New Delhi: A day after India reported 78,761 new Covid-19 infections in 24 hours, the highest number reported by any country, India’s Health Minister Harsh Vardhan, PhD, told Article 14 he was confident that the country and its health services are “more than adequately prepared”.
Vardhan’s assertion to us came a day after he predicted “very significant control” over the coronavirus that causes Covid-19 by Diwali, or around the middle of November.
“Let me assure everybody that there is no need to panic, we are more than adequately prepared to deal with any contingency,” Vardhan, 65, an ENT surgeon before he entered politics in 1993, told us.
In the interview, the minister denied community transmission of the disease and said he did not remember Prime Minister Narendra Modi saying the battle against the coronavirus would be won in 21 days [On 25 March, Modi said: “The Mahabharata was won in 18 days, the battle against Covid-19 will take 21 days”].
Vardhan detailed his government’s measures to deal with the virus: ramping up and allowing widespread testing and providing more protection equipment, ventilators, hospital beds and hospitals than were currently required to address the pandemic. He said he was hopeful that a vaccine would be made available to Indians “in a strategic manner” over the first six months of 2021.
Vardhan said India’s recovery rate of nearly 77% was the world’s highest and its fatality rate of about 1.8% the world’s lowest, attributing this to the government’s disease-management strategy. His data are largely accurate: Compared to 47 deaths per million in India, the death rate per million in the UK, for instance, is 625 per million, 587 per million in Italy, 574 per million in Brazil and 528 per million in the US.
But, as scientists have pointed out, Asia and Africa have lower death rates than Europe and the Americas, for reasons that are, as yet, unclear (here and here) and appear to have little to do with the government’s management of the disease. Within its neighbourhood, India is doing worse than any other country. The country’s death rate from Covid-19 is 47 per million people, compared to Pakistan’s 29.6, Bangladesh’s 26, Nepal’s 7.4, China’s 3.4 and Sri Lanka’s 0.6.
Many experts, such as epidemiologist Jayaprakash Muliyil, who advises the government on Covid-19 surveillance, have also pointed out—as he did here to the journal Nature—that the true scale of the pandemic in India may not be apparent because of a flawed death-registration system.
Vardhan also claimed, despite evidence to the contrary, that rural India, where healthcare is scant, “by and large remains unaffected”. This 30 August Hindu analysis of government data indicates otherwise, and the Hindustan Times reported on 26 August that more than half of all Covid-19 cases recorded in August came from 584 districts classified as “mostly rural” or “entirely rural”.
India’s Covid-19 pandemic is now registering more new cases than overall chart leaders US and Brazil, which unlike India, are at least bending the curve. Here is what the minister said:
Article 14: India's Covid outbreak is now the fastest growing in the world. There are now over 3.5 million cases. Unlike some other badly hit countries, cases in India have not peaked or stabilized, and new records are being set every day. The silver lining is that our case fatality ratio, or death rate, is lower than most other countries. But even if it continues to remain below 2.5%, our hospitals, which are on the verge of being, or are already, overwhelmed, will not be able to cope. As India’s health minister, what are your plans for this exploding pandemic?
Harsh Vardhan: Let me assure everybody that there is no need to panic. We are well prepared to deal with any kind of contingency that may arise. Even if we have more cases, we won't have a shortage of beds in the country. As of today, we have over 17,000 Covid-dedicated hospitals and Covid healthcare centres and Covid-care centres with over 17 lakh (1.7 million) beds. In addition, we have over 12,000 quarantine centres across the country, which again have lakhs of beds. There is absolutely no shortage of beds. In fact, we have a large number of beds that are unoccupied, whether in the ICU or beds with oxygen or with ventilator facilities. Only 3% of patients require ventilators, while 1.5 to 2% require ICU beds and 2.5 to 3.5% require oxygen.
You will recall that for a country with a population of 1.35 billion, initially all the experts who had come here from the US and other places had painted a very grim scenario for the country. In their interviews, they had predicted over 300 million cases in July-August itself and 5 to 6 million deaths. Today, seven months after the first case was detected, we have only 3.5 million cases out of which 2.7 million have recovered and are back home, and the rest are on the road to recovery. We have a recovery rate of nearly 77%, which is the highest in the world and the lowest fatality rate of around 1.8%. Our cases per million and deaths per million still continue to be one of the lowest, as compared to the global average.
I appreciate that the scale of the problem is evident to the government now, but many would still say your government has been overconfident and underprepared. The prime minister said on 25 March that the Mahabharata was won in 18 days and the battle against the coronavirus will take 21 days.
