With more than 1,000 confirmed cases of coronavirus infection in India, the health ministry accepted on Sunday that the country had entered the stage of “limited transmission” of the virus. However, this admission was not made in a press briefing – it was slipped into a document innocuously. This is in keeping with the government’s lack of transparency over critical questions related to India’s Covid-19 strategy. Basic information has been shrouded in secrecy – for instance, the list of privately-manufactured diagnostic kits that have been granted licenses for sale has not been made public.
Here are ten questions prepared by a group of health journalists that the government must respond to:
Testing
1. Most countries have made testing available for free. Why has the Indian government created a two-tier system by allowing private labs to charge for it? How did it arrive at a cost of Rs 4,500 per test (US$60) which is among the highest in the world? What is the central government doing to ensure all Indians have equal access to testing, no matter which state they live in and whether they can afford to pay for the test?
2. Why has the Drug Controller not released the list of Covid-19 testing kits that have been granted import and manufacturing licences? How many of the licenses are based on validation in India and how many on foreign regulatory approvals? What is the breakup between the RT-PCR kits and rapid antibody kits? Will rapid antibody kits be allowed for use in diagnostics for Covid-19 or will their use be limited to the community-level serological surveys announced by the ICMR?
Safety gear
3. With hospitals across India reporting shortages of personal protection equipment for health workers, why hasn’t the government released clear data on the existing stockpile of coveralls, masks, gloves, as well as estimates of future requirements and availability?
4. Why has the central government designated one institute as the sole testing centre for such equipment? In the current lockdown conditions, manufacturers say the centralisation is adding to delays. Why is the central government insisting on the “taped seam” requirement for coveralls when WHO guidelines do not mandate it? Most manufacturers in India say they will not be able to comply with this requirement.
Community-level work
5. Apart from the serological surveys announced by ICMR, what are the other steps that the government is taking to map the scale of the Covid-19 outbreak in the community? Have states started community surveillance for influenza-like illnesses and how will such surveillance take place if public health centres and outpatient departments in hospitals do not function?
6. Currently, all those who have tested for Covid-19 are being admitted to hospitals. In case of a likely increase in the numbers of people infected, what is the plan for isolating those who are mildly sick? Will they be asked to stay at home or does the government have plans to create decentralised isolation facilities at the community or village level? If so, what are the plans?
Healthcare access
7. Why have outpatients services been stopped and how will patients access healthcare and medicines during the lockdown? Has the health ministry issued guidance to ensure there is a functioning level of primary healthcare in every district? What arrangements have been made to ensure patients living with life-threatening conditions like cancer, tuberculosis, HIV that require continuous support are not deprived of critical care? Recognising that these persons are particularly vulnerable in event of Covid-19 infection due to lower immunity, what steps has the government taken to ensure uninterrupted care?
8. Some states have suspended their immunisation outreach programmes and Village Health and Nutrition Day services. Are such closures limited to the 21-day lockdown or will they be extended for longer periods? Does the government have alternative plans to avoid disruption of vital programmes like immunisation?
Health insurance
9. The government has announced Rs 50 lakh cover for health workers involved in the fight against Covid-19. Officials have said the 50 lakh cover is for accidental loss of life. Is this accident insurance or life insurance then? What happens if a health worker needs medical treatment? The finance ministry has said the cover is for three months. What happens if the pandemic extends beyond three months?
10. How many health workers will be covered under this scheme? Who is eligible for the cover – all health workers in the country, or a subset, and if so, how is that defined? What is the size of sum insured and premium that the government will be paying for this?
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