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Learning from COVID-19

COVID-19 is being referred to as a “once in a century event” – but the next pandemic is likely to hit sooner than you think.

In the next few decades, we will likely see other pandemics. We can predict that with reasonable confidence because of the recent increased frequency of major epidemics (such as SARS and Ebola), and because of social and environmental changes driven by humans that may have contributed to COVID-19’s emergence.

A COVID-19-type pandemic had long been predicted, but scientists’ warnings weren’t heeded. Right now, while we have the full attention of politicians and other key decision-makers, we need to start rethinking our approaches to future preparedness internationally and within our own nations. That includes countries like India, which are yet to face the full wrath of the pandemic.

We can’t say we weren’t warned

Less than five years ago, the world was caught unprepared when the Ebola outbreak spread like wildfire across the entire West African sub-continent.

Then, as now, WHO was criticised for its response to the outbreak. In December 2015 a meeting was convened by the organization to improve international collaboration and preparation for future epidemics and other infectious disease risks.

The very last presentation was from Dr David Nabarro, then the United Nations Special Envoy on Ebola (and now a Special Envoy on COVID-19).

In the wake of the Ebola outbreak, politicians were more focused on public health than ever before. Nabarro urged the global community to show greater leadership and capture that interest, before political and public attention moved on. He stressed the importance of trust, respect, transparent communication, and working with nature.

Yet five years later, we’re still talking about inadequate funding for pandemic preparedness; delays in adopting preventive measures; failure to develop surge capacity in health systems, laboratories and supply chain logistics; and reduced infectious disease expertise.

Read more: The US suspends funding for the World Health Organization

But there are signs that some lessons may have been learned. For example, countries most affected by SARS (such as Taiwan and Singapore) have tended to respond more quickly and decisively to COVID-19 than other countries.

Health workers stand ready to apply sanitising gel on people’s hands at a market in Taipei in May 2020, as Taiwan began loosening its COVID-19 restrictions.EPA/David Chang

Primed and ready, vaccine developers have progressed at enormous pace, with several COVID-19 vaccine candidates already undergoing clinical trials. The volume and pace of sharing scientific information about COVID-19 has been unprecedented.

We’ve also seen a number of rapid reports urging us to learn from this pandemic and past epidemics to protect us from future events – especially by taking an holistic “One Health” approach. This brings together expertise across human health, animal health and the environment.

For instance, last month the Lancet One Health Commission called for more transdisciplinary collaboration to solve complex health challenges. Similarly, the World Wide Fund for Nature’s March 2020 report on The Loss of Nature and Rise of Pandemics highlighted the likely animal origin of COVID-19, and how intimately connected the health of humans is to animal and environmental health.

What India can learn from COVID-19

As well as working more effectively together internationally, each country will need its own strategy. So what should we be doing to protect India from future infectious diseases threats? Perhaps, more importantly, how do we tackle the current COVID crisis in the country?

COVID-19 response in India requires a re-look (AP: News)

We need better data

A quick analysis of publicly available data, local health bulletins, government documents, interviews with district and state-level officials, and infectious disease experts suggests that these imperfect numbers at best, offer an underestimate of the coronavirus’s spread, and at worse, form the basis for misleading conclusions to support arbitrary policy decisions. 

Despite widely acknowledged inconsistencies and limitations of these data —the numbers are significantly dependent on India’s testing strategies and availability of testing infrastructure— senior health officials continue to display graphs at press conferences to give the illusion that the government is aware of how the pandemic is unfolding in real-time. Future projections of COVID-19 cases shared with states by the NITI Ayog and the Union Health Ministry are sometimes wildly divergent.

On April 11 for instance, the health ministry justified Prime Minister Narendra Modi’s controversial decision to lockdown the entire country without prior warning or planning, by presenting a graph that claimed India would have  witnessed 800,000 cases by April 15 had the lockdown not been imposed. Experts questioned this projection, noting there was no explanation to justify these numbers. 

If the decision to impose the national lockdown on March 24 was justified on the basis of such ambiguous data and modeling, the government has offered no empirical explanation for the subsequent extension or easing for the lockdown.

To be sure, countries across the world have struggled to collate robust coronavirus statistics.

On April 11, the health ministry claimed, with little evidence, that India would have witnessed 820,000 cases of COVID-19 had the lockdown not been imposed. Experts have questioned this estimate. (Health Ministry Press Conference)

But India, with its poor track record of data governance, has its own peculiar issues: Statistics routinely shared with the public by both the union government and state governments are compromised by long delays in processing tests, questionable interpretation of available numbers, and rudimentary modelling of India’s coronavirus crisis. This makes it hard to understand how the disease will spread over the next several days, weeks and months, when and where the number of cases will peak, and if India’s patchwork system of public and private healthcare will hold up.

The crisis in India’s data gathering, and the way this data is deployed by policymakers, is likely to become more pronounced in the coming weeks as travel restrictions ease and COVID-19 cases spike. Notwithstanding the obvious limitations in our ability to test such a large population effectively, it is imperative to at least use the right indicators to measure our performance and guide policymaking.

For instance, the prominent use of 'doubling time' to measure the country's performance has been widely criticized by global experts. “The doubling time is a crude measure. It is a measure on the relative scale,” Mukherjee from the University of Michigan said in a recent interview with Huffington Post. 

“For prioritization and resource allocation you need an idea about total case-counts, hospitalization counts and estimated counts for those that will seek critical care. I am not sure how ‘doubling time’ will help with these projections,” she said. 

We need preparedness as much as we need response

It took the central government till early April to extend the national insurance scheme to cover COVID-19 related medical costs. It was only last month that the center decided to engage the states directly in drafting policies to guide the COVID-19 response. Essentially, India is currently caught in responding to a crisis that it isn't ready to respond effectively to.

Effective policy measures that are future-pandemic proof must be implemented at the earliest. We allow scientists to work in silos, despite obvious overlapping interests and skill sets. Of particular importance for tackling infectious diseases is the need to break down artificial barriers between human, animal and environmental health.

We need to strengthen capability in such areas as epidemiology, modelling and outbreak management, and build pandemic plans that are flexible enough to respond to all eventualities.

We also need to better integrate science and research into the health system. This requires a culture change so research is regarded as business as usual for district health boards, providing the science needed to inform policy, preparedness and best practice.

Crucially, we need a new generation of scientists and professionals who are systems thinkers and comfortable working with multiple disciplines and across the human-animal-environment interface.

And we need the kind of leadership renowned global health expert, Dr. David Nabarro called for: science-informed and forward-looking, rather than reactive.

We have seen traces of science-based governing during the early stages of the COVID-19 response in the country. We now need to see this at all levels of health, research and politics to get us out of this pandemic in the best shape possible – and be better prepared for our next pandemic.