March 22, 2020

COVID-19 Pandemic: ACT NOW- to Save Lives

THE Jan Swasthya Abhiyan(JSA) and AIPSN(all India people’s science network) has issued a comprehensive statement on the COVID-19  pandemic.  JSA and AIPSNA have called upon the government to strengthen public health services and to safeguard livelihoods.

From January 30, 2020, when the first case of COVID-19 was reported, the number of confirmed cases in India has risen to 153, and there have been three deaths. The government of India has reacted swiftly to this epidemic by curtailing international travel, screening those coming in from abroad and their contacts, and either isolating them if they have tested positive, or placing them in quarantine, if they are asymptomatic. This has no doubt helped delay the epidemic. But as the government knows the worst is yet to come. While immediate executive action in the form of isolation of patients and quarantines, and a high-pressure campaign for social distance is most welcome, this would not be sufficient if community transmission is established and the pandemic peaks.

The nation is particularly vulnerable because of a high degree of past neglect of public health services, and the privatisation of healthcare. The nation is also vulnerable because a large section of population is struggling to meet their minimum basic necessities and the last decade of economic and social policies have pushed them to the brink. In such a social and economic context, this epidemic may prove the last straw and lead to an unprecedented catastrophe.

COVID -19 is the name of the disease caused by a particular strain of coronavirus that originated in China and has been spreading across the world. In symptoms, it is remarkably similar to the seasonal flu, earlier flu and coronavirus pandemics, but has a mortality rate higher than the seasonal flu, but lower than the other flu and coronavirus pandemics. Over 81 per cent of those who are infected will have only mild symptoms, another 15 per cent would have severe symptoms requiring medical consultation and often hospitalisation and about four per cent would require critical care, which may include ventilator support and ICU care. Mortality is highest in those above 80 years of age. Children are relatively spared. Though it is considered unlikely that a situation like the one caused by the 1918 flu pandemic will be repeated, because of better healthcare systems, but, it is not impossible. Neither an appropriate drug nor a vaccine is likely to become available within the next few months. Therefore, the reliance is still on the age- old measures of isolation, quarantine and social distancing. Once community transmission is established there would be a sharp increase in the number of cases, and this would be much so if there are many asymptomatic disease-spreaders or a very high susceptibility in the population. This disease could potentially infect 30 to 50 per cent of the current adult population in the country. Even with a lower-case, fatality rate of one per cent to critical care requirement of four per cent, the weakened public health systems would be overwhelmed and this would lead to millions of excess deaths in the coming year.

We do not know whether community transmission has been established and indeed we do not know the true level of spread of the disease because our current scope of testing for the virus is far too limited. In the absence of such testing, clusters of the disease-spread can develop and reach dangerous levels before they are noticed. Further the current approach to pandemic control that leads to shutting down of considerable economic and social activity is unsustainable and at best of temporary benefit. The epidemic peak may occur months later, and not now. Such a delay, or flattening of the epidemic curve as it is known, is useful because it would give time to the government hospitals time to gear up. But, if no efforts are made to prepare the hospitals or expand the testing, the delay only leads to prolonged economic and social suffering of the majority with adverse health outcomes deferred but not averted. There is a concern that in the name of promoting social distancing, the entire burden of accountability for averting the epidemic and preventing loss of life due to it is shifted to the people and within that, the most vulnerable sections. That being said, the main thing that communities can do is to protect themselves by rapid improvements in health-related practices and hygiene. The other task of communities is to extend solidarity with those who are health wise or economically suffering on account of the epidemic. People’s movements recognise the role they have in both promoting hygiene and in building solidarity. Finally, we call on governments to address both the adverse health outcomes and the adverse impact the control measures are making on the lives and livelihoods of people as equally damaging and requiring mitigation.

