At the Rajiv Gandhi Hospital on Wednesday. (Express photo by Amit Mehra)
The public snub to the World Health Organisation (WHO) and a threat to cut its funding is characteristic of Donald Trump, and may not find an echo in New Delhi.
However, the fact is when it comes to key aspects of COVID management, the government has politely sidestepped the periodic “advice” from the WHO and, instead, leaned on the Indian Council of Medical Research (ICMR) and the experience of several state governments — from Kerala and Uttar Pradesh to Rajasthan and Maharashtra.
This despite the fact that the WHO has been, like with immunisation, TB and other neglected tropical diseases, closely working with the Centre and states on the novel coronavirus outbreak, and its staff are helping state governments ramp up training and capacity-building.
Most recently, on April 3, the government’s advisory on the use of masks while stepping out of the house was at variance with that of the WHO, which said this should be only for those who are symptomatic, health workers, or caregivers to COVID patients.
That’s not the only point where the government veered off the WHO track.
💊On January 30, WHO Director General Tedros Adhanom Ghebreyesus said that WHO did not recommend travel restrictions to China — in fact, it was opposed to such an idea. This despite the fact that the same day, the WHO’s International Health Regulations Emergency Committee raised a global alert on the need for containment, surveillance, detection, isolation, and even contact tracing. By this time, India’s first advisory on avoiding non-essential travel to China dated January 25, was already in place.
💊Three days after the WHO statement, India advised citizens to refrain from travel to China, a step up from its earlier advisory.
💊On March 16, Ghebreyesus said that the WHO’s key message is “test test test”. On March 22, ICMR head Dr Balram Bhargava said: “There will be no indiscriminate testing. Isolation, Isolation, isolation.”
Hours later, India went into lockdown, starting with 75 districts and then, from midnight of March 24, the whole country. The decision was based on a paper by ICMR that quarantine is a more effective way of containing the virus than even airport screening.
US President Donald Trump during a press briefing. (AP Photo: Alex Brandon)
As the case count crossed 5,000, India has decided to ramp up testing although the protocol is likely to remain the same — symptomatic people with travel or contact history, health workers with symptoms, all hospitalised patients with severe acute respiratory illness (fever, cough etc), and asymptomatic direct and high-risk contacts of a confirmed patient (once between days 5 and 14 of having come in contact).
With the ICMR issuing an advisory for the use of rapid antibody tests in “areas reporting clusters (containment zone) and in large migration gatherings/evacuees centres”, the serological tests are also set to be conducted on a wider scale.
💊The day after the lockdown began, WHO executive director Mike Ryan said: “Without implementing the necessary measures, without putting in place those protections, it’s going to be very difficult for the country to exit (the lockdown). And when they do, they have a resurgence and I think that’s the challenge now.”
💊WHO’s clinical care guidelines clearly lay down that there is “no current evidence to recommend any specific anti-COVID-19 treatment for patients”. India, nevertheless, first included two of its undertrial antivirals — lopinavir and ritonavir — in its clinical care guidelines for patients of the novel coronavirus disease, and then revised the management guidelines to replace the antivirals with a combination of hydroxychloroquine and the antibiotic azithromycin.
It has, however, recently announced its decision to be a part of a global drug trial anchored by the WHO. This despite the fact that a 20-subject French trial on the efficacy of the two drugs is widely considered to be too small to be acceptable.
On March 26, addressing the virtual G-20 summit to deal with Covid, Prime Minister Narendra Modi’s remarks were telling when he underscored the need to “strengthen and reform intergovernmental organisations like WHO”.
WHO officials declined to comment on points of difference with the government.
Henk Bekedam, the WHO Representative to India, said: “India is at a crucial juncture in its fight against COVID-19. It is a moment that must be fully seized. WHO has been working closely with the Ministry of Health and Family Welfare and various state governments on preparedness and response measures for COVID-19, including surveillance and contact tracing; laboratory and research protocols; risk communications; hospital preparedness; training on infection prevention and control and cluster containment plan. WHO stands together in solidarity with the government in its firm resolve to overcome this unprecedented challenge.”
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