Our govt stands fully in support of frontline health workers: Union health minister Harsh Vardhan

Proactive handling of the Covid-19 crisis has helped India to keep the spread of the pandemic to the minimum, Union health minister Dr. Harsh Vardhan has said. In an interview with ET’s Prerna Katiyar, the minister also said there would be a planned scaling up of the testing capacity across the country in the coming days. Edited excerpts:
India has been lauded by WHO for taking proactive action to contain the spread of Covid-19. As the country’s health minister at the centre stage of managing this crisis, what is your message to the nation?
There is no doubt that India was extremely proactive in handling this entire crisis. Without sounding complacent, I can say that so far, we have a much lower incidence of confirmed cases as compared to other countries. We are working to ensure that we are able to mitigate this virus.

Given all constraints, India handled this very maturely – with speed, scale and determination. The world is appreciating the determination of our medical personnel and everyone who is involved in the disease management. I want to thank the national team of frontline health workers who are performing their duty to the nation in an exemplary way and who have shown utmost commitment.

India has taken a ‘thought leadership’ role led by Prime Minister Modi. I have always maintained that India is a spiritual nation and when India decides, it can do anything! The nation at large is grateful to Modi who continuously inspires all of us to follow the yogic path of being determined in the face of all odds and remaining calm in all situations.

Nobody believed that a vast country of over 1.3 billion people could be disciplined in this fashion to follow the rigorous Janata Curfew and now the 21-day lockdown. Many developed nations have failed to take timely decisions and implement them. Political ownership of stringent decisions is the need of the hour and our prime minister has taken unequivocal lead in this.


We have been testing a few thousand Covid-19 suspects per day. Why have we been testing below our capacity?
We have the capacity to test 20,000 samples every day, and we have been scaling up this capacity in a sustainable manner. So far, as on April 7, we have tested 104,764 cases. On April 6 alone, we tested 11,795 samples. We have utilised only a portion of our testing capability.

It is important to address the following issues before we talk about scaling up of testing: quality assurance of testing kits, so that we can reliably identify the cases; protection of lab workers is also vital, to ensure that testing sites do not become nidus of spread of infection; not overwhelming the labs so that quality and lab safety measures are side tracked; testing strategy should be appropriate for the given phase of Covid-19 transmission that we are in; and, availability of testing kits and judicious deployment of available resources to ensure optimal testing, beginning with the highest risk groups first to ensure that we have a higher yield of cases and can clamp down on infection transmission.

In the coming days you will see a planned scaling up of the testing capacity across the country. An advisory for the use of antibody-based rapid testing has also been released by ICMR (Indian Council of Medical Research), which will help in further scaling up of the testing capacity in the country.


Do you feel it is necessary to extend the lockdown?
A countrywide lockdown has socioeconomic implications, in addition to the health-related issues. Given the diversity of a country like India, it is essential to use the lockdown strategy judiciously. As the epidemic evolves in the next few days, it will become clearer as to how we should proceed.

The progress of the epidemic at the district level in the country, use of serology-based strategies to identify the hotspots, and, if required, calibration of lockdowns and strategies targeting these high-risk areas will be deliberated in depth. The data generated in the next few days will help us develop an ideal way forward.


Some of the migrant workers who have moved back to their villages may start showing symptoms around April 15. Don’t you feel lifting the lockdown could then be disastrous?
There is a likelihood that migrant workers may not be a high-risk group for transmission of Covid-19, as they may not have had a history of high-risk exposure. It would be prudent to ensure that they observe home-based quarantine on return to their native places and observing the lockdown should enable the same.

If district-based serology testing for high-risk groups can be initiated, they can be tested and then released from quarantine based on the guidelines, as appropriate. In any case, we have to ensure that whatever intervention is planned, there is buy in from the target communities, which ensures the success of any efforts.


Can you please share the best and worst-case scenario for India?
The best-case scenario is we can keep ahead of the curve, and keep the curve flat, and slow the spread of the infection in the country by reducing the doubling time. This provides our health systems time to respond and develop the clinical service capacity to deal with the surge in cases.

The worst-case scenario is that there is an explosion of cases, with high mortality, and tertiary healthcare needs which overwhelm the available clinical services capacity. This nightmare scenario is the one we need to avoid.


What is the probability of finding a cure or vaccine for Covid-19 in the near future?
There is no definitive cure for Covid-19 until now. Its management is mostly symptomatic and supportive. However, a lot of investigational therapeutics are being researched and India is also part of the international efforts at finding a cure, such as the multi-country ‘Solidarity’ trial of the WHO.

Several treatment alternatives are also under trial. Some of the agents under investigation include: Remdesivir, Favipiravir, hydroxychloroquine plus azithromycin, Lopinavir/Ritonavir, etc. According to WHO landscaping, there are over 40 vaccine candidates under investigation. However, most of them are in the pre-clinical evaluation stage, and only two have progressed to Phase 1 clinical trials.

The availability of the genomic details has accelerated vaccine production, but still we are unlikely to have a vaccine ready to scale up in the next 12 months. Intense systematic research is needed to generate reliable evidence.

