More Cases in Delhi, Mumbai Because People Did Not Follow Lockdown Properly, Says Health Minister

 

New Delhi: Blaming people in metros like Delhi and Mumbai for not following the lockdown guidelines properly, union health minister Dr Harsh Vardhan said that’s one of the main reasons these cities are not performing well in controlling the spread of coronavirus as compared to other cities in the country.

“I have a feeling that people in these cities have not followed lockdown principles quite adequately,” he told CNN-News18 in an interview after being asked about why major urban centres account for a lion’s share of India’s cases. “Rural (India) has behaved much more responsibly than urban India,” he added.

Mumbai, alone has reported more than 20 per cent of India’s overall cases. The overall case count in the financial capital stands at 8,613, while the death toll is 343. Delhi has so far reported 4,549 confirmed cases, after a record single-day hike of 427 cases on Sunday.

The minister, however, admitted that some of these big cities had also borne the maximum brunt of international travellers and that could have contributed to more cases there.

“They also have huge slums where it’s not practically possible to implement the guidelines of social distancing and lockdown principles in a perfect manner,” he said. He praised the response to the crisis in rural areas, and said he has a “feeling that these migrant labourers are not so much a cause of concern for Covid-19 because they probably never got in contact with those who got the disease from foreign lands because of the socio-economic status.”

The explanation for less cases in villages or migrant workers not being carriers of the virus does not take into account the variance in testing rates in urban centres and rural areas. India’s overall testing rate, at around 694 per million, too, is one of the lowest in the world and the testing figures vary by state.

Dr Harsh Vardhan pointed out that India has tested over a million people now and the number of positive cases is far lower than other coronavirus-hit countries at the same stage. The government had said on Sunday that India reported roughly 40,000 confirmed cases after a million tests, as compared to 73,000 in Germany, 1.6 lakh in USA and 2 lakh in Spain.

“We have plans to test 1 lakh people per day. Anybody with symptoms must be tested. We are testing in a judicious manner and the results speak for themselves. This is a well-crafted strategy,” he said. The minister further said that government data shows that over 11,000 patients have recovered, and “a majority are recovering well”. He told CNN-News18 that less than 1 per cent of the patients are on ventilator, 2 per cent need oxygen supply and 2-3 per cent are in ICUs.

The main goal of his ministry, he said, is to control unwanted mortalities. “Covid-19 is infectious and spreads fast. My concern is to catch everyone with infection early and make sure they are tested. If positive, they should be shifted to a hospital,” he said. He also insisted that India is not in stage-3 of transmission of the virus, or no community transmission has taken place so far. Going by the definition of the World Health Organisation, he said the government has saved the country from going into community transmission.

“In India we have checked at number of places at number of occasions, random samplings have also been done and we couldn’t find significant number of people who got the disease whose contact tracing we couldn’t do successfully. Again reiterating, we have saved country from going into stage 3 of transmission.

The minister also weighed in on the issue of treatment options, and said the use of experimental anti-viral drug Remdesivir, which has been called the biggest hope against Covid-19, is being discussed at highest levels of the government.

“Scientists at ICMR and CSIR are also deliberating upon this issue. Right now we are in the position to participate in the WHO solidarity trial. We have been given some 1,000 odd doses by the WHO. We’ll be able to use them in clinical trials on some patients in some states in India,” he said.

Edited excerpts:

Q. As lockdown 3.0 begins, how would you describe India’s fight against COVID-19?

A. India’s fight against COVID-19 has been exemplary and it has been acknowledged across the globe. Indians have shown determination and discipline.

Q. How are you planning to bring down the rate of daily infection?

A. COVID-19 spreads fast but we should not have unwanted mortalities. Our data shows that 10,000 patients have recovered and majority are recovering as well.

Q. On March 20, India tested close to 14,514 citizens…percentage positive was 0.43 percent…After testing nearly 10 lakh citizens, the percentage of people testing positive has gone up to over 3 percent. How do you read this graph?

A. Our graph has been steady. We have tested over million people and only 3 percent have tested positive. Our guidelines say that we have to test all symptomatic patients. I am content with the data.

Q. Why has the number of deaths in the past one week gone up? Is it because of the stigma that is associated with the disease?

A. It has nothing to do with stigma. Anybody who falls sick because of the disease is reporting to the health system with symptoms because of mass awareness. As far as deaths are concerned, most deaths are amongst co-morbid condition patients. Our endevaour has been early diagnosis and early transfer to hospitals. I want to ensure that no one dies because they couldn’t avail facilities.

Q. Though we are ramping up our testing capacity, many argue that it is much less compared to other countries. What is your view on this?

A. Our testing strategy is devised by ICMR. We have kept on revising and modifying strategy as per the need of the hour. From one lab in the country, we now have 420 labs. We are testing 75,000 people and we have done a million tests till now. We are testing in a judicious manner. Results speak for themselves and this is a well- crafted strategy.

Q. Given the size of our country, is the government looking at community-based random testing?

A. We are doing it regularly across districts. Some states like Karnataka and Odisha are doing it more aggressively. The National Centre for Disease Control is monitoring these tests.

