Paying a heavy price: Epidemiologists versus bureaucrats

Medical associations assert that it would have been much better had the government of India consulted epidemiologists who had better grasp of disease transmission dynamics than heavily rely on bureaucrats.

The Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and the Indian Association of Epidemiologists (IAE) in their second joint statement on COVID-19 pandemic in India issued on May 25 pointed out that India’s nationwide lockdown from March 25, 2020 till May 31, 2020 has been one of the most stringent steps ever taken. However, COVID-19 cases have increased exponentially through this phase, from 606 cases on March 25 to 1,38,845 on May 24. These associations assertively stated that it would have been much better had the government of India consulted epidemiologists who had better grasp of disease transmission dynamics than heavily rely on bureaucrats.

The joint statement said that from the limited information available in the public domain, it seems that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills. “Policy makers apparently relied overwhelmingly on general administrative bureaucrats. The engagement with expert technocrats in the areas of epidemiology, public health, preventive medicine and social scientists was limited. India is paying a heavy price, both in terms of humanitarian crisis and disease spread”, said the associations.

Without mincing words, the IPHA, IAPSM and IAE said that the “incoherent and often rapidly shifting strategies and policies”, especially at the national level, are more a reflection of “afterthought” and “catching up” phenomenon on part of the policy makers rather than a well thought cogent strategy with an epidemiologic basis. The joint statement argued that had the migrant population been allowed to go home at the beginning of the epidemic when the disease spread was very low, the current situation could have been avoided. The returning migrants are now taking infection to each and every corner of the country; mostly to rural and peri-urban areas, in districts with relatively weak public health systems.

These associations also warned that it is “unrealistic to expect that COVID-19 pandemic can be eliminated at this stage given that community transmission is already well-established across large sections or sub-populations in the country”.

Well aware of the fact that so far no vaccine or effective treatment is currently available or seems to be available in near future, the statement also pointed out that case fatality rate in India has been relatively on the lower side, and mostly limited to the high risk groups. IPHA, IAPSM and IAE also observed that the lockdown cannot be enforced indefinitely as the mortality attributable to the lockdown itself may overtake lives saved due to lockdown mediated slowing of COVID-19 progression. Abundant scientific and evidence-based interventions are available to control the pandemic at state and district levels in India. These measures should be implemented while at the same time ensuring optimal provisions for the livelihood of the poor and marginalized.

IPHA, IAPSM and IAE have recommended 11-point action plan during current COVID-19 pandemic. The 11-point action plan include constitution of a panel of inter-disciplinary public health and preventive health experts and social scientists at central, state and district levels to address both public health and humanitarian crises and free sharing of data in public domain. All data including test results should be made available in public domain for the research community to access, analyze and provide real-time context-specific solutions to control the pandemic. It has been suggested that the government should lift the lockdown and replace it with cluster specific restrictions based on epidemiological assessment.

While suggesting the resumption of all the routine health services, these associations said that the brunt of disruption of health services may even be higher in days to come. They have recommended that governments, media and local organisations need to be pro-active by making people aware and treating them with empathy and respect while conducting extensive surveillance for Influenza like Illnesses (ILI) through ASHA/ANMs/MPWs, and Severe Acute Respiratory Illness (SARI) through clinical institutions (including private hospitals), daily reporting to identify geographic and temporal clustering of cases to trace transmission foci (hot spots/cluster events). This must be supported by

trained epidemiologists from local medical colleges and public health institutions. Governments need to support free testing in private laboratories as well. As the number of (potential) contacts as well as returnee migrant populations continue to increase rapidly across the country, home quarantine need to be promoted and protocols followed with active participation and support from frontline health workers and local communities.

First Published:June 3, 2020, 10:14 a.m.