Experts call for national database on coronavirus
India needs a centralised national database on everything related to the coronavirus disease (Covid-19), including standardised data on turnaround testing time, surveillance, home and hospital isolation, and proportion of cases among people with contact history , say epidemiologists and public health experts.
In an opinion article in The New York Times, the former head of the US Centers for Disease Control and Prevention Tom Frieden recommended the compilation of standardised data on a range of parameters to better manage the pandemic that has so far infected 15,154,448 and killed 621,172 across the world. He wrote, specifically of the US that “we aren’t tracking the public health equivalent of vital signs” and that this is a “big reason the US is losing the battle against Covid-19”.
Frieden’s article is based on work done by his current organisation, NGO Resolve to Save Lives, which, according to an article in NYT found that states were reporting only 40% of the “data needed to fight the pandemic”. In some ways, experts say, India is similar to the US in terms of its geographical size and diversity. The same data collection and standardisation problems the US has, are also manifest here, they add.
The Resolve to Save Lives website lists some of this data. These include: “new confirmed and probable cases and per capita rates by date with 7-day moving average”;“new screening (antigen) and diagnostic (PCR) testing per capita rates by date, with threshold, with 7-day moving average”; “CLI (Covid-19 like illness) and ILI (influenza like illness) trends from emergency departments”; “diagnostic test turnaround time (specimen collection to test report), by week”; “time from specimen collection to isolation of cases”; and “new infections among health care workers not confirmed to have been contracted outside of the workplace, by week”.
Epidemiologists in India say this data is crucial for clinical and epidemiological research. “It is all relevant data, especially turnaround time for testing as in most urban areas where there is a surge in cases, we see that there is considerable delay in testing, which further leads to delay in communicating positive results, and can eventually affect the time of isolation of cases. Hence, these are important parameters to document, and should be documented scientifically. What does not get reviewed won’t get done,” said Dr Giridhara R Babu, professor, epidemiology, Indian Institute of Public Health.
Experts also advocate transparency — they suggest national data must be shared real-time with the public to empower them to protect themselves.
“Merely documenting information is not enough; what is documented should be put out in public domain for the benefit of people at large. If data is accessible publicly then there will be people willing to analyse it and come to conclusions that can help guide decision makers towards the right direction. As things stand now, the information that is in public domain is only what the government wants you to know. That’s not how it should be,” said Dr Lalit Kant, former head, epidemiology and communicable diseases division, Indian Council of Medical Research (ICMR).
“I should have access to information on, say, who is dying-- is it those who are marginalized and don’t have access to health care services or the section that has access to treatment. Also, which are the hot spots that I should avoid in case I am stepping out .”
Union health ministry officials say that the centre has been closely monitoring the Covid-19 situation across states and union territories, and data generated through its testing and surveillance network is regularly updated at the central level.
A union health ministry official said India is already collecting much of this data and following many of the suggestions mentioned in the article.
“Our integrated disease surveillance programme network is updated on a real-time basis and the data is collected till the grassroots level. There is a dashboard in the ministry that is fed all relevant information from states. Laboratories testing Covid-19 samples are also feeding real-time information digitally on identified online platforms. Central teams are being regularly sent to states with high case load to coordinate with and assist local governments in managing the outbreak and look for gaps that need to be filled,” said a senior health ministry official, who did not wish to be identified.
Where there are lapses, the problem is largely with the states, the official added.
“At least 80% of the contacts are currently being traced within 72 hours of reporting of a case, but it is not the same across states. States are being asked to ensure test results are put out within 48 hours of sample collection, but many states are not following it.
“Separate data is being generated from SARI and ILI cases for which all these patients are being tested for Covid-19 in the country. Some states are doing exceedingly well in data reporting such as Maharashtra and Gujarat where we can say the (real) numbers are what is being reported.”
There is a huge variation in tests being done per million population across states. While a lot of data may not be available in the public domain, it is available to those who need it, said an ICMR official.
“Testing data is duly documented from all 1270 approved laboratories that are conducting Covid-19 tests. Once a lab receives a sample, it takes up to six hours to process it and enter data into the ICMR web portal. The turnaround time is a maximum of 48 hours. All information is not being put out in public domain but internally the data is accessible to everyone who wants details. It’s an absolutely transparent and streamlined system,” said Dr Rajnikant Srivastava, spokesperson, ICMR.
Still, there is a massive discrepancy in testing rates, and opacity about turnaround testing time, surveillance and contact tracing , say experts.
“Aggressive testing is needed but we must also keep in mind that it has to be done in a scientific way, as per the requirement of each state given the country is diverse and no two states will have the same requirement. Some states will have lower testing capacity even though they need more. Focus on states that are backwards in comparison and help them build capacity to meet the demand, ” said Dr Jacob John, former head, virology department, CMC Vellore.
Frieden adds in his op-ed that the data would help serve as “an early warning system” about potential outbreaks or flare-ups; help improve “turnaround time of tests”; provide information on “size, lethality and status of control of every outbreak”; and make the system accountable for “how many health care workers have been infected each week.”