 Hello and welcome to NewsClick. Today, we are going to talk about the developing situation with respect to the coronavirus pandemic or COVID-19 in India. And with us, we have Dr. Yogesh Jain, one of the founders of Jan Swasti Sahiyog, an NGO that provides community health services in Chhattisgarh. Thank you so much, Dr. Yogesh for joining us. Yeah. I'm happy to be here. So I'll start with the issue of testing. So one of the key questions that journalists, health experts have been asking from the very beginning this news emerged was whether India is doing enough tests and when we look at the numbers are not completely available in the first place. And even when we look at the numbers, we find that there are huge variations. States like Kerala have done relatively larger number of tests, whereas there are a number of states which have done very, very few. And the question from the very beginning has been that whether the low number of tests probably is concealing the actual spread of the disease and the seriousness of the situation. So you've written a bit about this. So could you tell us what you think on the situation right now? So it's clear that the testing criteria as a way to decide whom to diagnose and to diagnose well enough has been flawed and seems to suggest that there is an attempt not to know the exact truth about the burden of the problem that we have in the country. So while in the garb of certain assumptions that the problem has not really been percolated into the community, has not spread into the community, we chose a very stringent criteria for the first several weeks of this pandemic in India. In fact, as late as still two days ago, this has been that we have been only investigating and offering the tests for the COVID-19 to only those who had come from abroad and were symptomatic with fever and cough. Or if there was a health worker or a family member who was in contact with a lab proven COVID positive person. Now with this restricted criteria, obviously the number that we picked up as problems were very few. Quite of the fact that there were several of us who were found to have been infected within the country. And we had been asking for evidence of the lack of community transmission as it is called that is transmission happening within the country where the experts who decide this testing criteria would say that in their limited search on the samples that they collected from some random patients, they did not find evidence of COVID-19 in their body secretions and thus they said the lack of evidence was evidence that there was no community transmission and thus there was no need to test them. I think in this limited criteria in this making such a stringent criteria. There were some things also operating such as whether the number of test kits that the country had at their disposal per fewer than what they needed. And secondly, they use the bogey of not creating a panic situation of a lot of people going for the test. But I think in the process we missed out a few weeks. I would say at least two weeks in picking up the problem in adequate numbers because without picking up someone who's got COVID positive, COVID-19 positive, even if we don't have any treatment for it, we would have been able to isolate and quarantine people who would be infected, preventing the disease from spreading to other people by appropriately isolating and offering treatment to those who would be able to get out with non-very high level treatment also like giving oxygen and other things that would have been possible. So we are learning in the hard way now and only as late as two days ago the ICMR which is the government body entrusted with deciding on the testing criteria has added a few more criteria for investigating so that now they also offer it for those with severe pneumonia who are coming to the public hospitals. Plus they are also now allowing it for symptomatic healthcare workers even if they don't have a contact with a COVID positive person, they are offering this test. But still the numbers have to pick up as late as yesterday. There were only 18,000 tests done for the entire country or which close to 500 samples are positive. So the key question like you mentioned here is also the issue of test kits. So is when we're talking about the lack of enough test kits, is it a supply issue or is it that could you talk a bit about what exactly is the problem there? So I think for performing this test which is a nucleic acid detection test, PCR polymerase chain reaction based test, you need machines that can do the PCR which we have in plenty so the country has more than 100 institutions which can do this test at least about 100 tests a day without even going into full steam. But you also need probes and reagents to do this testing of this specific genome of this virus and that has to be procured from various places. I know for one that the NIV Pune which is the nodal center in the country to do the confirmation test have developed their own test kits. And even as, even till yesterday there were 18 candidate tests clamoring for validation so that they could be offered to a much larger network of diagnostic labs of which two have been confirmed to be validated yesterday. And at the same time not only this is offers now, but even before this two extra tests were validated, the country had enough numbers I am told at least 100,000 kits they had which could have been, they could have ramped up their diagnostic process. So compared to countries like Germany and South Korea and Singapore and now increasingly, not as a good example, but United States is also doing a such a large number of tests now and yet we are with one of the lowest rates per million of tests being done. So in any case, the chance, the one thing that we are running is that we are missing out on some people who have the disease and are not picked up. And thus we are allowed the epidemic to progress where we could have picked it up earlier and sort of restricted the total number of secondary infections that would have happened. So what you are also saying is that community transmission is probably well underway in India already. Absolutely. I have no doubts that community transmission is there. Even the latest data from the last few days suggests that for close to 50 to 20% of patients, the most data sets say that they don't even know where the person got infected from. And whenever such a question is asked in press conferences, the people who decide to say that they don't want to share personal data in this case, which is actually one is not asking for personal data. One is asking for the mechanism where those people could have got infected in the first place, which is actually in the larger interest of the entire pandemic management that we need to understand. But even that information is denied to the people who are asking for that bit. And the other key question here is regarding the personal protection equipment for health workers who are in the front lines of, say, dealing with this pandemic. Now, we had this huge celebration, so-called celebration on Sunday to honour their work. But many media reports as well as testimonies from health workers themselves have pointed out that there seems to be in many hospitals at least and many centres are shortages such equipment, especially if you're looking at the possibility of a major inflow of patients. Absolutely. So I think there is a personal protection equipment, which includes masks, gowns, gloves and those hazmat suits. They are, and sanitisers, have been in short supply because of lack of information for the community and thus overuse and misuse and hoarding done by the people at large. In spite of the government having a lead time of close to three weeks from the end of February when they made a strategic plan to procure this personal protection equipment in large numbers to plan for the control of the epidemic, they did not set in place their procurement policies