Exclusive chat with Dr. Ashish K Jha

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Rising coronavirus cases in India: Has India faltered somewhere or is it a natiural course? Here's what Dr. Ashish K Jha, School of Public Health, Brown...
Doctor Jha I want to understand from you from your vantage point as you look at what is happening in India, two cases per day numbers constantly rising. Do you believe that this is that India has faltered somewhere or do you believe in the natural course, there will be these coronavirus waves from time to time. Is there something wrong with our policies? that's responsible for these increased numbers Or is it natural course. Yeah. so thank you for having me on first of all, I will say I am very worried about where India is right now. Two cases a day is very high, but I don't see it slowing down right now. I don't see this being the peak. I worry it will continue increasing that is the nature of this virus. The the the mistake here I think is over the last few months. I heard both from policy people as well as others. The sense that somehow India had beaten coronavirus where the rest of the world was still struggling. There is nothing. About India that makes it immune to the coronavirus we Indians are just as susceptible as everybody else, and I think there has been a relaxation of policy. I think there has not been enough focus on prevention and this is unfortunately the result of all of that. Are you for saying that it is inappropriate behavior that is responsible for it or is it COVID inappropriate governance or a mix of both that led to a lowering of the guard and a certain complacency? Yeah. I think the complacency is both. it is both from inadequate policy attention again. You know, just even a couple of months ago. I was hearing from leaders in India that COVID was done and we had beaten it and then, of course. Of course, on an individual level, I was hearing from family and friends in Bihar and elsewhere, their argument that that India had beaten it and therefore we could go back to normal and it made no sense to me because I'm not seeing any other country having beaten this. and so I thought why is India going to be different and I think that led to a lowering of the guard of relaxation of policies. we are seeing this with large crowds around elections around other things very very dangerous. And I think it's unfortunately fueling a lot of the infections. we're seeing. From your vantage point again, what is it that India could learn possibly from other countries that are going through similar waves as part of the nature of this virus, as you called it, What can we learn from the United States at this particular moment whether in terms of vaccination drives, whether in terms of other policy measures that need to be taken? Yeah, I think we can India can learn from the US but can certainly learn from Europe. What many European countries are doing in in a face of a major wave that Europe has been facing. look. There are three or four things that keep this virus under control. One is certainly universal mask wearing that Indian policy makers should be wearing masks. They should be promoting mask wearing across the country. People should not be gathered in large groups without wearing masks and people should really avoid indoor gatherings as much as possible. That's number one mask wearing second is crowd. And having fewer large events again, I've been seeing pictures coming out of India of these massive gatherings very very concerning now again safer if it's outside very dangerous if it's inside, but really pulling back third is I think we need to do more testing India has done a pretty good job on testing, but one of the advantages of a large scale testing is you find more infections and you can stop them from spreading and then certainly last, but not least is continuing to push on more vaccinations. India has a lot of vaccines. It's been doing a good job on vaccinations it has to. Drive that those vaccination drives numbers even higher for a population its size. all of this is a way to prevent lockdowns. If nothing else works, then you're looking at very aggressive type lockdowns, but that's a very costly costly measure, and my hope is that India can avoid that across the country and I know in some places we're starting to see lockdowns, but I think that should really be the policy of last resort when everything else has failed. So in your view, therefore, as you said lockdowns only as a last resort is there a critical stage at which a country must decide when to go in for a lockdown. Some countries have been very effective with their lockdowns. others have as you rightly said have found them extremely costly. So are you saying that this is too early premature for India to go in for a for you to even consider the potential of a of the possibility of a nationwide lockdown. Are you saying have time? Localized lockdowns Yeah, I don't know that a nationwide lockdown would make sense given how regional the infections are and how the outbreaks are so I would certainly try to limit it to local areas as much as possible. I think that's one second is that you know lockdowns as I said, are the last resort. So when should you trigger them when you start seeing the health care system truly get overwhelmed, you know, I'm seeing stories out of Mumbai elsewhere where hospitals are running out of beds that, in fact. Is kind of on the late side you want to see once you start seeing a surge of hospitalizations, you know you are in trouble and that's when you gotta get much more aggressive, maybe including lockdowns, but the hope is to never get there and and you know when I look at the India data case numbers have been rising for 2 months by late February, It was very clear that another wave