NEWS
27/03/2020 2:37 PM IST | Updated 28/03/2020 8:53 PM IST

ICMR's Coronavirus Study Too Small To Rule Out Community Spread: Govt Task Force Expert

Dr Girdhar Gyani on why the lockdown matters and the need to act like we are in ‘Stage 3’ already.

NurPhoto via Getty Images
People walking towards COVID-19 screening area, at Guwahati Medical College Hospital, in Guwahati, Assam, India on March 26, 2020. PHOTO: DAVID TALUKDAR (Photo by David Talukdar/NurPhoto via Getty Images)

On 24 March, a group of health care professionals who are part of a task force constituted by the Narendra Modi government to guide the country’s battle against the coronavirus outbreak, submitted a report pointing out that India will run out of medicines, personal protective equipment (PPE) and masks in a week in the “unlikely event of a massive outbreak”.

The task force also suggested that entire hospitals should be turned into COVID specialty centres, citing data from Italy which showed that reserving beds in a hospital with other patients ended up spreading the infection to 40% of the non-COVID-19 cases.

Dr. Girdhar Gyani is the founder director of the Association of Healthcare Providers (India) (AHPI), a non-profit organisation that works closely with healthcare professionals and does advocacy work for the government over issues of healthcare. Gyani holds a doctorate in quality and was the director on board of International Society for Quality in healthcare. 

“On 19th March some of our key specialty associations including AHPI and IMA were invited by Secretary Health to appraise us with the preparation for COVID and shared with the plan where private sector to participate as appropriate. Same group was invited for video conference with PM on 24th where IMA-led the team and assured government the full support to deal with COVID.

“On 20th all private sector associations came together to work out road map and submit to NITI AYOG and MOHFW. Same group met again on 23rd where NITI AYOG also joined and we finalized constitution of 6-task forces. The first was on dedicated COVID Hospitals which I led as convener. Other task forces were on fever clinics, telemedicine, home care, financing & capacity building/ training,” Gyani told HuffPost India

In an interview with HuffPost India, Gyani said that staying in denial about the presence of community transmission in the country won’t help anyone, and explained the purpose the lockdown is supposed to serve.

Edited excerpts:

You said in an interview to The Quintthat we are already in Stage 3 of the COVID-10 outbreak…

See, the issue here, if you keep saying that Stage 3 is about to begin, suddenly when the numbers come out, we will find ourselves lagging behind. So instead of waiting for that to happen, we should get hospitals identified as COVID hospitals and if possible, get them vacated. Problem will be, and I have been saying it again and again, you don’t need simple hospitals. You need hospitals with ICU beds, and half of them should be equipped with ventilators. That is the normal rule.

While like many other experts, you say we have entered a community transmission phase, the government is denying it. In fact, just yesterday, the Indian Council of Medical Research (ICMR) said we are not in the community transmission stage yet, based on a 2000 samples collected randomly.

No, the kind of population we have, that (sample size) is nothing.

The question is, infected people will show the major symptoms on the sixth day, seventh day, eight day. You know, we are testing only people who have three things: dry cough, fever and finally breathing difficulties. Now, many will begin with light fever, then dry cough will come, and breathing problem will only come on the 9th day, by that time it’s too late. Yesterday only, they (government) have announced that 29 private labs have been identified for testing. That itself is an indication that we are there.

Whether you are in stage 3 or not, long back only the ICMR had announced that third stage is inevitable.

Let me also tell you that, whether you are in stage 3 or not, long back only the ICMR had announced that third stage is inevitable. They had said back then, although I myself did not subscribe to that back then, thinking it will create panic.But internally we — at the government level and the medical level — should behave like stage 3 has started. If stage three begins and then you start preparing, then you are gone. So I think today only, the central governments have asked states to start identifying hospitals to vacate and turn into COVID hospitals. We sent this recommendation around two days back.

You are part of a task force, I wanted to understand what this task force is and how it was formed.

There are 2-3 task forces. One is on the economic packages, what is happening in the hospitals now is the patient footfall has gone down by 50-60%. So obviously, the cashflow has gone down. We wanted the government to take care of it. Today, one small announcement has been made, that Rs 50 lakh crore has been identified as a cover for healthcare workers. The first task force for which I was the convenor is one on how to make COVID hospitals. Our recommendation was we need not convert 10 beds, 20 beds in one particular hospital. Instead, we convert full hospitals. We offered them if beds are short, then some of the private hospitals can be identified.

How was this task force formed?

