While India currently has low fatality rate and high recovery rate for Covid patients compared to many other nations like the US and Brazil, the country needs to stick to basics like wearing masks, physical distancing and maintaining hand hygiene and surface disinfection till a safe and effective COVID-19 vaccine is found and the pandemic abates. This was stated by distinguished panelists who took part in a webinar organised by the Association of Healthcare Providers of India (AHPI) on the theme of “Covid Care: Community Transmission and Herd Immunity.”
The discussion was chaired by Dr Girdhar J. Gyani, Director General, AHPI, and included speakers such as Dr Alexander Thomas, President, AHPI; Dr Vinay Aggarwal, MD, Pushpanjali Medical Centre; Dr Alok Roy, Chair FICCI Health Services Committee & Chairman Medica Group of Hospitals; Dr. Narottam Puri, Advisor, FICCI Health Services Committee; Dr. Suneela Garg, Director Prof., Dept. Of Community Medicine, Maulana Azad Medical College, and Dr. Sanjeev Singh, Chief Medical Superintendent, Amrita Institute of Medical Sciences.
Addressing the audience, Dr. Gyani said, “India is in a much better position than countries like Brazil or the US in terms of COVID-related fatalities or recovery rate. India is seeing only 30 deaths per million COVID patients compared to a staggering 464 for Brazil and 492 for US. India’s recovery rate has gone up to 65 per cent, which is good. Fatality rate too has been continuously dropping. From 3.6 per cent at one time, it has dropped to 2 per cent now, though our wish is to see it go down to 1.5 per cent.”
In his presentation, Dr. Singh said, “COVID 19 is a public health crisis. Though the infection rate is high, the fatality rate is low in India, with low per lakh death rate, low crude mortality rate, low case fatality rate and low crude infection rate. The best way to approach the pandemic is screening actively, conducting contact tracing, testing in accordance to symptoms, with RT PCR being the gold standard diagnostic test, and symptomatic management. Early recognition and referrals to high-dependency unit or critical care unit is essential. To reduce community transmission, vaccination would play an important role. Six study groups are in Phase 3 trials and promising results are expected on short-term and long-term immunity. The most urgent step is to go back to basics with wearing masks, adhering to physical distancing and maintaining hand hygiene and adequate surface disinfection.”
Giving her point of view, Dr Garg explained,“There has been a shifting in epicenters of COVID in the last one month whereby Andhra Pradesh and Karnataka have maximum growth rate while Delhi is faring much better. If community transmission begins to occur, isolation and quarantine will have limited or no role to play. Community driven social changes will then play an important role in containing the spread such as wearing masks, washing hands regularly and maintaining social distancing. Lockdown in specific clusters will also be required. Herd immunity is indirect protection from a contagious infectious disease of a population through vaccination or through immunity developed from a previous infection. While isolation and quarantine open doors to reinfection, herd immunity offers protection in the long run. However, community transmission in a country like India may prove to be catastrophic and reinfection will prove to be a major factor preventing herd immunity.”
Dr Thomas opined,“Things are still evolving with respect to COVID. Prevention of COVID cases and fatalities includes steps like coming early to hospital if one has symptoms, focus on elderly and those with comorbidities, wearing masks, physical distancing and sanitisation. Government has to enforce wearing of masks strictly as many people are still not wearing these or wearing them improperly below their nose. We need adequate availability of beds equipped with oxygen and ventilators, as well as human resources such as doctors and nurses. Private hospitals are overwhelmed while there are few takers for beds in Government hospitals. Public private partnership is critical in meeting healthcare challenges like COVID.”
Giving an overview of the impact of the pandemic on the private hospital sector, Dr Roy said, “The pandemic has had a cataclysmic effect on the socio-economic fabric of India. Private hospitals are facing the stark financial reality of liquidity crunch in keeping patients safe. The healthcare delivery space is extremely capital and people intensive. We at FICCI have been urging the Government to provide financial stimulus up to minimum 3 per cent of GDP. The private healthcare domain should be incentivised to develop skills to handle a pandemic of this nature. Specific funds like Healthcare Infrastructure Fund and Healthcare Innovation Fund should be developed to boost entrepreneurship, start-ups and newer business models, which are needed to improve access, availability and quality, especially in smaller cities and rural areas. The serological surveys being conducted are effective as they help authorities make informed decisions about interventions that are needed to contain the pandemic. It will give us an outlook whether India can achieve herd immunity. The infection rate has been rapidly rising since the Government began to ease lockdown restrictions. India has logged a million new cases since then, but the recovery rate stood at 67.61 per cent, which means that over 13 lakh people have recuperated. While hospitals treat the patients affected by the virus, they should simultaneously take adequate precaution for non-COVID critical care patients. With timely case identifications and better and quicker turnaround of testing facilities, we are moving towards a phase which will help us stay ahead of the pandemic.”
Dr Puri spoke about how healthcare is going to fundamentally change after this pandemic. As he put it, “It is increasingly being seen as a basic human need and there will be lot of pressure from the masses on policy makers and politicians to deliver quality and affordable healthcare for all. COVID has also triggered social and cultural changes with the need for social distancing. These will have an impact on overall healthcare because a large part of our diseases comprises of respiratory infections, and this preventive social behavior will help bring down their incidence. Another change will be in how our hospitals are functioning. Pandemics are never won by the hospitals; they are won by communities and individuals. So we will now need to move from hospital mitigation to community mitigation, and from community mitigation to individual mitigation. We have been caught napping as were too focused on non-communicable diseases. Hospitals design and structural changes may become imperative now to prevent infections from passing on from one patient to another. Digital technology is going to change the face of healthcare delivery. We are already seeing the increase use of telemedicine which will become important in chronic disease management. Home healthcare will also get a major boost.”
Dr Aggarwal emphasised that the gold standard to contain COVID still involves the proper use of masks, sanitisation and social distancing, followed by testing and home isolation. Initial mis-management led to where we are today. Adding to this he said, “There was a lack of coordination from officers from the state to district level regarding COVID management, due to which cases have exponentially increased. In the last 15 days, the cases have doubled in the country. COVID has given hard lesson to healthcare organisations to reorganise, reframe and restructure. Digital platforms and telemedicine are going to be the main paradigm shift in healthcare going forward.”