and practices in the right place. And even a couple of days ago, we have known that from good media reports and from direct interviews with the manufacturers associations of these personal protection equipment that they would not be able to provide adequate numbers of these things even over the next few weeks. And we are already in a crisis. There is a shortage all over of all the equipment, personal protection equipment and which is going to worsen into a really an emergency in the next few days. There is a little doubt that that would happen. And in the middle of this, they come up with an advisory that they issued yesterday of offering a drug like hydroxychloroquine for health workers who are going to be exposed to those who are suspected or confirmed COVID positive. In a sense, making, you know, sort of trying to assuage the health workers who were not let taken in by those Thales and the Thales that they would, even if they don't have those masks and gowns, they would be having a drug to protect them. So we know clearly even that this drug is not going to replace the personal protection equipment value. And even if they look at the data, there is no data for preventive value of this hydroxychloroquine being available through any studies. It is only a stretch of imagination from some one study of its use in treatment of some people in France that they're extrapolating it to use to in a to for prevention of COVID infection. And in the process, being unscientific, as well as practicing poor public health management of a pandemic like this, where you are killing a drug which might be potentially useful for further use in treatment of people who become very sick, but also the same time, allowing the public with poor information and leading to a shortage and stockpiling of this drug, which would thus make it only available for a few people in the country rather than everyone who would need it. So one of the key areas of your work has also been on community health and that also involves looking at the socio-economic aspect of health itself. So as far as the government is concerned right now, what would you suggest are the key priority items on this front? When we're talking about livelihoods, we're talking about the economic impact, the number of daily wage laborers in India for instance. So keeping all these things in mind in addition to say ramping up testing in addition to providing or trying to procure as much as personal protection equipment as possible. On this front, what does the government need to do? So I would clearly say that we need two major interventions that should be there. First we need to protect people's health, not just from COVID infections, but also from all the other things for which people access the public health systems. So I don't want someone to die of tuberculosis because the person did not get his TB drugs in time and yet saved from COVID infection. So I would want all the public health programs that look at people's management of illnesses where time sensitively you require drugs to be continued, whether it is tuberculosis, diabetes, HIV, leprosy, cancer and so many other illnesses. I don't want the public health system to close its outpatients and chronic disease management strategies at the community and clinic levels to be crunched by our efforts to control this pandemic that we are still not doing very well at. The second which is far more important is the way we are using some strategies like lockdown. In this case, you know, locking up an entire community is called a lockdown. I don't know why it is not called a lock up of the community. Doing it in an inhuman way, killing the social and the economic lives of people where when we know that the majority of us are still in an informal economy situation to not protect people through adequate provision of food and their other needs is something that is, you know, completely unacceptable to make people die of, you know, of illnesses due to due to which are happened due to hunger or due to, you know, lack of money for other things, but save them from COVID infection. So even in the way this lockdown has been organized, suddenly stopping all means of transport has led to a large, you know, movement of people from cities where they have migrated to their rural areas in where they come from, whether it's Jharkhand, Chhattisgarh, Rajasthan, coming back from Gujarat, Maharashtra and other bigger towns, in a sense, also not getting leaving in haste and, you know, but also probably possibly getting, you know, the virus along with them and spreading it to the community where they're finally reaching. And in the process also, you know, completely without any protection for their livelihoods and their lives in a sense. So learning from the way Kerala has done and maybe some other countries have been doing which have higher social security systems, better security systems. We need to go on a war footing to prevent our people from, you know, from dying due to other reasons and their lives being destroyed for all the times to come. When, while we are trying to prevent this pandemic from, you know, killing people due to in the short and the long run. And, you know, we need to see this pandemic from a, we need to have a humanistic, you know, humanistic lockdown rather than like an inhuman lockdown that we've been having. And, you know, even prisoners in a lock up have certain rights, which we need to protect as at the moment if we are all prisoners of this of the state at the moment. People need to be protected by providing adequate food, healthcare and you know, what are all the other rights that are still valid when, you know, even you're locked up. Right. And finally, there's also the question of scientific temper, because we saw how on Sunday people gathered across the country in many places it became almost descended into a procession or a celebration. And before that there were all these WhatsApp messages, there's been a lot of fake news going around regarding how coronavirus can basically disappear in 12 hours or that clapping or sounds made basically kill the virus. And a lot of this is done by supposedly educated middle class people as well. So there's also the larger question of a social crisis we are facing in terms of scientific temper when as far as dealing with coronavirus is concerned. Yeah. So we are reaping the harvest of lack of scientific temper or I would say distemper in a sense of in the country. And added to this, you know, the lack of transparency and secrecy about information adds misery to the misinformation that goes around. If you don't tell people what are the symptoms and you don't test people when they want to test it, get themselves tested and don't provide the right information at the right time, then people will obviously imagine things about causes and treatments of problems that they face and attribute it to racial slurs or through destroying the poultry industry that has happened now where swine flu was probably confused with coronavirus infection. And thus people called, you know, thousands and lakhs of poultry in most of Central India are destroying the livelihoods of large number of people. Plus also, you know, endangering people's nutrition levels. This has been, this is, this is, this makes interesting yet makeover, you know, observation, the way crisis like these bring out the worst fault lines in our understanding of the world around and the lack of science and the scientific temper that we have in our minds as we approach. And also the lack of social, the social and the economic fault lines also come out very clearly. Most of this, most of the recommendations regarding social distancing sort of are targeted only at the middle class and the city folks rather than about all the city folk and about the rural folk where most of these advisories make no sense. Thank you so much, Dr. Yogesh for talking to us. That's all we have time for today. Keep watching NewsClick.