All major organisations like AHPI, like FICCI, like CII, like ASSOCHAM came together to form this task force. There are doctors like Dr Devi Shetty, Dr Naresh Trehan and several others also are a part. We also roped in consultancies like Boston Consulting Group to help us analyse the data.

This is a private initiative?

The initiation came from the NITI Aayog. We had a meeting with Alok Kumar(NITI Aayog adviser) last week, and based on that, we constituted these task forces. We also had a meeting with the Prime Minister. The members of the force interacted over video conferencing and provided the inputs to the government.

When was this task force formed?

On 20th March.

Don’t you think 20 March was a little too late to form it when the first case was detected here in January?

You see, on 19 March (the number of confirmed cases had crossed 180 then) secretary of health invited us. Then we presented data, and all the normal briefings happened.

See, so far the number which is coming in open is small. Secondly, the everyday increase still is arithmetic. That means, for example, the numbers increase like 40-45-60-80 and so on. In community spread, it will happen geometric. For example, 40 will become 80 next day, then 160 and 320 and basically increase exponentially. Now, I am not sure if they are saying we are not at community spread because actually we can’t measure...

Do you think the government underestimated the threat?

In the meeting with the secretary, we asked the same question. He said that 7th January, China reported officially. On 17th January, India constituted full advisory committee. And 18th January, I don’t know how sure we are, thermal screening started at the airports. We don’t subscribe that, because they may have started at a very limited level. Now the question is, I don’t know late or in time, now we cannot look back.

The problem with the preparation which is going on now, if stage 3 actually happens like it is known in the other countries, then I am sorry, we will be found wanting in the number of resources. We have to pray that it doesn’t happen in geometric or exponential fashion.

Because we have only 8 lakh beds in government (hospital), maybe that many beds in private. ICU beds in government facilities are 10% of the total number of beds, that too in district-level hospitals. There are 5,500 community health centres, which have 30 beds each don’t have any ICUs. In private hospitals, they may have 20% ICU beds, some bigger hospitals may have 40% ICU beds.

The problem with the preparation which is going on now, if stage 3 actually happens like it is known in the other countries, then I am sorry, we will be found wanting in the number of resources.

The only thing is, the spread till now is in pockets ― cities and towns. If we pool the resources, get doctors from other places to go and work there. The government is also planning that final-year students will be rushed into the practice, final-year nurses can also be summoned. I think it’s all in the planning, it will be revealed soon.

A big problem is not enough test kits are available, it has been revealed.

They are saying that they can do 15,000 tests a day but actually how many they are doing right now, I don’t know. Maybe 1,200-1,500 tests per day, I am not sure.

But all these labs have to use the kits…

Yeah, yeah. I will have to find out.

 

Will this lockdown really help and how will it help?

There are two purposes. One, the spread is arrested. That is the key purpose. Second, instead of suddenly peaking and the infected people coming out all at one time, the spread will now happen over a period of time. We will come to know in the next 20 days. If in one week, so many people get infected, we don’t have the capacity to deal with them. This graph was circulated a while back with comparison between Italy and South Korea… with a lockdown the spread slowed down.

But you see, by this time the people who are already infected, they are already there.

Yes, what about them?

Gradually we are coming to know, there are 80 per day or 100 per day and we are able to isolate them. And get them treatment. Without a lockdown, the spread will happen fast.

I was reading a WHO statement where it was being said that a lockdown works but only if you ‘test, isolate and treat’. If the testing is not done, how will this work?

See, even the US is facing this same problem. They don’t have the test kits.

I read today that the government has invited doctors, including retired ones, to volunteer in helping fight COVID-19. Are we facing a scarcity of doctors?

See, there are two things. There are going to be COVID hospitals and COVID centres. So some people with milder manifestations can be kept in some guest houses, or auditoriums being turned into isolation wards. They will need doctors there. Some private hospitals have volunteered to help, but we need doctors with equipment in these places. It was in connection to that.

What is the doctor-to-patient ratio we are looking at, at this moment?

We have around 0.65 doctors per thousand population. But we need 1 per thousand. But now that cannot be fixed at this time. That’s why we will have to use final-year students and rush them into the practice. Finally, it is also re-distribution of resources that we have to do. Say Delhi has too many doctors which is not needed. Can they be shifted from here to somewhere else where they are needed? That is the only way the government can manage. Next two days are vital, let us see.

What is the situation with ventilators? Did you raise it in the meeting?

Yes, we did. They told us that they are trying to make the ventilators ‘under the licence’ with the foreign companies. Under the licence agreement means, the technology is transferred to you and there are companies like say, Mahindra & Mahindra, who will be able to make it quickly if the technology is given to them by the foreign company. As far as I know, one such company has been identified.