Building systemic capability is the only effective way to deal with the Covid-19 outbreak.
The outbreak of Covid-19 caused by the novel coronavirus is now a worldwide crisis. The growing fatalities, rapid rate of the spread of the virus, and the structural inadequacies and unevenness in healthcare systems the world over, point to it emerging as possibly one of the worst peacetime crises faced by humanity in recent times.
The origin and epicentre of the virus has been traced to Wuhan in China’s Hubei province. However, the Chinese efforts on a war-footing—quarantining a city of 11 million people and building a hospital in 10 days—have succeeded in the containment of the virus across China and brought down the number of new cases per day. Even as the epidemic seems to be slowing down in China, its alarming spread in South Korea, Italy, and Iran raises the ominous prospect of it turning into a pandemic. Although the World Health Organization (WHO) has not declared it a pandemic, it has urged countries to be in the phase of preparedness to meet such an eventuality. As of 6 March 2020, India has 31 confirmed cases, with an additional 23 positive cases awaiting confirmation, pointing to local transmissions in the country having begun. However, with the looming threat of the further spread in West Asia, which has regular contact with India, our public health system will be put through a severe test; a system that is already reeling under shortage of infrastructure, staffing, and medical equipment.
The system’s experience with previous cases of outbreaks would be useful to tackle the emerging crisis. However, have any lessons been learnt from the past? That the very first batches of suspected cases in isolation wards in the hospitals and at the quarantine centres complained of poor facilities and inadequate containment measures is telling of how the public health situation has not improved in the decade since the 2009 swine flu pandemic had gripped the country and the rest of the world. In fact, swine flu has since been prevalent in India, and has already claimed lives this year, as we prepare for an impending Covid-19 pandemic.
As the government takes various measures towards the prevention of a Covid-19 outbreak in the country—including international travel advisories and scanning of all international passengers, setting up helplines, reporting, and quarantine facilities, increasing bed strength and setting up isolation wards in hospitals, formulating guidelines and disseminating information about precautionary measures to the public, etc—there is an urgent need to also check on how resilient the existing healthcare system as well as the population will be in the event of a major outbreak.
The strict quarantine methods used by China to contain and control the virus would not work in a country like India. However, India can learn from the consistent seriousness with which the virus has been met and tackled at all levels of government and among the citizenry in China, as borne out in the report of the WHO joint mission. This includes the running of their fever clinics (a practice that continues since the 2002 SARS [severe acute respiratory syndrome] outbreak) and hospitals, or the strict following of hygiene and self-quarantining among the public at large. However, how far the following of such practices can be expected in India during an outbreak in the absence of trust between the government and the citizenry when it comes to government services is anyone’s guess. The efforts to curb the outbreak with a well-functioning system in one corner of the country would be a lost cause if other parts of the country are not able to maintain the same standards. The smallest of slippages and leakages would result not only in super-spreader cases, but also infections among healthcare workers.
Besides, the precautionary measures being encouraged by the government for maintaining hygiene are neither prevalent nor encouraged actively the rest of the year or even during the flu season. How, then, are measures such as regular hand washing with soap and water and self-quarantining in the event of becoming symptomatic—where shortage of water on the one hand, and a large informal workforce dependent on daily wages on the other hand is a reality—to be put into practice is to be seen. It is invariably the poor, vulnerable and marginalised who will bear the brunt of this outbreak. If, besides precautionary advice, there are no support systems to enable them to practise self-quarantining, how would they take care of their basic daily needs? They would have to go to work, even if they are symptomatic, and would end up seeking medical help only when the illness turns severe, as was borne out by doctors’ experiences during the 2015 swine flu epidemic resurgence that saw large numbers of infected and dead.
State regulation and control of market mechanisms on a global scale would also be necessary as their unhindered operation can create unevenness, as evident in the cases of shortage of medical equipment like face masks and hand sanitisers, due to panic buying. Furthermore, it is crucial that the emerging crisis does not become a site for playing out already existing global conflicts. Elements of such an unfortunate approach have been visible in the initial Western reaction to the outbreak in China as well as the tendency to scapegoat migrants for the spread of the virus that has found traction among the European far right. Specific measures would also be in order to address the situation in sanction-affected countries, the most prominent being Iran. It is needless to say that a global-level solution to a crisis of this proportion would require a globally coordinated response, which would be predicated upon efficient state intervention.
Courtesy: Economic and Political Weekly
Post a Comment