healthcare workers

Coronavirus Pandemic: Is It Time to Wind Down the Rhetoric?

If we continue to panic, we will overwhelm our medical as well as economic resources, and precipitate unnecessary deaths.

A fear of the new coronavirus has all of us petrified – but it is important to look at the numbers in context and ease our impression of the virus’s lethality.

Ten million people die each year in India, most of them of old age, and often with pneumonia as a terminal event.

The seasonal flu or influenza mutates every year and spreads around the planet. According to the WHO’s estimates, 290,000 to 650,000 die worldwide every year as a result. The overall death rate is thus 0.1% to 0.5%.

Second, the kits to test for COVID-19 are expensive and not easily available. As a result tests are often restricted to patients at risk of, or those who already have, a life-threatening form of the infection. And while the mortality among these patients is high, it is not a true representation of the mortality with the infection overall. South Korea undertook a more general study, testing 140,000 persons for the coronavirus. Of them, 6,000 people had the virus and the mortality was 0.6%. Similarly, given the virus’s low mortality, the UK government has said COVID-19 is not to be classified as a ‘high consequence infectious disease‘ (like Ebola). In Italy as well, most deaths have been recorded among elderly people with a coexisting disease.

In other words, the severity of the COVID-19 infection is akin to heart attacks: they mostly occur in older persons. Occasionally a young man dies of a heart attack but that is the exception, not the rule.

But now, India has been plunged into a nationwide lockdown for three weeks. Nearly all economic activity has been suspended. The poor will have no work and no food. We are being asked to practice social-distancing, and every other person is to be treated as a potential source of lethal contagion. We are being alienated from one another.

Yesterday, a young lady in Bangalore died in a hospital of dengue. When they brought her body home, her neighbours complained to the police because they feared she could have had the coronavirus! In another instance, one gentleman spat on the face of a lady from Northeast India and called her “corona”; perhaps he presumed she hailed from Wuhan.

These scenes are not unique to India; similar stories have been documented in other countries as well. The question is – why?

Interestingly enough, some people anticipated how a pandemic would play out in October 2019, well before the first cases were reported in China. Researchers from the Johns Hopkins Centre, the World Economic Forum and the Bill and Melinda Gates Foundation had organised a pandemic response exercise called Event 201, and recorded and uploaded the whole thing to YouTube.

The participants of Event 201 discussed every detail of how the world should be locked down, how news and social media would have to be controlled, how the stock market would crash, how public unrest should be dealt with and how leaders who fall out of line should be counteracted by their counterparts in other countries. The simulated exercise even detailed how ‘positive’ stories of survivors must be publicised in the media.

Members of the Johns Hopkins Centre have emphasised that they only modelled a fictitious pandemic and that they didn’t endeavour to predict any real outcomes. By sheer coincidence, a new coronavirus outbreak began to unfold a month later.

Event 201 was just in time to indicate some protocols for the world to follow, and thus far we have gone by the playbook. Fortunately, the simulations weren’t entirely accurate in some ways. For one, Event 201 assumed a more lethal virus than the new coronavirus has been found to be. Some researchers have also found suggestive (but not conclusive) evidence that a relatively inexpensive drug called hydroxychloroquine could work as a prophylactic, and the Indian Council of Medical Research recently issued guidelines to administer this drug among healthcare workers attending to hospitalised COVID-19 patients.

This said, experts have also expressed concern that the economic debilitation could kill many people, especially in less rich countries like India. At this point, we must ascertain that if the new coronavirus is not much worse than the annual flu, can we get back to normal life? We still need to protect the elderly, and ensure that they are safe and isolated from the virus. The young also need to go out to work to earn and provide for them. If there is little risk of dying from the new coronavirus, the lockdown may turn out to be an extreme measure.

The rush for toilet paper in the West is a telling example of how people make irrational decisions in a panic. We need to tone down our rhetoric immediately to dispel this panic. If not, we will overwhelm our medical resources, precipitating unnecessary deaths, as well as overwhelm our limited economic resources, resulting in deaths among the poor who may not be able to access their rations. As Franklin D. Roosevelt said, the only thing we have to fear is fear itself.

Jacob Puliyel is a paediatrician in Delhi.

Why Are So Few Delhi Women Participating in the Workforce?

Delhi’s women Workforce Participation Rate has always remained below the national average and has further recorded a significant decline of 10% between 2011-12 and 2017-18.

