India needs large scale Coronavirus testing and aggressive containment policy
As Coronavirus spreads in India, i haven't seen a clear action plan or policy from the government to tackle this emergency. So far there has been usual public health warnings, creation of some special wards in Govt hospitals and Air travel ban etc. But what is the action plan to decisively neutralize this threat? By action plan, i mean measures like those taken in China and South Korea, that will bring an END to Coronavirus situation.
I have some possible ideas and solutions (all of them will come at great costs) which i will discuss in coming articles. But to address some immediate concern about testing kits and large scale initial action plan of containment. This is what i think.
ICMR / Health Ministry / Govt is not doing large scale testing right now. Maybe because of shortage of testing kits. Maybe they genuinely believe that Coronavirus is NOT yet in community transmission stage in India so a large scale testing is not needed.
Here i like to talk about Some actions plans and proven strategy to mitigate Coronavirus crisis. As its well known that right now there is no effective treatment or vaccine to cure Coronavirus, the best way to deal with it is emergency MANAGEMENT. That is management of healthcare system and slowing down rate of transmission so that hospitals can cope with the influx of critical care patients. This is logic behind city and states lockdowns, shut downs of schools, colleges, public gatherings etc, work from home options and what in general is described as Social distancing. Technically Scientists & Epidemiologists refer it to as "flattening of curve". Basic idea is implementing policies so as to accommodate critical care patients according to hospital capacity of country. The goal of "flattening of curve" is actually buying time to sustainable treatment of infected patients AND at the same time Scientists and Researchers get busy in finding cure of virus like antiviral drugs & vaccines. In Italy, the Govt failed to implement policies on time and created a situation with large number of old patients needing Ventilators and ICU beds which outnumbered available resources. Hence Hospitals & Doctors in Italy had to implement policy of TRIAGE to save some at expense of others.
Coming back to India and why i explained Theory of Flattening of Curve. The emergency management of Coronavirus has Two phases. First - Containment of virus. This make sense when there are very few patients which can be easily quarantined. Second - Slowing down Transmission. This is when virus gets bigger and there is community transmission. The goal is then slowing down of transmission and "flattening of curve" policy measures.
But lets look at India on how these two phases pan out. I believe that the REAL and MOST aggressive focus should be on Phase 1, rather than preparing too much for Phase 2. Phase 2 is not an effective option in a country like India. Reason - India's healthcare system is in such a poor shape, understaffed, overloaded, resource-less and weak that it cannot implement any accommodation of large scale critical care patients. And also the dynamics of densely populated Indian cities, hygienic and sanitary conditions and also socioeconomic culture is such that we cannot slow down the transmission (regardless measures to slow down transmission should still be taken but in a well targeted way).
So developed countries have Two lines of Defense. Containment of Virus and Slowing down of Transmission. But India effectively has only one line of defense that is initial containment. If virus reach stage of community transmission, its pretty much out of control by then. You can't flatten the curve in country like India.
India needed a very STRONG and aggressive containment policy. The travel ban which came few days ago should have come much earlier. At least 1 month earlier. Reason for such drastic measure - India only has one line of defense.
So it makes me wonder about present policy of Govt which is not testing enough people and creating a robust quarantine policy for Containment. Why is Govt waiting for Community transmission phase to start large scale testing? When virus reach community transmission (may already have), then it will be pretty much out of control by that time and all these hoarding of 1 million testing kits will be useless. By this time the virus will be spreading uncontrollably to tens of millions of people.
So why not double down and hope for the best? Why not engage in more aggressive initial containment policy? That means immediate buildup of Quarantine zones and large scale testing.
I have some possible ideas and solutions (all of them will come at great costs) which i will discuss in coming articles. But to address some immediate concern about testing kits and large scale initial action plan of containment. This is what i think.
ICMR / Health Ministry / Govt is not doing large scale testing right now. Maybe because of shortage of testing kits. Maybe they genuinely believe that Coronavirus is NOT yet in community transmission stage in India so a large scale testing is not needed.
Here i like to talk about Some actions plans and proven strategy to mitigate Coronavirus crisis. As its well known that right now there is no effective treatment or vaccine to cure Coronavirus, the best way to deal with it is emergency MANAGEMENT. That is management of healthcare system and slowing down rate of transmission so that hospitals can cope with the influx of critical care patients. This is logic behind city and states lockdowns, shut downs of schools, colleges, public gatherings etc, work from home options and what in general is described as Social distancing. Technically Scientists & Epidemiologists refer it to as "flattening of curve". Basic idea is implementing policies so as to accommodate critical care patients according to hospital capacity of country. The goal of "flattening of curve" is actually buying time to sustainable treatment of infected patients AND at the same time Scientists and Researchers get busy in finding cure of virus like antiviral drugs & vaccines. In Italy, the Govt failed to implement policies on time and created a situation with large number of old patients needing Ventilators and ICU beds which outnumbered available resources. Hence Hospitals & Doctors in Italy had to implement policy of TRIAGE to save some at expense of others.
Coming back to India and why i explained Theory of Flattening of Curve. The emergency management of Coronavirus has Two phases. First - Containment of virus. This make sense when there are very few patients which can be easily quarantined. Second - Slowing down Transmission. This is when virus gets bigger and there is community transmission. The goal is then slowing down of transmission and "flattening of curve" policy measures.
But lets look at India on how these two phases pan out. I believe that the REAL and MOST aggressive focus should be on Phase 1, rather than preparing too much for Phase 2. Phase 2 is not an effective option in a country like India. Reason - India's healthcare system is in such a poor shape, understaffed, overloaded, resource-less and weak that it cannot implement any accommodation of large scale critical care patients. And also the dynamics of densely populated Indian cities, hygienic and sanitary conditions and also socioeconomic culture is such that we cannot slow down the transmission (regardless measures to slow down transmission should still be taken but in a well targeted way).
So developed countries have Two lines of Defense. Containment of Virus and Slowing down of Transmission. But India effectively has only one line of defense that is initial containment. If virus reach stage of community transmission, its pretty much out of control by then. You can't flatten the curve in country like India.
India needed a very STRONG and aggressive containment policy. The travel ban which came few days ago should have come much earlier. At least 1 month earlier. Reason for such drastic measure - India only has one line of defense.
So it makes me wonder about present policy of Govt which is not testing enough people and creating a robust quarantine policy for Containment. Why is Govt waiting for Community transmission phase to start large scale testing? When virus reach community transmission (may already have), then it will be pretty much out of control by that time and all these hoarding of 1 million testing kits will be useless. By this time the virus will be spreading uncontrollably to tens of millions of people.
So why not double down and hope for the best? Why not engage in more aggressive initial containment policy? That means immediate buildup of Quarantine zones and large scale testing.
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