Time to act firm

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

The next issue we are going to face is to take care offlorid cases of the disease. These need ICU care with capability of providingprolonged ventilatory support. The additional funding of Rs 15,000 crores toaugment this care is a welcome move. What is needed is a dedicated and trainedstaff consisting of doctors, nurses and paramedics to provide the necessarycare. Being under high risk, these professionals need to be backed up by secondand third line of personnel to take over as the need increases. There is also aneed to recruit fresh crop of general duty doctors who need to be trained incritical care medicine in selected institutions in every city. Time is shortand this has to begin immediately and authorities need to accredit them. Seeingthe example of countries like Italy with more than 6000 deaths till date thereis going to be a need of additional intensive care beds with ventilators inlarge numbers. There has to be a public private partnership to augment thisfacility and lists of available beds should be made available online with clearguidelines of the criteria for admission. There is a need for setting up newIsolation facilities as per the new guidelines specific to Corona virusoutbreak. Cities have to be divided in zones and COVID ambulances manned bytrained staff with connectivity with the identified centres earmarked for arapid transfer. In this regard a tie up with fire brigade department ispossible after adequate training.  Mobile phone apps should be developed and artificial intelligenceutilized to accomplish some of these tasks.

   

With entering the phase of community transmission, theproblem is going to get into countryside and villages sooner or later and thisneeds to be kept in mind. The control policies need to factor this in. Theprimary health centres and selected district hospitals need to be equipped forhandling these patients. Once again training by visiting teams and crashcourses and certifications are needed. Rapid means of transferring very sickpatients to nearby cities and towns has to be planned at this stage. ThePanchayat heads need to educate people in preventive strategies.

Lastly it is very important to carry out multi-centricclinical studies in our patients to identify the demographic characteristicsand therapeutic measures. In this regard the role needs to be studied of someof the agents like retroviral drugs and chloroquine analogues along withazithromycin which at present is only anecdotal and not based on any clinicaltrials. India can become a leader in these studies and could also join theinternational community. Development of vaccine needs to pursued, and till itbecomes available by end of 2021, we need to continue our efforts to minimizethe RO.

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

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

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