Position Statement on Updated Containment Plan for Large Outbreaks (COVID-19)
Submitted by Baldeep Singh Gill, Associate Editor, The Indian Learning
On 17th April 2020, the Ministry of Health and Family Welfare published the Updated Containment Plan to break off the COVID-19 spread efficiently. The plan propounds strategic scenario-based approach includes the following 5 (five) possible scenarios of the disease outbreak:
The approach towards travel-related cases includes inter-ministerial and centre-state coordination (operational part of such coordination remains mystified), universal screening of international passengers, surveillance to track travellers, maintaining PPE buffer stock, early testing and public awareness. It is noteworthy that to maintain PPE and screening machines buffer stock, the Government of India should take initiatives to boost the production of PPE and other medical supplies and equipment. The Government of India recently declared the contribution towards the PM Care Fund as CSR expenditure but instead of that, the Government of India should direct the Companies and Corporations to contribute their CSR expenditure towards the production of PPEs and other medical equipment. Instead of importing and sourcing the medical supplies from other countries, the Government should work towards boosting the regional production of medical supplies and equipment.
To obstruct the local transmission, cluster containment strategy has been put in place for extensive contact tracing in containment zones. The measures include testing, isolation, quarantine and social distancing.
Containment of Large Outbreaks
Large outbreaks have been defined as an abrupt increase (15 or more) in COVID-19 cases in a geographical area (city, town, village, etc.). The containment for large outbreaks calls for geographical quarantine, active research and testing, perimeter control (absolute interruption of public and vehicular movement) and adoption of Cluster Containment Strategy by identifying buffer zones and containment zones. The geographical quarantine strategy for COVID-19 is parallel to the H1N1 Influenza (2009) pandemic strategy which laid down measures to contain the virus by identifying the hotspots or containment zones. Furthermore, the approach provides for the testing and surveillance of SARI (Severe Acute Respiratory Infections) cases, a disease which already exists in India.
Concerning the legal framework, existing legislations have been put in place. It includes the Disaster Management Act (2005), Epidemic Act (1897), Cr.PC, IPC and State-Specific Public Health Act. It is pertinent to mention that the plan considers “SOME” of the Acts/ Rules and fails to mention a precise legal framework. This demonstrates the lack of comprehensive legislation or National Strategy for managing such epidemics.
With regards to the surveillance measures, surveillance workers or COVID warriors will visit 50 (fifty) households to interview the people through a questionnaire regarding the symptoms, travel history or contact history with COVID suspects. Albeit no measures have been mentioned for the protection of COVID warriors if they are pelted stones at, abused or beaten up. Respecting the doctors, health workers and other related staff shall be made a part of Fundamental Duties (Part IV-A Art. 51A) of the Constitution on India. If the former recommendation seems extreme, a Code of Public Conduct, Etiquette and Ethics towards the Medical service providers shall be enacted.
In terms of laboratory support, governmental and private VRDL, BSL2 and BSL3 laboratories are assigned the task of collecting and testing the samples. The Hospital Care includes a three-tier management system for COVID cases categorised according to the severity of the cases (ranging from very mild to severe cases). Though, the plan for an exponential surge in COVID cases seems inadequate because it fails to establish exhaustive measures.
Clinical management, proper infection control in health facilities, discharge policy, pharmaceutical and non-pharmaceutical interventions, quarantine and isolation measures have been apparently considered in the plan.
Wide-spread community Transmission of COVID-19
No measures have been put in place for obstructing the widespread community transmission of COVID-19.
India becomes endemic for COVID-19
Though the numbers of COVID-19 cases remain in control, the increase of the spread of the virus is unforeseeable. Thus, if India becomes endemic in future, there’s no containment strategy for such a catastrophe.
The Way Forward
India needs a robust and Comprehensive National Strategy or Pandemic Readiness and Preparedness Plan. Countries like Singapore and Taiwan already have full-fledged strategies due to their prior experiences with such pandemics and disease outbreaks. India after considering the national statistics and data of the COVID-19 outbreak, a national strategy can be made on similar lines with countries like Taiwan or Singapore.
“एतदपि प्रत्येष्यति” This Too Shall Pass
To leave all the readers with a positive note, since the lockdown began, India’s R0 has declined significantly, more than 5800 patients have recovered as of April 26 and a patient in New Delhi has completely recovered through convalescent plasma therapy. The Ministry of Health and Family Welfare took reasonable care about psychosocial support. It released an advisory aka “Minding our minds during the COVID-19” to manage stress, anxiety or panic in these difficult and demanding times. In addition to that, the Ministry in collaboration with the Public Information Bureau (PIB) has done a sterling job in fighting COVID-19 and the infodemic (accurate and inaccurate information).
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