"Not doing enough to inform people": Former Health Secretary K Sujatha Rao on India's battle against coronavirus

Are we doing enough to stop the spread of novel coronavirus?

So far so good. There are relatively very few cases. We have to wait as they (the authorities) are expanding their testing sites and getting more samples to know whether we are still in the cluster or the second phase, or we have moved into the community penetration mode. 

Since the ICMR said that we are the second stage of the Covid-19 outbreak, then we are in the second phase because there is no other data available in the public domain to counter the claim. But unless and until they do some more testing, it's difficult to know if the virus has spread into the community or not. 

What steps has the government taken to suspend outbreak to stage 2?

A strategy is already in place. They are doing social distancing. Almost half a dozen states have shut down almost every place where people could congregate. I understand that in some places, they're even trying to shut down the local trains. So they're trying to implement social distancing in whichever way possible. Which was proved to be extremely effacacious in Singapore, Taiwan and most importantly in Wuhan. 

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They are also effectively doing contact tracing. We have seen in Kerala itself that it was very quick, expedetious and speedy contact tracing that they did, which helped them identify and diagnose the first three cases, then there was a lag before the second round of cases came up. But they (the health department) seem to have their act together on contact tracing and getting hold of the people who came in contact with the affected people. So I think that's an extremely effective strategy which we have applied before, even for HIV AIDS, 

Social distancing and contact tracing are key cornerstones of our public health strategy. 

How do you rate the government's efforts to raise public awareness and to inform people?

I am not too happy with how much the authorities are doing to inform people. I hope and wish there was much more intensive information and communication activities. When people say there is panic, part of that fear and panic is that there is not enough information about the virus or how it spreads and how it does not spread. So I think that knowledge is extremely critical. So I hope they bring in all these measures into full swing as quickly as possible. 

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There is a thought that India is reporting less number of cases because we are not testing enough people. What do you think?

I am interested in is tracing out people which have the covid-19 infection. I had the cold and a cough the other day, but I am not infected by coronavirus. There are many viruses in the environment. The symptoms of Coronavirus are very clear, as has been said by the doctors treating all these patients, that you must have fever, must have cough, you must have some amount to throat-ache, you must be feeling a little weaker - these are some of the symptoms that say that you could possibly be having Coronavirus. And it's such people who ought to be tested. It's not like everyone of the 1.3 billion stand in a line and say test me. No, not all.

If you look at the data, since 7th March they stepped up testing and right now it's over 12,000 samples that they have tested. Of which about 7,000 are just in the last 10 days. Corresponding to the increased testing is also the increased number of positive cases that have been identified. So testing is extremely important and as you see in the statements made by the DG, ICMR, they are trying to expand access by increasing the number of laboratories both in the public and private sector. I welcome that measure and I hope that they make it easier for people to access testing sites.

Secondly, I also worry about the delays in getting the results across and for that I think the DG, ICMR has said that the states will identify the laboratories which can do the confirmatory testing. If that is actualised, then the time lag between taking the swab and sending it to the laboratory and getting the second confirmation, which is very important to the patients can be shortened leading to a very good development. 

I think the DG, ICMR should give us the results of the thousand random samples that they tested, very soon. That will give us an insight into whether the virus is going beyond those who have a travel history. 

Also they shouldn't end with this. Rather, they should do more and more testing of random samples, to get to know about where exactly the virus is. 

Government had been pushing for more of an insurance-based private health infrastructure, so do you think coronavirus outbreak will lead towards a course-correction in favour of a stronger public healthcare system?

I won't want to put this issue in the public-private binary debate. It's the state's responsibility - that is the central and the state governments together - to contain infectious diseases and ensure population health. That cannot be outsourced to any private sector. No country does that. Also this crisis has externalities which the private sector cannot handle or even expected to handle.

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Infectious diseases fall under the category of public goods and therefore the state's role is primary and very central. Now, coming to the fact whether we should outsource and have a more privatised health system, well I'm not for it. I'd rather have a controlled and regulated private sector, but definitely have the public sector equally good and equally strong so that they provide a much more competitive environment. You can't have a situation like in the US, where the entire health system virtually is in the private sector. Because it is very costly and that is something that we can't afford. 

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Coming to the infectious disease laboratories and infrastructure, I think it's very critical that India invests more money, more institutes like National Institute of Virology, Pune. We should have excellent laboratory infrastructure to cope with public health requirements, because unlike other countries, we still have leprosy, we still have Tuberculosis, we still have the burden of infectious diseases. So it's extremely important for us to have the infrastructure in the public domain to ensure that we are able to contain the infectious diseases in India.

If you were a part of the health ministry now, what you'd have done differently?

What I'd have done is what my colleagues are doing. That is to intensify social distancing, contact tracing and ensure that all the states are on board. But I'd have focused a lot more on information dissemination. I'd have also done a lot more testing and most importantly, I'd have persuaded my political leaders - whether it's a minister or the Prime Minister, because you need the PM's support behind you. Which is there in this case right now. But I'm saying it in the context of having even the Chief Ministers on board. 

I think that kind of a face-to-face meeting between the Prime Minister and the Chief Ministers would go a long way in giving the much-needed political leadership at the state level and a more coordinated approach to the entire battle against Covid-19, should it unfold to become more intense in the days to come.

I am not at all suggesting that it's not there, but I'd like to see the Prime Minister call upon all the chief ministers of the states to come and get as serious as he is in implementing the measures that are required at the state level. Because you must remember, that disease control as per the seventh Schedule of our Constitution is a concurrent responsibility - both the centre and the state have an equal responsibility to handle infectious disease control. Therefore it's neither just the baby of the centre, nor is it just the responsibility of the states to get. Together they have to see that health security is obtained for the people of India.