Despite India’s proximity to China, COVID-19 has not yet become an epidemic here. But with new cases steadily rising, can India face the deadly threat?
How Good are Indian Defences against COVID-19
Out of 195 countries, India ranks 57th in the Global Health Security Index of 2019. The country was assessed on six indicators, with an overall score of 46.5 out of 100. This was broken down into Prevention 34.9/100, Detection and Reporting 47.4/100, Rapid Response 52.4/100, Health System 42.7/100, Compliance with international norms 47.7/100 and Risk environment 54.4/100. In comparison, the average score for high-income countries stood at 51.9.
India built its first line of defence against COVID 19 by using health surveillance systems. About 30,000 persons were brought under community surveillance, 5,57,431 passengers were screened at the airports, and 12,431 people were screened at major and minor seaports. Now all inbound international flights will be screened, up from the earlier listed 12 countries.
With respect to the infrastructure, there are 8.5 hospital beds per 10000 population and eight physicians per 10000 persons. The Ministry of Health and Family Welfare has designated 962 hospitals for isolation of suspected persons which has 7532 beds in total. The availability of ventilators in these wards is 2041. The barometer for the situation would be the sort of crisis that Wuhan faced, with clinics and hospitals being overwhelmed with patients.
Accommodation for quarantine purposes with the capacity of an average of 200 persons has been located in different parts of the country. Ten dedicated Call centres have attended up to 9200 calls since the beginning of February. Reagents to test up to 25000 samples have been made available in the 15 functional labs.
Impediments to Research
Just before the outbreak of Coronavirus, the government of India demanded the United States Centre for Disease Control and Prevention to halt Nipah illness surveillance project with the Manipal Centre for Virus Research (MCVR). The government also issued directions that all foreign funding would be approved by them. A number of high-profile virologists in India have spoken out against this senseless move.
NIPAH outbreak - Kerala Success Story
Like COVID-19, Nipah was a zoonotic virus with its natural host being the fruit bat. In 2018, 17 out of 18 persons affected by the virus died in Kerala and a second outbreak was reported in 2019. But Kerala has been on the alert and has been able to contain the outbreak both the times. A team of multi-disciplinary health professionals from the National Centre for Disease Control investigated the outbreak and based on its recommendations, syndromic surveillance, hospital and community surveillance were strengthened. The Virus Research Diagnostic Laboratory at Manipal Hospital and National Institute of Virology conducted laboratory testing to confirm and rule out cases.
Kerala appears to have absorbed the lessons of Nipah infection well. It was the first to report COVID -19 cases in India. As soon as the World Health Organisation published the severity of the virus, strict surveillance began at the airports, and isolation wards were prepared in all districts. Over 40000 health officials and staff have been mobilised in the state. The rest of the measures concerned logistics and management, which the State health administration managed well. Overnight, the State Control Cell set up 18 sub-divisions (for surveillance, training and awareness, sample tracing, transportation and ambulance, etc.), charted out the roles and responsibilities of each team, even to provide assistance and ensure that families quarantined at home had adequate food and supplies delivered to them. All three COVID 19 patients were cured and discharged.
CONVID-19 Infections in India
India 40 confirmed cases as on 8th March including 16 Italian tourists and three Kerala patients who have since been discharged following recovery. All foreign cruise ships are denied entry into Indian ports till 31st March. Two deaths occurred on 8th March, one in Ladakh and the other in West Bengal, with the victims showing symptoms of COVID-19. However, the cause of death is awaited after testing.
India’s success in battling HIV/AIDS, polio and Nipah is well documented. With the right preparation, India’s health care system has the potential to tackle COVID-19 for a short period of time.
But the quality of medical infra varies from state to state as the overall health care system is quite fragmented. A state-wise analysis can help the Central government to plan its anti-COVID-19 campaign. Smaller states with a lesser population always perform better, as in the case of Kerala. Outbreak preparedness in each state is an investment which will pay a rich dividend in the long run as such epidemics will reoccur in future too.
In the last few years, the health tech start-ups in India have brought in a paradigm shift in the healthcare industry. However, there seems to be a shortage, when it comes to public healthcare for rural areas, and nothing much has changed. The greatest vulnerability is the huge migratory population which is on the move in India at any one time due to employment purposes. 12,617 trains carry over 23 million passengers daily – equivalent to moving the entire population of Australia.