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Insights into Editorial: Measuring the epidemic: Publicness, decentralisation of science and governance is needed

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Context:

It was four weeks ago that the states were finally given more freedom in managing the epidemic.

They are, of course, better placed to deliver on public health and welfare. They are also generally more accountable.

According to the recent ICMR serological sample study conducted in mid-May, barely 1 per cent of non-metropolitan India was infected.

Thus, as the infection spreads and eventually stabilises, there is a lot of heavy lifting that the states must do.

Since the brahmastra of lockdown is now exhausted, the message of prevention and the device called containment zones are the only ways left to manage the epidemic.

Resilience of the Indian health system must be urgently addressed:

As epidemiologists tend to consider that the peak of the COVID-19 epidemic may not come before July, the question of the resilience of the Indian health system becomes more pressing, especially in cities like Mumbai, Delhi and Ahmedabad.

The limitations of the country’s public health system are well-known. India’s public hospitals have only 7,13,986 beds, including 35,699 in intensive care units and 17,850 ventilators, according to a recent study by the Center for Disease Dynamics, Economics & Policy (India) and Princeton University.

The general perception behind the inadequate provision and availability of healthcare services is attributed to the country’s developing nation status.

However, India lags behind its BRICS peers on the health and quality index (HAQ index).

As per the National Health Profile 2018, India’s public health spending is less than 1 per cent of the country’s GDP, which is lower than some of its neighbours, countries such as Bhutan (2.5 per cent), Sri Lanka (1.6 per cent) and Nepal (1.1 per cent). In fact, according to the World Health Organisation, India finishes second from the bottom amongst the 10 countries of its region for its percentage spending of GDP on public health.

Maldives spends 9.4 per cent of its GDP to claim the top spot in the list, followed by Thailand (2.9 per cent).

What can be achieved within the current framework:

  1. Firstly, any area classification must include key socio-economic and demographic determinants. For example, the density of the area, number of people in dwellings with one room or less, or the fraction of people using community toilets.
  2. As we know, much of the infection is spreading within dense clusters. Such metrics would indicate vulnerable areas and the limits to reduction in contact rate through policing. Here, decongestion measures such as out-migration may be required. This will also serve as a guide to the future of the locality or ward.
  3. The state is staging a comeback everywhere in the world in the context of the COVID-19 crisis.
  4. In India, one of the domains where it has to step in is public health. A debate on the lack of investments in public health is bound to take place in the country after the dust has settled. But the return of the state does not necessary mean more centralisation.
  5. Some state governments are doing a better job than the Centre today and the most effective ones are the most decentralised ones see Kerala.
  6. It does not mean that civil society has no role to play either: In fact, the situation would be much worse if NGOs and private foundations (using CSR money sometimes) did not play such a huge part at the grassroots level.
  7. But the most effective interventions seem to take place when there is a high degree of coordination with the state apparatus.

Monitoring and preventing the transmission of the covid at local levels:

  1. Ensuring that our villages and towns are prepared to meet the disease is an important objective.
  2. One metric to measure preparedness is the number of beds, doctors and ambulances per 1,000. This may then be compared with the active cases in the region.
  3. In fact, the adverse mortality in some areas is directly correlated with the local shortage of medical care. For most districts in Maharashtra, shortages would start biting at about 200 cases per day.
  4. Much of this data at the district level is already being submitted by the states to the central data portal covid19.nhp.gov.in.
  5. An important addition would be village-level data on the running of the local quarantine, the functioning of the PDS and availability of drinking water.
  6. Coming to prevention, the importance of masks, distance and open ventilation is still not appreciated.
  7. A simple statistical metric is to measure the prevalence of masks in an area. This can be done by installing cameras in suitable locations and counting people with masks.
  8. Social distance measures are also amenable to indicators. For example, the fraction of buses which have installed a sheet between the driver and the passengers, or recording innovative ways of ticket vending.
  9. Popularity of such colour-coding may be effective in social mobilisation.

Conclusion: Mitigation and adaptation require social comprehension and local solutions:

These need scientific studies by regional institutions and partnerships with civil society. Creating and supporting good metrics and providing data is an important step in that direction.

This will not only save lives, it will reduce fear and help re-start normal life. And yet, the central bureaucracy and elite scientific institutions have not followed this route.

The epidemic has underlined that publicness and decentralisation of science and governance is the only way to atma-nirbharta, of creating knowledge and the professional ability to solve our own problems.

Without this, the post-corona Indian society would be an unhappy attempt at making the old arrangement work in a degraded reality of fearful and angry people.

Ultimately, we must learn to live with the virus, but we must also find joy. Only through constant engagement and adaptation will we overcome fear and forge a new society that will sustain both life and happiness.

 


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