New Delhi: The Narendra Modi government should focus on controlling deaths due to Covid-19, and not only on recovery rate that boosts optimism, according to K. Srinath Reddy, president of the Public Health Foundation of India (PHFI).
India’s present recovery rate stands at 58 per cent as on 27 June, which is seen as a silver lining in the fight against Covid-19 and has been repeatedly highlighted by the Ministry of Health and Family Welfare.
“While it is good for public morale to show optimistic numbers, we must recognise that a cumulative recovery rate is bound to grow over time. Early discharge policy, introduced recently, has also boosted the estimated recovery rate,” Reddy told ThePrint.
His organisation, PHFI, is a public-private initiative for strengthening training, research and policy development in the area of public health. It was set up in 2006.
According to India’s revised discharge policy, released in May, mild and moderately ill patients can be discharged from hospital 10 days after the onset of symptoms, if there is no fever and no need for oxygen therapy for three days, “without testing them before discharge”.
In the earlier policy, a patient was considered fit to be discharged if he/she tested negative on day 14, and then again in a span of 24 hours.
“Instead of focussing on fuzzy intermediate indicators, which may cloud our vision as they are reported frequently, India must strive to assess and count the actual deaths — within and out of hospitals,” said Reddy, a member of the executive group of the steering committee of the World Health Organization-led solidarity trial on Covid-19.
“It is expected that ultimately over 95 per cent patients will recover, fully or partially. Countries which experienced an earlier surge than India have reported even higher recovery rates than ours,” he said, pointed to Denmark’s recovery rate of 95 per cent, Italy’s 84 per cent and France’s 72 per cent.
Difficult to predict ‘peak’, better focus on deaths per million
Reddy, former head of the Department of Cardiology at All India Institute of Medical Sciences (AIIMS), said the earlier “optimism that the gains of the first two stages of the lockdown would be consolidated quickly was ‘belied’ in the later stages of a relaxed lockdown”.
“Predicting the peak of the infection depends on whether we are talking of daily case counts or daily deaths. Both are difficult to predict at this stage,” he said, adding that the reason was that the lifting of the lockdown and the sudden rise in mobility of people coincided with a marked increase in testing.
“These together resulted in a rising case count. While rising case numbers are certainly a matter of concern, time trends are difficult to interpret when testing criteria and test numbers vary between time periods,” he said, emphasising “it is better to track deaths, which offer a more uniform basis for comparison over time”.
Even if deaths are undercounted, Reddy added, “it is unlikely that there would be marked time to time variations in the degree of undercounting. So, the time trends of deaths can be studied with greater confidence than case counts”.
“Even now, deaths per million population in India are much lower than in most countries — 12 per million. Can we keep it that way? That remains a challenge. But when this rate starts coming down consistently over 10 days, we can be confident of a turnaround,” he said.
With present trends, Reddy highlighted, “the descent of daily death count may be a few months away”.
“Ultimately, after the pandemic ends, its impact and our ability to blunt it will be judged only on one criterion — how many persons died in India due to Covid-19?” he said.
Did the lockdown work?
Reddy clarified that there was no doubt that the two-month lockdown helped slow down Covid-19 transmission, “when it was complete and stringently enforced in the initial phases”.
However, he added: “In this relay race, we ran well in the first leg, faltered in the next, and are now trying to catch up with the virus, which has sped past.”
With the “progressive relaxation of the lockdown”, Reddy said, the virus found it easier to spread. “Planning for the post-lockdown phase should have been better and containment measures executed more effectively.”
While ramping up hospital facilities, equipment and test kits did happen to an extent, “public health measures for case detection, isolation and extensive contact tracing remained in low gear”, he said.
“Citizen education and engagement was not undertaken at the level required, even as mixed signals were being sent about public gatherings at political and religious events,” Reddy claimed, adding that “different state governments reacted with varying levels of alertness and efficiency, with a patchy picture of control measures across the country”.
All of India is not seeing community transmission
In general terms, the determination of ‘community transmission’ is dependent on whether an infected person can be clearly linked to a contact or not.
According to Reddy, the label of ‘community transmission’ does not readily attach itself to all of India. “We must recognise that the epidemic is at very varied levels of intensity in different parts of the country. We cannot compare the present state of Delhi to a village in Jharkhand or Chhattisgarh,” he said. “With low levels of contact tracing in many cities, the link to a contact remains a tenuous surmise.”
If data from antibody-based serological surveillance conducted in May was also available for urban containment zones, apart from the released district data, he said “we could have gained insights into the extent of spread in the cities”.