Be it the 1854 Broad Street cholera outbreak of the United Kingdom, or the Spanish flu of 1918, governments and health officials have played an apposite and influential role in gripping malignant pandemics and shrinking their outreach. However, in the wake of the Coronavirus growing at breakneck speed, the Integrated Disease Surveillance Programme, which is the foremost and the best-equipped body to spoor pandemics in India, has taken a backseat. The Integrated Disease Surveillance Programme (IDSP) is a subsidiary of the National Centre for Disease Control (NCDC) that used to trace the spread of diseases and probabilities of epidemics while publishing weekly reports of the same on its website. Pioneered in November 2004, after the SARS ( Severe Acute Respiratory Syndrome) outbreak, the IDSP punctiliously published surveillance and track reports of diseases like Malaria, Dengue, Chickenpox, Mumps, and many other diseases that India is a victim of, until February 2020.
The IDSP, which should have played a significant role in educating the citizenry about the footing of the suffusing pandemic, has stopped publishing its weekly reposts since February 2, after reporting the first three positive cases of the novel Coronavirus in India. This unceremonious halt in sharing data is accompanied by the IDSP’s absence in government initiated pandemic response meetings. The entity, in its 15-year stint, had dotted the I’s and crossed the t’s of disease management. However, amidst a period for which it was fundamentally tabled, the IDSP has miserably jiggered and fell short of performance.
The IDSP, along with the ICMR constitutes the two primary sources from where the Health Ministry acquires its medical specifics. The former has comparatively a more comprehensive dossier of statistics and data garnered from contact-tracing operations, quarantine houses, Rapid Response Team (RRT) reports, and State/UTs’ weekly submissions on disease outbreaks. Technically, the IDSP should have lead from the front to contain the multiplicity of the disease, or at the least, been above board and transparent with respect to the statistics and progress of the virus. However, it has de-operationalised itself during these testing times for which it was instituted and refuses to justify its absence.
Consequently, such a kaput has raised questions among the concerned health officials, doctors, clinicians, and epidemiologists who are racking their brains day and night to flatten the numerical curve of the ever-mushrooming Coronavirus cases. An ad-hoc High-Level Committee was constituted by the Health Minister Harsh Vardhan to analyse the situation of Coronavirus in India. It would look into fast-tracking methods of the approval process for drugs, research, and vaccine development and identify and institutionalise these measures that would aid in handling the Coronavirus spread. Among the many topics discussed in the first meeting, pertinent questions were raised regarding the absenteeism and dormancy of the IDSP by the members of the committee. However, the Health Minister gave no justification for the slipshod conduct of the IDSP and subsequently refused to publicise the data gathered, if at all gathered.
The outbreak has lead to the IDSP and ICMR, which form the backbone of health information in India, to lock horns with each other in terms of barter of information. To add to the bargain, the health and academic partners of the government are also devoid of substantial information from the health sector. The past being a prologue, trading of health reports between medical agencies has been a cornerstone of any and every pandemic engaging nation. The government’s inability to share a substantial and veracious account of the Coronavirus condition has left the masses and the health experts in the dark. With no background details of the origin, point of spread, and current situation of the virus, the aiding partners of the government comprising health officials, doctors, clinicians, epidemiologists, researchers, and scientists are jilted in a wild goose chase to trace the virus from its grassroots. The malfunctioning of the IDSP has had cascading repercussions on the testing policy.
The concealed data includes contact tracing information and reports of influenza-like illness, which is mandatory for the epidemiologists to trace the escalation of the virus in India and augur its future course. The withholding of specifics by the IDSP is also the reason for the miserable failure of India’s containment zone as it ruled out the possibility of tracing the primary contact and alienating him/her in time. This led to an inordinate testing backlog, the brunt of which is now borne by doctors and scientists who are given nothing but utensil battering applauses and 9 P.M. candle condolences. Throughout the world, be it the New Zealand, which has discharged its last patient, or South Korea, which is reportedly tracking down every potential carrier and testing vociferously, the Centers for Disease Control of the respective countries are leading from the front to whittle the spread of the virus. However, the situation in India begs to differ. While a research agency is steering the wheel, the central disease control unit i.e. the NCDC has lost its purpose and has preferred the hang loose.
