Covid-19 cases in India seem too low, they do not reflect reality: Former Health Secretary K Sujatha Rao

‘Public spending must be increased from the abysmal 1.3% of GDP to 2% with the extra funds going to strengthen public health and primary health care,’ she says

Photo courtesy- social media
Photo courtesy- social media

Ashlin Mathew

India has so far identified only 580 positive Covid-19 cases, but the cases could be much more. K Sujatha Rao, former Union Health Secretary, says that the numbers seem too low and she doesn’t think they reflect the ground reality.

“They have to expand access and undertake testing immediately. We need to have more data,” adds Rao.

Excerpts of an interview with K Sujatha Rao:

1) What is your assessment of the Indian government’s response to Covid-19 threat? Is the government fumbling? What else can the Central government do?

The government response was a bit late but then they took some strong measures. Now with the 21-day lock down, if enforced well, there will be an impact on disrupting the transmission of the virus and it will reduce case loads. If not, the epidemic will continue to circulate and flare up later. So, implementation of the lock down should be taken seriously.

2) How serious is the threat of Covid-19 to India?

The fact that the PM has addressed the nation twice within five days and announced an unprecedented lock down besides earmarking Rs 15,000 crore budget for health implies that the threat of Covid-19 is truly serious. But the government will have to give more as and when the cases increase. It will depend on how many people have been tested and how many hospitals need help. If around 40,000 people test positive, a lot more money will have to be allocated.

3) Does India have emergency public health funds to tackle crisis such as this? How much do you think our public health spending must be to tackle the crises?

The economy is in trouble and now with this epidemic the situation must have got worse. So there is not much money but then given the gravity of the situation India will have to find the money required – whether by raising resources or reducing budgets for other less essential sectors and spend on the containing the epidemic and ensuring it doesn’t happen again. Public spending must be increased from the abysmal 1.3% of GDP to 2% with the extra funds going to strengthen public health and primary health care.

4) Does India have health care systems in place to counter the spread of Covid-19 pandemic?

It depends on how extensive and intense is the infection. Beyond a point India’s health system will not be able to cope. However, in some parts of the country, where the health system is weak, even a small increase of caseloads can be heavy to cope with. We have a shortage of hospital beds, isolation wards, ICUs and trained personnel in intensive and critical care medicine. So, infrastructure is a serious bottleneck.

Now there is already a shortage of PPE suits and masks. Soon, once the indigenous Covid-19 test kits become readily available, we would require skilled manpower for it. And that is also a challenge.

5) Currently India has said there are only 570confirmed Covid-19 cases. Do you think there could be more and should India test more aggressively?

The numbers seem too low and so I don’t think they reflect the ground reality. They have toexpand access to and undertake testing immediately. We need to have more data so we know exactly the extent of the problem and formulate our strategies accordingly.

6) How many tests should India be ideally conducting everyday?

There’s no norm like that. But they should try to test all cases of patients who have symptoms that are suggestive of corona viral flu. They should have tested the persons coming from abroad and close contacts of those found positive. In other words, tests are not done on everybody but only those with probability of having been at risk.

7) ICMR chief Balram Bhargava said that the WHO directive to test does not apply to India. Is that India being complacent?

Yes. I don’t agree with the stand of the DG ICMR. I think he is in denial. We should have and must test more.

8) Do you think the lockdown and social distancing will be effective in India which has a majority of people depending on their daily wages to survive?

It’s a very major challenge, more particularly in urban areas that have a lot of makeshift slums. The density of population here is very high as in one room more than four or five people crowd in. Secondly, most of these people depend on agencies to supply essentials like water and food supplies. So if this fails and is not done properly it can create a lot of hardship. It’s tough and will need the dedicated commitment from all government agencies. Besides, for those who live on daily earnings like scooter and taxi drivers, street food vendors, labour etc. the hardship will be unimaginable as in the absence of safety nets, their ability to buy food can also be problematic. The social and economic costs of the lock down can be grave and will take time to get sorted out.

9) Are there any states which can handle the pandemic and which states cannot, considering health is a state subject, yet also falls in the concurrent list?

Health is a state subject but infectious diseases control is a concurrent subject where the union government has an equal responsibility. Kerala seems very well prepared and considering they have of late had the worst floods etc. they seem to battle ready. The least prepared will be the northern states as their infrastructure is so weak that there are limits to how much they can ramp up. Their main challenge will be getting doctors and hospital beds to treat severe pneumonia.

10) Our governments have not invested enough in public health systems. Moving forward, what can the govt do to strengthen our public health system?

I am convinced that the single most important policy initiative would be to constitute a Department of Public Health that will stimulate establishing and restoring the public health discipline as a priority. India has a substantial burden of communicable diseases and can ill afford to neglect public health. In the absence of such an administrative system, there is a loss of institutional memory. It must be noted that India has a rich knowledge base having eradicated small-pox, polio, reduced incidence of HIV/AIDS, and done reasonably well in containing malarial fevers etc. There is still a lot to be done. Sadly, the neglect of public health has resulted in the virtual decimation of this discipline. Such neglect has been global and is one of the explanatory reasons for the explosion of this virus today.

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