India COVID fight: Simply not enough resources, says task force member


Dr Naman Shah, an epidemiologist and physician advising an Indian government coronavirus task force, feels that though rural India has so far not been affected by the COVID-19 pandemic, it is only a matter of time.

Dr Naman Shah

In an email interview with indica News, Dr Shah fielded questions on the coronavirus situation in India, which is the third worst-hit country in the world with more than a million infections recorded already.

What is the job of the coronavirus task force that you are part of?
The Indian Council of Medical Research (ICMR) has stepped up to help lead the response to COVID-19 in the country. I am a member of the Epidemiology and Surveillance Working Group. Our team of ICMR scientists and external members helps develop and prioritize research projects, conducts data analysis, and provides advice to ICMR and the government on the trends and monitoring of the disease. Working at the level of such a large and diverse country is a challenge but the experience has been positive, and I have learned a lot from the other committee experts.

Over a million people have been infected in India by the novel coronavirus and the numbers of both deaths and cases are rising to newer highs. What’s the reason behind the steep rise of COVID in India?
India has a high population density and this disease is very contagious. I think the rise in cases is expected. Our public health system has been chronically underfunded so while states have done their best to test, contact trace, and isolate, there are simply not enough resources given the extent of the epidemic.

Which parts of India have become more COVID infected? What could be the cause and are there enough treatment resources for them both in the rural and urban India?
So far, the cities are the worst affected. This is because the infection first arrived in Delhi and Mumbai as major international hubs and since then the living and working structures of the population enable high contact and spread.

When a man like movie star Amitabh Bachchan and his family test positive for COVID-19, and I am sure they must be taking precautions, what does it signify, how grim is the situation in India?
I think this speaks more to the virus than India. It just enough deadlier than the flu but still very transmissible. Other than movie stars, even heads of states like Boris Johnson have become infected.

What medicines are being given to COVID-19 patients in India?
There are many different protocols in use. Patients with severe disease are receiving steroids, remdesivir, plasma therapy, hydroxychloroquine, and more. However, only dexamethasone in those requiring oxygen or a ventilator has shown any survival benefit thus far. In a new disease we have many unknowns but with careful research, including trials in process by the ICMR, we can improve our protocols with time.

What is the scene on a vaccine from India?
The Indian vaccine industry, among the largest manufacturing capacity in the world, has an important role to play. Some early safety trials have started but it will be a while before we know what works.

Many Indian states and cities are going in for fresh, stringent lockdowns. What is the main challenge? Is it still a mysterious virus? Or is it about shortage of resources such as personal protective equipment (PPE)?
We are facing different epidemics with different challenges in very different contexts. This is true around the world and within India. In some cities, it is difficult to get tested, in others the hospital or ICU beds are nearly full. The truth is we don’t always have a complete picture, instead we get partial feedback. I do think we need better real-time measures for these processes, testing, PPE and hospital capacity to help solve local problems.

Do you think the Indian government failed to control the pandemic? How is the situation in rural India?
Rural India has been largely spared thus far. But it is only a matter of time. I don’t think control is the right word for this pandemic. Our perspective should really be on how to best deal with living with the virus which will be with us for some time.

Do you think India imposed a stringent total lockdown too soon, given that cases are touching new highs every day and the economy is being forced to open up because it is in dire straits?
I think lockdowns can be useful tools but are best applied locally on a case by case basis using local data. Ideally they are applied near or before peaks, so that the system doesn’t collapse, but not applied too liberally either which is disruptive to people’s social and economic lives with the worst burden carried by the poor whose incomes were strained to begin with. People should not die of COVID, but they should also not die of hunger or in childbirth if they cannot get to a hospital.

Researchers from MIT have warned that India might record as many as 287,000 coronavirus cases per day by the end of winter 2021 in the absence of a COVID-19 vaccine or medicines. Do you agree with that projection?
I don’t put much stock in model projections. I also don’t know how many of the infections that occur we will be able to record. Many will asymptomatic and not be tested. It depends on the choices we make in the coming months and also what new tools are developed to help us.