I don’t remember the PM giving such a statement.
We responded in double quick time, as soon as we learnt of the outbreak in China. On 7 January, the WHO (World Health Organisation) was informed of the outbreak of Covid (in India); the next day, that is on 8 January, we held a meeting of experts. This was much before the first case was reported in the country on 30 Jan. We had issued detailed health advisories to all the states and Union territories across the country. We immediately started community health surveillance, also point-of-entry surveillance at airports, seaports and land borders. A GOM (group of ministers) led by me was constituted by the prime minister, immediately after the first case was reported.
As of yesterday (30 August), the GOM has held 20 meetings. From the very beginning, we have adopted a proactive, preemptive and graded strategy . We’ve also taken various dynamic and bold initiatives and interventions like janata curfew, countrywide lockdown , handling the huge issue of migrant labour ensuring free supply of rations food, money in bank accounts of over 800 million poor people. In addition to taking decisions like unlocking the country in stages, we have also tried to strike a balance between revival of (the) economy, without compromising on the fight against Covid. Immediately after the outbreak, the prime minister provided Rs 15,000 crore to the health sector. Followed by Rs 1.7 lakh crore to the Garib Kalyan Yojana and later Rs 20 lakh crore for Atmanirbhar Bharat. Each and every Indian appreciates this, but the sacred duty of the opposition is always to oppose and criticise, though in their heart of hearts they also appreciate the work we have done.
A badly planned lockdown without testing enough, building enough infrastructure or taking care of migrants, experts are saying, is responsible for drastically increasing rural infections. Why was initial planning on these issues so inadequate and how are you addressing the drastic rise in rural cases?
I must tell you each strategic intervention, including (the) lockdown has been thoroughly deliberated at the highest level and in consultation with the top experts. We could fare far better than the rest of the world because of the timely intervention.
The figures available with us show that rural India by and large remains unaffected.
Around 80% of the cases and the deaths are in seven to eight states and that too mostly in urban areas and urban slums. Earlier in 2014, every time we had to diagnose a virus, we had to send the test swab or sample to the CDC (Centers for Disease Control and Prevention) in the US. The situation now is very different.
In February 2020 when we started noticing the first few cases in India, we had only one laboratory, NIV (National Institute of Virology) Pune, to test the virus. Now we have over 1,500 labs, out of which 1,300 alone are in the public sector. We have already conducted over 4 crore (40 million) tests in the country and have developed capacity to conduct over a million tests a day. Yesterday alone, we conducted 1,026,000 tests. The furthest one has to travel in rural areas to get a test done is only 3 hours. In the initial stages there were shortages of PPE (personal protection equipment) kits, ventilators and even N-95 masks. Today, we have developed the capacity to manufacture 5 lakh (500,000) PPEs a day and lakhs of N-95 masks and ventilators. We have not assisted the states financially but have already supplied more than enough PPE suits, masks, ventilators and HCQ medicines to all the states—so much so that some of states have asked (us) to hold back supplies because they don't have enough places to store them.
India has tested about 1.1% of its population, and while the testing rate has increased, it is still among the lowest in the world. We should have tested at least 5% of the population to find out how far the coronavirus has spread. Why are we not testing more and allowing anyone who wants a test to get one? Why not allow private labs to offer a corona test like a blood-sugar test?
The WHO recommendation is to test at least 140 people per million. All over the country we are testing thousands per million. We’ve already tested 4.36 lakh (436,000). We are testing more than a million a day. Anybody can now get himself or herself tested. We’ve also simplified the procedure; any doctor can recommend a Covid test now. Already, more than 500 private labs have been included in our fight against Covid. Their rates have also reduced significantly.
One big problem in understanding the scale of the pandemic has been the absence of national data; there is no attempt to track and compile every death. Daily briefings are erratic and incomplete and government data that can predict the trajectory of the disease are not available. How can we understand the disease if we do not have or do not release data?
That’s not true at all. There is accurate data available from different multiple sources. All this is compiled, synchronised and analysed and reported nationally and internationally in an extremely transparent manner by experts. Our strategy has been from the very beginning to track, test , isolate, treat and ensure minimum mortality. We intend to bring down mortality to less than 1% in the country.
Let me give you an example of how data are not being shared. The Integrated Disease Surveillance Programme (IDSP), which is the sole government agency to publish data on disease outbreaks nationally, has not published a bulletin since 22 March. That means no data since the pandemic started in India. Why is the IDSP, which has been publishing data for 10 years, now withholding data?
