- Issue of disease watch
- Lax surveillance system
- Silent epidemics
- Vested interests
- Selective Priority
Time to reboot India’s disease surveillance system
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The recent data of the Ministry of Health and Family Welfare shows that 75.3% of deaths in India have been concentrated in the age group of 60 years and above, and in 83% of deaths, the deceased were battling pre-existing identified health conditions. In medical terms, this is a situation of comorbidity (existing medical conditions concurrent with primary), which in ways makes it difficult to differentiate between dying of COVID-19 or dying with COVID-19.
Issue of disease watch:
- In comparison to many western countries combating the disease, India appears to have the advantage of a relatively young population.
- This is, of course, negated by the poor health conditions of the vast majority of Indians.
- It is then imperative that we do not ignore already prevalent diseases and illnesses.
- Unfortunately, the recent experiences of the public health-care system in India indicate the side-stepping of precisely this issue.
- There are many among the poor who are battling various diseases but now have little access to major public hospitals in the wake of the lockdown.
- Routine functioning, particularly of out-patient department services in public hospitals, has been severely affected, and largely, emergency cases are being entertained.
- In such circumstances we can expect an aggravation in the poor health conditions already affecting large sections of people who have limited access to health-care services.
- Evidently, we have reason to fear the novel coronavirus for which we have no established cure.
- However, there is even more reason to fear a combination of COVID-19 with existing illnesses and medical complications.
- The disease is lethal for those with compromised immunity brought on by age, existing respiratory infections, or essentially, malnutrition.
Lax surveillance system:
- Many of the adverse medical conditions prevalent among the vast majority of our country are not even identified due to the lax (careless) disease surveillance system.
- A significant number of the infected (poor and marginalised people) do not have access to health-care facilities and so fail to report their condition to certified medical practitioners.
- Even when an infected person has access to such facilities, their clinical case does not always culminate in the required testing.
- There is a widespread practice among pathological laboratories to categorise diseases on the basis of the pre-existing classificatory system.
- This results in failure to identify the definitive cause for an illness by differentiating and separating pathogens (disease-causing microorganisms) on the basis of variations in groups, subgroups, strains, etc.
- There is pervasive non-identification of a definitive cause behind a number of illnesses.
- Many ailments are simply clubbed together and referred to by generic names such as ‘Respiratory Tract Infection’, ‘Urinary Tract Infection’, ‘Acute Undifferentiated Fever’, ‘Fever of Unknown Origin’.
- Certain of these undifferentiated illnesses are known to affect lakhs of people every year worldwide.
- For Example, Acute Lower Respiratory Tract Infection (ALRTI), which affects mostly children below the age of five years, has been known to infect approximately 3.40 crore people every year worldwide.
- In recent years it has led to roughly 66,000 to 199,000 deaths.
- Shockingly, 99% of these deaths are reported from developing countries, and India has a larger share in it.
- The large number of hospitalisations, enormous deaths and suffering caused by contagious undifferentiated diseases indicate the prevalence of persistent but undeclared silent epidemics.
- Even if the definitive cause of an illness is identified, it does not necessarily gain the focused attention of scientific research.
- As the disease evolves but “interest” in it remains fleeting, the differences developing in the sub-groups, strains in the genotype of the pathogen concerned fail to be consistently tracked.
- Knowledge of the pathogen and the required disease control soon lag behind.
- This overall process is due to the selective, biased approach of mainstream scientific research that is driven by the profits of private pharmaceutical companies.
- It is the fallout of the lack of priority that governments assign to general health care and diseases of the poor.
- Even when the identity of a contagious disease and its treatment are well known it does not mean that the disease’s prevalence will generate the necessary reaction.
- TB is a suitable example. According to public health experts, one person in every 10 seconds contracts TB, and up to 1,400 people in India die every day of the disease.
- This indicates that TB has a R0 value (basic reproduction number) and fatality rate that is way higher than those attributed to COVID-19 so far.
- However, it is important to note that TB and many other contagious diseases are ignored as “ordinary”, and elicit very low attention.
- In contrast, some diseases are quickly identified as epidemics of greater public concern.
- Diseases are being selectively discovered and have the propensity to be identified as an epidemic when they have a signalling effect for the scientific community.
- In a majority of instances, it is only when there is a threat of transmission to the well-to-do sections of society or wealthier regions that the disease actually has such a signalling effect.
- It is not a coincidence that a relatively downplayed disease such as TB is largely a poor man’s disease.
COVID-19 has gained singular prominence over several other lethal diseases. The pre-existing diseases have the potential to combine with COVID-19, causing devastating consequences. Thus it becomes imperative to identify the comparative fatality rates of many of the silent epidemics, and give them the required due attention and priority.