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In an exclusive interview, the Union’s Minister of Health, Harsh Vardhan, states that the blocking measures cannot continue forever and that it is an extreme intervention to break the chain of transmission. “The closure has great repercussions for the economy, society and psychology,” he says. The Minister adds that worldwide, so far, seven candidate vaccines are in a clinical evaluation stage, while 82 are in a preclinical evaluation stage, which includes those developed by half a dozen Indian companies.
How long can we continue with the block, social distancing and delayed transmission in the absence of any treatment? Also, are there leaders in the WHO solidarity trials?
It is true that in the absence of treatment, social distancing measures cannot continue forever to restrict transmission. Blocking is an extreme social distancing intervention available to break the chain of transmission and prevent the spread of the disease. This does not destroy or kill the virus, but it is an important measure that flattens the peak of the epidemic, slows the growth of the epi curve, and provides time for health and social systems to mount a response. Blocking and social distancing, when supported by public health measures such as case detection, contact tracing, isolation, and case management, help contain the disease effectively. At the same time, a nationwide blockade has socio-economic implications, in addition to health-related problems. Given the diversity of a country like India, it becomes essential to use this extreme strategy wisely.
Regarding the leader in solidarity trials, based on laboratory evidence, animal and clinical studies, four treatment options were identified: Remdesivir; Lopinavir / ritonavir; Lopinavir / Ritonavir with interferon beta-1a; and chloroquine / hydroxychloroquine, which are under consideration. International clinical trials have begun to evaluate its relative effectiveness against COVID-19. By enrolling patients in multiple countries, the solidarity trial aims to quickly discover whether any of the medications slow disease progression or improve survival. In addition, seven candidate vaccines are in the clinical evaluation stage, while 82 others are in the preclinical evaluation stage, including those developed by half a dozen Indian companies as well.
Does the government recommend opening certain areas due to economic considerations, knowing that the virus has not yet peaked in India and the prime minister has said it will occur in June-July?
As I have indicated previously, although the blockade is of great importance to break the chain of transmission and control of the disease, it has great repercussions for the economy, society and psychology. Therefore, any decision on the relaxation of the confinement after its continuous imposition must take into account the wide diversity in the country and such relaxation must be made in such a way that it does not harm the gains in disease containment during the confinement. At this stage, it would suffice to say that we need an optimal combination of relaxations and restrictions so that disease control continues with little or no impact on the economy.
Taking this into account, while designing the strategy of dividing the country into three zones: green, red and orange, identifying the containment regions in the red zones, as well as identifying possible relaxation in various zones, we are ensuring that the situation of the disease is regularly monitored at various levels throughout the country and the situation does not deteriorate.
India appears to have a particularly large number of asymptomatic patients. How will we handle this group now in the absence of aggressive testing that was proposed for this period?
An asymptomatic case is a person infected with the COVID-19 virus, as confirmed by a laboratory test, but does not develop symptoms. Asymptomatic transmission refers to the transmission of the virus from a person who has the disease without any symptoms. There are few reports of laboratory confirmed cases that are truly asymptomatic, and to date, there have been no documented cases of asymptomatic transmission. However, this does not exclude the possibility that it may occur. Asymptomatic cases have been reported as part of contact localization efforts in some countries.
A patient develops symptoms when the viral load is high in the throat and nose and the diagnosis of infection can best be made using the RT-PCR test when a patient reports symptoms. Almost 80% of COVID-19 patients tend to report no or very mild symptoms, and such patients may not even report such mild symptoms when presented in isolation. Recently, the Center for Disease Control and Prevention (CDC), Atlanta, USA. It has also included symptoms of headache, muscle pain, conjunctivitis, loss of smell, loss of taste, severe chills, and sore throat in the COVID-19 list of symptoms, although additional studies have been recommended before these symptoms. Finally they can be included in the list, it is known that these symptoms may be present but not reported by patients in India.
Any infection carrier can present challenges in containing the transmission of COVID-19 to others. However, all those who are contacts of any laboratory confirmed case are advised to isolate the home and maintain a safe physical distance. Identifying all of these asymptomatic cases will require repeated testing of our Rs 130 million population, which is a costly and time consuming exercise for any country and is neither possible nor recommended due to its feasibility.
