Focus on robust data for managing future COVID-19 outbreaks

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Instead of focussing on the actual or fake numbers, a more pragmatic path at this juncture would be to build a strong, data-driven health apparatus for braving the next wave.

Focus on robust data for managing future COVID-19 outbreaks
The trajectory of the second wave of COVID-19 may be on a decline but the government needs to brace itself for any future waves. A sound database, regular updates on health portals and transparency in research and findings should be the key components of the strategy. Besides improving the health infrastructure there is an urgent need to station more health professionals in the grassroots zone.
As of June 1, at 8 am, India reported 127,510 new coronavirus disease (COVID-19) cases in the past 24 hours, as displayed by the Union health ministry dashboard. The death toll, too, was pushed to 331,895 with 2,795 new fatalities recorded in this duration, it showed. The confirmed cases stood at 2,81,75,044 and recovered 2,59,47,629 which was 92 percent. The total daily new cases on May 31 pegged at 1.27 lakh, which was the lowest in 54 days.
Data dilemma—Underreporting or Overreporting?
Experts have raised questions on the shortcomings and lack of clarity in registration, testing practices, and classification of the COVID-19 deaths. There have been large-scale media reports on underreporting of deaths. Instead of focussing on the actual or fake numbers, a more pragmatic path at this juncture would be to build a strong, data-driven health apparatus for braving the next wave.
Last week a New York Times report estimated that about 16 lakh Indians had died due to COVID-19 during the second wave of the pandemic, contradicting the country’s official data, according to which only 307,231 deaths have taken place as of May 24.
The government had dismissed the report as ‘completely baseless,' saying it was not backed by any evidence. But underreporting of cases especially in the case of an epidemic is not confined to India.
Last month, an analysis made by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine had underlined that COVID-19 deaths were significantly underreported in almost every country.
Globally, COVID-19 had caused approximately 6.9 million deaths, more than double of what the official numbers show, the report had said. Many deaths from the infection go unreported because countries only report deaths that occur in hospitals or in patients with a confirmed infection.
According to the World Health Organisation, death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma).
There should be no period of complete recovery from COVID-19 between illness and death, the WHO says. Death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of the pre-existing conditions that are suspected of triggering a severe course of COVID-19.
The figures of both the testing and deaths will not match with the public data primarily because some deaths do not happen in hospitals and are unrecorded. There have been many cases where people have succumbed to the disease without actually getting tested. Then in rural areas especially the small villages, people shy away from getting tested and many of them die outside the premises of hospitals. This obviously adds on to the ‘unreported’ cases.
So what then is the actual number? Somewhere in between.
Under-reporting of deaths and cases cannot be ruled out—but over-reporting can also be mentally devastating and create panic.
Bhramar Mukherjee, Professor of Epidemiology, School of Public Health, University of Michigan maintains that capturing all the COVID-19 infections and deaths is impossible for any country.
“There are many covert or asymptomatic infections and cause of death is misclassified. But this has been more prominent in wave 2 in India. This could hurt our future policy decisions. Good data is at the heart of fighting the pandemic, “ Mukherjee says.
Gautam Menon a professor of physics and biology at the Ashoka University, who has been modelling COVID -19 in India says that the NYT article lays out a number of scenarios but there is little to tell what is actually correct.
“While the first wave was an urban phenomenon, the spread of the second wave has hit rural India. Mechanisms for testing and for recording the deaths in rural India are weaker than in urban locations. I fear that the true toll of the epidemic in India will only be apparent much later and in retrospect,” Menon said.
Testing & Treatment
There is a need to build an equitable, cost-effective and scalable Covid response along with regular bolstering of the vaccination programme. While the second wave in India may be on the decline, it is imperative that the government does all its homework for the much predicted third wave.
Health infrastructure has to be spruced, especially at the rural levels. India’s expenditure on health as a percentage of GDP needs to be increased for building a better architecture.
The Rockefeller Foundation in its report released on May 21 has advocated strengthening the COVID 19 testing in the light of emerging variants and staggered vaccination rollout. The report titled—The Road Ahead for Smart Covid-19 Testing and Tracing in India—also suggests on intensifying testing for all populations, including the vaccinated, adopt cafeteria approach to testing(creating a choice of tests and specifying their mode of delivery to cater to distinct needs of the population), encourage testing innovation, standardize the seroprevalence survey design and expand the genome sequencing.
The report is essentially a blueprint for an equitable, cost-effective and scalable Covid 19 response amidst a staggering surge of cases, formidable vaccination roll out and the threat of emerging variants.
Experts stress the need to bolster the testing apparatus with emphasis on door-to-door surveys in villages, identifying the symptomatic patients, getting them tested and accordingly treated.
Genome sequencing plays a pivotal role and research needs to be boosted in this domain. It is vital for tracking the genetic profile of the virus as it continues to mutate and develop vaccines that are as potent against new variants. Experts stress the need to bolster the testing apparatus with emphasis on door-to-door surveys in villages, identifying the symptomatic patients, getting them tested and vaccinated.
Adequate steps should be taken to ensure that all the hospitals are linked with an online portal for updating on Covid deaths. The mechanism for the updates should be transparent, quick and correct.
The government needs to focus on vaccination, integrating sequencing with surveillance and getting data out on time.
A data-agile public health surveillance system is at the heart of managing future outbreaks.
We need to be better equipped and more planned for the next invasion.
—Dr Vanita Srivastava an alumnus of IIT Kanpur and has worked as a senior journalist covering science and health issues for over two decades. The views expressed are personal.

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