“Isolate, test, treat and trace” : Prof T. Sundararaman
In this interview with Aarthi Kannan, Prof. Sundararaman, former dean, School of Health systems at Tata Institute of Social Sciences (TISS) talks to us about how COVID-19 is different from the 2002 SARS or MERS, the science behind a minimum fourteen day quarantine and the strategy India needs to follow while battling COVID-19.
Yesterday was such a long time ago. Tomorrow, we will be several steps ahead, as the people of India witness changes with every passing moment during the COVID-19 pandemic. As the scenario rapidly evolves by the hour with number of cases rising, we see an evolving response too – be it new governmental policies, ramping up testing, involvement of the private sector or the coming together of eminent industrialists to innovate and offer financial support at this hour. Professor Sundararaman, enlightens us with his perspective on COVID-19 in this interview.
1. How is the COVID-19 illness different compared to 2002 CoV SARS or MERS?
COVID-19 is far more contagious than SARS and MERS. It has a lower case fatality rate. (Case fatality World Health Organization definition : measure of the severity of a disease and is defined as the proportion of reported cases of a specified disease or condition which are fatal within a specified time).
However, COVID-19 has a higher “R” value, which is a measure of its infectivity - and much of this is because the patient remains infective for a longer period and can be infective before symptoms develop. In contrast, SARS is typically infective only in the severely ill period.
2. Why is quarantining done for a minimum of two weeks for international travelers as a measure to prevent COVID-19 spread?
The answer lies in the incubation period – that is, the time from getting infected with this virus to manifesting symptoms like fever is about 1 to 7 days. Rarely this incubation period can be as long as 12 days. The quarantine period is often about twice the incubation period. That way when a patient is released from quarantine we know that he or she was not infected and will not get the disease.
3. With several examples of our international travelers and high-risk people disregarding the importance of home quarantine or self quarantine, what new measures do you suggest be taken to ensure the minimum home quarantine requirement in our population of 130 crores?
Persuasion, persuasion, persuasion. The moment you try coercion, people will stop reporting even if they die from it. We know this from the times of the plague epidemics. Stigmatization of the disease and blaming the victims will set the fight back.
4. What in your opinion are current essential duties and responsibilities we need to commit to, at individual level follow to curb the spread of COVID-19?
Isolation at home if there are typical symptoms and reach out to government to get tested at the earliest. If test positive, follow medical advice from government. If negative, and symptoms subside, resume normal measures.
Home quarantine in case of contact with those who are tested positive for COVID-19 or with typical symptoms but where testing could be organized
Social distancing, in that order of importance
5. The government is trying its best to prevent panic, but as a result of that effort, is the public unable to understand the seriousness of the problem? How do we help the public understand the gravity of COVID-19 and the importance of social distancing?
The government needs to be more transparent with the numbers and increase the testing numbers to about 50,000 plus per day. The problem is not panic, the problem is that it will be difficult for most common persons who have to earn on a daily basis, and who live on the brink, close to poverty to follow all these rules of social distancing. Social distancing is necessary- but not sufficient. It is isolation, test, treat and trace- that should be the main strategy.
6. How do we protect smaller towns and villages? What measures can we urge the government to take?
Largely the same as in larger towns. Take the help of elected bodies of local self government, the school system, the social welfare system and of course the health system to reach out.
7. Is a preventative lockdown reasonable in smaller towns without documented COVID-19 cases, but with people at high risk of transmitting the virus?
It is not reasonable anywhere unless we have data that indicates that we are in the early community transmission phase.
8. What do we lack as a health system that hurts us most at this time?
A very weak public health systems that by policy and design is designed to give a very selective and very basic package of services and with minimal capacity with the understanding that the rest would be taken care of by the private sector. But this is a maximum situation. Public systems must be designed with some redundancy, some excess capacity, that can absorb an extra load during such times. Also we need a much more robust and flexible disease surveillance system that could have ramped up to testing for COVID-19 much sooner.
9. What are two strategies do we need to adopt, which will help our nation in battling the pandemic?
We need to have both a higher level of public expenditure on healthcare and the concept of health sovereignty with respect to essential health commodities and technology.
10. What is the best way to support daily wage workers at this hour to help them contribute to their safety and the safety of those around them?
We would need to provide a cash transfer as an immediate measure. Additionally, better forms of social security and employment guarantees should be the focus in the long run.