A “public health approach” to control the COVID-19 pandemic, with the maximum possible good for the largest possible numbers, has been strongly advocated by the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM), and the Indian Association of Epidemiologists (IAE).
The third joint statement released on Thursday by the organisations said: “The ongoing pandemic is a public health problem that is fast worsening existing health inequities. It is not a law and order problem and should be dealt with empathy and meaningful community engagement. The way forward needs to take into account contextual constraints and community interests and design optimal interventions that require technical competence blended with good judgment, clarity and trust.”
A Joint Task Force of eminent public health experts of India was constituted by the IPHA and IAPSM in April this year to advise the Government of India on containment strategies to counter the spread of the COVID-19 pandemic. Subsequently, the Indian Association of Epidemiologists (IAE) also joined the task force.
The purpose of the Joint Task Force was to review and collate scientific epidemiological literature pertaining to COVID-19 in India at the national, state and district levels. It was also constituted to develop a consensus among the experts regarding COVID-19 epidemiology, trends, and develop an action plan based on the consensus. It was supposed to widely disseminate the consensus statement and action plan to public health experts, health professional associations, and other key stakeholders, and to share the consensus statement with policy makers at the highest level at the centre and the states.
In their second joint statement, which was released on May 25, the organisations had said that that humankind will have to “live with the virus” and that operational strategies rapidly need to be recalibrated from containment to mitigation. They had pointed out that if the Indian government had consulted epidemiologists who had a better grasp of the situation, it could have dealt with the situation more successfully.
The task force has recommended that lockdown as a strategy for control should be discontinued. They said that geographically limited restrictions for short periods may be imposed in epidemiologically defined clusters, and cluster restrictions should be considered only in areas with no community transmission. The statement said: “Even cluster restrictions should be imposed after weighing the impact of the same on the livelihood of the target population. With adequate health system preparedness, including facility care for severe cases, cluster restrictions can be totally done away with and should be the ideal way to address this pandemic.”
COMMUNITY-FRIENDLY QUARANTINE POLICY
Another important recommendation made in the statement is that quarantine and isolation policy should be made community friendly. It said that the present policies, where the houses of all persons who test positive, are stamped and isolated by barricades is creating a fear in society. This practice should be abandoned immediately. It also added that at a time when the majority of the states have been affected by the virus, there is no rationale for quarantining inter-state travellers who are required to go through it for 14 days in some states, and it should be stopped immediately.
Even as the centre focuses on scaling up testing across the country, the statement said, “Universal scaling up of testing at the current community transmission stage of the pandemic may not be an optimal control strategy and will divert attention and resources from control measures.”
Advocating pragmatic testing policy, the organisations said, “With the availability of sufficient understanding of the natural history of disease and at-risk population, testing should be used with due diligence. Targeted testing of high-risk individuals, healthcare workers, elderly with co-morbidities, screening prior to surgical procedure etc. is recommended. However, in areas in the very early phase of pandemic (where zero or very few cases have been reported) testing may be used as a surveillance tool.”
It said that in cities and towns with high caseloads, all symptomatic cases should be considered COVID-19 cases and be treated at home or hospital depending on the clinical conditions, even without testing.
INCREASE HEALTH EXPENDITURE
An immediate resumption of comprehensive health care services has also been recommended by the statement. It said, “Primary, secondary and tertiary health care services including outpatient and inpatient services including routine/emergency surgeries should resume as early as feasible, at least those areas that are progressing towards higher levels of immunity and in towns/districts with no cases. Adequate safety measures should be put in place for the safety of health care staff engaged with optimal PPE and testing of patients for COVID-19 as may be appropriate.”
The organisations also urged the Union government to increase healthcare expenditure to 5% of the GDP. The statement said, “Public health care should be significantly strengthened and enhanced with overall public expenditure to be increased to at least 5% of the GDP. The focus of increased health expenditure should be on primary health care and human resource and infrastructure strengthening rather than opening/strengthening tertiary care centres.”