Coronavirus Brings Renewed Reminder For Prioritising Public Health
How long can borders be monitored, vigil maintained, visas suspended or businesses stopped asks ex-Health Secretary K Sujatha Rao.
Infectious diseases are known to have wide externalities affecting economies and at times even political stability. In 2016, the ebola epidemic resulted in a fall of 4 percent points in the gross domestic product of Sierre Leone and Liberia, while in 2003, China witnessed the flight of over $2 billion and migration of thousands of Chinese to Canada as a result of the SARS outbreak. In 2009-10, the emergence of H1N1 got India to exclusively focus on containing the spread and the panic that it caused. The then health minister not only took reviews of state health ministers and secretaries but also spoke to every chief minister to galvanize political support for the fight against H1N1. Yet, 2,000 people died in that pandemic.
The outbreak of the Coronavirus epidemic in 2020 has once again created panic. Within eight weeks over 1,10,000 persons in over a 100 countries have been infected and over 3,800 have been killed. China alone accounts for 80 percent of the number that led it to enforce draconian measures of locking down millions of people and extensively using smart technology, at the risk of violating privacy laws, to identify potential transmitters and isolating them. These measures have also triggered ripples in China-dependent economies – Iran, South Korea, Italy and so on. The economic loss has been extensive: over $113 billion loss in civil aviation and the downstream losses in terms of cancelled hotel bookings and indirect losses of a vibrant tourist industry. It is estimated that global GDP has fallen by 0.4 percent underscoring the impact of globalisation, the interdependence of the economies of nation-states and the need for every country to act responsibly in containing the epidemic.
As of today, India has 42 reported cases of infected persons, largely in eight states, many of them Italians. Visas from five countries – China, Italy, Iran, South Korea, Japan have been suspended; over 7 lakh visitors returning from abroad have been screened at the airports so far and screening is now being stepped up to screen all persons coming from outside India.
Further intensification of these measures and constant vigil should help India tide over the crisis as a super spreader has not been detected as yet and the infection does not seem to have gone into the community.
In the meanwhile, due to the lockdown in China, India’s trade, tourist and pharmaceutical industry etc., have been hit. These blows are likely to hurt given the economic slump that India is already facing.
The Response
The first case in India was detected in Kerala to be quickly followed by another two. Kerala’s swift response by enforcing the two classical principles—diagnosing and speedily isolating the infected on the one hand, and on the other diligently tracking down all persons the patient had come in contact within the last two weeks—helped stem the transmission of the infection. Combined with good case management all three got cured. Despite that five new cases seem to have been identified.
A comprehensive strategy for containing infectious diseases has four components:
- wide dissemination for creating an alert and informed public;
- early diagnosis;
- contact tracing; and
- treatment.
In terms of the health system, it implies having an informed media and a surveillance system that can screen out potential cases; availability of testing kits and a network of excellent laboratories to quickly diagnose the disease; isolate the infected and take up contact tracing. Such contact tracing has a snowballing effect as tracing of anyone infected in the chain results in tracking down his contacts. Contact-tracing thus becomes the bulwark of a preventive strategy – for infections that have no treatment, the aetiology is not fully known and there is no vaccine.
Missing cases in contact-tracing can have the possibilities of the infection slyly spreading into the community, making containment that much harder necessitating harsh measures that are also often difficult to enforce.
It is for this reason that speed, diligence and thoroughness are critical. The fourth component is the health infrastructure – hospitals and beds, doctors and nurses to treat the patients back to health. At any given time, about 5 percent of the infected may be serious cases and delay in treating or ineffective management can often be fatal. The silver lining with Covid-19 compared to SARS is that it is only 30 percent as fatal.
What’s Next?
While it is impossible to predict which way the wind will blow, the hope is that the epidemic will subside with rising temperatures. Reality is that there is no proven connection between moderately high temperatures and the survival of the virus as seen in Thailand, Indonesia, Malaysia. This implies that north India, in particular, will need to be on the alert till June when the real hot summer starts. The reason for optimism could be the decline in the cases in China. But that could also be due to the very aggressive steps that China took that are difficult to enforce and also afford in other countries. For how long can borders be monitored and vigil maintained, visas suspended or businesses stopped? All the cases so far detected in India have been imported. Can they be contained? How virulent or mild is the infection will be critical concerns.
The only option for containing this disease is to be cautious and alert. Personal hygiene is the only barrier - washing hands with soap frequently and social distancing to those having a cough or cold.
While face masks give one a psychological sense of security, its utility is limited to those having symptoms of the infection or taking care of the infected.
Likewise, hand-washing with soap is as effective with no need for sanitizers. These are all common sense and good behavioural practices in their own right. At such times, they get pronounced. It is important that we practice them as a lifestyle as our environment is increasingly becoming risky.
Policy Priorities
In the short term, the Prime Minister needs to immediately convene a meeting of state chief ministers and alert them on the multiple-level of impacts of the Covid-19. One lazy state is enough to undo the work of a Kerala. Additional budgets need to be immediately sanctioned to the states to strengthen the response systems to act with speed and accuracy, besides ensuring the availability of essential commodities. The focus of governments needs to be on containing the virus that may also mean giving a lower priority to other work.
It is essential to reset priorities by focusing on building public health infrastructure centered around the community and less on the privatisation of government hospitals and promoting insurance-based programmes.
Promoting healthy lifestyles needs to be the focus. In the olden days when there were no antibiotics, many such routine personal habits were practiced as religious rituals that got inculcated with constant repetition. Such religiosity is required in matters of public health also. Investing in training the million-plus front line workers, and using media to spread the word on the need for personal hygiene and healthy habits is the way to go.
Notwithstanding the above, infectious diseases like the covid virus still have the ability to sneak in. In the United States, the level of sanitary practices and personal hygiene are considered to be quite high. Yet, California is under lockdown with over 80 infected cases.
Spring In The Time Of Coronavirus
Besides, public health education, countries need to formulate public health laws to regulate personal behavior alongside increasing public health budgets to build the required infrastructure – surveillance systems, laboratories, treatment facilities, and isolation wards, etc. Equally important is the need for India to step up its efforts and budgets for promoting research in government and private bodies. Covid-19 is related to MERS and SARS. We need to understand why it hits when it does and work on developing a vaccine.
In India, we have been lucky so far. Given the severe shortfalls in the robustness of the health system, particularly in the northern states, I am not sure that we would have been able to contain the epidemic had it unfolded with the swiftness that it did in China.
K Sujatha Rao is former Secretary of Health and Family Welfare, Government of India; and the author of ‘Do We Care? India’s Health System.’
The views expressed here are those of the author and do not necessarily represent the views of BloombergQuint or its editorial team.