Time to act firm

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Prime minister’s passionate appeal to 1.3 billion Indians to lockdown themselves till 11th April is very important for the whole world. If India can contain COVID-19 effectively, it would be a major step in levelling the risk of contracting the disease which otherwise with the reproduction number (RO) of 1.7 (which could be an underestimation), India could face between around 100,000 and 1.3 million confirmed cases of the disease by mid-May. If it continues to spread at its current pace, it will put its health system under severe strain. Need of the day is to have very reliable and cost-effective methods of testing for the virus. It is heartening to know that an indigenous test already approved by Indian FDA is going to be made available by a Pune based company. The quick and very reliable confirmatory test based upon reverse transcription polymerase chain reaction (RT-PCR) has the ability to perform bulk testing of up to 1 lakh tests per week. Training of personnel to collect these highly contagious samples is critical and is going to be a challenge. By widespread testing one can detect early cases and apply measures to contain the virus expeditiously.

The next issue we are going to face is to take care of florid cases of the disease. These need ICU care with capability of providing prolonged ventilatory support. The additional funding of Rs 15,000 crores to augment this care is a welcome move. What is needed is a dedicated and trained staff consisting of doctors, nurses and paramedics to provide the necessary care. Being under high risk, these professionals need to be backed up by second and third line of personnel to take over as the need increases. There is also a need to recruit fresh crop of general duty doctors who need to be trained in critical care medicine in selected institutions in every city. Time is short and this has to begin immediately and authorities need to accredit them. Seeing the example of countries like Italy with more than 6000 deaths till date there is going to be a need of additional intensive care beds with ventilators in large numbers. There has to be a public private partnership to augment this facility and lists of available beds should be made available online with clear guidelines of the criteria for admission. There is a need for setting up new Isolation facilities as per the new guidelines specific to Corona virus outbreak. Cities have to be divided in zones and COVID ambulances manned by trained staff with connectivity with the identified centres earmarked for a rapid transfer. In this regard a tie up with fire brigade department is possible after adequate training.   Mobile phone apps should be developed and artificial intelligence utilized to accomplish some of these tasks.

With entering the phase of community transmission, the problem is going to get into countryside and villages sooner or later and this needs to be kept in mind. The control policies need to factor this in. The primary health centres and selected district hospitals need to be equipped for handling these patients. Once again training by visiting teams and crash courses and certifications are needed. Rapid means of transferring very sick patients to nearby cities and towns has to be planned at this stage. The Panchayat heads need to educate people in preventive strategies.

Lastly it is very important to carry out multi-centric clinical studies in our patients to identify the demographic characteristics and therapeutic measures. In this regard the role needs to be studied of some of the agents like retroviral drugs and chloroquine analogues along with azithromycin which at present is only anecdotal and not based on any clinical trials. India can become a leader in these studies and could also join the international community. Development of vaccine needs to pursued, and till it becomes available by end of 2021, we need to continue our efforts to minimize the RO.

We are passing through challenging times and need of the day is to steer the country out of the emerging disaster. All the steps that need to be taken are possible and practical; we have the human resource to achieve even the impossible; but we cannot delay any further.

Author is a cardiologist, Recipient of Padamshiri and Dr B C Roy award