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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 5  |  Page : 117-119

India fights the invisible: A saga of strategies, hope, and resilience


1 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
2 Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
3 Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India

Date of Submission01-May-2020
Date of Decision16-May-2020
Date of Acceptance02-May-2020
Date of Web Publication04-Jun-2020

Correspondence Address:
Dr. Mohit Dayal Gupta
Room 125, Academic Block, First Floor, GB Pant Hospital and Associated Maulana Azad Medical College, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_72_20

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How to cite this article:
Goswami S, Gupta MD, Batra V, Girish M P, Verma M. India fights the invisible: A saga of strategies, hope, and resilience. Int J Health Allied Sci 2020;9, Suppl S1:117-9

How to cite this URL:
Goswami S, Gupta MD, Batra V, Girish M P, Verma M. India fights the invisible: A saga of strategies, hope, and resilience. Int J Health Allied Sci [serial online] 2020 [cited 2020 Jul 2];9, Suppl S1:117-9. Available from: http://www.ijhas.in/text.asp?2020/9/5/117/285968



Sir,

There is light at the end of tunnel!

The world is going through the humanity's biggest invisible war – coronavirus disease 2019 (COVID-19) crisis. Such wars are not won individually, but collectively.

The first case of COVID-19, was described in November 2019 in Hubei Province of China. This was neither reported nor informed by China, and it was only in January that the World Health Organization did take cognizance, but still failed to acknowledge the severity of the problem. The COVID-19 has not only battered lives but has shattered economies globally. With more than 200 countries already affected, the disease has already devastating China, much of Europe (especially Italy and Spain), and some cities of the USA.[1] It is evident that the virus does not respect borders. Every country has to be prepared for its first: case, cluster, and community transmissions. To get it right or wrong is in our hands.

Developing countries like India were no exception. In a country of more than 1.3 billion people, it is a race against time and the virus while crossing obstacles such as extreme poverty in many areas and extraordinarily densely populated areas.[2] The first case in India was detected on January 30, 2020.[3] India followed a simple, smart, and dynamic strategy of observing, absorbing, integrating, and acting [Figure 1]. This is a dynamic interlinked process and has a direct impact on our survivability in a crisis.
Figure 1: Strategic approach to coronavirus disease 2019 in India

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It was evident that the management of this pandemic required acting at three levels of a pyramid: at the base were policy decisions for the whole nation, at the middle were individual steps for prevention at local level, and at the top was the hospital care for the infected patients. India recognized that its only chance to stop this pandemic rip through its population was prevention. It observed that even the countries with best health-care systems were unable to manage the situation. Hence, it was necessary that we acted on the roots: taking some tough decisions and formulating powerful policies.

India took almost 3 months to reach the first 100 positive cases of coronavirus (March 15, 2020), which then multiplied four times over the next 10 days. Comparatively, Japan saw a 13% daily increase in cases before reaching 100 cases and an 8.1% daily increase in cases from its 100th case to its latest. The decrease in the average daily increase is indicative of a flattening curve and several countries, such as South Korea and Singapore, were on the same path. Realizing that India is going in the opposite direction, the government enforced the Epidemic Disease Act, 1897, followed by the National Disaster Management Act, 2005, in mid-March. All organizations, educational institutions, and companies were asked to work from home and movement of people was restricted. All flights (domestic and international) were discontinued, and all passenger trains and buses were put to halt. Special flights were arranged to evacuate national citizens from other countries. Special buses were arranged to facilitate the movement of staff on duty. Knowing that millions of poor people would be left in running around for food, the central government, respective state governments, and many nongovernmental organizations have opened makeshift night shelters and distributing food and necessary material to millions of people across the country. This was the spirit of togetherness. India knew that partial measures would not help contain the spread of the disease and hence such harsh steps in the interest of the nation were important. This was unprecedented. Consequently, India has so far been able to limit the massive community transmission. It was evident that the gravity of the situation needs to be put across to everyone in the nation in a right manner keeping in mind the limitations that we have. From that perspective, the prime minister (PM) of India was clear and decisive. Understanding that such decisions in a democracy require the support of people of all races and ethnicity and states being governed by different policies, he gave an impactful emotional address as a citizen of India asking people to cooperate and support his decision for their well-being. He took everyone along with him. He is regularly connecting with the chief ministers of different states and key leaders of various political parties and social and religious organizations and even panchayat leaders asking for opinions and suggestions. This is the spirit of true leadership.

