Early measures reason for fewer cases in India: WHO regional director
Fewer cases in India are attributable to early and aggressive action to contain the spread of coronavirus disease (Covid-19), said Dr Poonam Khetrapal Singh, regional director, World Health Organisation, South East Asia Region, of which India is a part.
High engagement with people; finding, isolating, testing and treating cases and tracing every contact; readying hospitals; and protecting and training health workers are needed to combat Covid-19, she says. In addition, adequate staffing, clinical rotation and psycho-social support to healthcare workers is a must to prevent burnout.
She speaks to Hindustan Time on Covid-19 lockdown and India’ efforts in slowing the spread of Covid-19. Here is the full interview:
Q: How should lockdowns be lifted?
Dr Poonam Khetrapal Singh: Lockdowns must be lifted slowly, when six criteria are fulfilled -- transmission is controlled; health system capacities are in place to detect, test, isolate, treat cases and trace every contact; outbreak risks in health settings are minimised; preventive measures are implemented in social settings such as workplaces and schools; importation risks can be managed; and communities are fully educated, engaged and empowered to adjust to the “new norm”.
Q: How do you rate India’s efforts to slow transmission?
Dr Poonam Khetrapal Singh: So far, the numbers in India are far less as compared to other countries, which can be attributed to early and aggressive measures that the country has been taking. The top-most leadership is driving a whole-of-government and whole-of-society response to the global pandemic.
Q: How does WHO define community transmission?
Dr Poonam Khetrapal Singh: Community transmission is confirmed when the source of infection is not clear. In other words, when transmission in a given area is extensive, in multiple locations, without reported travel history to areas reporting community transmission, and without epidemiological links to known cases. But whatever the stage, the key action points remain -- engage with people; find, isolate, test and treat cases and trace every contact; ready hospitals; and protect and train health workers. That’s the only way to combat Covid-19.
Q: Some states in India are adopting pool testing. Is it an effective public health tool?
Dr Poonam Khetrapal Singh: WHO is aware the Indian Council of Medical Research is going ahead with pool testing in some states, especially in the non-hotspot areas. While WHO is working on bringing out comprehensive guidelines, we welcome measures to scale up testing.
Q: Given the shortage of kits, how can testing be scaled up?
Dr Poonam Khetrapal Singh: Good laboratory practices that produce accurate results are key to assure a good public health response. The availability of timely and accurate results can be threatened when testing demands outstrip capacity, such as when there is a backlog for testing and it is no longer possible to turn around results within 24 to 48 hours; the demand for laboratory reagents exceeds the capacity for supply; laboratory staff are exhausted and working hours need to be reduced; the number of incoming samples exceeds the capacity for safe pretesting storage; critical staff become infected or are otherwise unable to perform their duties (for example, being in quarantine); or laboratory instruments can no longer be serviced or properly maintained. Some of these constraints can be overcome by a proper risk assessment in the early phase of an outbreak and preventive solutions put in place in advance.
Q: What are the WHO recommendations for testing when resources are limited?
Dr Poonam Khetrapal Singh: When resources are limited in areas with community transmission, prioritisation for testing should be given to people who are at risk of developing severe disease and vulnerable populations, who will require hospitalisation and advanced care for Covid-19; health workers (including emergency services and non-clinical staff) regardless of whether they are a contact of a confirmed case (to protect health workers and reduce the risk of nosocomial transmission); the first symptomatic person in a closed setting (for example, schools, long-term living facilities, prisons, hospitals) to quickly identify outbreaks and ensure containment measures. All other individuals with symptoms related to the close settings may be considered probable cases and isolated without additional testing if testing capacity is limited.
Q: Does warm and humid weather slow Sars-CoV2 transmission?
Dr Poonam Khetrapal Singh: There is no evidence yet that the virus would not survive in high temperature.
Q: What steps should India take to protect health workers?
Dr Poonam Khetrapal Singh: To prevent infection in healthcare settings, WHO recommends the use of contact and droplet precautions by health care workers caring for patients with Covid-19; and airborne precautions in settings where procedures and support treatments generate aerosols are performed.
The correct use of personal protection equipment (PPE) is critical, in particular wearing appropriate PPE for the clinical setting, paying special attention to procedures to put on and remove it correctly, and adhering to hand hygiene and other infection protection and control (IPC) measures. When these precautions are applied correctly and consistently, alongside standard precautions and administrative, engineering and environmental controls, the risk for health care workers’ infections is substantially reduced or avoided altogether.
WHO has also developed a risk assessment tool for health care workers exposed in a healthcare facility and a sero-epidemiological protocol to determine risk factors for infection among them, and is finalizing an in-depth epidemiological surveillance tool for health care workers’ infections.
Health care workers caring for patients with Covid-19 are subject to long working hours, fatigue, occupational burn-out, stigma, physical and psychological violence, and back injury from patient handling. IPC measures must be complemented by occupational safety and health measures, psycho-social support, adequate staffing levels, and clinical rotation, to reduce the risk of burn-out, for safe and healthy working environment.
Q; What is the WHO recommended treatment for Covid-19?
Dr Poonam Khetrapal Singh: No pharmaceutical products have yet been shown to be safe and effective for the treatment of Covid-19. However, a number of medicines have been suggested as potential investigational therapies, many of which are now being or will soon be studied in clinical trials, including the Solidarity trial co-sponsored by WHO and participating countries.
Q: What is the progress on the Solidarity trial of four new therapies? When are results expected?
Dr Poonam Khetrapal Singh: WHO is working hard with international researchers to generate the evidence about which medicines are most effective for treating Covid-19. So far, 74 countries have either joined the Solidarity trial or are in the process of joining and more than 200 patients had been randomly assigned to one of the study arms. Each new patient who joins the trial gets us one step closer to knowing which drugs work.
Q: Will President Trump’s suspension of funding affect WHO’s work?
Dr Poonam Khetrapal Singh: Right now, Covid-19 is the WHO priority.