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Editorial Articles

Issue no 44, 29 January - 04 February, 2022

Reinforcing India's Fight Against Covid-19

Galloping towards cent percent vaccination coverage, India has emerged as a world leader in the fight against the COVID-19 pandemic. On 16th January – one year after the launch of the nationwide COVID vaccination drive-India had administered 157 crore doses with 93 percent of people above 18 years having received the vaccine. Out of the 93%, 70 percent people have received both doses. The vaccine coverage has now been extended to the population in the age bracket of 15-18 years. Moreover, in order to create a robust health-care system to tackle such emergencies in the future, the government has taken up a mammoth project under the Ayushman Bharat Health Infrastructure Mission. A multipronged strategy has been adopted to achieve targets under this mission. In an interview with Bhupendra Singh for Employment News, Shri Lav Agarwal, Joint Secretary, Ministry of Health and Family Welfare, Government of India, spoke in detail about the government’s strategy in the ongoing fight against the coronavirus including the new Omicron variant and about the larger plans of the government vis a vis the health sector.

 Question: It has been observed that the Omicron variant has more transmissibility in comparison to previous variants, though hospitalization is low. So how has the ministry recalibrated its strategy to combat this new challenge?

Lav Agarwal : Let me just highlight the fact that the Omicron variant is found to be highly transmissible. Also, it has a shorter incubation period, which means if you are infected; it can lead to faster spread of the infection. However, the onset of symptom is early and mild as well. Taking that into consideration and taking all the available evidences from the world as well as India, we rely on our ongoing strategy based on five principles - Test, Track, Treat, Vaccination and Adherence to COVID Appropriate Behavior. These principles remain applicable even to this variant and even within the overall framework of COVID-19 management.

Having said that, it is very critical for us to understand that since most of the cases will be mild and the fact that this is a highly transmissible variant, it is important that we give priority to containment aspects and follow these principles where needed because the virus does not infect on its own, it infects if you provide it an opportunity to infect. So, if we focus on containment and do not allow the virus to infect others, then we will decrease the number of cases within the country to a large extent. Second, given the fact that the infection is mild, there will be a situation where larger number of patients would require home isolation. In such a scenario, we need to focus if the home isolation protocols are being followed properly. Third, some of the patients in home isolation may require follow up in the hospital setting. So, to that extent, we will revise our clinical management protocol, upgrade our health infrastructure and see to it that we are able to manage all the cases which need hospitalization. The fourth and most important aspect is – community support, community awareness, and alertness within community. Since it is a highly transmissible virus, we need to follow COVID appropriate behaviour which is primarily the use of mask and following ‘do gaj ki doori’ -physical distancing as a ‘new normal’ in our life.

Question: While dealing with the first and second wave of the pandemic and the simultaneous vaccination drive, there was massive data sharing between the central and state administrations. How helpful has this data been in devising the new policy guidelines?

 Lav Agarwal: Actually, the whole COVID-19 management in this country has been, primarily, data driven insights. From the moment when the COVID pandemic started across the world, we created a COVID19 portal through which we collected data that came from Districts and States. The data made us understand what the trajectory of the cases is across the country. When we even provide that data to the community at large, we are able to highlight the places where cases are rising the most and instruct authorities that these are the places where you need to take a public health action in terms of containment and other measures. Similarly, data provides us insights in terms of understanding where, if death is happening higher in numbers, is it because those infected are late in adopting home isolation? So, to that extent we follow our surveillance mechanism more stringently. Likewise, data from the clinical side provides us details in terms of understanding what additional changes need to be done in the clinical management protocol; what type of medicines may be useful, so our national task force take those details into account in defining the clinical management protocol. So, what I would like to highlight in that it is these data driven insights which make it important and useful for us to understand the trajectory and take the required action at the field level.

Question: The Union Health Ministry has recently revised the protocols for home isolation. What are the salient features of the revised guidelines?

Lav Agarwal: Home isolation guidelines have recently been revised and if I were to highlight the most important aspect, I would like to submit that first and foremost, it is important that only mild or asymptomatic people should go for home isolation. If you are having moderate or severe symptoms, you need hospitalization.

So, who are the set of people who should go for home isolation? These are people who have sufficient rooms within their house, where a positive person can remain in effective isolation in a much ventilated space and there is also room available within that house for quarantine for other family members. It is also important that the patient has a care-giver to provide support and this care-giver, as we have specifically highlighted, should preferably be a person who has completed his vaccination schedule. We have also highlighted that it is important that the care-giver should remain in touch with the medical officer so that the required technical support can be provided. If a care-giver is entering into the room, he should use a triple layer mask and if they are in close contact, and if feasible, they can even use N-95 masks. We have suggested the patient to actually take adequate rest, maintain hydration. He should also follow respiratory etiquettes; he should maintain hand hygiene and there should be no sharing of whatever the patient is using including utensils with other members of the family.

