That humankind will have to “live with the virus” and that operational strategies rapidly need to be recalibrated from containment to mitigation, was pointed out a joint statement released on May 25 by the Indian Public Health Association, (IPHA), Indian Association of Preventive and Social Medicine (IAPSM), and the Indian Association of Epidemiologists (IAE).
The statement pointed out that the pandemic has been accompanied by a humanitarian crisis which encompasses an estimated 114 million job losses (91 million daily wage earners and 17 million salary earners who have been laid off) across 2,71,000 factories and that between 65 million to 70 million small and micro enterprises that have come to a standstill.
A Joint Task Force of eminent public health experts of India was constituted by the IPHA and IAPSM in April 2020 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 amongst 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 statement, the organisations have said that emerging evidence unequivocally indicates that COVID-19 has worsened health inequities and that public health measures need to make that concern central. The statement said: “The global community is collaborating and sharing information to formulate a comprehensive, effective, efficient and sustainable strategy and plan of action to control this pandemic. At the same time each country, and regions within the country, have to adapt the larger general model to its own specifics. Open and transparent data sharing with scientists, public health professionals and indeed the public at large, which is conspicuous by its absence till date, should be ensured at the earliest.”
It was pointed out that even though India’s nationwide lockdown, that has been in place since March 25, has been one of the most stringent across the world, COVID-19 cases increased from 606 cases on March 25 to 138,845 on May 24. The statement called the lockdown “draconian” and said that it was implemented “presumably in response to a modelling exercise from an influential institution which presented a ‘worst‐case simulation’. The model had come up with an estimated 2.2 million deaths globally. Subsequent events have proved that the predictions of this model were way off the mark.”
In the statement, the task force pointed out that if the Government of India had consulted epidemiologists who had a better grasp of the situation, it could have dealt with the situation more successfully. It says that from the limited information available in the public domain, it seemed that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills.
“Policy makers apparently relied overwhelmingly on general administrative bureaucrats. The engagement with expert technocrats in the areas of epidemiology, public health, preventive medicine and social scientists was limited. India is paying a heavy price, both in terms of humanitarian crisis and disease spread. The incoherent and often rapidly shifting strategies and policies, especially at the national level, are more a reflection of “afterthought” and “catching up” phenomenon on part of the policy makers rather than a well thought cogent strategy with an epidemiologic basis,” the statement added.
The organisations also pointed out that if the migrant workers had been allowed to leave for home in the initial stages of the pandemic when the spread of the novel coronavirus was low, the current situation could have been avoided. “The returning migrants are now taking infection to each and every corner of the country; mostly to rural and peri-urban areas, in districts with relatively weak public health systems (including clinical care),” the statement said.
According to the task force, it is unrealistic to expect that the COVID-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country. No vaccine or an effective method of treatment is currently available or seems likely to be available in the near future. It added that even though the lockdown has managed to keep the case fatality rate in India relatively on the lower side, and mostly limited to the high risk groups, this came at a cost of “extraordinary inconvenience and disruption of the economy and the life of the general public”.
“However, the lockdown cannot be enforced indefinitely as the mortality attributable to the lockdown itself (primarily because of total shutdown of routine health services and livelihood disruption of nearly the entire bottom half of the Indian population) may overtake lives saved due to lockdown mediated slowing of COVID-19 progression,” the Joint Task Force’s statement said.