Present Goa pandemic management team would know where they are going wrong due to the lack of knowledge centric, research and science-based approach
Nandkumar M Kamat
By now it has become clear that the government and the opposition have reached informal consensus on not insisting on or releasing the crucial R value or effective reproduction value, an indicator of how fast the infection can spread on a regular basis. Both the government and the opposition do not give any importance to the genomic and sero surveillance drives. Any pandemic exit strategy involves an idea of herd immunity. Depending on the R value Goa would need between approximately 60-85 per cent of the population to recover from infection with sufficient levels of antibodies to achieve herd immunity.
Every pandemic needs an exit strategy, and it is not for the first time that Goa is facing such a public health challenge. Everyone in health sector in Goa could turn to the work done by Goa’s famous tropical microbiologist Froilano De Mello (May 17, 1887 – January 9, 1955) in the first half (1911-1945) of the last century to manage various endemic tropical diseases and epidemics, a few being more dangerous than the present pandemic.
The Old Goa Medical College library holdings would have most of his work available somewhere unless looted by agents of antique books or destroyed by moisture, rats, termites, or human neglect. The present Goa pandemic management team presiding over the fate of 16 lakh Goans would know where they are going wrong due to the lack of knowledge centric, research and science-based approach.
Portuguese medical historian Cristiana Bastos in her professionally researched paper- “From India to Brazil, with a microscope and a seat in Parliament: the life and work of Dr Indalêncio Froilano de Melo’ published in 2008 wrote- “already in 1911, young Froilano de Melo was part of the committee formed for the reform of public health in the colony and was also the interim director of the vaccine institute. That was the year of a bubonic plague epidemic in the harbour of Mormugão, and Froilano could show, as the official delegate to fight the epidemic, his commitment to organised public health measures. His work attracted laudatory official remarks, which were repeated in 1914 for his action in the province of Salcete. His commitment to sanitary action continued throughout his life. We can suggest that he became the ultimate biopolitician of Panagi, as one who at once governed and watched over the collective body and individual bodies, as well as over animal bodies and the invisible bodies that threatened them.
Malaria was one of his early interests; in 1914 he presented his research both at the sanitary conference of Lucknow and at the first sanitary conference ever organised in Goa, promoted by himself in that same year. In that conference he presented a few papers on malaria, smallpox, vaccines, immunity, ancylostomiasis, cholera and public health. In 1917 he was lobbying for the construction of a network of canals in the city. In 1923 he coordinated field research on water wells and anopheles’ mosquitoes that led to anti-malarial preventive policies.
Epidemic outbreaks mobilized him for immediate action, but the prevailing endemic diseases interested him too. In 1928 he created a sanatorium for Tuberculosis in Margão, and in 1932 a Leprosarium in Macasana. He directed the bacteriological institute between 1914 and 1945, and in 1938 he became the mayor of the city of Panagi. He remained in the job until 1945, when he was elected to the Portuguese Parliament. As mayor he could implement public health, and biopolitics, on a wider scale; not only upon human beings, but also upon dogs (rabid dogs were slaughtered), upon trees (jacarandas and acacias from Cuba were planted), upon stones, constructions, places, and spaces.
A critical analysis of the approaches and strategies adopted by Froilano to control and contain Malaria offers excellent starting points for Goa’s pandemic exit strategy. To understand various phases in a pandemic, exit strategy we could refer to the report of The American Enterprise Institute, (March 2020) entitled ‘National Coronavirus Response: a Road Map to Reopening’. It stressed on four phases. Each phase needs to be completed before the next is reached. Phase I stresses on the community-level physical distancing measure to slow down the transmission and communities are ordered to stay at home to reduce infections. This phase is successful if diagnostic testing and public health facilities are expanded to allow health care systems to treat the virus. Then for entering the Phase II four criteria need to be met (1) the number of new cases must have declined for at least 14 consecutive days, (2) rapid diagnostic testing is proved to be sufficient to test all people with COVID-19 symptoms, (3) healthcare systems are able to safely care for all patients, and (4) public health capacity allows for effective contact tracing. During phase II, some businesses may begin reopening with COVID-19 appropriate measures in place. Phase III is considered the time when effective therapeutic vaccines are available. Lastly, Phase IV, is when society reflects on their preparedness for tackling the next health threat. But speaking of the whole state the scenario appears demographically and geographically very diffuse.
Since May 5, 2021, I calculated the demographics of community scale or local morbidity based on available population. The data was sourced from daily health bulletins of state government on a daily basis for 32 centres and separately for the tourists tested positive. When the number of active cases every day was expressed as the ratio of the total local population the demographics of morbidity became noticeably clear. Therefore, these 32 centres need to be the elements of microlevel management for state level pandemic exit strategy. The morbidity demographics showed three categories- highly, moderately, and less morbid. As on Saturday May 8, 2021 these are the most morbid centres in Goa with figures indicating number of people per 1000 local population infected with Covid-19-Betki (388), Cansaulim (325), Pernem (260), Dharbandora (224), Candolim (213), Colvale (140), Casarvarnem (134), Corlim (125), Aldona (124), Lotulim (121), Siolim (105), Madkaim (104), Sankhali (101) and Valpoi (95). In other words, in these areas about 9.5 to 39 per cent of people are infected with SARS-COV-2 indicating a very heavy disease load.
A ‘test, trace and isolate’ strategy is to be adopted for these areas because it is the cornerstone of managing epidemics and has been strongly advised by the WHO. So, these areas need to be targeted for suppression of viruses, following ‘testing, tracing and isolation’ and mass vaccination.
A microlevel pandemic exit strategy could be first launched for these highly morbid centres. Second on target would be moderately morbid centres and the last on the list should be the least morbid centres-these as on May 8 included Vasco (10), Porvorim (24), Margao (26), Quepem (30) and Curchorem (35) where less than five percent people are infected. (To be concluded).
Courtesy: The Navhind Times, Goa. www.Navhindtimes.com