Context: The initial misplaced optimism that India is somehow protected from the COVID-19 pandemic has proved to be illusory, with rapidly escalating numbers of cases and deaths in urban India.
- The urban blight is so intense that it occupies the entire attention of the health-care workforce, planners and policy makers.
- The medical services in these urban areas — Mumbai, Delhi and Chennai (the three major epicentres of the epidemic) — have been overwhelmed.
- However 65% of the country’s population is rural and they have been relatively underexposed, with very few cases and deaths. Thus, the large, vulnerable majority in rural India is yet to feel the heat of this epidemic.
- There is a pervasive and false confidence among the general public that, somehow, rural India will escape with minimal casualty.
- The recent (limited) restoration of public transport and a relaxation of restrictions on the movement of people have set the stage for the inevitable and even more dangerous wave of this epidemic.
- Rural wave is just beginning while the urban wave is about to peak
Contrasts in health care: The lockdown of the entire country led to a paralysis of urban and rural life synchronously while the urban and rural waves of this epidemic are clearly asynchronous.
- Two vital indices of human development: There has always been an urban-rural divide in India in health care and education.
- This deficiency has been very costly not only in terms of rural lives and livelihoods but also overall national wealth creation.
- If the first urban wave of the COVID-19 tsunami is overwhelming our relatively better urban health-care resources, one can imagine the predicament of rural India with its already deficient health-care resources when it faces the rural epidemic tidal wave.
- Administer the social vaccine:
- A decentralised approach with participation of all stakeholders in each village, taluk and district is the need and potential of the day.
- The most important step would be to educate rural people with all the tools at our disposal — print, radio, the electronic media, and messages through mobile phones.
- Need to give them accurate information in simple language to make them clearly understand that their self-protection and the protection of their families are entirely in their hands.
- Two behavioural changes are critical — every man, woman and child must wear a cotton cloth mask when out of the home, and observe strict hand hygiene. All elders and any person with a co-morbidity should be cocooned (by reverse quarantine- practice of detaching most vulnerable people from general people).
- Proceeding step by step: At the State and district levels, we need a systematic approach.
- It must entail blocking urban-rural importations, quarantining those who move from red zone to green, diagnosing and managing clinical COVID-19 syndrome with or without positive PCR test results, and providing field hospitals exclusively for isolating and managing COVID-19 cases.
- At the same time, we need to protect and sustain existing hospitals and primary health centres not to be frequented by COVID-19 patients.
- Mildly and moderately symptomatic COVID-19 patients should be managed by home isolation, delivering essential and medical supplies at home, and home monitoring of oxygen saturation by readily available portable finger pulse oximeters.
- Each such patient should be followed up daily by a designated medical professional.
- Non-communicable diseases and other common diseases should be handled on a tele-medicine platform manned by experienced and older (age more than 55 years) medical personnel.
- follow-up over the mobile phone:This approach will minimise the loss of medical manpower due to COVID-19.
- When a person had a contagious illness, keeping him away from other healthy people was a method that was traditionally used in public health over centuries.
- This is called quarantine, or isolation. The objective is to physically prevent him from infecting the people around him, until he was no longer a threat.
- Reverse quarantine is exactly the opposite. When a person is vulnerable and there is imminent danger of his getting infection from other sick people, he is kept away until the danger passes.