The IDSP is no doubt the most robust and effective programme monitored by the National Centre for Disease Control (NCDC) in Delhi. It is the excellent work of the people involved in this programme at the district, state and national level, aided by surveillance officers and rapid response teams, that has ensured effective community surveillance of over 32 lakh (3.2 million) people in the country. Such an exercise has never been undertaken, never ever undertaken in the country to this extent. NCDC has detailed data of even the smallest unit in the country, which is being shared regularly with all concerned .
Health is a state subject. Why, during the most important part of the epidemic–the months of March, April, May–did the Centre prevent the states from responding to the crisis based on what is best needed for their own circumstances? As a result, states as diverse as Bihar and Kerala had to follow the same set of guidelines on testing and case management. For instance, Kerala had considered a mandatory test (RT-PCR) for all returning expatriate workers, a move that would have prevented the subsequent spike in cases. However, the Centre did not allow the state to do so.
We issued the first guidelines on 17 January, after detailed consultations with all the experts and stakeholders, to all the states and union territories. These initial guidelines have been supplemented from time to time with SOP’s (standard operating procedures) relevant to the emerging situations and problems. I feel satisfied in saying that all states and union territories have by and large followed them religiously. Many states also developed their own good practices which have also been shared with other states through us. Time and again we have placed on record our appreciation for the good work being done by the various states. It's a matter of pride that the whole country has fought unitedly against Covid under the leadership of Prime Minister Modi.
Does India have a system of independently verifying the sensitivity / specificity of tests that are currently being used? Can the government create a public repository of such information so policymakers, doctors, and citizens can learn about how well these tests actually perform? The current problem is that manufacturers exaggerate the performance of their tests and this information is hard to rely on without independent studies. It would be easy to solve if India allowed its research institutions to do what they can do.
Yes. The ICMR (Indian Council of Medical Research) has developed an institutionalised mechanism of validating these kits and also evaluating the efficacy of each one of them. The data can, of course, be shared in a very transparent manner with all the relevant stage holders depending upon the need.
At the beginning of the epidemic, the ICMR told states they could not conduct research or surveillance without permission from ICMR. Thousands of research papers have been produced globally but very few in India. Effectively, some experts say, India ended up responding to the epidemic—scientifically—in New York or Italy because no one at the time knew what the state of the epidemic in India was, and no one was allowed to study it properly.
I think our strategy has been devised with inputs from our experts as well the WHO guidelines. And we’ve also tried to learn from the experiences of many developed countries. And the various experiences of researchers are being published from time to time at various places including ICMR.
I want to ask you about community transmission. Why did the government continue to insist there was no community transmission for so many months? It is now clear that community transmission has been going on for a while—the sero prevalence numbers coming from large cities shows there has been widespread transmission for a long time.
I have been consistently saying and will reiterate again that there has been no community transmission India even now. Although there have been few places where there has been localised transmission. As of today, there is a clear cut definition of community transmission and even the WHO has endorsed our viewpoint and lauded our efforts in no uncertain terms.
Why has the government allowed political leaders and supporters—mainly from your party—to spread misinformation about treatments? Your minister of state said 15 minutes of sunlight would kill the virus. Another minister is marketing papads that he says can develop antibodies. You are a doctor. What do you think we should do to push science and empirical evidence in our approach to addressing the greatest pandemic of our times?
At no point of time has the prime minister or me, as the country’s health minister, ever said any such thing. The government's approach to tackling Covid is strictly scientific and is the result of extensive consultations with all the top experts in the field. It's a difficult situation, the whole world is struggling in dealing with it. Despite the size of our population, I do believe we in India have done a very good job of it. We will continue to strive to do better.
Do you believe there is a second wave upon India?
No, I do not think so. There is no definite evidence of such a thing being reported in significant terms across the world. Like many other viruses that have come to us, this virus shall also slowly become endemic at some places for sometime both inside and outside the country.
How far are we from a vaccine?
Right now, the whole world is actively pursuing research for developing a vaccine under the supervision of WHO. We in India are also not lagging behind anyone else in the world in our contribution towards the development of such a vaccine. Right now we have around seven vaccine candidates in India, out of which three are in clinical-trial phases, while others are in pre-clinical-trial phases. If all goes well, I’m hopeful that by the end of the year we should have a successful and effective vaccine developed in the country and during the first six months of 2021 will be made available to Indians in a strategic manner.