The focus should be to prevent deaths from COVID-19, says public health task force

There is a need for a “public health approach” for controlling the coronavirus pandemic with the maximum possible good being done for the largest possible numbers, stated the public health joint task force, which was constituted in April to advice the government on the pandemic.

“The testing strategy needs to be pragmatic from a public health perspective. Vaccines do not have any role in controlling the COVID-19 pandemic in India. Vaccines with proven efficacy and safety, as and when available, should be administered according to the WHO’s “strategic allocation” approach or a multi-tiered risk-based approach,” said the experts in their third statement on COVID-19.

“Many decisions taken during the early phase of the pandemic, with the benefit of hindsight, appear to be inadequate or even inappropriate. However, we should be bold to effect course correction in light of the new and emerging evidence,” added the task force.

The team was constituted by the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists (IAE).

The team has stated that lockdowns as a strategy should be discontinued. In large cities, here already there has been substantial spread, there is no advantage of creating containment zones and aggressive testing. The focus should be to prevent deaths from COVID-19 and not on containing the infection. People should be taught to watch for symptoms in order to report early for testing.

In small cities and townships where the virus has spread only mildly, existing testing and cluster containment strategy can be continued. “Although testing strategy attached with mandatory isolation, needs to be reviewed in view of social stigma,” said the task force in a statement. In rural areas, ASHA workers should undertake periodic surveillance.

Additionally, the task force members stated that the current policy of stamping the houses of those who test positive should be avoided as it creates a sense of fear.

They have recommended the opening of primary, secondary and tertiary health care services including outpatient and inpatient services, at least those areas that are progressing towards higher levels of immunity and in towns with no cases.

The taskforce, which has 20 doctors, are of the opinion that schools and other educational institutions must be opened in a graded manner. “Even in low infection areas, schools may be opened with due safety and with adequate surveillance for any outbreaks acceleration due to schools.”

Public health care should be significantly strengthened and enhanced with overall public expenditure to be increased to at least 5% of the GDP. The focus of increased health expenditure should be on primary health care and human resource and infrastructure strengthening rather than opening/strengthening tertiary care centres.

The team advocated the setting up of a dedicated, efficient, and adequately resourced public health cadre as Indian Health Service (IHS) at the Centre and across states as recommended by various national committees and expert groups since 1946 similar to the Indian Administrative Service (IAS).