Covid-19: An overhaul of public health infrastructure is needed

At first glance, the extraordinarily low incidence of the novel coronavirus disease (Covid-19) in India, with 147 positive cases and three fatalities so far, would seem reassuring. However, it coincides rather too neatly with a low number of testing facilities. The Indian Council of Medical Research (ICMR) has, between March 1-15, availed of 51 of its 106 Viral Research Diagnostic Labs (VRDLs) for random testing 20 samples per lab, of patients suffering from Severe Acute Respiratory Infection (SARI) and Influenza Like Illness (ILI). As 500 tested samples turned out to be negative for Covid-19, the conclusion is that there is no community transmission yet, and the situation in India is way better than China or Italy. The ICMR Director Balram Bhargava has accordingly dismissed WHO Director General Tedros Ghebreyesus’ advice on “test, test, test” being the best way to control the Covid-19 pandemic.

The official version contrasts sharply with the consensus among clinicians and public health professionals who believe that the incidence is not necessarily low, but grossly under-reported. There are no cases from Bihar and Gujarat, both of which have a large migrant population. Bihar has only one testing facility and Gujarat has two. Overall, 71 ICMR testing facilities (scaled up from 51 in recent days) are currently active, which makes it abysmally low at one facility per 10 districts. Community spread under such circumstances seems quite probable. Although the Centre has advised self-quarantine and isolation, such measures only apply to well-to-do Indians and will hurt daily wagers, casual workers, small shops and establishments, the self-employed and unorganised sector workers, who account for about 80 per cent of the workforce.

India should prepare for a larger number of people needing hospitalisation. It needs to gear up its testing facilities and number of beds to deal with pandemics such as Covid-19, which seem to break out once a decade, if not earlier. Given the lack of response of the private sector to the ICMR Director’s ‘appeal’ for free testing of Covid-19, it is clear that situations of this nature cannot be dealt with through a policy that revolves around health insurance and PPPs. The best practices to be emulated here originate in the government sector. Kerala not just battled the far deadlier Nipah virus with considerable efficiency, but is also showing the way in the present crisis. The State is collaborating with private entities to set up virtual personal contact histories of each case of Covid-19, positioning thermal imaging centres at airports, ports and surveillance facilities at its land borders. Invoking the Epidemic Diseases Act in all seriousness, the Chief Medical Officer in each district needs to map each bed and clinic in his district and account for essentials such as antibiotics in the case of secondary infections, ventilators et al . A rehaul of India’s public health infrastructure from the grassroots cannot wait any longer.

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