Lack of community engagement, top-down strategy, complacency, lack of respect for data and inadequate attention to rural areas are some of the critical mistakes in Covid management in India, a public health expert said.
Covid has a deep social impact that could lead to a surge in child marriage and child labour because many underprivileged children have dropped out of school and do not have access to online education, said another expert.
Abhijit Chowdhury, mentor of Liver Foundation in Bengal, and Rajeev Seth, medical director, Child Health & Development Center, New Delhi, and managing trustee of BUDS (which works for the well-being and education of children), said social aspects of the pandemic were as important as the healthcare aspects. Unless the social aspects are addressed, the biggest public health crisis cannot be managed.
Chowdhury and Seth were speaking at a webinar organised by the Johns Hopkins University and the Indian Council of Medical Research.
Complacency
“We had prematurely assumed that after the first wave of Covid, the battle was won. It gave a false sense of security. It also led to a lack of preparedness,” said Chowdhury. “This was one of the important factors responsible for the casualties in the second wave.”
In India, a large number of people came down with Covid and were in need of oxygen support in a short period during the second wave earlier this year. But there was almost no planning for a sufficient supply of oxygen, Chowdhury said.
Also, the governments allowed people to drop their guard. “Now this lesson should be learned when a third wave is being apprehended,” he said.
Engagement, data
“In India, health planners and administrators are the only people to decide on what to do and how to go about Covid management. But creative ideas are often generated from below and community involvement could have triggered many such ideas,” said Chowdhury.
He also said better communication with the community could have led to more awareness among the people.
In Darjeeling, for instance, many tea garden residents who died of Covid sought medical help only when they were in an advanced stage of the disease.
“Residents of villages within tea gardens go to (garden) clinics for ailments. But we have seen many not going to the clinics despite having fever and other symptoms of Covid because of the fear of being ostracised,” said Sandeep Mukherjee, principal advisor, Darjeeling Tea Association.
Chowdhury cited the lack of respect for data analysis.
“Initially, there was poor handling of data, which led to a further surge in Covid. Proper analysis of data could have led to better preparedness and planning,” said Chowdhury.
He said Covid cases had been rising slowly in some pockets of the country since February, before the onset of the second wave. A proper analysis of data back then could have reduced the number of deaths in the subsequent months, he said.
Norms
Lockdowns and other curbs should have been implemented differently, Chowdhury said.
“There should have been more involvement of the common people in this. People should have been explained about the importance of such measures through government agencies like panchayats and municipal bodies and also through NGOs and clubs,” he said.
Chowdhury felt the curbs failed to have the desired effect after a certain period of time.
“Many people are moving around in public places without masks, which is not allowing the cases to go down further. Imposition has not been effective in this case,” he said.
Impact on children
“Covid led to loss of livelihood for hundreds of thousands. It also led to many children being forced to drop out of school and other educational institutions. Many of them are not studying because they don’t have access to online classes,” said Seth.
Covid, he said, has an indirect impact on society. A study by BUDS revealed an increase in domestic violence against women and a break in regular vaccination chains for children during the pandemic.
“Malnutrition due to lack of income and break in the immunisation chain are two major impacts of Covid on underprivileged children. There will also be more child marriages and child labour now that many girls and boys have dropped out of school,” Seth warned. He said his organisation was helping children with vocational courses to generate incomes.