“Three likely scenarios”

COVID-19 Health Magazine

Dr Daya Prasad Kulkarni is a public health specialist and development consultant. He founded Arogya Seva Foundation in Bangalore, a platform to provide free healthcare services to the underprivileged. He teaches at Syracuse University, New York. He is currently advising the Karnataka government on measures to detect, contain and treat the Coronavirus disease. Nissim Jacob asked Dr Kulkarni how prepared we are. Excerpts from their conversation:

Given our poor standards of public hygiene and sanitation, how will we be able to contain the spread of the coronavirus? 

The World Health Organisation (WHO) has laid out guidelines that include precautionary measures necessary to contain the spread of the disease. It recommends that people washing their hands regularly, not rubbing their eyes and nose with unwashed hands, etc. In India, lack of access to clean water is a cause of concern. Issues relating to public sanitation need to be addressed on a regular basis so that when an outbreak occurs we are equipped to deal with the crisis more effectively and contain the spread of the disease.

There are three likely scenarios. In the first case, the coronavirus cases will be limited to a handful, and the disease will become irrelevant until the time a vaccine is developed. In the second case, the disease spreads and we will have to enhance our ability to surveil and contain the spread of the disease. In the third case, if it goes out of hand, then we will have to plan a response according to indicators (epidemiological indicators which show how the disease evolves) that were observed in China.

The government needs to improve awareness among the public regarding the disease. There is a lot of misinformation that needs to be tackled and the stigma of getting infected needs to removed so that people come forward if they show the symptoms.

Given virtually unimpeded internal migration in India, how can we contain the spread?

The WHO has put forth guidelines restricting air travel to infected countries and screening upon arrival at airports. Iran for instance, which has seen a surge in the number of cases, hasn’t imposed appropriate quarantine measures. India is now screening all arrivals from severely affected countries. India has quarantined as required and if the situation worsens, it will have to impose a lockdown of an entire state, as millions of lives will be saved.

Has India ever dealt with an infectious disease as virulent as coronavirus?

India dealt with variants of SARS and the HINI influenza in the past. While there were deaths during these outbreaks, it did not become an epidemic. Comparatively, India’s response has improved, as there have been no deaths. With time, the progression of the disease slows down and virulence comes down, and that is likely to happen with Covid19. In China, we saw that the number of newer cases has reduced.

What is the ability of different states to surveil, monitor and isolate coronavirus cases?

Some states have a better health infrastructure compared to others. While states like Kerala and metro cities have a higher number of cases due to global traffic, they also have been able to contain the spread better. Moreover, the people who have been travelling from abroad are educated and aware of the disease and follow the advisory from the government and WHO. If the disease spreads to states with poorer health infrastructure such as UP, then it will be difficult to contain the spread of the disease.

Does the Indian public health system have the ability to contain and treat a pandemic like coronavirus?

While there are gaps in the Indian public health system, the system as a whole is equipped to deal with a pandemic like Covid19. The people involved with health are capable and during times of crisis medical personnel are actively involved. The government taps into resources and contributions from the entire medical fraternity. Currently, there is a global partnership at the government level, on limiting the spread of the disease and coming up with treatment and vaccines.


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