We have prescribed certain specific guidelines to be followed primarily by the patient. It is important that the patient should remain isolated in a separate room which is well ventilated. Patients should, at all point of time, wear two triple-layer mask and he should discard this mask after eight hours of use or if the mask is wet or soiled. Now, it is very important to focus on how the mask has to be discarded: so you should take that mask, cut it into pieces, so that it cannot be reused, put it in a paper bag, keep it for 72 hours- by that time we expect the germs which are there on the mask will not be surviving- and then dispose it off. This biomedical waste should not become a reason for us to pass on the infection to others. Simultaneously, the patient should self monitor his health, particularly with respect to oxygen saturation, the temperature, etc. People who have an ongoing co-morbid situation should only go for home isolation as per the prescription given by the treating medical officer. There may be some set of people who may actually be having immune-compromised status; for example, people who may have cancer or other malignancy, etc. Those set of people are generally not recommended for home isolation. Even if done, it should specifically be done as per the recommendation and advice given by the treating medical officer.

We have also specifically highlighted that it is important to use telemedicine because you are staying at home and you would need guidance. So either it is the e-Sanjeevni platform made available by Government of India, or any other similar platform, you should make use of that platform to remain in touch with the treating doctor. You should take the medicines based on doctor’s advice for the management of symptoms. If you have fever, you should take paracetamol, etc. We have also specially highlighted that if even after taking four paracetamol tablets during the day, the fever is not going down, you should immediately get in touch with the doctor. There are certain specific things we have highlighted in this particular home isolation guidelines and this is based on our learning and experience of the earlier times.

We have also given specific guideline on when you should discharge yourself from home isolation. They are different from what had been given earlier based on the emerging evidence. So, what we have indicated is that a home isolation person will stand discharged and end his isolation seven days after testing positive and if he does not have fever for three successive days. But we strongly suggest that he should use mask even after that and he should continue self monitoring. We have also given indication that there is no need to take aretest because there are chances that a person may be shedding a dead virus - dead virus means which is non infective - it cannot infect others but a test may indicate that he is still RTPCR positive. There is evidence that after seven days, if you do not have fever for three days then you are non-effective. We also suggest that asymptomatic contacts should also basically isolate themselves and not get tested.

Question: There are many non-authentic and nonevidence based treatment protocols which float on social media. What is your say on this?

Lav Agarwal: We have suggested that you should not go for or fall prey to those nonevidence based information because it will harm you, it will create panic, it will create an element of anxiety which is not needed. We have specifically highlighted that whether it is blood test or X-rays or MRIs or CT scans, unless and until prescribed by the doctor; kindly do not go for them. A lot of people had, in the earlier wave, gone for CRP-marker. We need to understand that it is common for inflammation-marker to rise if there is any infection with in your body. Needlessly measuring the inflammation level will create an unnecessary element of panic and anxiety in the patient.

I would also like to specially highlight about steroids. We are all aware that people act out of anxiety at times because of this type of information floating on social media. They have to understand that steroids are not to be given for mild and asymptomatic patients. There are evidences that if you are taking steroids without the required prescription, without the required follow up, then it may lead to a second infection. We all heard about Mucormycosis - the fungus infection. So, we have specifically highlighted that kindly do not take steroids. Every patient requires different treatment. So, when it is going to be different for every patient then we have to ensure that we follow those treatment protocols as advised by the medical doctors, as well as their specific guidelines for the care-givers.

Question: With the onset of the third wave, the public perception about the COVID vaccine has changed given the fact that despite successfully administering over 150 crore doses, the new variant is still spreading at an unprecedented rate. Can we infer that the vaccination drive has helped reduce the severity of the pandemic but more needs to be done in terms of reducing transmissibility?

Lav Agarwal: It is a very important question. We all need to understand that as per the available evidences across the world and even in India, it is vaccine along with the other COVID protocols like the use of mask and physical distancingwhich is going to be our biggest support. The evidences clearly indicate that if you are fully vaccinated, you have much lesser chance of getting infected by the virus including the Omicron variant. Evidences also clearly indicate that if you are fully vaccinated your chances of hospitalisation are much lesser. Evidences also indicate that if you are fully vaccinated you do not get severe infection. So, I would really submit to everyone that it is critical that as and when the vaccines are made available and you are eligible, kindly get yourself fully vaccinated.

