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COVID-19 throws up tough questions

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A week into the 21 day lock down, are we more confident of confronting the coronavirus?

As on April 3, 9:00 GMT, according to the Ministry of Health & Family Welfare dashboard, India had a total of 2088 active cases, 156 cured/discharged, 56 deaths and one migrated).

Among the states, Maharashtra and Kerala switch between the top two slots. The latest crowd MoH&FW data shows Maharashtra with 335 cases, Tamil Nadu with 309  and Kerala with 286. The numbers will change, but the trend shows the true picture: Maharashtra reached the first 100 cases in 15 days, but it took just six days to double, and two days to reach 300.

These numbers are still small in relation to the global case load. For instance, the US now tops the list by a huge margin. Are India’s numbers low due to lack of testing? Or as a research paper suggests, does nation-wide BCG vaccination give some degree of immunity? Will we see a spike in positive cases now that some private labs are being allowed to test for COVID-19? India has chosen to test only those at risk, given the shortage of test kits and personnel; this is perfectly justified as testing should be followed by isolation and treating. Hopefully the national 21-day lock down will slow down the virus transmission and flatten the curve of disease progression.

Also, as more private labs are being authorised to test for COVID-19, will their results be seen as credible by public health officials? Will they relieve or add to the burden on public labs, as the test results of the first 10 samples done by private labs need to be verified by the public labs? Let’s forget that even in normal times, with basic samples like blood, urine etc, no two labs, even from the same chain, will give 100 per cent matching results. There are so many variables: from the way the sample was drawn to the reagents used to the interpretation. To compound matters, COVID-19 testing requires throat and nasal swabs, which need careful collection and handling. But private labs are a valuable resource and are rising to the challenge, training their collection staff. There is no doubt that these initial glitches will soon be resolved.

There is also a controversy brewing about the mortality rates and therefore the exact number of ventilators that will be required. According to a paper published in the The Lancet Infectious Diseases, in a study of more than 70,000 cases in mainland China, the overall death rate from COVID-19, including those from unconfirmed cases, could be at 0.66 per cent, with the deaths only from confirmed cases at 1.38 per cent. These numbers could be change as the diseases unfolds. Other countries could show different percentages as well.  

As per the WHO, 80 per cent of COVID-19 positive cases would be mild and moderate, which do not need hospitalisation. Thorough hand-washing, isolation/self quarantine/social distancing, and the use of personal protective gear like masks would do for these cases. But it is important that access to diagnostics is increased so that these positive cases can be detected as early as possible and isolated to prevent transmission.

While 15 per cent cases may require hospital care, where oxygen therapy would be crucial, five per cent would require critical care involving ventilator support.  As per a recent Brookings report, the country might need anywhere between 1,10,000 – 2,20,000 ventilators by May 15 in the worst-case scenario. However the country reportedly has around 57,000 ventilators. This scarcity has caused the prices of ventilators, as well as other medical devices, to escalate. There are reports of housing colonies purchasing ventilators for the use of their residents. The shortage of ventilators is universal, with even health authorities in the US scrambling to procure ventilators.

Biomedical engineers are baffled why a nation known for its jugaad, is chasing an expensive solution like a ventilator, when a ‘bag valve mask’ could be modified to do the same job. It took two professors from IIT Hyderabad to spell out details. Prof BS Murty, Director, IIT Hyderabad and Prof V Eswaran, Department of Mechanical and Aerospace Engineering, IIT Hyderabad, reasoned that such ‘bag valve masks’ are small devices, already being used to deliver breathing support in emergency situations and are inexpensive, easy to produce, and portable. These seem to be ideal for the COVID-19 crisis, with some caveats of course. Boston’s MIT too has shared the design of a low-cost ventilator to aid in this pandemic. Of course, these low cost ventilators may not have the air pressure that severe cases of respiratory distress require but could help reserve high tech ICU ventilators for the most serious cases. 

The medical device sector has stepped up efforts to bridge the supply gap. Rajiv Nath, Forum Coordinator, AiMeD has welcomed the interest shown by the who’s who of India Inc to make life saving medical devices. With the likes of Mahindra & Mahindra and Maruti, to name just two companies, pledging to make ventilators, there is no doubt that the sector will grow faster.

The worry is that while these brands will do a credible job and pay attention to quality control and the other finer nuances of making life saving devices, that may not always be the case. Both these companies have tied up with reputed brands (M&M with SkanRay as part a consortium with BEL and BHEL while Maruti has tied up with Agva) but who will monitor the quality standards of smaller companies who are only out to make hay during the COVID-19 scare?

But better late than never. The hope is that COVID-19 crisis will bring in more funding and better monitoring mechanisms in our healthcare sytems. As hospitals look for solutions to create temporary isolation units in parking lots, as corporates join hands to scale up production of life saving devices, as we get used to wearing face masks and washing hands for 20 seconds, let’s hope we are not asking the same questions when the next epidemic comes knocking. 

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1 Comment
  1. Dr Param Hans Mishra says

    Very well written

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