India’s preparations as well as inventory, in contrast to the vast needs that we will face in the coming days from what country examples indicate, look extremely modest.
There is news that the government is likely considering a phased exit from lockdown, based on the number of new cases reported in specific states. In the last week of the lockdown, the central as well as state governments are moving forward in a coordinated manner based on the Ministry of Health and Family Welfare’s ‘Containment Plan for Covid 19’ (CP henceforth), the latest version of which was released on 4 April, Saturday.
It is a dynamic document responding to the ground situation, and a series of revisions has already been done on the first version which was shared with the state governments as well as the public in the last week of February itself. The latest version is called Containment Plan for Large Outbreaks. The document admits that clusters have appeared in multiple States, particularly Kerala, Maharashtra, Rajasthan, Uttar Pradesh, Delhi, Punjab, Karnataka, Telangana and UT of Ladakh. Out of a total of 755 districts, 211 — according to CP, are now reporting COVID19 cases and the risk of further spread remains very high. Within two days of this assessment, crowd-sourced data indicate that the number of districts has expanded to 314. The situation is grave.
According to the containment plan, India is following a scenario-based approach, based on five possible situations:
The strategy involves extensive contact tracing and active search for cases, testing of all suspect cases and high-risk contacts, isolation of all suspect/confirmed cases and provision of medical care, quarantining contacts, implementing social distancing measures, and intensive risk communication. Efforts like active surveillance for cases and contacts in the identified geographic zone and implementation of a stronger social distancing measures with strict perimeter control will be rolled out depending upon geographical spread of the virus.
As parts of India move towards geographic quarantine, which is near absolute interruption of movement of people to and from a relatively large defined geographic area, the document specifies that quarantine will be applicable to such areas reporting large outbreak and/or multiple clusters of COVID19 spread over multiple blocks of one or more districts that are contiguous, and calls for moving from a nation-wide approach to a differential approach.
The document states that operations will be scaled down if no secondary laboratory confirmed COVID19 patient is reported from the geographic quarantine zone for at least four weeks after the last confirmed patient has been isolated and all contacts have been followed up for 28 days. The containment operation shall be deemed to be over 28 days from the discharge of last confirmed patient(following negative tests as per discharge policy) from the designated health facility will be complete.
Interestingly, Scenario III, which the current iteration of the Containment Plan responds to, is a new addition to the set of possible scenarios that existed in the earlier version. Initial Containment Plan had only four possible scenarios, namely:
There is a global reluctance to call Community Transmission by its name; partly following WHO practice, where despite unprecedented human cost across geographies, no country in the world yet has community transmission, if the daily situation reports of the UN agency are to be believed. The invention of the new category shows that India is playing along. The last-minute addition of the new category perhaps shows our reluctance to be proactive and aggressive in fighting the challenge head on. While part of the reason may be to curb panic around “community transmission” which has by now become the buzzword for many media outlets, we indeed may be following a defensive, reactive playbook, which will not be as effective as a ruthless and aggressive approach.
One hopes that areas for geographic quarantine will not be selected based on narrow, conservative definitions of “large outbreak”, privileging economic costs over health costs. It will be a mistake India can ill-afford, given the lack of preparedness, and capacity, in our healthcare delivery system. Given the strong resolve India showed in enforcing an early country-wide lockdown — which in economic terms, it could barely afford, this incremental approach looks tentative and therefore surprising. We cannot keep tweaking categories and hope that the disease will wither away. Government response should be based on the premise that there is indeed community transmission in Indian states, unless otherwise proven, and regions for geographical quarantine should be selected accordingly.
In addition to the overall challenge of system preparedness is the widely perceived shortage of protective equipment for healthcare staff. France, a country with half the population of Maharashtra at 67 million, has ordered two billion masks from China for its healthcare needs. While the country was reeling under a severe shortage of masks, it was still using up 40 million face masks weekly, according to officials. The United States, a country with 327 million population would need about 3.5 billion masks to get through the pandemic, according to senior government official Dr. Robert Kadlec’s congressional testimony in March.
India’s preparations as well as inventory, in contrast to the vast needs that we will face in the coming days from what these country examples indicate, look extremely modest. India had some 2.5 million masks in stock across the country, and some 150,000 were ordered, as on 4 April, according to ministry sources. India has a difficult fight at hand, and we have reached a stage where semantics or categories do not matter — only strong, decisive actions do. The political leadership must admit that there will be pain, communicate it well to the public, help generously those who need support to tide over this challenging phase, and take fellow Indians into confidence while enacting the comprehensive containment plan, instead of going for a minimalist approach.
For more, read India’s Containment Plan for Large Outbreaks here.
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Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...
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