Q. What is the thinking behind classifications into various zones?

A. To fight a disease, you need to have a well-defined strategy. With two stages of lockdown gone, people have made huge sacrifices. In India, 319 districts are unaffected while 130 are hotspots. Well-defined containment strategies must be there for areas with high infected numbers. We need to have house-to-house survey. Affected houses must be sealed with relaxations. We must take care of the disease in a scientific manner and open economy is a graded manner.

Q. The Health Ministry has said that that case doubling rate for many states like Karnataka, Assam, Telangana, Haryana and UP are much higher than the national average of 12 days doubling rate. But the fact is that we have states like Maharashtra, Gujarat, Madhya Pradesh where it is below the national average. Is it a cause of concern and what is your ministry doing at this front? Also, are some states under reporting?

A. The situation is a cause of concern for us and we are monitoring them at all levels. I have been personally talking to their health ministers. We had central teams for all these states. We feel they also have to start performing well.. We expect that everyone will report every case or mortality in their state.

Q. Which stage of the infection India is currently passing through? How confident are you of India avoiding Stage-3 infection?

A. I have said this repeatedly and WHO has also endorsed what I have said. In India, we have checked at number of places at number of occasions, done random samplings and we did not find significant number of people who got the disease whose contact tracing we couldn’t do successfully. I am again reiterating, we have saved the country from going into stage 3 of transmission.

Q. Another area of concern is our urban centres like Mumbai, Delhi and Indore. These places have dense population and are centres of country’s economic activities. What according to you went wrong in these cities? Also, what’s the assessment of rural India now that migrants are returning home too?

A. It is very difficult to pin-pointedly establish the cause of these cities not performing well even at this stage. But some of these bore the maximum brunt of the international travellers. They have huge slums where it is not practically possible to implement the guidelines of social distancing and lockdown principles in a perfect manner. I also have feeling that people in these cities have not followed lockdown principles quite adequately and that is the reason that these cities are not performing well compared to the rest of the cities in the country. The good thing for India is that rural India behaved much more responsibly that urban India. We saw some of the best examples from panchayats and village heads training and motivating people. I have a feeling these migrant labourers are not so much as a cause of concern because they probably never got in contact with those who got the disease from foreign countries.

Q. There has been a lot of misinformation and confusion around rapid testing kits. What exactly is the government planning to do? And, do you have the sufficient quantity of these kits?

A. RTPCR test is confirmation for the diagnosis of COVID-19. These tests are used for surveillance purposes, epidemiological studies and research purposes. To assess the extent of infection in the community, we had plans to use them in our hotspot areas. We procured kits for the whole country and distributed to the states. But when we got reports from the states that their efficacy was under doubt, we withdrew them after testing them in our own labs. As soon as we get good quality kits, we can think about restarting these antibody tests.

Q. Who is responsible for this entire fiasco around testing kits?

A. I think ICMR or the empowered committee have adopted the exact procedure for procurement of the kits and they had given the contract to the lowest bidder. Unfortunately, kits by china were ineffective and as soon as we came to know about it, we ensured that we are no longer using them. Also, we have not paid anything to china for these kits.

Q. In US, FDA has allowed use of Gilead’s Remdesivir for emergency cases. Many are calling it biggest hope for treatment. Now, the debate is how to bring it to India. Gilead has today said that it is open to partnering with an Indian company. How soon can we expect that to happen and is your ministry involved in the process?

A. It is being discussed at highest level at government also. Scientists at ICMR and CSIR are also deliberating upon this issue. Right now, we are in the position to participate in the WHO solidarity trial also. We have got some 1,000-odd doses given by WHO. We will be able to use them in clinical trials in some patients in some states in India.

Q. India’s supply of HCQs to the world when it needed them the most stood out. Some foreign policy observers called it ‘HCQ diplomacy’. What are we doing to ensure mass manufacturing?

A. We have always been very large-hearted. There is strong push from the government to support the industry. We have been supplying HCQ to 97 countries of the world and now saving some for us. We are also supplying paracetamol to 103 countries. The government in its exit plan for the lockdown is supporting the industry to improve its production of various drugs because large number of drugs are exported to some of the less developed countries by India.

Q. Even though India is among the leaders in manufacturing of generic drugs, we are heavily dependent on China for import of APIs. What can be done to become self-reliant vis-a-vis APIs and how are we planning to do that?

A. India has done well in the pharma sector. We have been exporting drugs to some developed countries also. Are only drawback had been that we have been importing these APIs from countries like China. But now endeavor is to attain self-sufficiency in APIs also and is a significant reform that is taking place in this industry at this moment.

Q. Many economists are making the argument that since our mortality rate is so low, probably we should open up the economy in one go and treat people as much as cases come. The view is quite contrary to most of public health experts’ advice to flatten the curve like South Korea, etc. What is the way forward for India?

A. Our government’s thinking is very clear and has been elaborated by PM himself when he said that ‘jaan’ is also important and ‘jaahan’ is also important. For me as Health Minister, my foremost duty is to save every life from succumbing to COVID-19. We are into a dynamic strategy to mitigate covid but you have seen yourself we are now opening up lockdown also and that’s been done by the Home ministry is to make sure that we are able to take care of the economy also and we are able to help people who have suffered because of the economic slowdown post-lockdown.