 Hello and welcome to the news clip. Today we are joined by Dr. Yogesh Jain of the Jain Swasti Saiyog and we are going to be talking about the COVID-19 lockdown rapid testing as well as what kind of quarantine measures need to be done. So Dr. Yogesh, thank you so much for joining us. So first of all I will start with the recent controversy over the antibody testing kits. The Delhi High Court yesterday declared that it is being sold at too high a price to the government. Meanwhile, almost at the same time the ICMR said that they were actually cancelling the permissions for the contract because apparently the quality was not good enough. So this has been a big issue because we all been talking about need to test more and then we have rapid testing kits themselves proving faulty. So has there been a failure in terms of actually evaluating what exactly were the kind of kits needed and how they should be procured considering there has been issue of the quality front and the price front? I think this is symptomatic of the problems that are there when one is managing an epidemic of disproportion where we don't get our act together of how to govern various components of our work. In this case the Indian Council of Medical Research that is otherwise given the work of conducting medical research on issues that come up before the country. In this case could be how to diagnose the disease correctly, what are the treatment that should be given, how should data be maintained. Now this function of ICMR certainly they should have focused and kept on that. But ICMR was also burdened with the task of in this case also procuring the type of kits that choosing the kits not only validating those kits. And because of this they seem to got themselves into a tangle where they even asked to fix the rates and choose the company from where to buy and this only stopped once they realized that the kits that came in the first two kits at least. There are several more in the pipeline. Those did not in the validation test that they did first up even that was a little delayed after the kits had been already dispatched to two states in the country. Then the results of those validations were not encouraging enough to continue testing on them and they have been withdrawn. But in the process the tangle regarding procuring of the kits at prices which were higher than they should have been and allowing profiteering for certain companies that fought with each other. And finally having to face this problem of returning these kits now. This could have been done easily by another arm of the government which is involved in the procurement of such equipment and reagents in quick time. This was not something that would instill faith and respect from the large society which is at the moment dealing with the problem of the pandemic. Absolutely. And do you think that this is going to probably have an impact on our larger preparedness itself because rapid testing was seen as one of the key components at least by many states definitely in evaluating the status of the lockdown also. Well I would say the entire diagnostic workup of patients with the presumed COVID is still unsettled. We have had problems with the PCR test, RT-PCR that we do for diagnosis of active disease which has its own problem because it is not very sensitive. It is only 63% sensitive and the testing criteria has always been a subject of debate with us in the last few weeks. And the antibody tests which the antibodies that appear in blood they usually appear a week later and sometimes 10 days later and their primary function that was expected of them of tests which were to pick up people's antibodies in blood were for surveillance purpose. This would allow one to know what is the burden of disease in a particular community or in certain sets of virus people like health workers or people who come with a specific severe respiratory infection to hospitals of this country. This would have allowed us to plan first who will be the first line health workers who would be looking at problems when people come to hospitals from among the large mass of health workers to choose the most protected people. The second thing was it would have allowed us, the trends in the burden of disease in a particular district would have allowed us to choose in a more granular method, processes of social distancing including lockdowns and controlling movements of people, movement of goods and also allow us to take other public decisions about how many beds to create how many people do we need for quarantining, how many beds we require for isolation and so forth. But now this might push back these things, this problem about kids might push it back by a few weeks but I hope at least I know that in Chhattisgarh the antibody test kits from South Korea have as late as yesterday have shown promise and in fact Chhattisgarh is going ahead with this surveillance methods within this week itself and doing it at a district level now. So just to elaborate a bit more on this process because many states are thinking about easing some restrictions and that's probably the most significant question on people's minds. So how do we see this the lockdown slowly being eased? First of all are we in a position to think of it or at least are most states in a position to think of it and if we are how exactly, so what should be the medical process involved? Well I think it's locking up a set of people or entire people of a country or a state actually is positing the problems of life and health due to COVID and non-COVID illnesses against livelihoods of people which are themselves an important determinant of the state of the people. So and therefore people have had to do a balancing act about not allowing major effect on livelihoods so that people's other systems of life, other aspects of life between education means future of people actually every day eating and other needs are looked at and at the same time strike a balance at a societal level to accept a certain amount of morbidity and mortality due to COVID and non-COVID illnesses. So in fact this is, so there in this case knowing about the burden of disease in a particular area and calling them as by various names which have their own problems like hotspots and entertainment areas have problems but you know we I would say overall we are not in a situation we are not a country with a very formal economy with a lot of people who live from day to day that we cannot have a life lockdown that we have had now for 40 odd days continuing for any longer we will have to go into a mitigation strategy where we minimize the damage that is done to people's health because of COVID related illnesses or due to even the non-COVID related illnesses we don't want people to not, we don't want to give people a choice that either you die of COVID or you die of tuberculosis which is not looked after. So we need our health systems to start running again as well as we need people's economies to be not damaged anymore than what they have been done in the last two weeks and I would argue that we should be able to accept the a certain amount of damage due to COVID related illnesses to happen to minimize that to the extent that we can do whether whatever our health systems are but not damage other reasons which are more in our control which is like livelihoods and non-COVID related healthcare. And finally, so there is a question of once for instance we do start looking at easing some restrictions there is a possibility of the number of cases rising or if not massively by a steady rate the number of cases still is continuing to rise. So there is also a question of say at a time when say restrictions are eased what kind of quarantine measures do we do as a government as a society do we look at instituting these how do we for instance sort of ensure that certain sections are not cracked down upon very strongly so that the rest of society continues as normal. So what kind of measures and what kind of thinking needs to go into that? I would say that first we should be protecting people from non-COVID illnesses you know consequences the bad consequences of people dropping out of treatment for tuberculosis not being able to see treatment for tuberculosis or people's treatments for cancers not being disrupted anymore, their treatment for other chronic illnesses like diabetes hypertension, asthma, joint diseases, mental illnesses not being disrupted anymore and women and childhood illnesses problems should be looked after as well as they were or even better than what we were what we had before we started having the problem of COVID. But at the same time I would say that we need to allow people to be able to access these services which would mean that we have to have public transport going again, going on we need auto rickshaw, we need our buses, we need our trains to run so that people can access care how many people in this country can travel by their own transport to public services to public health services I don't think it's more than 20% of people who can afford to either use a cycle of their own or a bus or a car or motorcycle of their own most people require depend upon public transport to be able to access healthcare certainly secondary level healthcare. So we need public transport and I think that itself and in the absence of you know allowing big gatherings of people we should pretty much open everything else where people I think are sensible enough to be able to maintain whatever distancing that they can do from each other as well as look after their own hygiene of hands and of their faces so that they protect themselves from this virus that we have in our midst at the same time not allow other problems to happen Thank you so much Dr Yogesh for talking to us