Delhi recorded a high population growth of 8% between 2000 and 2011. Among the reasons were increased rate of migration of people from neighbouring states as well as other parts of the country.

However, its women Workforce Participation Rate has always remained below the national average and has further recorded a significant decline of 10% between 2011-12 and 2017-18.

A disaggregated division of Workforce Participation Rate (WPR) in the state, across consumption classes portrays a disturbing picture. Within the state, the lowest WPR is recorded amongst women of the low consumption class while the women of the high consumption class recorded the highest WPR in both the periods, 2011-12 and 2017-18.

Also, over time, women of the poorer households witnessed the larger decline in WPR when compared to women of rich households. This could possibly be explained by the fact that most jobs in Delhi are in the service sector and the chances of securing these jobs are higher for the educated high consumption class rather than women from the poorer sections.

In addition to this, the average monthly consumption expenditure in the state has also declined significantly (15%) among the poor households whereas the rich experienced an increase in consumption expenditure. So, the poor households experienced a decline in consumption spending while experiencing a fall in women WPR. This indicates both their economic as well as financial hardships.

Also read: A Multitude of Challenges Facing Women Home-Based Workers in Delhi

For women, the decline in WPR is also explained by their increased involvement in household chores such as cooking, cleaning, washing, shopping, caring for the elderly and children. However, women’s involvement in household chores vary across consumption classes, as poor women largely have to manage domestic chores by themselves while women of richer households have the ability to hire domestic workers to manage their chores.

This is also indicated by the last available National Sample Survey Organisation data (2011-12) and Periodic Labour Force Survey data (2017-18).

Women in service

A look into women’s employment pattern in Delhi indicates that across industries, more than half (60%) of women workers were involved in the service industry, which has remained the largest employment provider in both the periods.

Within the services, the biggest employers are health, social work and the personal service industry, where an increase in job opportunities for women was visible between 2011-12 and 2017-18. Most of these jobs were understood to be ‘informal’ in nature.

Women’s labour is largely invisible. Waghri women workers and their children at old clothes bazaar at Vadodara. Photo: Kunal Soni

In India, nearly 9.2 million women were engaged as domestic workers in 2017-18 and in Delhi, the approximate figure was more than two lakh in the same year. Similarly, in health and social work, women were largely involved as ASHA and Anganwadi workers and were not on direct payroll. Because of this, most of their services were considered “voluntary work,” though they often performed roles which was beyond their contracts.

Also read: Until We Properly Define Home-Based Workers, Their Labour Will Be Ignored

Moreover, over the period of 2011-12 to 2017-18, within the scope of paid employment, the proportion of women workers in the informal sector declined considerably and the decline was larger for the lowest consumption class.

If we consider both paid and unpaid work then women generally work for a longer time period than men. However, the recent Periodic Labour Force Survey (2017-18) study reported that if we consider all the economic activities performed during the week, then on an average, a woman in India works 43 hours per week (in the April-June 2018 period).

Men’s average is 49 hours. In urban areas, both men and women work for time periods longer than these. This is generally misleading as women perform the vast majority of unpaid household and care work and in rural areas, they even work harder and longer but much of their work is not ‘counted’.

Free transport

Given the larger decline in employment opportunities for women of poor households, the proposed decision by the Delhi government to make public transport free for women is definitely a welcome policy decision.

Also read: Is the Delhi Metro Really Public Transport?

But there is a possibility that the most needy may not benefit from such a policy that much. This can be ascertained from the fact that the PLFS (2017-18) data shows that a majority of poor women employed in the informal sector choose to work either from their own home or in areas which are closer to their houses. Very few women choose to work in a far-off location as are compelled to strike a balance between their paid work and unpaid domestic responsibilities.

Thus, a greater need is for full day affordable quality child care facilities so that even the poorest women also can easily take part in the job market.

Secondly, along with an increase in employment avenues, flexible working hours will also encourage women to take part in the job market.

Lastly, public policies must ensure that all women working in the essential social services like health and education are treated as proper public employees and paid at least the minimum wages.

Shiney Chakraborty is a research analyst at the Institute of Social Studies Trust.

African Scientists a Step Closer to Testing for TB in a Matter of Minutes

According to the WHO, 1.5 million people died from TB in 2014. The challenges in tackling the disease include the facts that people are tested too late and that the turnaround for most tests is long.

