MAY 2020  
Special Report
War Against Novel Coronavirus: Weapons to Win this Battle

The number of novel coronavirus cases and deaths around the globe continue to shock us. The national preparedness or rather the lack of it haunts us. It is a concern, because we have a population of 1.3 billion in India, it is a bigger concern because nearly 900 million Indians live in 2 rooms or less, it is a still bigger concern because 15 lakh huddle up in the metro rail every day in a metropolitan city like Delhi.

Apparently healthy people could be carriers of the disease and this may prove lethal to their loved ones. The virus has no treatment, and the major weapons are quarantine and social distancing. The rapidly emerging knowledge from across the globe, informs us that being older, already suffering from a disease, puts a person at higher risk for the worst symptoms.

The crisis from COVID-19 brings to fore an interesting and unprecedented community-level action. While the boon of digital connectivity has opened new vistas of information, and has filled the gap of critical information, however it has fuelled fear. Would the new world order of protective and preventive action last beyond the virulence of coronavirus 19? COVID-19 has opened new discussions on funds for the health sector, the equity in availability of resources across urban and rural India and their adequacy within these communities. It lays bare the need for feedback loops which inform and determine on an on-going basis adequacy of the health care resources (for instance, India has a doctor: patient ratio of close to 1:10,000, as opposed to 1:1000 recommended by the WHO).  This information is needed to strengthen a bottom up approach so that affordable health facilities are really 'available'.

The Legacy

In our favour, is the fact that we are a younger population (median age of
28 versus 45 in Italy, and 38 in USA), fairly compliant, and deeply sensitive people. What is against us, in India, amongst the children 36 per cent are underweight; and 58 per cent anaemic; amongst the adult women 22 per cent have low body mass index (BMI) and 53 per cent anaemic.

Rural and urban health workforce combined gives a ratio of 31.6 per 10,000 in Kerala to 1.5 for a population of 10,000 in Bihar, and 2.2 in Himachal Pradesh and Assam. The highest density of qualified allopathic doctors was in Maharashtra (8.7 per 10,000); in comparison, states such as Bihar (0.3 per 10,000) and Himachal Pradesh (0.1 per 10,000) had among the lowest densities of qualified doctors. The density of qualified nurses and midwives was highest in Kerala (18.5 per 10,000) and lowest in the states of Uttar Pradesh (0.5 per 10,000), Bihar (0.4 per 10,000), and Tripura (0.3 per 10,000). Needless to say there is inequity within the states, with better availability in urban than rural areas.              

The Government of India spared just 1.28 per cent of its gross domestic product (GDP) in 2017-18 on public health with a plan to increase to 2.5 per cent of its GDP by 2025 as opposed to the global average of 6 per cent. Nearly all of this is spent in developing a system which focuses on curing illness, and treating the diseased. Protecting public health through prevention is seldom emphasized. Surely, none of this can be a recipe for success of public health in India.

Our collective worries about preparedness are real and true for any epidemic, let alone a pandemic. Especially as it has no treatment in sight, the consequences this time could be harrowing—as the carriers could potentially roam around unaware and unsuspecting for a long time. COVID-19 is now a pandemic. The situation is complicated by the absence of definitive treatment and lack of vaccine, thus making containment of disease challenging.

The Government of India has adopted measures to control the increase of coronavirus cases. The required control measures such as behaviour change (wearing face masks, social distancing, and so on) are difficult to sustain and strict control measures (lockdown, travel ban, school closing) are not sustainable over long period of time because of associated social repercussions and financial impact on economy. Therefore, the appropriateness of these measures needs to be continuously reviewed.

The immediate need to deal with the peak will be to have testing kits, setting up of new isolation wards, including turning hospital beds into intensive care unit beds, infection prevention and control amongst essential service providers, and purchase of personal protective equipment (PPE), ventilators, and medicines, particularly for district hospitals and designated infectious disease hospitals. With the legacy of abysmally low healthcare provider to population ratios, this would be exceptionally tough in some of the states.Social distancing, lockdown,
strict travel ban, contract tracking to flatten the curve are the only means to attenuate the burgeoning need for the ventilators or the required isolation beds. Needless to say patience is needed by those in lockdown.

Transition Is Required for All Viruses to Come

While we will successfully tide over this crisis, we need 4 A’s in our quiver to ace this war or any other future war for protecting public health. The 4 A’s would create more health care actors across all states, bring agility in the health system to respond proactively through tracking change in diseases, integrate accountability into the health care system to fill the gaps in health care provisions, and attack the disease before it gets a chance to become a public crisis, that is, prevent to flatten the burden on the health care providers for all disease linked to air, water or climate.