Question: What additional efforts are being made to tackle the vaccine hesitancy in the current scenario?

Lav Agarwal: From moment one, we had a very clearly defined communication strategy. For example, when I say that we have crossed the threshold of 150 crore vaccine doses in the country, it is part of our approach to eliminate hesitancy. Equally important is highlighting the humanitarian service done by our field staff. I am sure you would have seen those videos in which our ASHA workers and ANMs are crossing mountains and rivers to go to the farthest areas of this country, educate people and administer the vaccines. We have also taken help of the community at large: whether it is our community based organisations, NGOs, civil society organisations, village elders; everyone have been supportive in this initiative– the world biggest vaccination drive. Along with this we have also expanded our program. I am happy to highlight that we have started vaccination for 15-18 age group also. Simultaneously, we have started precautionary dose for healthcare workers, for our frontline workers, and for people above 60 years who are having co-morbid conditions.

Question: The government has recently sanctioned vaccination for children above the age of 15. Is there any ongoing effort to ensuring vaccine shield for children below that age?

Lav Agarwal: Our efforts in managing COVID-19 since the beginning have been focused on a very important parameter - evidence based approach. Based on that approach only, we started with vaccination for healthcare workers initially. On 16th January last year— we added frontline workers; after that elderly people, and then made it free to the community at large. And now we have reduced the age limit to 15 -18 years. Our future actions will also be dictated by the same strategy - emerging evidences and scientific approach.

Question: The Union Government has provided India COVID-19 Emergency Response and Health System Preparedness Package Phase II for strengthening health infrastructure across the country. What tangible results have been achieved so far?

Lav Agarwal: We have realised that we need to focus on upgrading the available health infrastructure for management of COVID-19. And it is through this fund we are focusing on creating beds, isolation beds, beds with oxygen, the ICUs also are being upgraded. We have also worked towards ensuring that we create field hospitals through this fund. We have worked towards creating additional pediatric ICU beds, additional ventilators. With this fund, we are working towards increasing the testing infrastructure, providing RT PCR labs across the country. We have used this fund also to provide liquid medical gas pipeline, as well as the liquid medical storage tanks in hospitals across the country. Besides this, we are utilising this fund also for creating and incentivising the human resources for management of COVID- 19, creating a buffer stock of drugs. Availability of telemedicine platform is also coordinated through this fund.

Question: Given the high rate of transmissibility of the Omicron variant, healthcare providers are the most vulnerable section. What efforts are being made to ensure adequate human resources in the health sector to tackle an imminent third wave? Has any new guideline been framed for that?

Lav Agarwal: We have launched precautionary dose of COVID vaccine for healthcare workers. We have also incentivised them by providing funds under the emergency COVID response package. We have also worked towards upgrading their skills and reskilling them, considering the new Omicron variant. And I am happy to submit that through our center-of-excellence initiative under the aegis of AIIMS Delhi, we are now doing a series of webinars with the State centresof-excellence. The initiative is cascading down upto the District and lower levels to all our healthcare workers dealing with COVID-19. Equally important is that we have also requested the state authorities to utilise the services of MBBS students, nursing students so as to upgrade our existing human resources. The biggest focus is on how to ensure infection prevention and control practices in the hospitals. The healthcare workers of this country have really stood up to this challenge and supported the COVID-19 management effort so far.

Question: How is the PM Ayushman Bharat Health Infrastructure Mission going to play a critical role in building capacities to tackle future public health emergencies like the COVID19?

Lav Agarwal: Under the Ayushman Bharat Health Infrastructure Mission, we have launched a mammoth program at the directions of the Prime Minister wherein Rs 64,000 crore are to be spent in terms of upgrading health infrastructure across the country and this is primarily focused on 4 pillars – the first pillar is ensuring that we are able to increase the research labs across the country. Whether it is Bio Safety Level 3 or Bio Safety Level 4 labs, that network is being established. Second, focus on creating public health labs across the country. We should be able to detect any infectious disease at the right time. Only then we will be able to respond to that disease so that infrastructure is being expanded. Third is the management of infrastructure in terms of creating Infectious Diseases Blocks across the country. That infrastructure is going to be expanded. Fourth, focus on ensuring that we provide the required support for research network so that as and when new challenges in health sector start appearing, our research community is able to manage those challenges.

(The interviewee is Correspondent, All India Radio, New Delhi. He can be reached at airnews.bhupendra @gmail.com).

Views expressed are personal