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Have adequate facilities, but we are ramping up hospital capacity by 40%

CK Mishra, chairman of the empowered group on hospital availability, disease surveillance, testing and critical care, said India’s Covid-19 count will plateau with people’s effort to cut down transmission.

, ET Bureau|
Last Updated: Jun 02, 2020, 08.46 AM IST
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CK Mishra, chairman of the empowered group on hospital availability, disease surveillance, testing and critical care.
CK Mishra, chairman of the empowered group on hospital availability, disease surveillance, testing and critical care, said India’s Covid-19 count will plateau with people’s effort to cut down transmission. Mishra, who is also the outgoing Union environment secretary, discusses the government’s Covid-19 strategy in this interview with Anubhuti Vishnoi. Excerpts:

On longer lockdown
In hindsight, there will be many views and it will be a matter of public health debate. At the time the lockdown came, there was a challenge and it was felt that the lockdown was best to address it. And there are huge dividends from that--from initially cutting transmission to reducing deaths and giving time for preparation.

At the end of the day, the government has to slowly allow people to resume their life. A huge responsibility is now on the people.

On virus numbers
It is not as if the infections will end by the month-end. Fresh infections as well as positive rate will increase, especially as we ramp up testing - this is nothing to be alarmed about. The progression of the disease is fortunately not exponential and we are on predictable lines to far.

Several modeling forecasts point at a July-August peak.

Also, beyond a timeframe, the number of Covid infections becomes irrelevant.. The numbers will plateau by people’s effort to cut down transmission.

What becomes relevant for the government is management of cases, control of death rates.

We have a mortality rate of 3-4% as on date; not more than 6-7% of the affected are in hospitals—as per our learning over the last two and half months. In the Indian context, our recovery rate is very good.

Given this trend, our concentration is, and should be, on treatment in hospitals and creating enough capacities to check mortalities.

On virus and India
Our ability to withstand the virus is much better than other countries. There could be several reasons from BCG, etc., to it, but it is a fact, so far.

There was excessive focus on ventilators, keeping the western experience in mind, but we shifted the narrative to availability of oxygen beds, which has served us well with higher recovery rates.

This also clearly shows that country-specific strategy is key.

On the Mumbai-Delhi problem
When we started, our strategies were uniform and all-India in nature. Now we have started shifting strategies to cities. One of the reasons for the problems in Delhi and Mumbai is density. So they need different treatment from a district, and that is being done for a fortnight now. Containment zones have been identified and enforcement has to be steered there to ensure there is no spread out.

On movement of migrants
Yes, Uttar Pradesh, Bihar, West Bengal and Odisha saw a sudden spurt in cases. However, we have also seen that even if they did have infection, hardly any of these people needed serious hospitalisation and they recovered on their own. So, the virus did travel with the movement of people but hasn’t caused the kind of damage it was expected to cause. Once the disease cycle is over, they will not shed and spread it to rural areas. Covid-19 is still - up to 85% - an urban phenomenon.

On low testing
There are mainly two reasons for states testing less--some states, particularly in the eastern part of country, did not have adequate testing infrastructure and, hence, couldn’t ramp up testing. Here we pushed in alternative technology like TRUNAT machines, and this has been addressed.

However, there were also states like Telangana and Gujarat where the testing was low despite presence of infrastructure. They have begun picking pace on testing again, but more needs to be done.

Tamil Nadu’s numbers are very high but their management of cases is quite good and, hence, their death rate is among the lowest. At one point, Gujarat deaths went up--and the issue was hospital-level case management. So containment and hospital case management are key.

On hospital readiness
Leaving aside a few cities, the majority of hospitals in the country have adequate facilities. Our district-wise analysis shows adequate facilities and we are creating an alternative arrangement to ensure additional 40% capacity. However, we will keep over preparing to meet any scenario.

On lessons from Covid-19
A key learning is that the state of urban health infrastructure is a cause of worry. In Mumbai, that is borne out clearly--both in terms of density and health capacities and investment in them. The Smart City mission must redesign itself to meet health infrastructure demands and municipalities need to be focussed on, especially in urban areas.

Also, we have not prepared ourselves for any outbreak of this nature. No coherent strategy was in place, because after the plague, we were dealing with sporadic outbursts, say of dengue, chikungunya and nipah, which were geographically specific. Preparation and capacity creation should have been all India level.

The biggest takeaway is that this is a opportunity to redefine and strengthen the health system. It is also critical to decide on how the partnership between public and private sector will move ahead in the country.

On role of private sector
The private sector associated themselves with this issue and come together with government but I don’t think we have been able to exploit their full potential of the private sector for various reasons from logistics to availability of doctors. They flagged off concerns on testing to us and we could address most of these - you now have 200 private labs testing for the virus. There are issues around financial liquidity which we are trying very hard to address. We may probably need a joint platform to address issues of concern.

On non-Covid patients
I am extremely concerned and pained on this issue as the overwhelming COVID-19 focus has left many people who need regular health monitoring without this care. More than 60% people go to clinics for their regular checks and it is essential that they open up immediately and even offer telemedicine. This needs a joint effort with the private sector.

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