INTERVIEW | Public role key to break COVID-19 chain: Dr PV Ramesh

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Express News Service

What is more important to break the chain of COVID-19, the pandemic that has brought the entire world down to its knees? “Citizens’ responsibility coupled with government strategies,” says Dr PV Ramesh, the additional chief secretary (to CM) of Andhra Pradesh.

In an interview with Express, the physician-turned-bureaucrat explains why the world, let alone the State, is in the fight against COVID-19 for a long haul, how coronavirus would change how the civilization behaves for months (or years) to come and how the concerted efforts of the government in the last ten months in strengthening the public health deliveries helped in stabilising the situation in Andhra Pradesh.

Exactly a month ago (March 12), AP recorded its first COVID-19 case. In four weeks, we saw a significant spike with 420 cases, seven deaths and 14 recoveries. What is the situation now in AP?

We have a stabilised situation now. But, the problem is the virus is known only for three months. Whatever information we have now may not be relevant tomorrow as the behavioural dynamics of the virus changes. That said, an essential prerequisite to effective control of an epidemic, or a pandemic in this case, is a robust public health system. AP had a poor public healthcare system, much of which was privatised in the last five years.

After the change of guard last year, the government has taken various steps for strengthening the public healthcare system through Navaratnalu programme. Secondly, we put in place a decentralised governance system: village/ward volunteers, a revolutionary programme.

These things we have done in the last 10 months helped us and will continue to help in the time of crisis. Then, we have started tracing and testing foreign returnees much before the Centre asked us. In fact, we are one of the first states to have started screening international returnees and identified over 1.1 lakh returnees and their contacts.

And since the first case was reported, we stepped up our tests.  We have since undertaken two door-to-door surveys.

Then, our functionaries identified another 5,000-cluster of Delhi returnees and their contacts. But, there is a small number of cases that don’t fall in either of the above two categories.

Does this mean community transmission has begun in the State? What about the much-talked-about curve?

I believe that we should not be fixated if community spread is there or not. It is inevitable that a large number of people would be affected in one way or the other. When there is a large cluster like Delhi or foreign returnees, it is relatively easier to identify, isolate, test and treat them. But, when you have somebody who is not known to have contracted the virus from either source but still has an infection, we have to assume from some source. It does not really matter if we have community spread or an internal spread as management protocol is essentially similar.

Several States have changed their guidelines regarding usage of masks and AP also seems to have changed it now. There are conflicting studies regarding the usage of masks. At one time, the WHO said those with infection, their contacts or the healthcare professionals treating them only needed masks. Some demonstrated that masks necessarily do not stop virus transmission. But, the fact is that those who wear masks are preventing virus transmission as asymptomatic cases are there. However, the most important thing here is its disposal. 

There has been an advisory from the Centre that States should stop procurement of critical equipment like masks, ventilators and testing kits and that they would be supplied by the Centre. What is AP’s stand on it?

Our country’s capacity to produce critical equipment is limited. Domestic production has begun only recently. Maintenance of quality in procuring them is essential. It has to be of a specific design and standard.

So monitoring of a centralised agency, especially when the entire globe is trying to source it from the same places as there is a global demand, will help. We will have a price advantage, diplomatic outreach and many other advantages. But the downside is delayed procurement and delivery. 
Large supplies mean small deliveries.

The State government will bank on both. We have already placed orders. We have taken advanced action for the requirement and are working through various channels. Now that the GOI advisory has come in, we will weigh all our options.

How often are we getting supplies from the Centre?

We have stocked enough equipment. PPE is to be used by those who are treating positive cases. We have also started making them locally. We have given local workers specifications, designs and other needs for preparation. So, we are well stocked.

What about rapid testing? 

We are expecting at least 2 lakh rapid test kits, which are essentially antibody tests. These have to be used strategically as antibodies appear only 10 days after being infected. There is no way we can test the entire State as it is not practical.

How are village volunteers helping in combating the pandemic?

Village and ward volunteers did a splendid work along with the government functionaries. They should be appreciated for tracing foreign and Delhi returnees, by going home to home. Also, in terms of delivery of services such as  pension, essential services and others, they have played a much bigger role. That is why we devised a distinct strategy for rural and urban areas.

More than 4,000 ASHA workers, 23,000 ANMs, more than 2 lakh volunteers have become crucial in the containment of the pandemic in rural areas. In urban areas, we adopted a slightly different strategy. We pooled in all migrant workers, homeless to one place and are taking care of them.

What are the challenges ahead for the government?

The government thus far has done whatever needs to be done, although there could always be scope for betterment as we constantly seek to improve. But citizens’ responsibility is crucial. This diseases chain will be broken only with citizen participation. This is a war where we don’t know how the enemy comes or its strategy. So, citizens role is paramount.

We have to limit our movement, maintain physical distance. Till a vaccine is found, the virus will be lurking around somewhere. This pandemic will change our behaviour fundamentally. We can’t be unhygienic. Everything changes. We are in this for the long haul.

Is the availability of doctors and healthcare professionals also a challenge?

I think we, right now, are in a better place in rural areas with MEPMA, self-help groups and  volunteers available. We need a similar system in urban areas, which have communicable diseases and non-communicable diseases. So when you put them together, we need a much stronger healthcare system. Aarogyasri works in that direction.

When can normalcy be expected?

What we know now may change tomorrow as the situation is dynamic. We can’t really assess it. Normally, in a pandemic of this nature and magnitude, like Spanish Flu, these infections were contained only after the vaccine was found. Every virus behavioural dynamics are different. All we can hope for is that there will be a vaccine soon. It usually takes 12-16 months. Let’s keep our fingers crossed. 

Ramesh’s appeal to people 

Maintain physical distancing, which is different from social isolation and is essential for breaking the chain of virus transmission

Immediately seek medical help if symptoms like cough, loss of sense of smell/taste, shortness of breath are observed

Wash hands regularly

Those with comorbidities like diabetes, blood pressure and respiratory issues should take more precautions

Never touch the front of the mask, remove it from behind. There are three ways of the disposal: putting in a soap solution for certain hours, burn it, third is to bury it

People may become restless due to the lockdown. Call 104 or 1902, there are counsellors available. There is nothing wrong. All of us get depressed, worried and anxious. There is no stigma attached.

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