A vial of blood used to test for tuberculosis. Credit: Shutterstock

Tuberculosis ranks alongside HIV/AIDS as a leading cause of death worldwide. According to the World Health Organisation, 1.5 million people died from TB in 2014. The challenges in tackling the disease include the facts that people are tested too late and that the turnaround for most tests is long. To remedy this a point-of-care rapid diagnostic test for TB has been developed by a multinational team of scientists led by researchers at Stellenbosch University in South Africa. One of its co-inventors, Professor Gerhard Walzl, spoke to The Conversation Africa’s health and medicine editor Candice Bailey.

How have TB tests been done up until now and what are the challenges?

There are three main tests that are currently in use.

A culture test – the most sensitive – requires people to produce a sputum sample that is sent to a centralised laboratory where a culture test is done. A positive result shows up after ten days. A confirmed negative result takes up to 42 days.

The problem with this test is that it is only available in centralised laboratories, which means patients must make several trips to a hospital or health facility to get their results. And it is very expensive.

Then there is the sputum microscopy test. This is widely used in Africa. It requires the sputum slides of each patient to be individually checked.

The test is inexpensive. But it is labour intensive, which means that only a limited number of smear tests can be assessed a day. In addition, it only has a 60% sensitivity rate.

On top of this, the test poses particular challenges for children and for people living with HIV.

In the case of young children, samples need to be taken from their stomachs as they cannot follow instructions to produce a good quality sputum sample. This requires the use of a nasal tube, which is not pleasant for the child or the health-care worker.

The test also isn’t effective for people living with HIV. This is because their sputum often has low levels of the bacteria, which can lead to a false negative test result.

There is also a molecular test that detects bacterial DNA in the sputum sample. This test only takes two hours to produce a result and although it speeds up the detection of TB, it is not widely available to people in rural areas as instruments are placed in a centralised manner.

How will your test change this?

If our test is accepted after clinical trials are completed it will be able to provide almost immediate results. People will be able to be diagnosed and start treatment in a single visit to a health-care facility.

The test is done with blood obtained from a finger prick and can make a TB diagnosis in less than an hour. The diagnostic test is a hand-held, battery-operated instrument that will measure chemicals in the blood of people with possible TB. This test will not have to be done in a laboratory and health-care workers will be able to perform it with minimal training.

It is a low-cost screening test and has the potential to significantly speed up TB diagnosis in resource-limited settings.

At what stage is the test?

The test is still in development. We have patented the biosignature, which identifies the levels of chemicals in the blood of a patient. A biosignature consists of a combination of chemicals and indicates a disease state. This signature was discovered by African scientists. The inventors included South African, Cameroonian and Ethiopian scientists.

The test’s accuracy and efficacy will be tested in five African countries over the next three years. We will recruit 800 people who have TB symptoms from Namibia, the Gambia, Uganda, Ethiopia and South Africa.

Clinical research sites will be set up or strengthened in all five countries. And participating countries will be able to use the data generated from this project.

We are still trying to improve the signature by adding additional markers. In addition, we would like to optimise and fine tune the device to enable it to measure the signature on a strip similar to a pregnancy test or a glucose test strip.

Why is the test important for South Africa?

South Africa has the highest TB rates in the world. Each year between 450,000 and 500,000 people develop TB. This gives the country an incidence rate of 834 infections for every 100,000 people. On the rest of the continent, the incidence rate is between 300 and 600 infections for every 100,000 people. In China the incidence is 68 for every 100,000 people and in most European countries it is less than ten for every 100,000 people.

One of the challenges in South Africa is that people in remote areas with high TB incidence still do not benefit from newer developments in TB testing. As a result they face long diagnostic delays and often need to come back to clinics on several occasions before they are diagnosed.

This test will mean that health-care workers with minimal training can use the test at grassroots level and get immediate access to screening test results.

It would also reduce the cost of testing for TB. Our test would initially cost US$2.50 per test. With commercialisation that price could drop significantly. Currently the culture test costs $45 per test while the DNA sample test costs $12 per test.

How does this test fit into the bigger picture of dealing with TB?

The test would be used best as a screening test. This is because it can identify people who need further investigation and can screen out those who don’t. So far we have been able to identify 70% of patients who do not need further testing.

The World Health Organisation has identified a screening test as important for high-prevalence areas, for those who are in contact with people who have TB, those living with HIV, homeless people, immune-compromised people and those living in areas with poor access to diagnostic services.

Gerhard Walzl is Head of the Immunology Research Group at the Division of Molecular Biology & Human Genetics, Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Stellenbosch University.

This article was originally published on The Conversation.