COVID-19: An Urgent Need for Disease Surveillance in India

As per WHO reports, more than several million population from >200 countries are affected from severe COVOID-19 infections worldwide with millions of deaths. Although the rate of survival is high among the COVOID-19 patients, however the rate of infection is growing exponentially in several countries including India. The question arises whether this probable COVOID-19 related mortality data is misleading or it has some false interpretation. As per several reports from independent and government agencies like WHO, CDC, ICMR, a huge population is under surveillance showing symptoms like COVOID-19 and testing is still going on for these suspects but it is not possible to test these suspects within the limits of the period required for the virus to cause death. If a suspected person dies before the confirmation of COVOID-19, it is very difficult to say that this patient was really COVOID-19 affected and most likely it would be a false addition to the COVOID-19 related mortality.

Influenza is a common flu and its symptoms are similar to the COVOID-19 and shows similar pathogenic events like fever, sore throat, muscle aches, headaches, runny or stuffy nose, pneumonia and other respiratory illness. According to Centers for Disease Control and Prevention (CDC), around 40 million people were infected with common flu in USA this season and caused more than 20,000 deaths in current season only. Likewise Chinese Center for Disease Control and Protection, reported more than 40,000 confirmed cases with 5 percent severe illness. However, it’s not a realistic data as most of the patients don’t go to hospitals and get recovered through their immunity. The similar patterns can be found for the rest of the world as well.

In USA, pneumonia and influenza related deaths has increased since the end of February, this year. This could reflect an increase in deaths from pneumonia caused by non-influenza associated infections, including COVID-19. Therefore, deaths due to COVID-19 may be misclassified as pneumonia or influenza deaths in the absence of positive test results.

The problem with the developing countries with huge population like India, is the lack of registration of the patients. Most of the Indian flu patients do not go to hospitals and there is no such efficient registration and data collection policy till date. India has launched Integrated Disease Surveillance Project in 2004 and it was also included and funded in 12th 5 year plan. As per recent report it has not been funded in 13th 5 year plan. But why?

One may say that this might be ignorance of the government, however the hurdles to run such kind of  programs is not so easy to understand in a country like India having followers of several religious beliefs, literacy rate, socio-economic imbalance and most importantly the fringe elements in the society. These elements are so powerful that they can influence a large number of population and in absence of strict laws and political support, a punishment is forbidden.

As per recent media reports, during peak of the COVID-19 infection in India, doctors, paramedical staffs and security forces are being assaulted by the suspected (in some cases, confirmed) COVID-19 and their family members and supporters. The reason for this unaccepted and unexpected act is also not so easy to understand. It’s too complicated. One can understand if the act is being done by a person or a small group of people affected with the outbreak or by some people suffering from some socio-economic discrimination in some specific geographical area. But the problem becomes worsen when this unlawful and inhumane act is supported by the intellectuals, political leaders and a small group of influential people. They smartly condemn the act by hiding their agenda to support the act and it is very difficult to understand their mindset. The problem is also extended by the VVIP culture of India and bad mindsets of some political leaders holding constitutional positions. They go beyond the limits of stupidity to show their “Absolute Power” and personal benefits.

The story is not new and it started in 1988, when the Global Polio Eradication Initiative was formed. Religious opposition by fundamentalists is a major factor in the failure of immunization programs against polio in Nigeria, Pakistan  and Afghanistan and extended to India as well. Over the years, several kidnappings and beatings of vaccinators was also reported. A 2009 report from Aligarh city published in 2015 PLOS ONE journal, elaborated the roots of the problems. The study shows that formation of segregated neighborhoods facilitating the physical transmission of poliovirus. Although the study has a biased evaluation, however the overall conclusion was worrisome. Study shows that lack of political will was the major cause for resistance to vaccination and was linked to fears of sterilization influenced by the “Family Planning Program” from 1976-1977. It was aimed to eradicate the burden by 2000 but it only came to happen after two decades by dedication of the newly formed government. If we compare us from the western world with respect to Polio eradication, USA was polio free in 1993 while all EU countries eradicated it in 2002.

Polio mortality rate was negligible and morbidity was the only problem of concern having impact on society and GDP of the country. Not only in the case of Polio, but also other vaccination movements are opposed by the religious beliefs around the world. We can see several scientific articles on this issue. These studies show that refusal of vaccination based on the religious beliefs are increasing. We are afraid that even after getting the vaccine for COVID-19, the religious fanatic elements will try to influence population in a wrong way.

However, COVID-19 is a deadly disease and must be under proper surveillance, registration, diagnosis and proper treatment. Indian government has taken all the necessary actions for the management of the outbreak, however problems created by these fringe social disasters will impact the whole Indian society. It will not affect the mortality rate of the COVID-19 patients but will create a barrier between the healthcare systems especially surveillance strategies and the society.

Swaroop Pandey, Scientist, Ben Gurion University of Negev, Israel

Vikas Pandey, Post-Doctoral Fellow, University of California, Los Angeles