New evidence is emerging every day, but till now, social distancing strategies seem to be the most effective way of reducing the transmissibility of Covid-19. I have been saying that all nations must use lockdown and social distancing as they have the power of a social vaccine. So far, across the globe, this is the only available best, tried-and-tested tool to slow down and gradually reverse the Covid-19 pandemic curve.


What has India learnt from other countries grappling with the pandemic?
Covid-19 has been a unique experience globally. It has started in various countries, following seeding, and in a staggered way. We are seeing the epidemic curve coming down in countries like China, South Korea and some other countries with smaller caseloads, whereas, the curve is on the rise in countries of Europe and North America.

Lockdown as an intervention has been the most important learning from many countries, especially China. One key learning has been to focus on reducing the clinical load on the tertiary care facilities. This is essential to ensure that the systems are not overwhelmed and can provide triage and treatment for those who are most in need of it. Another key intervention has been social distancing – and the impact it has had on transmission disruption.

The third key learning has been in providing sustainable scale up of testing facilities, while mounting adequate public health responses. Humane, people-centric quarantining strategies, including building of community-linked quarantine facilities have also been seen as effective strategies. Building robust institutional policies, infrastructure to respond to the diagnostic and therapeutic needs, and raising community awareness have also been identified as key input strategies to break the chain of COVID-19 transmission.

Finally, community ownership of any intervention remains key, because, without the participatory action/implementation approaches, any intervention is fated to fall short of universal coverage. However, we must remember, that each country has its own context, its own strengths and weaknesses, and have responded to the Covid-19 challenge in their own way. India has acted proactively so far, and has kept the curve of epidemic as flat as possible. However, with rise in the number of cases, we have to scale up our responses and build on our strengths.

This is a new virus. Everybody is imbibing each other’s best practices. We, too, continue to closely follow the best practices of some countries on how they are managing Covid. There are some good practices in Singapore, South Korea, Thailand, etc. Our endeavour would be to save our citizens from this disease and prevent deaths to the maximum extent possible.

Has China shared any input or insights related to Covid with India?
The published evidence coming out of China has provided us with a lot of intelligence on how to deal with the challenge. Additionally, Chinese Embassy in India held a webinar with their researchers about a month back, where they described their experiences and gave their impressions on what works and what does not.

Further, inputs on diagnostics, particularly the use of serology test kits, have been helpful in shaping our testing and response strategies. The global health leadership community has come together in responding to the Covid-19 challenge, and we have seen unprecedented amounts of health diplomacy and cooperation across the board.


What do you have to say to recent attacks on doctors and healthcare professionals who had gone for sample collection and contact tracing in some localities?
I have outrightly condemned the recent attack on doctors and healthcare professionals. I consider it most unfortunate. They are the ‘Covid Warriors’. On the issue of ostracization, I must tell you that our government stands fully in support of frontline health workers.

Time and again, Modi has spoken out against the violence against doctors and appealed to the nation to protect our medical personnel. He has equated them with God! The home ministry has taken cognizance of such incidents and advised the authorities to take stringent action under the National Security Act.

Now our doctors and health warriors should work without fear as the government is standing in all its strength with them. Doctors, nurses and the healthcare workers deserve our respect, support and cooperation to keep the fight going.

We have advised all state governments to take appropriate action against those who are indulging in violence, be it landlords who are evicting doctors and their families. I am happy that the Delhi government is taking appropriate actions to raise the morale of this workforce. They have already directed that penal action must be taken against all those landlords who are force evicting healthcare workers.

Our government has also launched the Pradhan Mantri Garib Kalyan Package Insurance Scheme for Health Workers Fighting Covid-19. This accident insurance scheme covers loss of life due to Covid-19 and accidental death on account of Covid-19-related duty. All public healthcare providers who may have to be in direct contact with Covid patients and who may be at risk of being impacted are covered under this scheme. This includes our doctors, too. The entire amount of premium for this scheme is being borne by the Union Ministry of Health & Family Welfare. Rs 50 lakh will be paid to the claimant of the insured person.


There have been reports about the stigmatisation and ostracization of families under quarantine? Are there steps being taken by the ministry to stop people from doing this?
I feel pained that there is so much stigma being attached to this disease and people who are self-quarantining or those who are being quarantined are facing the unnecessary wrath of the public. There is no need to stigmatise families whose members are being quarantined as suspect cases.

We are making continuous efforts to reach out to the masses on this issue of stigmatization. I appeal through your media house to all your readers that there is no need to stigmatize or ostracize any person suffering from the disease or healthcare workers treating such patients.


According to ICMR, 5% of infected patients will need ICU and half of those admitted will need mechanical ventilation. Do we have enough ICUs and ventilators to handle the situation? By when can we expect India-produced ventilators in bulk quantities? And what steps are being taken to train staff for operating ventilators?
India, with a population of over 1.3 billion, decided on a strategy to lock down the entire nation to break the chain of transmission and quickly enhance its healthcare facilities to face the pandemic.

