According to the recent ICMR report, the projected Covid-19 cases in India has already crossed 140 Mn which is about 1% of India’s population. “One of India’s foremost virologists and the winner of the coveted Shanti Swarup Bhatnagar Prize in 2000, Shahid Jameel, says if the ICMR serological survey results, made public on June 11, are correct, then it follows that India has 140-150 million corona virus infected people today.

Dr. Jameel, the CEO of the Wellcome Trust DBT India Alliance, says this follows from the findings that at the end of April 0.73% of the population, which is 10 million people, had the virus. Seventy-five days later, given India’s doubling rate of 20 days, the number of people infected today would be 140-150 million.

“Even as India struggles, the true scale of the epidemic there might not be apparent. The country has an incomplete death-registration system, which means that not all deaths are recorded, and the documented cause is often incorrect.This raises questions about India’s COVID-19 mortality rate, which is officially 11 deaths per million people in the population — among the lowest in the world. By comparison, the United Kingdom has seen 635 deaths per million people, and the United States has seen 376. Jayaprakash Muliyil, an epidemiologist at the Christian Medical College in Vellore in the state of Tamil Nadu, has been advising the Indian government on COVID-19 surveillance and helped to design the government’s first sero-surveillance survey, of 26,400 people, to estimate the proportion of the population with viral antibodies”

  • CDC also has alleged that the control of spread is next to impossible at 1% of infection level. It has also been mentioned in the 3rd containment plan for large outbreaks by the MoHFW. RT-PCR efficacy in India is close to 30% with the rest of the cases being false negatives.
  • Hence the actual number could be much larger. The IgG-IgM also known as the “Rapid Antibody” test, which was previously used to detect community spread, can be used to detect active individual infections if used in a timely manner. These tests are already being used by Kerala, Chhattisgarh, Uttar Pradesh, Tamil Nadu to detect community spreads. Each of these tests cost around Rs. 200 without the need of cold chain or extensive infrastructure.

If one looks at the reported spread in the rural parts of the country, doubling rate has reduced to a fourth of its previous value in the last one week in non-urban Assam, Chhattisgarh, Uttarakhand, Himachal Pradesh and rural areas of Maharashtra, Telangana and Tamil Nadu will follow suit.It is essential to adds vaccination can not functioning without a cold chain and even then the efficacy would be closer to just <10% as is with any flu shot, after 2 doses of administration. The general life span of body’s memory molecules to remember these viruses does not exceed 3 years in its Genus, so heard immunity is out of question.

Cost of Prevention

What Next?

  • Focus on prevention of mortality
    • At a time of an emergency, the need of the hour was to look for any treatment that is saving lives. We are inching towards the million mark and we have over twenty-two thousand people dead. We need to save lives. Even if the infection goes up, can we reduce the mortality rate is the big question. In recent times we have come to know that the virus acts very strangely. It acts to hyperactivate the immune system to create a cytokine storm.
    • Some drugs are positioned as a biologic molecule to prevent the cytokine storm and get rid of this. The way these acts is by modulating the immune system upstream to prevent these cells from producing cytokine. Small clinical trials we did under the emergency criteria are allowed because the need of the hour is to get access to such life-saving drugs.
    • We have seen a very statistically significant outcome between the control arm that did not receive active drugs and the arm that did.
  • Plan of action
    • Team of Epidemiologists, Pulmonary Medicine Specialist and Intensivist should create categories for stage of disease identification based on investigations (low cost, minimally invasive and with the relatively less technical expertise)
      • Mild
      • Moderate
      • Severe
      • Severe + Complications

The categorization is supposed to be based on management of the disease in terms of Clinical and Invasive.
Detailed strict treatment protocols should be created along the lines of MoHFW report 29th June 2020.
Strict protocols should be set up for admission / intervention as follows:

  • PHC / UCHC (Primary Centres) – First contact of Mild or Moderate patients, No reference necessary for actions under this category. All other patients are to be referred to Secondary Health Care Centres.
  • Here we add almost 1200000 beds through utilizing existing infrastructure into the treatment pool which is only 700000 rich right now.
  • Here we add over 900000 in position health care workers to the COVID response going by the final RHS report of MoHFW 2018-19.

Secondary Health Care Centres – Direct admission of Severe and Severe + Complications category of patients. Should have no direct contact with Mild or Moderate patients. All Severe + Complications patients to be referred to Tertiary Health Care Centres.

Tertiary Health Care Centres – No direct contact with any non-referred patients and strict adherence to WHO guidelines of maintaining a Chinese wall.

  1. Set up a portal for all healthcare workers which combs the internet (ML) for most verifiable and recent updates for streamlined information dissemination. (
  2. Primary healthcare workers should be trained for management and treatment of Mild and Moderate cases. (Enter resources + stats here)
  3. Safety of health-related human capital must be maintained (Tele medicine).It takes 15 years to replenish the specialized healthcare workforce so it should be utilized extremely judiciously
  4. Infrastructure management of PHCs should be covered under MNREGA for rapid capacity utilization.

5. Logistics:
Well-functioning supply chains to deliver medicines, vaccines, and other health products form the backbone of the health system. Health product supply chains in developing countries are fraught with many problems. Ineffective supply chains weaken the overall health system’s ability to respond to the healthcare needs of the population and put treatment programs at risk. This article provides an overview of the structure of health product supply chains in developing countries and outlines the main challenges and their root causes. It aims to identify key areas of reform to ensure that supply chains enable—or at least do not impede—achieving the targeted health outcomes from the increased investments in global health.

PHC & SHC – Lack of road connection can be remedied by drone delivery of PPE kits and pharmaceutical aid.

Tertiary HC – Verification of generic and label medicine should be done to prevent drug fraud.

Drone delivery is a valuable innovation that can save lives in medical emergencies. Urgently required blood, medications, vaccines, and small medical equipment can be delivered by drones. Drones, with rapidly improving technology, have the advantage of speed and efficiency compared to traditional forms of transportation, which are dependent on adequate infrastructure. 
“… We’re likely in for a long-term fight against COVID-19. Using contactless drone logistics will be an important tool in that effort. The work we hope to do here in India will provide the rest of the country with a blueprint for how to build the most resilient and responsive health care system possible.”

Students awaiting permits to practice should be utilized as a reserve force for training of healthcare workers and Telemedicine support for on-ground workers.

Controlling mortality through disease prevention is the only workable logical solution at this point.

About the Author
Dr. Sabine Kapasi
A gynaecologist and a health policy and governance strategy lead. For the last 5 months she has been working in Tehran, Barcelona, Paris, London Washington DC and Lima.

She has worked with several health care business and projects in public and private sector industries. Studied data strategy from The Wharton School, HBS and Stern NYU. She advise the governments of 11 states of America on health policy and office of the PS health GOI. She has Worked on pricing models of Obama Care and incepted and helped design Ayushmaan Bharat. And is a governance strategy lead and a supply chain procurement head at MSF UN. Has worked in 27 countries and teaches at HKS NUS and INSEAD.

She is enthusiastic about working in health tech,  strategy consulting, healthcare and/or women centric businesses and governance consulting largely.And a really proud mom of 2 cats 3 dogs and several others.

Rafiq Shaikh
MBA with a glorious history of analysing financial data for international banks and agencies and making them billions after which he set up his business consulting firm and how uses his powers for good.Proud father of two amazing cats 3 dogs and others.

Sir Dr.Hari Krishna Maram
Digital Brand Ambassador and Chairman of Vision Digital India, Vice Chancellor – Global Digital University, USA, Pharmacist & Ex-Novartis Global Pharma


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