me to say that retrospectively.
I think the way we approached the entire problem should have been different. As I told you, in the beginning only a few states had the problem. But from day one, we had a straightjacketed approach for the entire country. Your approach to intervening should be tailor made for states. Yes, the basic tenets are the same, but that local pool of expertise should be used for each place.
Also, sometimes I think in the guidance [dictating India’s response], there was more administrative control than technical expertise. That has its own implications. As a public health specialist, I should probably not go into all those things.
How would you rate the efficacy of the lockdown in India on a scale of 1-10?
Efficacy is a loaded term. To answer that, I have to have a model that analyses a situation of no-intervention versus our interventions.
The purpose of a lockdown is to slow down the spread and buy time to build up resources. From that angle, they have done something. Whether that is adequate or not, I can’t say because I don’t have the data. But the consequences of the lockdown has compounded many other social and economic problems including other health issues.