Every Indian state has priorities like adding new beds, increasing capacity of intensive care units, requisitioning portions of private hospitals, ordering lifesaving ventilators, recruiting medical practitioners on contract, weighing in on extending services of retiring doctors and nurses, and earmarking select government hospitals for Covid-19 patients.

In addition, many medical colleges and hospitals have postponed their routine planned surgeries, thereby adding more numbers of dedicated ventilators to the available capacity of isolation beds for Covid-19. Every effort is being made to augment this availability of ventilators by another 48,000 in the coming weeks, about which we are very hopeful that we shall be able to achieve.

For this, the health ministry is continuously in touch with a number of domestic manufacturers. The government is well aware of the training needs of the healthcare personnel. All levels of healthcare workers are being given appropriate training.

Doctors, nurses and paramedical workers posted at intensive care facilities are being trained to operate the ventilators. Training workshops on usage of ventilators have been conducted by my Ministry periodically during this period.


There have been reports of anti-malarial drug hydroxychloroquine getting wiped out from drug stores after ICMR said it could be given to healthcare workers as a precaution. What steps are being taken to stop the hoarding of this essential drug?
To prevent hoarding of hydroxychloroquine, the government has moved the drug to another, stricter ‘schedule’ of the laws, i.e., schedule H1 drug, and now it can be sold on prescription only. In this regard, the health ministry issued a gazette notification on March 26.

As per the notification, the sale of the drug from now on should be in accordance with the conditions for sale of drugs specified in Schedule H1 to the Drugs and Cosmetics Rules, 1945. ‘Hydroxychloroquine’ is essential to meet the requirements of emergency arising due to pandemic Covid-19 and in the public interest, it is necessary and expedient to regulate and restrict the sale and distribution of the drug hydroxychloroquine and preparation based thereon for preventing their misuse.

The central government has made modification in schedule 2 of ITCHS export policy prohibiting export of Hydroxychloroquine and its formulations.


There have been several reports of doctors reporting on lack of PPEs especially beyond big cities. What is the health ministry doing for its adequate supply?
Availability of PPEs has been a problem worldwide during the Covid-19 outbreak. The problem was even more acute in India because they were not manufactured locally. With the help of the Ministry of Textiles, all the potential domestic and foreign manufacturers based in India were contacted and provided handholding support to make good quality PPEs.

The health ministry along with the external affairs ministry and the textiles ministry have identified several other foreign sources that are being pursued. A total of 164.45 lakh PPEs have been ordered or pledged already against a projected requirement of 153 lakhs in a three-month period ending June 2020.

Further, in this regard, several foreign suppliers have been roped in through philanthropic contributions from the Indian corporate sector and Red Cross. They are starting supplies of around 31.30 lakh PPEs soon. The health ministry has also taken a number of steps to strengthen the supply of such items.

States have also been directed to prevent hoarding of PPE, masks and gloves, if any, and to monitor the availability of such items.

Exports for these items have been banned since January 31, 2020 to ensure the continued availability of these items in the country. Foreign supplies have been tied up and we hope that there will be a steady supply available in future. As of now, hospitals in the country have around four lakh PPEs available with them.


Do you feel that countries that have universal vaccination for BCG have fared better in controlling Covid?
I am aware of the study suggesting a link between BCG vaccination and Covid-19 caseloads. However, we need to study the evidence critically before leaping to conclusions. First, it is an ecological study, which means that the analysis is done with country-level data.

What may hold true at the aggregate or population level, may not hold true when the individual-level heterogeneity is considered. This is a hypothesis generating approach, which needs more careful consideration before making sweeping policy decisions.

Secondly, this is a correlation study, and we must remember the epidemiological adage – correlation does not imply causation. Thirdly, we need to consider the biological plausibility of this assertion. BCG confers protection against a bacterial disease, and that too against more severe forms of the disease.

The idea of a vaccine which protects against a bacterial lung disease also conferring protection against a viral lung disease might seem like a tidy connection, but till the pathophysiological pathways are clarified, these assertions will remain hypothesis generating rather than policy-altering. It is also important to remember that BCG is known to be an immunomodulator.

However, we provide it as soon as a baby is born. It is unclear whether immunomodulation continues to be present even if we grow older and for how long. One must at least remember that even if we have received BCG, we should not be complacent in practising the well-known preventive measures.


What percentage of Covid-19 patients in India have needed critical care?
A very small fraction of Covid-19 patients required critical care support in India. As of April 7, 2020, 9:00 am, we have had 4,421 cases overall, out of which 3,981 cases are currently active, 325 have recovered, and 114 have succumbed.

With such a small number of cases under consideration, it would be premature to look at proportions and base decisions on them. Our focus should remain on two aspects – preventing the cases from becoming severe and landing up in the hospitals; and preventing deaths from COVID-19.


Are there plans to start serological tests in India for diagnosis of antibodies?
The Task Force on Covid-19 is considering the issue of undertaking serological testing for screening of people, and an advisory on this matter will be issued shortly.