Integrating the data and information with preventive strategies and appropriate management patterns according to our needs is critical, and it requires intersectoral coordination. This is being done under the direct supervision of high-powered committee. Measures such as social distancing, mask wearing, and handwashing are the key strategies that have been put across to the public by messages, advertisements, and social and digital media as the key preventive measures.

A cluster-containment strategy was being adopted, seeing the successful results in eastern Asian countries. India started working on enhancing testing capacity, workforce training, and increase in hospital resources such as isolation wards, intensive care unit, and ventilator as done by countries like Germany which have a low case fatality rate. Sufficient isolation beds and supplies have been made available in the tertiary facilities across the country to manage any outbreak. The number of tests per million in the country was 5 as of March 14. In comparison, it is 26 in the USA, 76 in Japan, 1005 in Italy, and 4099 in South Korea.[4] India realized its limited testing capability, led primarily by the apex laboratory at the National Institute of Virology at Pune. The Indian Council of Medical Research (ICMR) started working on increasing its diagnostic ability, allowed private labs to test. Within a week, 111 additional labs for testing became functional on March 21. Pool testing was further approved by the ICMR in the low infection areas to increase the capacity of the testing and save resources.[5] This is one area where India needs to focus and work on. The scientists of India are working day and night to develop a vaccine against COVID.

The Ministry of Electronics and Information Technology launched a smartphone application called Arogya Setu to help in “contact tracing and containing the spread” of COVID-19 pandemic in the nation (in line with privacy and data security parameters). This has drawn global attention and praise. While all these are being done, one must understand that health-care facilities are much less accessible and available for a large portion of population as compared to those of Western countries. We cannot build a new health system now for sure but can appropriately triage the facilities for accommodating the increasing number of patients. A large number of quarantine facilities have been created by all the states. While sealing and cluster containment is being done after identifying the hotspots, this needs to be stepped up to prevent community transmission. Individuals, organizations, and institutions have come forward to contribute liberally to PM Relief Fund. The most important backbone of the health-care system are the health-care workers. Steps have been taken up at all levels to provide adequate personal protective equipment (PPE) to them, but the performance on this is still patchy. Lack of PPE might lead to quick decline in the number of health-care workers. The government has taken adequate steps for maintaining the safety and dignity of health-care workers and has enforced a special law against anyone attacking a health-care worker. They have also given special insurance covers to health-care workers.

The COVID-19 has not only battered lives but has shattered economies globally. If lockdown and distancing remain protracted, large parts of the economy would collapse. Can a developing nation afford to take the route of avoiding economic lockdown, allowing the epidemic to spread and treating those who get affected? India is ready to pay any price for saving the life of its citizens. Although India has managed to be in the plateau zone of pandemic curve, the curve is gradually rising. India is not among the worst-hit countries, but its grossly underfunded and patchy public health system, with huge variations between different states, poses special challenges for the country's disease containment strategy.

COVID-19 has not yet proven itself to be in the same class of lethal diseases – and may it ever be so – but at this point, the premier medical treatment is: “take measures not to contract it.” Adopting preventive strategies – repeated hand washing, maintaining distance, folding hands instead of shaking hands, usage of mask, working on oneself to increase immunity and better adaptation – remains the mainstay.

“It is not the strongest or the most intelligent who will survive but those who can best manage change.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO-China-Joint-Mission-On-Covid-19-Final – Report. Available from: https://www.who.int/docs/def ault- source/coronaviruse/who-chi na-joint-mission-on-covid-19-fin al-report.pdf. [Last accessed on 2020 Apr 16].  Back to cited text no. 1
    
2.
Isaac Chotiner I. How COVID-19 Will Hit India. The New Yorker: Isaac Chotiner; 2020. Available from: https://www.newyorker.com/ne ws/q-and-a/how-covid-19-w ill-hit-india. [Last accessed on 2020 Apr 16].  Back to cited text no. 2
    
3.
World Health Organization: Corona Virus Disease Situation Reports. Available from: https://www.who.int/emergencies/diseas es/novel-coronavirus-2019/situ ation-reports. [Last accessed on 2020 Apr 20].  Back to cited text no. 3
    
4.
2020 Coronavirus Pandemic in India. Wikipedia. Wikimedia Foundation. Available from: https://en.wikipedia.org/wiki/2020_coron avirus_pandemic_in_India. [Last accessed on 2020 Apr 20].  Back to cited text no. 4
    
5.
ICMR Strategy for Testing CoVID19 in India. Available from: http://www.newsonair.com/New s?title=ICMR-creates-new-strat egy-for-Covid-19-testing-in-Ind ia and id=385193. [Last accessed on 2020 Apr 07].  Back to cited text no. 5
    


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