A joint task force of public health experts in India has submitted an action plan to the Centre to combat the escalating coronavirus crisis, in which it has suggested that lockdowns be discontinued and only cluster restrictions be imposed. The experts also cautioned against the “false hope” of a vaccine being launched anytime soon and called for increased expenditure on health infrastructure.
The suggestions were put forth by the Indian Public Health Association, Indian Association of Preventive and Social Medicine and Indian Association of Epidemiologists in their third joint statement on the coronavirus crisis in India, which was released on August 25. This joint task force was constituted in April to assist the government in its fight against the health crisis.
The experts called for a “public health approach” to the coronavirus, with the “maximum possible good being done for the largest possible numbers.”
The experts began their action plan by discussing the need to discard lockdowns. “Lockdown as a strategy for control should be discontinued,” they said. “Geographically limited restrictions for short periods may be imposed in epidemiologically defined clusters.”
“Cluster restrictions should be considered only in areas with no community transmission,” they added. “Even cluster restrictions should be imposed after weighing the impact of the same on the livelihood of target population. With adequate health system preparedness, including facility care for severe cases, cluster restrictions can be totally done away with and should be the ideal way to address this pandemic.”
The task force added that vaccines had no role in the present coronavirus situation. “However, whenever available, the vaccine may play a role in providing personal protection to high-risk individuals like HCWs [healthcare workers] and elderly with co-morbidities,” they said. “While being optimistic, the prevention and control strategy should also prepare for the worst. It must assume that an effective vaccine would not be available in near future. We must avoid false sense of hope that this panacea is just around the corner.”
The experts suggested that the Centre increase spending on healthcare. “Public health care should be significantly strengthened and enhanced with overall public expenditure to be increased to at least 5% of the GDP [gross domestic product]. “The focus of increased health expenditure should be on primary health care and human resource and infrastructure strengthening rather than opening/strengthening tertiary care centres.”
The task force also called for a revision in coronavirus testing strategy. “Universal scaling up of testing at current community transmission stage of the pandemic may not be an optimal control strategy and will divert attention and resources from control measures,” it said. “With the availability of sufficient understanding of the natural history of disease and at-risk population, testing should be used with due diligence.”
“Experience from other countries indicates that increased testing does not prevent the deaths from COVID-19,” the experts added.
The task force added that the “test, track, treat and isolate” strategy is only helpful in the early stages of the pandemic and the Centre’s focus must now be on reducing deaths. “Since the virus has already widely spread in the community in many geographical areas, current strategy would not serve the intended objectives,” the experts said. “Moreover, confirmed cases represent only a fraction of the total estimated cases as is indicated by serosurveillance surveys. Hence, a greater number of tests being carried out will yield a greater number of detected cases without any benefit in reducing the deaths, which should be the primary goal.”
The experts suggested that all symptomatic cases in high-load areas must be “treated on the lines of confirmed cases to isolate and treat, to reduce the spread and mortality even without testing as the probability of being positive is quite high”. They added that testing may be used a surveillance tool in containment areas and smaller towns.
The experts observed that India has emerged as the worst coronavirus-hit country in Asia. They added that India is presently reporting about 30% of the daily new cases and 20% of one-day deaths globally. The experts also said that the count of daily new cases had increased dramatically from 9,472 on June 5 to to 61,749 on (23 August), through two months of “Unlock”. They said that the peak of the pandemic in India may still be far away.
The experts also called for the re-opening of schools, higher education institutes and other health services. “Due to preoccupation of the entire health system with COVID-19 response, other national health programs have received limited attention,” they noted.
India’s coronavirus case count reached 36,91,166 on Tuesday after it reported 69,921 new cases in 24 hours. The infection has killed 65,288 people in the country. India has now overtaken Mexico’s toll (64,414). The World Health Organization said later in the day that India led the rise in global coronavirus cases last week, reporting nearly 5 lakh of the 18 lakh new worldwide infections.