What is the place for a single year in the history of a nation? A lot, if it was 2020. A year ago, on January 30, 2020, India’s first confirmed case of Sars-CoV-2 (then called novel coronavirus 2019 or 2019-nCoV) was reported. Till the fourth week of March 2020, though India had reported only a few hundred confirmed cases, experts using a “modeling-based study” projected that the country could have hundreds of millions of cases and a few millions of deaths by July 2020.
In the year that is now behind us, the virus, the pandemic and related interventions changed many things around us. For most, daily routines were disrupted. The lockdown and other pandemic responses resulted in reduction of economic activities, the loss of job opportunities, economic slowdown and caused hardship to every citizen. The migrants walking across highways became the disconcerting and defining image of challenges faced by people during the pandemic. People tested positive for the virus were discriminated against and stigmatised. Frontline workers, while out for contact tracing, were abused and attacked. The “infodemic” became a major hurdle in effective response to the pandemic.
This period also witnessed an unprecedented high-level policy discourse on the need to strengthen the Indian health system and boost public health services. The health workers toiled against all odds to defeat the virus. COVID-19 specific services such as testing, contact tracing and treatment facilities were scaled up. Within the country, production of personal protective equipment (PPE) coverall, testing kits, and ventilators was ramped up and self-sufficiency achieved. Multi-sectoral and multi-agency collaborations were formed to mount a joint response.
Researchers and scientists joined hands to develop new testing kits, to conduct clinical trials on treatment regimens as well as vaccines. Citizens internalised COVID-appropriate behaviour in their routine. In early 2021, two SARS CoV-2 vaccines were licensed in India and vaccination has started. The COVID-19 vaccines manufactured in India are being used in a number of other countries as well.
A year since India first confirmed COVID-19 case, the country has reported nearly 10.7 million confirmed cases and 1,53,000 deaths. This, by any count, is not a small number but, as a whole, the COVID-19 situation in India has not been as bad as it was projected and better than many countries (if we compare in terms of per million). However, the fight is not over yet. The emergence of new strains in many countries is a cause of concern. A fresh surge in Manaus, Brazil, in spite of high sero-prevalence in the city, is a warning that the virus cannot be taken lightly and that the pandemic is far from over.
While we will ultimately win in the fight against COVID-19 pandemic, the victory will be incomplete if the lessons are not learnt and then acted upon.
Diseases have social and economic impact, with the poor, marginalised and vulnerable populations often being the worst affected. In the COVID-19 pandemic, it was the marginal and informal sector workers whose sources of income decreased, and many of whom lost jobs. Children’s education was adversely affected. Women had difficulty in accessing routine health services. The ongoing pandemic has reportedly widened inequities and Oxfam has termed COVID-19 as “the inequality virus”. India as a country, aiming for “Antyodaya” (upliftment of the weakest in the society), needs to urgently increase investment on strengthening its health systems. Government investment on health has potential to address various types of inequities, alleviate poverty, prepare the country for future epidemics and pandemics, and can help accelerate economic growth. That is the first learning.
Second, the need for strengthening India’s health system had received the highest level of political attention during the early part of the pandemic. This needs to be sustained and followed through. A stronger health system is possible when interventions are done in various areas, including governance and leadership, health financing, service provision and delivery, health infrastructure and workforce, medicines, diagnostics and vaccines and health information system. Merely increasing hospital beds or getting additional ventilators would not be sufficient.
Third, keeping society healthy requires a broad range of health services — preventive, promotive, curative and diagnostics and rehabilitation. This is possible by transforming the hospital-dominated “medical care” system into a “health system” which delivers both medical (curative and diagnostic) as well as public health (preventive and promotive) services. This is possible through setting up community clinics and strengthening the primary healthcare system in both rural and urban areas.
Fourth, increased spending on health, by both states and the Union government, should be prioritised and earmarked for the primary health care and public health services. There is need for a specialised cadre to deliver public health services and preventive health interventions as well as strengthening public health laboratories and disease surveillance systems. The provision of mental health services needs a boost, as does the health data and information system. Tele-consultations can be effectively used to this effect.
Fifth, sustain the three-way partnership between policymakers (elected leaders as well as administrators), technical experts (medical and public health experts) and community members, which has been formed for pandemic response. This would be essential to ensure that health policies are evidence informed, effectively implemented and services widely used by the community. People’s participation and community engagement has been vital to pandemic response and need to be sustained.
The victory in this fight against COVID-19 pandemic is assured. However, the real victory would be when the learnings are used to create a stronger healthcare system in India, which will provide accessible, available, affordable and quality healthcare services to the last person in the society. Our actions will determine the place of 2021 in the history of the nation.
This article first appeared in the print edition on January 30, 2021 under the title ‘Once upon a Covid time’. Lahariya is a public policy and health systems expert, and Guleria is Director of All Indian Institute of Medical Sciences, New Delhi. They are co-authors of Till We Win: India’s Fight Against The COVID-19 Pandemic. Views are personal