Guard against over-enthusiasm; govt tactic of lockdown relaxation right: IMA's Asokan
By Sfoorti Mishra
New Delhi, May 5 (IANS) India on Tuesday recorded the highest spike in novel coronavirus cases and fatalities. At least 3,900 new cases and 195 deaths in 24 hours have been reported today, with the total tally of cases at 46,433 and the toll at 1,568. India is currently in the third phase of lockdown with conditional relaxation. Honorary Secretary General of the Indian Medical Association (IMA) Dr R.V. Asokan says the government is on the right track in terms of relaxing the lockdown, but it is testing less.
He spoke exclusively to IANS about RT-PCR testing, lockdown strategy, peak of COVID in India and a host of related issues.
Here are the excerpts:
Q: The country saw a record jump of 3,900 new cases and 195 new deaths in the last 24 hours in the number of coronavirus cases. Do you think the government strategy of relaxing lockdown is correct at this point in time?
A: The government's approach is right. It may not be possible to extend the lockdown any longer. There are issues other than COVID-19 in our country. People may not even survive in lockdown any further. It is extremely difficult to extend severe measures such as a lockdown. We have to look at other non-health issues too. So, the government is perhaps doing the right thing.
Q: Do you think the government will think of extending the ongoing lockdown any further?
I don't think that Lockdown 3.0 will be extended any further. The government is trying to optimise the response. It means they want a lockdown which is optimal and it wants a staggered exit and, perhaps in the right time. In my opinion lockdown 3.0 is given with some relaxation so that a staggered exit may be made at the right time.
Q: Do you think India has reached the peak in terms of novel coronavirus cases?
A: We have not reached the peak yet. Our population is 1.3 billion. The only measure we have to take is to prepare all our hospitals, clinics and other institutions with the knowledge that 80% cases of novel coronavirus are with mild symptoms, 15 per cent of people need oxygen, only 5% patients become critical and of that only 2% among them go for an ICU treatment.
Q: Is it certain that India will see a peak of COVID cases?
A: We will have the peak most probably. It may not be a plateau. So far it has not been a plateau. It can be a short peak. Actually what we are having is a delayed peak. In other nations cases were ambushed (cases rose suddenly). Now in the past two months, the people, administration and doctors, hospitals and clinics and the industry have prepared themselves.
Q: Do you think the country is ready to face the peak?
A: The government has responded very well. We have a surplus of ventilators and PPEs. Only the quality (of PPE) is not fully adequate and there is a mismatch of distribution. But so far, the country has risen to the challenge. I am fully confident that we will be able to handle all these situations. There is just one fear -- overenthusiasm of certain government officials. Quarantining big hospitals and doctors in spite of following best practices is blatantly wrong and will backfire.
Q: Are you saying quarantining doctors is incorrect?
A: When you quarantine a full hospital, the services to the non-COVID patients are affected. There are best practices available in the world where the hospitals were decontaminated and deep-cleaned in 24 hours' time. Like the Singapore model or Hong Kong model where the hospitals were back to work in 24 hours. I think some of our (state) governments have agreed that if propper Personal Protection Equipment (PPE) have been used and the contact with the patient is less than 30 minutes, then there is no need to quarantine a doctor...because doctors will increasingly come in contact with patients and the number of doctors who are treating is not infinite. These are the practices which we are advocating.
We are advocating 1. Do not quarantine hospitals; 2. do not quarantine doctors if they have used PPE properly otherwise what is the point of using PPEs? Gujarat government has agreed to some of these points. We are working with state governments and modifying the scientific facts. Looking at it from a bureaucratic, epidemiologist point of view is not adequate. We will have to look at it from the medical point of view because ultimately, the doctors are going to treat and touch the patients and not the government officials.
Q: Do you think India is conducting enough tests? When do you think there will be a peak in India?
A: Many models of the peak of the cases have come out, but I think no one has got the correct model. Also the number of tests that are required is inadequate. One model of John Hopkins University says that one-third of Indian population will be affected. The testing here is inadequate. As compared to the population, our testing is certainly meager. The Union Health Minister says there is no need to test all patients for COVID who are going for surgery, this is not acceptable. This is irrational. Why can only labs test? They should allow hospitals to conduct tests. There are many hospitals which have the facility.
Q: Do you think delay in rapid testing may be an impediment in the fight against Coronavirus?
A: We have to be prudent. We need not do everything just because we are scared. Rapid antibody tests are not reliable as compared to RT-PCR. The test may give us the result of antibodies, but we still do not know what these antibodies mean, whether they are protective or indicate infection. So, scientific data has not emerged. I think we will have to wait. There are antibodies which are protective, for example, we have vaccination for smallpox because we know that these are protective antibodies. But there are antibodies which don't mean anything, we don't know what they function for. So there is a lack of evidence. I agree with the ICMR statement that although we are in a fight with this pandemic we can not create false sense of security also.
(Sfoorti Mishra can be contacted at sfoorti.m@ians.in)
