[Authored by: Mandar Garge, Apr 14, 2020]
I have quoted studies and articles from external (non-governmental) private health agencies to highlight the fact that India's strategy of handling COVID seems to be working under Harsh Vardhan's leadership.
While we all guess, contemplate, admire or criticize the government's handling of the crisis, it is important to bring to everyone's notice how this farsighted leader is working relentlessly to keep India two steps ahead of the COVID’s proliferation.
While PM Modi and his other ministers may be making economic, financial and administrative decisions during this crisis, they have left the medical and health related decisions to this one man who carries immense grasp of India's public health, its handling of mass immunization programs as well as the administrative challenges associated with such mass immunization activities.
National and State level health ministries work collectively, but the union health minister drives the overall plan and strategy to fight the virus.
I must mention that at this juncture the health ministers and departments of all state governments are working closely with the Union health minister and health officers. However Dr. Harsh Vardhan is in the driver's seat in the war against Corona. All key decisions at the national level, that you have been reading about India's rapid response to COVID, the passengers screening and quarantine in the very early stages followed by the lockdown are all his decisions, all coming out of his wisdom, farsightedness and vision combined with experience. His team then issues directives to state level health machinery to follow certain norms, be it about COVID reporting, medical preparations, testing the masses, identifying clusters and deciding the high level approach of weeding out the disease.
Evaluation the impact of the India lock-down:
Look at the following graph, published & updated daily
by Shamika Ravi, a Sr. Fellow of the Governance Studies Program at the
Brookings Institution Washington D.C:
Ref: Shamika Ravi’s tweet of
April 14, 2020
This study measures the spread of Corona in terms of its rate of doubling rather than the absolute number of cases found. Going by this count, it seems that "the curve has started flattening".
- March 12, India's count of COVID-19 cases was doubling every 3 days.
- March 23, the count of COVID-19s was doubling every 5 days (flattening had started). This was before the lockdown.
- March 29 -- doubling every 4 days -- a setback that can be attributed to Tablighi conclave aftereffects.
- April 06 -- doubling every 6 days. The lockdown had started showing a positive impact.
- April 13, the numbers were doubling every 7 days -- flattening had picked up further.
The research estimates that without the lockdown the
positives would have been more than 67,052, as against the real count of April
13th of 10,453 (a 541% higher rate). Institute of Mathematical Studies (IMS) in
Chennai had also estimated that without the lockdown, by the COVID count by mid-April
would be have been 35,000 at a minimum.
The lockdown has surely worked. Of course, the testing
levels in India are around 190,000, but one can assume, based on the sampling,
the trend (proportion) will be consistent across a larger population.
Ref: India
Today
Yes, indeed 10,815 (India count as of 14th April
2020, with 353 deaths) is a large number, but in an enormously populated country
like India with enormous population density, this is really a small number, thanks
to the strategy and approach taken by Dr. Harsh Vardhan. 10,000 as against 60,000
is a Great news. Compare this with 5.3 Lakh positives in the US with > 20,500
deaths.
The Basic Reproduction Number (R0)
The R0
(R-naught) number (Reproduction Number) is a mathematical term that
indicates how contagious an infectious disease is. It’s a number that indicates
how many people can an infected person infect. E.g., R0 number of 10 means one
infected person can infect 10 other persons. An R0 of below 1, renders the spread
of infection ineffective.
The R0 number of COVID-19 in India is improving.
- Mid-March: 1.7
- March 23: ICMR had estimated it to be 4. This is where the farsightedness of Harsh Vardhan must have prompted him to go into an immediate 21-day lockdown starting 25th March.
- 6th April: 1.83
- 11th April: 1.55
- 18th April -- awaited.
The approach his ministry has taken is to stay two steps
ahead of the coronavirus growth curve. The ministry feels that they have put in
place a good amount of measures to be ready to tackle the rising cases of
COVID.
The first goal of the Lockdown was not to contain and
end COVID altogether, but to "Flatten the curve" by breaking the
chain of transmission. The goal was to severely suppress the spread of the
disease by as much as possible avoiding the outbreak of Community transmission
(that is when Virus is all over, on surfaces in public places). Well such a
suppression refrains the population from developing herd immunity to the virus,
but the transmission rate is expected to be much lower after the lockdown is
removed.
The second goal is to meticulously study daily
growth, extrapolate the number of positives at the end of lockdown and
aggressively prepare for handing the outbreak based on the estimates. Buy time
to prepare and setup the medical facilities, spaces, beds, trained staff to handle
that anticipated outbreak. The immunity of people will grow as well, but at its
own pace.
An interesting report in New York Times by Dr. Faheem
Younus, MD at University College Hospital of Maryland, USA outlined the “hospitalization
rate” and “fatalities rate” in New York, the new epicentre of COVID-19 across
different age groups. See a graphic from his tweet below:
So, the trend in the worst impacted place in the world shows
that average hospitalization rate is less than 8 per 100,000 people up to age
of 65, with the highest at 17 per 100,000 for ages above 80.
Today India has 10,815 positives. So, going by NYC estimates,
very small number needs hospitalization. Even if India were to hospitalize all
10,000, the health ministry has announced that it is ready with 25,000 beds.
And they are constantly increasing the following every day:
- Number of beds
- Quarantine facilities
- Trained medical staff
- Testing Kits & medical equipment
- Medical supplies
And this is what it means by staying two steps ahead of the
coronavirus growth curve.
One important decision that Dr. Harsh Vardhan took is that he
followed the ICMR when most world leaders were looking at WHO. His team is also
constantly following important medical and health bodies countries with
infections and observing what has worked and what hasn't in those countries.
A little bit about Dr. Harsh Vardhan:
Harsh Vardhan, born in Delhi, graduated with a Bachelor of
Medicine, Bachelor of Surgery in 1979. He did his Master of Surgery in 1983. He won an election in Delhi in 1994 and became the State Minister of
Health the Delhi government, during which he oversaw successful
implementation of the pilot project of the Pulse Polio Program which mass
immunized 1 million children in Delhi. Then In 1995 he led a similar program of
similar nature immunizing 88 million children, but across the entire Nation. WHO
declared India polio-free in 2014.
His understanding of Public Health in India is impeccable.
He flawlessly planned the state-wide and then nationwide immunization programs
very successfully and hence has a fantastic grasp of the meticulous administrative
outlining and planning involved in such mass immunization programs.
There is no doubt that India will defeat Coronavirus soon,
but the measures by Dr. Harsh Vardhan, his ministry officers will go a long way
in improving the Healthcare and Medical treatment readiness of the nation in an
irreversible manner.
[Authored by: Mandar Garge, Apr 14, 2020]
Credits:
- Shekhar Gupta, Chief Editor, The Print (Cut the Clutter Episode #443)
- Shamika Ravi, Economist, Brookings (Twitter)
- Dr. Faheem Younus, MD, Maryland UCH (Twitter)
- Wikipedia (Dr. Harsh Vardhan’s page)
- India Today
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