It’s Time To Rethink Our Flawed Strategy To Beat Covid-19

Globally, Covid-19 has reared its head again. India has also started reporting the highest number of Covid-19 cases in the world for the past few days, and this is a worrying sign.

So, what is going wrong and how to correct it? We must contain the spread. Else, the madness of lockdowns will tear apart the economy and society. Some sectors had started crawling back towards revival when the second wave has stuck. 

On 7th April 2020, I wrote about the plan to tackle Covid-19 and moving out of lockdown from mid-April 2020, and post the detailed analysis of the global scenario, in July 2020, I wrote that the extended lockdown might not be the best strategy. Aurangabad is already going into a complete lockdown after a year again, and the plan may be to extend lockdowns if the Covid-19 explodes. Which could spell disaster! So where did we go wrong? 

Communication strategy: 

We kept denying that the community spread had happened, despite the fact that it had started post the first few weeks of Covid-19. Till 4th April 2020, the ministry of health dissuaded the general populace from wearing masks, till the Disease Management Association of India sent an SOS to the Prime Minister. So, our communication strategy went wrong.

Lack of Scientific approach:

I was a chair of a leading newspaper's panel discussion on Covid-19 with a few state health secretaries,  and I asked the senior member of the Covid-19 task force and the government’s key advisor on Covid that 'Despite the high number of cases, why is India's fatality rate low'? To which he responded, 'We don't know, it is a million-dollar question.” His response summed up our understanding and also our approach.

Poor compliance at the top:

When leaders don't wear a mask during their public appearance and conduct election rallies with thousands in attendance, the campaign and enforcement of Covid-19 guidelines suffer a fatal blow.

Illogical decision making:

Let us look at the vaccination guidelines 

Who can take the vaccine?

Frontline health workers 

Individuals above the age of 45 years (third phase of vaccine rollout).

Individuals with hypertension, diabetes, asthma, pulmonary, liver, or kidney disease, and chronic infections that are stable and controlled.

The interim recommendation is that immune-compromised persons who are part of a group recommended for vaccination may be vaccinated, though when possible, not before receiving information and counselling.

Known people living with HIV with a controlled health condition can get vaccinated after a healthcare provider's recommendation. 

If vaccination is about curbing the spread of Covid-19 in the country, then the strategy mentioned above is neither scientific nor enough. Let us consider the following:

Senior citizens who are not working should have been asked to stay at home and avoid physical contact with people moving out, and the vaccination for them must have been an optional priority. These senior citizens are, in fact, at the least risk in terms of spreading or getting should they be following physical distancing and other measures besides staying at home.

We should have instead prioritised the young who are working and have multiple touch-points like house helps, drivers, shop-keepers, security guards, fuel station and other attendants and factory workers of all ages to be vaccinated on top priority. But they are not even on the list!

It is not just the age or comorbidities but people with multiple touchpoints who should also have been vaccinated on top priority else they will become the super spreaders, and we will not be able to contain Covid-19. So, it is important to consider ‘exposure’ besides other factors, and just addressing vaccination based on ‘age’ and ‘comorbidities’ will not be enough to contain the spread. 

The recent spate of Covid-19 amongst children indicates that we must go back to the drawing board, else we have a bigger headache ahead.

Maharashtra, instead of considering stopping local trains, should increase the 'halt time.' People forget social distancing as the trains stop for 30 seconds or so, and this should raised to two minutes so that people do not brush past each other to alight and board the local trains. Also, strict enforcement of distance-based seating is needed.

Similarly, a state has put guidelines that shops will close from 8 pm to 5 am. And that trucks will not ply in the morning. Did the planners even stop to think how these shops will get supplies when they open at 8.00 am, when the trucks stop moving at that time? I fail to understand the science or logic behind these guidelines, and the public will surely suffer and break the rules of night curfew if they don't get essential supplies.

Also, there is neither logic nor science in the night and weekend curfew imposed by many states. We must never do it, and instead, 24 x 7, we should enforce physical distancing and masks. Covid-19 is here to stay, but we need to keep its incidence under control. 

The resurgence of the economy will suffer collateral damage due to the resurgence of Covid-19, and if we don't go to the drawing board and redo our strategy and the team in charge of Covid-19, we are in for a big shock.

Also, it is time for the government to consider a Union Minister of State for Public & Digital Health. We have enough examples of countries where Covid-19 was managed well despite proximity to the epicentre of Covid-19. The Prime Minister has played a crucial role in ensuring a balance in the successful rollout of the world's biggest vaccination drive and vaccine diplomacy. So, I am hopeful India will course-correct before it is too late. 

The author leads Health Parliament – A Think Tank on Evidence based policy formation, and is a former advisor to the Union Health Minister. He tweets @rajendragupta