was coming and you know here we are mid April. The policy response is just too slow like if you wait and. You have this many infections, things are going to get much much worse. so acting early is the key here right now. I think localized lockdowns make some sense where hospital systems are really struggling, but other than that I would try to avoid anything national. Would you would you also support vaccinations for all that rather than have targeted groups? try and expand the vaccination pool in the fastest possible time so that all over twenty-one are vaccinated if they choose to do so, Yeah. This is a tricky one because of course, we know that it's older people who are at highest risk for death and complications, but we also know that that it's the young people who tend to spread the disease. so there's a balance in. Act here what I would say is certainly trying to make sure older people are vaccinated to protect them, but if you're running into any hesitancy, if you're running into populations where you're having vaccines sitting around, but not getting in them, absolutely then expanding it to other people. Young people is a good idea. The problem here is we don't have a lot of experience with starting with young people. first and most countries have focused on older people initially, but given the shape that India is in, I would certainly be willing to vaccinate a lot of young people if that helps slow down the transmission. One worry of course in the Indian doctor Jha that in a vast densely populated country, how do you achieve social distancing? This was a problem we faced during the first wave. It's a problem. Even now, people need to go out to go out to find in some instances of course, going out for festivities and and valleys, which is you said, is not. But how do you communicate a need to operated where at times? it is a necessity. To be out in the large number of people. I just did. Yeah, you know it's obviously very difficult to have true social distancing in in many many parts of India. I think about you know I grew up in Patna. I like it's not a city where you can get a lot of social distancing happening easily. I will say a few things first is I think anything that is unnecessary that is not absolutely essential should be cancelled right now so festivities elections. I mean, I don't know if you need to cancel the elections but collection rallies should certainly be cancelled. If you're going to hold any of them, you gotta have everybody wearing masks second is I do understand that people need to get out and do things, but the two things that we can do to make them much safer are make sure as much of it is outside as possible. so things that are outside tend to be relatively safer and second is mask wearing if people are out and about doing things, but they're wearing a mask that will help a lot again. It's not ideal, but nothing here is ideal what we want to do is try to reduce risk as much as possible. Dr Jha one final question in terms of community. You know the government in the first wave had this to Tali Baja, all kinds of campaigns launched to build consciousness of the need for social distancing for masking for support for COVID Warriors would you suggest course correction has the time come to focus less on event management as some call it and look at science and data much more seriously and then communicate. Absolutely what we have seen in country after country around the world is countries that have done a good job of managing the pandemic countries that have done a good job of stopping large outbreaks. You've had very clear communication from political leaders. We need that starting from the prime minister all the way down to chief ministers, health ministers. Others everybody needs to be talking about the science that evidence and what it is that India needs to do to get through this. The good news is that this pandemic will end it. End when a large proportion of India is able to get vaccinated until then, we have to be very careful right now we are in a crisis in India, it needs to be brought under control before things get much worse. So would you say that you know the crisis has in some way been mismanaged or would you say that the government has done a reasonable job? I would say there has not been enough communication from the government about the seriousness of where we are. There has not been enough focus on these rising cases until things got very bad. The policy response here is too slow and the communication is ineffective. We need much more aggressive action from policy makers at the state and at the central level. And even if let's assume the case is tapered down, you're saying there's no room for complacency. are we looking at another 6 months to even a year where we will continue to get these waves is that the worry that most of health experts have that this is not going to stop in a hurry. This is not going to stop in a hurry. This is going to take a while, but here's the key point you don't need waves this size. If you act early when you start seeing waves, you can usually stop them with relatively. Mild measures If you let it take out of you know, get out of control and take off, then yes, you have to get very aggressive. so the key point here is to be much more proactive get this wave under control, but then be proactive over the next 6 months. While India gets vaccinated, India has a lot of vaccination capacity, it needs to get it needs to vaccinate its population. and while it is doing that, yes, we will have to continue to be careful not lockdowns not anything. Like that, especially if we stay proactive. Okay, Doctor Jha Always a pleasure talking to you. Thank you very much for joining me here on the day. Thank you so much. Thank you.

Posted 18 days ago in Health & Medical