India has managed to smoothen the Covid -19 curve and keep fatality rate low. While increasing positivity rate is a concern, India is better placed than many other nations, ICMR DG Dr Balram Bhargava told Sushmi Dey.
ICMR has been on the forefront in the Covid-19 battle. How is the battle progressing?
A: We have spent about three months now working 24 x7 to provide facilities for testing and also have a calibrated testing strategy which can respond to the need of the hour. We have been able to take care of mortality. It is obviously open to question as to why mortality is low in our country but early diagnosis is one aspect and also because we probably have higher immunity. Deaths were our only concern from day one. Though (our infrastructure) may not be A+ uniformly but we have to remember that our healthcare spending is 0.9 percent of GDP as compared to 19 percent in US, which is a 19 trillion dollar economy, so their health budget is more than the budget of this country as a whole.
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How do you plan to ramp up health infrastructure in order to deal with the growing number of cases?
A: We have now got 642 labs in the country with a vision that every state should be self-sufficient and ultimately states decide how much testing they can do. We have ramped up the infrastructure, also in remote areas, in terms of manpower, laboratories, equipment and consumables so that the testing can be increased. We now have a testing lab even at 18,000 ft in Leh and machines and equipment were airlifted during the lockdown. Besides, we are now locally manufacturing testing kits and reagents. At the beginning of the epidemic, we were dependent a lot on foreign players. Local manufacturing has brought down the cost. Along with testing, we have also created more beds, more oxygen beds, intensive care beds, ventilator beds.
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But isn’t there a regional disparity in availability of health infrastructure?
A: We have had problems in Mumbai, Ahmedabad, also in some hotspots where there were problems with number of beds. But as the state governments are also working very, very hard to increase the number of beds and in Maharashtra they have been able to increase intensive care beds to about 14,000 from June 1. So everyone is pitching, everyone is united. The role of the government has been exemplary in terms of taking everyone along in this fight against Covid.
What is your reading of the curve? Does the trajectory of cases and deaths match your modelling? Are states like Maharashtra, Gujarat and Delhi influencing the curve?
A : If you remember, there was panic in Indore that was taken care of, there was panic in Bhopal that has been taken care of. About ten days back, there was a huge spike in Mumbai and it was worrying but that seems to be taken care of. So, these ups and downs will happen… It is very difficult to predict the trajectory but the case fatality rate is very reassuring.
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Are you worried about the way cases are increasing on a daily basis?
A: Frankly, I am actually only worried about deaths. I am being very honest. I am worried about deaths and that is being hovering around 150-170 which is quite reassuring from that perspective but at the same time we have to continue with all our measures to control the infection. We are trying to control it at every level so that it does not spread.
You can argue about what Britain did and they and US tried for getting herd immunity. That did not seem to have worked. What we have done in our country is not flatten the curve, but distributed the curve in the sense that the curve may be longer but it is not that high. This has happened because of implementation of the lockdown. Now, when we are opening the lockdown, behavourial practices have clearly changed.
Hopefully we are able to strike a balance between some level of immunity, some level of vaccine, some level of medication. How H1N1 suddenly came in a big wave, was here for a long time and suddenly disappeared. I do not know whether that can happen with this virus … but it is always good to be positive.
Many feel India is still not testing enough. Is there a scope for further expanding the testing guidelines?
A: We have a population of 1.3 billion. It is not possible to test everybody. We have actually, as per our notification of May 18, expanded those guidelines immensely to include front-line workers, ILI…See, the basic philosophy that we have stuck to is that you test only symptomatic and, I think most parts of the world have stuck to this philosophy of testing.
You think it is feasible to lift lockdown at this point in time?
A: Lockdown has been kind of lifted in terms of the fact that people are moving everywhere, a lot of these trains are taking people. But I feel this night curfew may be useful if it continues.
There are concerns that community transmission has not been acknowledged in India.
A: There are clusters which are clearly there and we are doing the national sero-survey of more than 24,000 individuals to check that. Perhaps it is important to understand that it is increasing transmission that is a cause of worry.
So are you worried about the increasing transmission?
A: Our test positivity rate has gone up from 4.3 to 4.9. So that is definitely there.