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A Ground Plan for India’s COVID-19 Response

Context

India’s daily new COVID19 cases have crossed the 8,000 mark for the first time after more than 100 days. However, the cases (moderate to severe) and COVID-19 related hospital admissions continue to be low. The spike in infections has raised some worries about the start of the fourth national COVID19 wave in India.  Clearly, while the concerns about another national wave are unfounded, the ongoing surge demands a fresh approach to the COVID-19 pandemic response in India.

Relevance

GS-II: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Dimensions of the Article

  • Why this spike in COVID-19 cases?
  • Not a Public Concern Anymore
  • A dynamic response strategy
  • Way Forward

Why this spike in COVID-19 cases?

  • Spread of a disease is an outcome of a complex interaction of the agent (or pathogen, in this case SARSCoV2 and its variants), host (humans and their immunobiological characteristics) and environment (social and behavioral factors).
  • Since the third wave in January 2022, with minor variations in sub lineage, the agent (Omicron variant of SARSCoV2) has remained largely unchanged.
  • though antibody levels wane with time and susceptibility to infection increases, declining immunity alone cannot be attributed to rising infection as neither a past infection nor COVID19 Vaccination protect from subsequent infection.
  • the low rate of severe disease and hospitalization shows that our immunity against SARSCoV2 is holding up.
  • there is increased travel now, economic activities are back to or even higher than their pre pandemic level, there are regular social gatherings, and also noticeable lower adherence to facemasks wearing in crowded places.
  • Clearly, more than the agent and the host, environmental factors are driving the spike.
  • However, as SARSCoV2 is likely to be around and localised COVID19 case spikes are going to be a reality in many settings and for many months (and possibly years) to follow

Not a Public Concern Anymore

  • The reason is that June 2022 is completely different from March 2020.
  • Back then, SARSCoV2 was a new virus; no one had immunity against this virus, and everyone was equally susceptible.
  • There was no vaccine available and the risk of adverse outcomes after SARSCoV2 infection by age and other attributes, was unknown and unpredictable.
  • It was clearly a public health challenge.
  • Nearly 27 months into the COVID19 pandemic, most people have developed immunity either after natural infection (during three national waves) or through vaccination (nearly 97% of the adult population has received at least one shot while 88% has had two shots of COVID19 vaccines).
  • There is a better scientific understanding of who is at higher risk of outcomes (everyone in the 60 years plus group and any age group with comorbidities or weakened immunity), and the risks are known and largely predictable.
  • Arguably, COVID19 is less of a public health issue and more of an individual health issue.

A dynamic response strategy

Yet, a rise in daily new cases should not be ignored. However, continuing the five pronged ‘test, track, treat, vaccinate and COVID appropriate behaviour’ approach is not the best strategy for India any more and needs to be thoroughly revisited.

  • Urgently revise the indicators to monitor and track the COVID-19 situation. The two operational monitoring indicators which should be used now can be daily new symptomatic COVID19 cases and new hospitalizations.
  • Any setting which reports a spike in COVID-19 cases should be prioritized for enhanced and expanded genomic sequencing, including the sequencing of all hospitalized COVID19 cases and a subset of asymptomatic and the mild symptomatic cases, to track the emergence of any variant.
  • A stronger linkage between health departments and the Indian SARSCoV2 Genomics (INSACOG) Consortium network conducting genomic surveillance is needed to correlate the variants and the clinical outcomes.
  • From now onwards the risk of SARSCoV2 infection in India (or any setting across the world) is unlikely to be zero. The facemask recommendations should be calibrated, targeted, context specific and evidence guided and not uniform for the entire population. Science communication and public education should be used to high-risk population groups to adopt such behaviour.
  • The mandatory facemasks requirement for school going children (implicit or explicit), is unscientific and without evidence. Mask guidelines for school children should be voluntary, without indirect coercion as is the case for some Indian States.
  • There is a known benefit of third shots of COVID-19 vaccines in select, specifically high-risk population groups, and hence just one additional COVID-19 vaccine shot to get some enhancement in the level of antibodies and possible protection makes some sense.
  • Every surge should not result in a renewed demand and a push for booster dose uptake for adults in all age groups.
  • A disproportionately high attention on COVID-19 is not completely innocuous and rather, it diverts attention from other equally and even more pressing health needs such as tuberculosis, diabetes and hypertension, which affects a far greater proportion of India’s population. It is undoubtedly time, Indian States bring the attention back on longstanding health challenges and on strengthening primary healthcare services.

Way Forward

SARSCoV2 appears to be on influenza’s trajectory. Factoring in country-specific SARS CoV2 epidemiology, the population-wide application of the pandemic response in India can be transitioned to be focused on individual protection. India’s COVID-19 response strategy, in the days and the months ahead, should focus on protecting the vulnerable; promoting voluntary facemask use; strengthening COVID-19 surveillance, and using local COVID-19 data for decision making. We are on the path of learning to live with COVID-19.

Source – The Hindu


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