Tracking COVID-19- Public Health and Socio-economic Surveillance

- ICRIER and KAS India

The Indian Council for Research on International Economic Relations (ICRIER) together with the India Office of Konrad-Adenauer-Stiftung organized a virtual discussion on "Tracking COVID-19- Public Health and Socio-economic Surveillance" on 27th April 2021.

Key Takeaways:

  • The webinar focused on the population health and socioeconomic surveillance approaches adopted by selected countries for tracking COVID-19, the kind of results that such approaches have yielded and lessons for as well as from India.
  • The discussions were of utmost significance not only from the perspective of COVID-19, but prospects and challenges for growth and development in the country at large.
  • In India, we announced victory against the COVID-19 pandemic far too early.
  • Younger people have been hit hard in the second wave, challenging the notion that they have some sort of natural immunity against the novel coronavirus and that only those aged 60+ years are at risk from a demographic perspective.
  • Every day we get frightening statistics – but behind those statistics, there are destinies, there are people, there is life, that is something we should not forget.
  • The current COVID-19 crisis is an unprecedented wake-up call that is showing how crucial it is for countries to have right policies and legislations for ensuring pandemic preparedness and prevention.
  • COVID-19 has highlighted the critical pandemic under-preparedness of health systems worldwide. With 33.2 % of the world GDP and 14.3% of its population, it is shocking to see Europe and North America account for 61% of COVID-19 deaths.
  • It is ironic that the top 9 countries with most COVID deaths are G20 members.
  • G20 countries have been disproportionately impacted by COVID-19. We need some interesting conversations around what is happening globally, but we also need to examine as to what went wrong, who has been impacted, in what ways and degrees, by the pandemic in G20 as well as in other countries.
  • Americans account only for 1 in 25 persons on the planet for COVID cases, but 1 in every 5 deaths.
  • In the US, the way they identify COVID cases and deaths begins at public and private testing sites/providers. They have to report to local health departments. Local departments report to states health departments, who then report to the CDC at the national level.
  • For much of the pandemic there were problems in the US regarding lack of central leadership and transparency in the data. Therefore, a lot of trust was placed in university, media outlets and other private groups.
  • Effective dissemination to public health authorities as well as the public at large requires timely and usable data and trust in institutions.
  • In the US, race and ethnicity are primary social stratification variables that have been examined to understand health equity and disparity.
  • In Georgia, in 95% of the cases, they were able to collect age and sex data. This shows that it is possible to collect demographic data on cases. However, the data on race has been difficult to collect.
  • Data for COVID-19 has been difficult to collect due to asymptomatic cases, under-testing, undercounting and, inter alia, the denominator for testing being unclear.
  • There are also lessons to be learnt from rich countries like South Korea, on how to effectively contain spread of the virus without strictly restricting routine life.
  • Countries such as South Korea, Australia and New Zealand have demonstrated how we can learn from past mistakes and deploy effective, long-term solutions to any health crisis that may arise in the future.
  • ICMR has played a phenomenal role in tackling the pandemic at the national level. It instituted a multi-pronged approach to understanding the disease and tackling it through its work in clinical management, diagnostics, epidemiology, and building task forces, consortiums, collaboration with multiple stakeholders to plan and undertake a whole host of initiatives.
  • ICMR set up national COVID-19 clinical registry to collect high-quality, real-time data on various clinical, epidemiological and outcome aspects of the disease.
  • The Indian government has set up a national institute on One Health in Nagpur for systematic studies on outbreaks as well as biosafety and biosecurity needs.
  • The surveillance capacity, in particular, for COVID-19 needs to be strengthened on a priority basis for robust evidence and evidence-based policymaking.
  • Surveillance involving timely and systematic collection, analysis, dissemination and use of data for suitable public health action is highly critical in such crises.
  • We tend to not learn from the past. Let’s hope that what is happening in India currently is a lesson for the leadership and also for individuals to take responsibility in ways they can. Let’s also hope that the death and suffering can be a lesson to others in the LMICs (low and medium income countries) about how we can address this pandemic and get ahead of it quickly.
  • What is happening in India shows the lack of health system preparedness in terms of resources availability and their utilization.
  • Surveillance of health outcomes such as case fatality rate, ICU rate tell us about how well we are doing.
  • We can also get valuable information regarding the novel coronavirus through various public health surveillance measures, including sewage surveillance.
  • We can build additional surveillance systems over existing ones – for example, the Integrated Disease Surveillance Program (ISDP) in India, several countries have SARI surveillance. For COVID-19, we need rapid surveys as well.
  • Greater use of ICT (information and communication technology) is required to understand and disseminate the data quickly.
  • In disease like COVID-19, the geographical positioning of cases is an important parameter to look at.
  • In the Indian context, the elephant in the room is the data from private sector. More or less, our surveillance systems do not capture what is happening in the private sector. Therefore, there is urgent need to develop mechanisms through which information in private sector is routinely brought in surveillance systems.
  • Most Indian surveillance systems have numerators without good denominators, and it is not easy to interpret these numerators. Comparison also becomes very difficult – across districts, states as well as countries.
  • If the quality and trustworthiness of data is missing, then the action is not going to be useful either.
  • Channels for communication of data to decision-makers should be ensured in a meaningful way so that evidence-based policymaking can happen. Presently, this is also a big challenge in India.
  • As surveillance is ultimately about action, the capacity to act is very important – the second wave of COVID-19 infections in India has clearly demonstrated that such capacity is missing.
  • It is time we make communities equal partners in the decision-making process, and create systems by which information is routinely shared with communities. Such aspirations have been enshrined in the design of National Health Mission (NHM) – now is the right time to make them a reality to strengthen participative processes as well as address the public trust deficit that has emerged with the second wave of the COVID-19 infections in the country.

Peter Rimmele