The Indian Government also constituted a National Task Force for Covid-19 comprising epidemiologists and infectious disease experts headed by the NITI Aayog member, Vinod Paul with the primary task of studying the basis and implications of a complete or partial lockdown in terms of evidence bases medical parameters. DCS Reddy, who heads the research group on epidemiology and surveillance expressed his dissatisfaction with the government for not sharing a substantial amount of data with the force. “Also, this is a stronger reminder to the government to share data so that all the talent that we have in the country can analyse it.”  The task force, since its inception, is devoid of critical data that would catalysize the research and surveillance. With almost three months of rigorous and unmoored study, the task force is yet to derive any data about the contact tracing or the point of spread that lead to community transmission.
With cases increasing as we speak, it is imperative to acknowledge the absence of the IDSP that has mutated into the white elephant of the Health Ministry and hold it accountable for its inaction. This should be done with a view to assist doctors who, without concrete information, think that they’re barking up the wrong tree. There is still much to be done and the impairment of the IDSP is like an anti-terrorism squad refusing to engage in combat with terrorists while putting at stake the lives of thousands, in the current scenario, millions.
Correctly Interpreting Government's Data
With the caving in of the principal agency and under a blackout of information, little comfort can be derived from the facts which are currently at the government’s hand. The Boston Consultancy Group (BCG), which assists the government in scenario mapping, planning responses, and analysing trends, lately estimated that the number of deaths averted in India as a consequence of the lockdown scaled as high as 2.1 lakh. Much resentment has been raised by health experts who question the authenticity of the reports published by the BCG on which the government is blindly relying, claiming it to be baseless and uncorroborated with substantial evidence. Such an allegation finds ground on the notion that figures and statistics, without a transparent and substantial account of evidence, are nothing but cherry-picked numbers from a maths book. However, as against this, the Indian Scientists’ Response to COVID(19) (ISRC) Group, using a detailed epidemiological model, has estimated that approximately 8,000-32,000 fatalities have been averted till May 15. Comparing the highest numbers of the two entities, there arises a deficit of 1,78,000 deaths. This whopping deficit is considerably large and has raised serious scepticism in the medical research space regarding the authenticity of BCG’s reports which fail to furnish the grounds from where these numbers were derived.
Moreover, the established protocol mentioned in the government’s Containment Plan for Covid-19  includes three primary tests where the patient is mandated to test negative twice. These two negatives must be ascertained at consequent 24-hour intervals. Around the second week of March 2020, for about a whole week, the difference between the number of samples tested and the number of people tested, remained stagnant at 890 until the ICMR ceased to accommodate the ‘number of people tested’ criterion in its reports. This raised many eyebrows as an average suspect is tested at least twice before getting discharged. In such a scenario, keeping in mind that all suspects do not report positive, a varying difference is an indispensable strand of a government’s numerical report. Technically, repeated samples are included in the total number of samples. Thus, the numerical value of the total number of samples should be much greater than the number of people tested, making it impossible for the underlying difference to be stagnant.
With data being grossly manipulated, smoked, and obscured, the concerned authorities cannot fight shy of the questions shot at them. It is crying wolf to an already misinformed, disinformed, and uninformed citizenry that is under the perception that the mitigative policies are flawlessly successful. With the virus fanning out a mile a minute, cooperation between the government units and transparency to the people is a critical prerequisite to stifle the juggernaut Coronavirus, without which, the tussle against the pandemic would be like the Vietnam War which cannot be won; a wrong war, with the wrong weapons, against the wrong enemy, on the wrong battlefield.
Consultations Before Lockdown, Scroll.in [Link: https://scroll.in/article/963439/head-of-government-research-group-we-werent-consulted-for-extending-or-modifying-lockdown]
ISRC Press Release [Link: https://indscicov.in/wp-content/uploads/2020/05/ISRC_PressReleaseMay27.pdf]
Containment Plan of the Indian Ministry of Health and Family Welfare [Link:https://www.mohfw.gov.in/pdf/3ContainmentPlanforLargeOutbreaksofCOVID19Final.pdf]
Views expressed are solely those of the author.
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About the Author
Saahas Arora is currently reading law at the ILS Law College, Pune. He has been enthusiastic about writing and debating which he pursued with a Debating and Public Speaking course from the University of Oxford in 2016. As a budding lawyer, he takes a keen interest in Constitutional Law, Criminal Law, and women’s rights. Gathering experiences from working under the Indian National Bar Association, LexLife, and the Central Law Agency, he likes analysing and decoding government policies and diplomatic affairs and has been dissecting several socio-legal issues through his writing. At leisure, you would find him indulging in reading, food, and FIFA.