India is not equipped to tackle a full blown epidemic: Former health secretary K Sujatha Rao

22 March 2020
Adnan Abidi / REUTERS
Adnan Abidi / REUTERS

Kanuru Sujatha Rao served as the secretary of the ministry of health and family welfare from 2009 to 2010. Prior to that, Rao was the director general of the National AIDS Control Organisation, a division of the health ministry that is at the apex of the HIV/AIDS control programme in India. She has represented India on the boards of the World Health Organisation and the Joint United Nations Programme on HIV/AIDS. Rao is also the author of a book on healthcare in India, titled, Do we care?:India’s Health System.

In an interview with Tushar Dhara, a reporting fellow at The Caravan, Rao spoke about India’s response to the COVID-19 pandemic and the country’s current protocol for testing. “By not doing tests we may be under reporting or missing out on cases,” she said. “The more you increase access to testing, the more robust the strategy and greater the control over the epidemic.”

Tushar Dhara: Where does India stand currently with regards to the spread of COVID-19?
Sujatha Rao: If you go by government figures, it’s doing well. Compared to other countries, we seem to be containing the infection. We now have 315 cases, which for a population of our size is not bad. [According to health ministry figures at 8 pm on 22 March, India had 329 active COVID-19 cases.] Given that around the world, nearly three lakh people are infected and the fact that we are a highly populated country with not much of a public health system, we seem to be doing well. This is good, if these figures are right. But, there are doubts on these figures as there has been inadequate testing—about 10 per million population.

TD: The Indian Council of Medical Research,the nodal agency framing India's policy for COVID testing, says that there is no evidence of community transmission. Does this claim hold up?
SR: India is following a policy of restricted testing confined only to those having a travel history and people who have come in contact with them. This has since yesterday been extended to include two more cohorts, all hospitalised patients with severe acute respiratory illness, shortness of breath, fever and cough; and two tests— one on the fifth and the second on the fourteenth day of all asymptomatic direct and high-risk contacts of confirmed cases.

Besides the Indian Council of Medical Research has tested 826 samples on a random basis and found them all negative. The sample methodology is unknown and so it is hard to say anything. But then such testing of populations not connected to persons with travel history needs to done regularly and in a structured manner. Maybe it will be useful to also establish sentinel sites, as some experts feel that this infection may not be a one time affair but be erupting in surges throughout the year. A sentinel site is one where a similar sample of tests are conducted at set intervals from the same site or place. Overtime, it provides information on changes, if any. We need such data and information to help us analyse and understand the trajectory of the virus, who is getting infected and where? In short the epidemiology of the virus. I haven’t seen any good analysis of that yet.

Tushar Dhara is a reporting fellow with The Caravan. He has previously worked with Bloomberg News, Indian Express and Firstpost and as a mazdoor with the Mazdoor Kisan Shakti Sangathan in Rajasthan.

Keywords: COVID-19