As cases continue to touch daily highs, experts from three associations say in joint statement that community transmission of COVID 19 is here, govt policy is “incoherent”
Even as India touched yet another daily high – 8380 – in the number of Novel Coronavirus Disease (COVID19) cases, several experts from AIIMS and other prestigious institutions, in a joint statement, have said that community transmission has set in.
“It is unrealistic to expect that COVID-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country. No vaccine or effective treatment is currently available or seems to be available in near future (there are a few promising candidates though). The expected benefit of this stringent nationwide lockdown was to spread out the disease over an extended period of time and effectively plan and manage so that the healthcare delivery system is not overwhelmed. This seems to have been achieved albeit after 4th lockdown with extraordinary inconvenience and disruption of the economy and life of the general public. The case fatality rate in India has been relatively on the lower side, and mostly limited to the high risk groups (elderly population, those with pre-existing co-morbidities etc.). However, the lockdown cannot be enforced indefinitely as the mortality attributable to the lockdown itself (primarily because of total shutdown of routine health services and livelihood disruption of nearly the entire bottom half of the Indian population) may overtake lives saved due to lockdown mediated slowing of COVID-19 progression,” reads the joint statement issued on behalf of the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) & Indian Association of Epidemiologists (IAE).
“The incoherent and often rapidly shifting strategies and policies especially at the national level are more a reflection of “afterthought” and “catching up” phenomenon on part of the policy makers rather than a well thought cogent strategy with an epidemiologic basis”
Community transmission means that the chain of transmission of a disease is not clear and an infection is circulating in the community among unknown people so that any person can get infected at any point.
Among the signatories of the joint statement are Dr. Shashi Kant, Professor & Head, Centre for Community Medicine AIIMS, New Delhi and Dr. D.C.S. Reddy, Former Professor & Head, Community Medicine, BHU. The two are also members of a ICMR research group on epidemiology and surveillance for COVID19 constituted on April 6. Dr Reddy chairs the group.
The statement says: “India’s nationwide “lockdown” from March 25, 2020 till May 30, 2020 has been one of the most stringent; and yet COVID cases have increased exponentially through this phase, from 606 cases on March 25 to 138,845 on May 24. This draconian lockdown is presumably in response to a modeling exercise from an influential institution which was a ‘worst-case simulation’. The model had come up with an estimated 2.2 million deaths globally. Subsequent events have proved that the predictions of this model were way off the mark. Had the Government of India consulted epidemiologists who had better grasp of disease transmission dynamics compared to modelers, it would have perhaps been better served. From the limited information available in the public domain, it seems that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills. Policy makers apparently relied overwhelmingly on general administrative bureaucrats. The engagement with expert technocrats in the areas of epidemiology, public health, preventive medicine and social scientists was limited. India is paying a heavy price both in terms of humanitarian crisis and disease spread,”
In a scathing indictment of the policies for COVID control and the fallout, the statement added: “The incoherent and often rapidly shifting strategies and policies especially at the national level are more a reflection of “afterthought” and “catching up” phenomenon on part of the policy makers rather than a well thought cogent strategy with an epidemiologic basis. Most COVD-19 infected persons are mostly without symptoms. Even if symptomatic, the symptoms are mild and not life threatening. Majority of the patients do not require hospitalization and can be treated at domiciliary level with a modified “enforced social distancing” imposed on the household. Had the migrant persons been allowed to go home at the beginning of the epidemic when the disease spread was very low, the current situation could have been avoided. The returning migrants are now taking infection to each and every corner of the country; mostly to rural and peri-urban areas, in districts with relatively weak public health systems (including clinical care).”
Among the other signatories in the statement are Dr Anil Kumar, deputy Director General of Health Services, Dr Puneet Misra, professor or community medicine at AIIMS, Dr Kapil Yadav, additional professor CCM AIIMS, Dr. Rajib Dasgupta, Professor, Community Health, Jawaharlal Nehru University, Dr. Sanghamitra Ghosh, CMO (SG) Ministry of Defence,Kolkata, Dr. Farooq Ahmed, Former Director NEIGRIMS, and Pro VC KBN University, Dr. A. C. Dhariwal, Former Director, National Vector Borne Disease Control Prigramme & NCDC, and Advisor NVBDCP to the government of India. Dr. Chandrakant S. Pandav, former Professor & Head, Centre for Community Medicine (CCM), AIIMS, Dr. M. K. Sudarshan, Chief Editor, Indian Journal of Public Health (IJPH) and Dr. Rajesh Kumar, Former Professor & Head, PGIMER, Chandigarh.