None of the A’s is earth-shaking recommendation, or revelation. However, each needs to be considered deeply and acted upon as health crises are mostly preventable in India. Flattening the curve is required and plausible for nearly all diseases, if only we measure and track them.

Even more relevant, would be to question our practice and belief, that absence of data is absence of disease, be it effects of air pollution, or climate change. Would COVID-19 jolt us into re-aligning our priorities, in building infrastructure with ethos in protecting the people through cleaner environment, freedom from toxic air, or contaminated water?

What Can We Learn from Our Past Experiences?

What is very apparent is that India is not shielded from disasters, whether, natural or man-made. What is uncertain is how seriously does India prepare for future threats and take action for better health protective infrastructure and policies, or puts deeper thought into tracking the healthy, and adopts transformative changes to protect its people.The 1918 influenza pandemic, showed that India had one of the largest number of deaths in any single country (10-20 million) as well as one of the highest percentage of excess deaths (4.39 per cent) in the world.

Testing times were also faced during September 1994 when plague struck Surat in Gujarat. Hospitals in a number of neighbouring cities of Surat were alerted for possible arrivals of plague-infected people. Government had to forcefully stem the exodus with the help of paramilitary forces and prevent the disease from spreading. Because the disease was diagnosed and suppressed quickly, the outbreak did not have the devastating impact originally feared, but it generated considerable anxiety worldwide. The plague outbreak is pegged to have resulted in a total business loss of over $260 million in Surat. Since then, Surat’s disease surveillance system has been ramped up, and infrastructure enhanced.

Not long ago, on October 29, 1999, a super cyclone with a wind speed of 300 mph had struck Odisha, making it probably the greatest cyclonic disaster ever recorded in the last century. Effects included a death toll of over 10,000 people, children were orphaned, people injured and livestock lost, over 13 million people were feared affected.  In the aftermath of the super cyclone, the capacity of the Indian Meteorological Department was enhanced; knowledge network that includes the Indian Meteorological Department, Earth System Science Observation, the Indian Space Research Organisation, Central Water Commission, Geological Survey of India, and National Remote Sensing Centre has been created. This network is generating critical information to avert harm from future disasters.

What is uncertain is how seriously does India prepare for future threats and take action for better health protective infrastructure and policies, puts deeper thought into tracking the healthy, and adopts transformative changes to protect its people. Each disaster, has led to a better system, so would the COVID-19 crisis. Building social capital, investing in prevention, are long-term investments in people, in infrastructure for their health, building health system for sustainability networks of knowledge, would be a dream come true.

Health and economy could be so intertwined was not so easy to show until now! Impending disasters from hazardous levels of pollution, warming temperature, threatened nutrient supply linked to climate change, do not conjure up a healthy future for India. Pivotal change, required, would be a marked increase in public expenditure on health as percentage of GDP. 

Ms Meena Sehgal, Fellow, CWM, TERI, New Delhi.

© TERI 2020

Nominations open for CSP Today India awards 2013

The inaugural CSP Today India awards ceremony takes place on March 12, and CSP developers, EPCs, suppliers and technology providers can now be nominated.

CSP has made tremendous progress since the announcement of the Jawaharlal Nehru National Solar Mission in 2010. With Phase I projects now drawing closer to completion, the first milestone in India’s CSP learning curve is drawing closer. CSP Today has chosen the next CSP Today India conference (12-13 March, New Delhi) as the time for the industry to reflect upon its progress and celebrate its first achievements.

At the awards ceremony, industry leaders will be recognized for their achievements in one of 4 categories: CSP India Developer Award, CSP India Engineering Performance Award, CSP India Technology and Supplier Award, and the prestigious CSP India Personality of the Year.

Matt Carr, Global Events Director at CSP Today, said at the opening of nominations that “CSP Today are excited to launch these esteemed awards, which will enhance the reputation of their recipients. I am particularly excited to launch the CSP India Personality of the Year award, a distinguished honor for the industry figure deemed worthy by their peers.”

All eyes will be on the CSP Today India 2013 Awards when nomination entry closes on February 4 and the finalists are announced on February 11. The awards are open to all industry stakeholders to nominate until February 4 at or by e-mail to [email protected]

Matt Carr
+44 (0) 20 7375 7248
[email protected]