The total number of confirmed Covid-19 cases across India has crossed 114 at the latest, according to the Union Health Ministry. Amid the mounting cases, the Jan Swasthya Abhiyan (JSA) and the All India People’s Science Network (AIPSN) has released a statement, urging the government to strengthen the public health services, to safeguard livelihoods, and to save lives.
The organisations have commended the Indian government for its swift actions of curtailing international travel, screening those coming in from abroad and their contacts and either isolating them if they have tested positive or placing them in quarantine if they are asymptomatic. However, the statement said, even though the prompt actions taken by the government have helped delay the epidemic, “the worst is yet to come”.
JSA and AIPSN have also said that actions taken by the government – in forms of isolation of patients and quarantines, and a campaign for social distance – will not be sufficient if community transmission is established, and the pandemic peaks. The statement said that India is particularly vulnerable because of a high degree of “past neglect” of public health services, and privatisation of healthcare. Another thing that makes India vulnerable, the statement pointed out, is the fact that a large section of the country’s population continues to struggle to meet their basic necessities. The statement released by the organisations also includes a people’s charter of demands, and points out, “In such a social and economic context, this epidemic may prove the last straw and lead to an unprecedented catastrophe unless the government pays heed to the entire charter of demands.”
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The 13-point charter includes healthcare-related demands, demands about social distancing and human rights, and demands urging the government to redress economic inequity as cause and consequence of the pandemic.
The organisations have urged the government to expand testing facilities for Covid-19. It points out that testing should not be limited to the people who have travelled to certain foreign countries in the recent past and are showing systems, and people who have been in contact with them. It says that any clinically suspected person should be able to get tested. It said, “While containment by isolating patients with the disease, tracing contacts, and quarantining individuals returning from nations with an established outbreak may continue to be relevant for a longer period, the system needs to gear up for addressing community transmission.”
It also says that the Union government must rapidly strengthen the public hospitals to prepare public health services for a surge in patients requiring healthcare and hospitalisation. It said, “This would require, at the very least, one hospital with an ICU; potential isolation wards and ventilators; and oxygen supply in every five to ten lakh population. It would also require corresponding improvement in supply of relevant medicines and consumables such as oxygen and deployment of human resources. We reiterate that such an expansion was anyway long overdue, and this epidemic is an opportunity to rush such preparation through.”
In the event that the pandemic becomes a full-blown emergency in any part of the country, the statement said, it would be necessary that all existing medical facilities be brought under a centralised district authority, including all private hospitals. Allocation of medical facilities will have to be done by this authority and not by the market mechanisms. The protocols and administrative and financial measures required for doing so must be put in place as part of epidemic readiness.
It has also called for immediate strengthening of the Integrated Disease Surveillance Programme, by a major increase in capacity to test for this disease, and to report on all seasonal flu and other fever-related deaths from across all facilities - public and private. “In the absence of such expansion, we caution that the country could even go through an epidemic without knowing it, or could be surprised by large cluster-outbreaks where they are least expected,” it said.
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As a long-term measure, JSA and AIPSN have called for establishing a Government Centre for Disease Control in every district which is staffed and facilitated to test, identify and provide alerts and advice precautionary measures for pathogenic attacks like the current Covid-19 pandemic.
Social Distancing and Human Rights
The statement points out that social distancing must necessarily be done by public education and persuasion. It said that the use of coercive measures would be unfair and unhelpful. Mass gatherings, public events, whether social, religious, sports related, cultural or political, could be dissuaded for some time more- but should not be banned.
The statement has also said that active community support and outreach services need to be built up for those in home quarantine, those whose social security benefits are curtailed due to closure or those having difficulties in accessing essential services. Many under home quarantine will have co-morbidities that would require access to follow up care and medication. Many children will need access to supplementary nutrition programs, more so, when their parents’ livelihood is compromised. Shutting down such services without providing for alternatives would be unfair.
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It also pointed out that if and when populations are placed under lockdown or quarantine, special measures would need to be put in place to ensure that this is done in a humane manner and without abuse to core human rights. Governments need active engagement of human rights institutions and civil society organisations and trade unions to inspect and report back on standards of care and the problems that the most vulnerable sections are facing.
Redressing Economic Inequity- as cause and consequence
Maintenance of routine economic activity, which primarily means safeguarding of the livelihoods of the majority, should also be acknowledged and acted upon as a public health priority, pointed out JSA and AIPSN. They said, “Public education should also address the need to build solidarity in such times. The working people and poor take a much larger economic hit due to disruption of livelihoods than the salaried section and the affluent, and this should be acknowledged. There has to be active community support and support from employers to those in home quarantine and those whose livelihoods are compromised by these lockdowns.”
They have also demanded that there must be an immediate increase in public expenditure that leads to widespread demand-side support in the form of increased social security and food security measures such as enhancement of entitlement under the Public Distribution System (PDS), and cash transfers. It said, “This is urgently required to address the attack on livelihoods of the majority that have already been compromised by a decade of economic policies that intensified capital accumulation, but destroyed livelihoods. Further concessions to corporate industry to counter the crisis they are also facing, and further austerity for the working people would be most counter-productive and iniquitous.”