Based on the understanding that is discussed above (and elaborated in a background paper on the COVID-19 epidemic), the people’s science movement and the people’s health movement have adopted a charter of demands that articulates its understanding.
Health Care Related

• The government must rapidly prepare public health services for a surge in patients requiring healthcare and hospitalisation by strengthening the public hospitals. This would require, at the very least, one hospital with an ICU; potential isolation wards and ventilators; and oxygen supply in every five to ten lakh population. It would also require corresponding improvement in supply of relevant consumables (?) (Not clear to lay person), and deployment of human resource. We reiterate that such an expansion was anyway long overdue, and this epidemic is an opportunity to rush such preparation through.
• In the event that the pandemic becomes a full blown emergency in any part of the country, it would be necessary that all existing medical facilities be brought under a centralised district authority, including all private hospitals. Allocation of medical facilities will have to be done by this authority and not by the market mechanisms. The protocols and administrative and financial measures required for doing so must be put in place as part of epidemic readiness.
• While containment by isolating patients with the disease and tracing contacts, and quarantining individuals returning from nations with an established outbreak may continue to be relevant for a longer period, the system needs to gear up for addressing community transmission. Key to this is a much wider availability of testing, other than contacts, every single patient with typical symptoms requiring hospitalisation can be offered the test.
• Immediate strengthening of the integrated disease surveillance programme, by a major increase in capacity to test for this disease, and to report on all seasonal flu and other fever related deaths from across all facilities - public and private. In the absence of such expansion, we caution that the country could even go through an epidemic without knowing it, or could be surprised by large cluster-outbreaks where they are least expected.
• As a long term measure we call for establishing a government centre for disease control in every district, which is staffed and facilitated to test, identify and provide alerts and advice precautionary measures for pathogenic attacks like the current Sar-Cov2 pandemic.
• Ensure safe working conditions and adequate protective equipment for healthcare and support staff. These are to be provided not only in hospitals but also for frontline workers supporting home quarantine and isolation. This would require that medical tools such as effective facemasks and sterilising fluids are prioritised for front-line healthcare workers and patients.
• Ensure that the distribution of scarce resources in the event of a widespread outbreak should be governed by a clear evaluation of the public health needs, rather than on sales to the highest bidder (This problem emerged with Oseltamivir(Tamiflu) during the 2009 H1N1 influenza pandemic). International collaboration vis-a-vis developments in medication and vaccines is a must, and care must be taken to prevent patent monopolies from limiting production of potential treatments.

Social Distancing and Human Rights

• Social distancing must necessarily be done by public education and persuasion. The use of coercive measures would be unfair and unhelpful. Mass gatherings, public events, whether social, religious, sports related, cultural or political, could be dissuaded for some time more- but should not be banned.
• Build up active community support and outreach services for those in home quarantine or whose social security benefits are curtailed due to closure or difficulties in access to essential services. Many of those in home quarantine will have co-morbidities that would require access to follow up care and medication. Many children will need access to supplementary nutrition programs, more so, when their parents’ livelihood is compromised. Shutting down such services without providing for alternatives would be unfair.
• When populations are placed under lockdown or quarantine, special measures would need to be in place to ensure that this is done in a humane manner and without abuse to core human rights. Even the most well- intentioned governments would require active engagement of human rights institutions and civil society organisations and trade unions to inspect and report back on standards of care and the problems that most vulnerable sections are facing, so that these problems are also part of litigation.
• The freedom of the media to report on the epidemic and its consequences must be safeguarded at all times. However, when carrying a message that is on the nature of spread, the source of infection or on treatment, news media must be encouraged to keep to the parameters set by government  channels, international health institution channels, or of universities and research institutions. Where information is from outside these sources, the news must be accompanied by a disclaimer that this is unverified and could be fake. Any blanket ban on media freedoms is unwarranted and should be resisted.
Redressing Economic Inequity- as cause and consequence
• Maintenance of routine economic activity, which primarily means the safeguarding of the livelihoods of the majority, should also be acknowledged and acted upon as a public health priority. Public education should also address the need to build solidarity in such times. The working people and poor take a much larger economic hit due to disruption of livelihoods than the salaried section and the affluent- and this should be acknowledged. There has to be active community support and support from employers, to those in home quarantine, and those, whose livelihoods are compromised by these lockdowns.
• There must be an immediate increase in public expenditure that leads to widespread demand side support in the form of both increased public employment and social security, including measures akin to ensuring a universal basic income. This is urgently required to address the attack on livelihoods of the majority of the people. Further concessions to corporate industry, to counter the crisis they are also facing, and further austerity for the working people, would be most counter-productive and iniquitous.