Where is India in terms of infrastructure to handle a surge in cases (beds / ventilators / blood capacity and dialysis machines)?
India is in a reasonably good position in terms of infrastructure to handle an increase in cases. Before going any further, I would like to inform you that 80% of COVID-19 infections are mild or asymptomatic, 15% are serious infections requiring oxygen, and 5% are critical infections that may require artificial ventilation. The most important thing is the supply of oxygen, which is needed in 20% of cases, 15% through masks or cannulas and 5% through a ventilator.
As of now (May 6), the status in dedicated facilities identified by the Central Ministries, States, and UTs is: Total number of 2.41,505 isolation beds (excluding ICU beds), total beds ICU is 27,663, the total number of beds with oxygen support is 88,753 and the beds with ventilators are 19,257. In addition, several national fan manufacturers have been identified and orders have been placed for 60,848 fans, which will be phased in in May and June. Many hospitals and medical colleges are increasing the number of ventilator beds. Several hospital owners in the private sector have come forward to dedicate their facilities to the nation’s cause.
Dialysis facilities are available across the country through the Pradhan Mantri National Dialysis Program at 862 dialysis centers through 5,305 dialysis machines across the country. In addition, the data suggests that the prevalence of acute kidney problems among COVID-19 patients is low. We have published revised dialysis guidelines in view of COVID-19. For the management of blood requirements in the country, an online portal, e-RaktKosh, is available, which manages the reception, issuance and current availability of blood. The blockage has resulted in a decrease in blood donation due to the restricted movement of donors and mobile trucks. However, I have written to the State and UT Ministers of Health to issue special permission to voluntary blood donors, as well as mobile vans to facilitate their movement and promote blood collection during the closing period. To date, we have around 3,311 licensed blood banks in the country that collect almost 12.4 million units of blood per year.
I myself organized a video conference with volunteers and Indian Red Cross officials across the country to facilitate blood collection. I also opened a blood donation camp at Red Cross facilities on May 4 to encourage voluntary blood donation. In addition to this, I have also been holding regular meetings (via video conferences) with various social support organizations such as Rotary International, Lions Clubs International, my own political party workers, etc. and exhorting them to come forward and participate wholeheartedly in voluntary blood donation. . We are committed to maintaining an adequate supply of safe blood and ensuring its proper use for those in need.
Given that hospitals are becoming hot spots and India has traditionally run out of medical personnel, how will we manage when the shutdown ends and people go out and the transmission hits again?
It is a fact that the COVID-19 outbreak has placed unprecedented demands on our already overburdened healthcare system. However, given the current scenario and the crisis posed by COVID-19, our health and workforce centers are currently busy with many related activities. Resources available with other government departments such as railways, ESIC, defense, and other public sector units have also been actively activated. Various professional bodies such as the Indian Medical Association (IMA), as well as nurses’ associations, also participate in this gigantic task of controlling COVID-19. Physicians belonging to various streams of traditional medicine under AYUSH are also assisting with control measures.
Furthermore, the government has also taken proactive steps to engage with the large pool of private sector health resources available in the country. The central government and states maintain an ongoing dialogue with private associations of healthcare providers and hospital chains. As I said earlier, several hospital owners in the private sector have come forward to dedicate their facilities to the cause of the nation.
Without autopsy, etc., are we eliminating possible COVID-19 deaths? What is called the death of COVID-19?
COVID-19 death is defined as a death resulting from a clinically compatible disease in a probable or confirmed case of COVID-19, unless there is a clear alternative cause of death that cannot be attributed to COVID-19. There should be no complete recovery period between the disease resulting from COVID-19 and death. You see, the main purpose of an autopsy is to determine the exact cause of death, if the doctors cannot determine it, or if you are under challenge. Therefore, the majority of autopsies performed worldwide are medical or legal or clinical. Medico-legal autopsies are carried out in cases of unnatural, unanticipated or suspicious deaths in accordance with the laws of the country. This is also the principle followed in India. In the event of COVID-19 deaths, the treating physician can determine the cause of death of a patient under treatment, so there is no need for autopsy.
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