‘Lessons learnt from past, health department all set to handle Covid surge’

In an interview with TNSE Health Commissioner Randeep D underscores the importance of preventing the spread of infection, measures to curb female foetus abortions and progress in mental health.
Health commissioner Randeep speaks during Express Dialogues with TNIE staff,in Bengaluru. (Photo | Vinod kumar T)
Health commissioner Randeep speaks during Express Dialogues with TNIE staff,in Bengaluru. (Photo | Vinod kumar T)

With the spike in Covid-19 cases, the fear of the virus is back to haunt people. While there are no rigid restrictions, Health Commissioner Randeep D underscores the importance of keeping the guard up to prevent any spread of infection. In an interview with The New Sunday Express, he spoke in detail about the new variant and measures taken by the health department. He also touched upon measures to curb female foetus abortions and progress in mental healthcare in Karnataka.

Can you explain the present Covid situation in the state and about the new variant JN.1?
The most important aspect for all of us to realise is that Covid is very much amongst us and to an extent that some would argue, it has become endemic. One of the things we have to watch out for is if any strains are different from the earlier ones. In a new strain, we look at transmissibility i.e, the rate at which it spreads and the severity. Its impact on health and does it lead to more hospitalisations and deaths. Information is still flowing in about JN.1 and this is a subvariant of Omicron which was in circulation earlier. There are a high number of hospitalisations across the world and it is one of the fastest spreading variants. It is possible if one is infected at home, it spreads to the other family members. The data available now indicates that there are not many deaths and serious hospitalisations. Serious illness and death are largely among senior citizens and those with multiple comorbidities.

Many have taken double vaccines. Will it save people from getting infected?
Because of the additional mutation in the sub-strain JN.1, some theories indicate that it can evade acquired immunity. Double vaccinated are also getting infected. Vaccines provide protection and reduce the impact of the symptoms and to an extent, mortality, according to the World Health Organisation. But the jury is still out as to what extent the current vaccines will protect or if a further dose is required or do we need new vaccines that have come up. All these things have to be taken up and recommended by the Covid Technical Advisory Committee.

How well is the government prepared this time after learning lessons from the past?
Systems and protocols are in place now. The advantage is that the oxygen capability of the state has increased with almost every taluk and district hospital having Pressure Swing Adsorption (PSA) plants and LMO tanks in place. In case active cases increase in the coming days, it would take less time to ensure the hospital beds and related ICUs and infrastructure are made available. The support systems can be put in place faster now because of institutional memory and the infrastructure addition that is in place along with Covid protocols that have evolved over the last 3 years.

Can we call the current spike in Covid as the next wave?
We cannot jump the gun and term this a wave. We will conduct more than 5,000 tests per day and increase them in the coming days. We don’t know what numbers will throw up with the ramped-up testing. We would like to look at some prediction models to plan our graded response better. Unlike our previous ‘random testing’ strategy, our current testing is ‘targetted’ -- at hospitals, amongst ILI / SARI patients and co-morbid etc. We expect the Covid numbers only to go up in coming days.

In the first wave, we knew where the virus was coming from. What is the scenario now?
JN.1 was first detected in Europe and has spread to other countries the like USA and Brazil. The population is highly mobile today and it is difficult to conclude where the first new variant came from. Kerala and Goa have already detected them and there are very good chances that they would have come from returnees from abroad, where it is already in circulation.

As the year comes to an end, there will be many who will be travelling. When they come back they may be infected...
Take precautions while travelling and once you are back, observe your health for a while. If you are not feeling well, isolate yourself and get tested. Do not ignore a cold or cough just as a viral infection in these times.

What is the government waiting for to impose strict restrictions to curb the spread at the initial stage?
We have two options before us -- to clamp down and curb travel or to go for a graded response that is proportional to the anticipated threat. But the data as on date doesn’t support harsh decisions. If we have a lead from the GoI or TAC or international trends indicating overwhelming hospitalisations or deaths, the government will appropriately consider recalibrating its response and impose strict restrictions. However, given the present scenario, unnecessary pressing the panic button is not needed and self-precaution is the order of the day. If things start heading south, the recently formed Cabinet Subcommittee on Covid will take appropriate decisions.

How long will Covid persist, considering the recurring emergence of new variants each time there is an assumption that it has been eradicated?
Over the course of various Covid waves, there have been significant changes in our approach to handle them. People have gained a better understanding of how to manage and live with the virus. For individuals in good health, Covid is like any other flu. Factors such as general immunity, overall fitness and good dietary practices play a substantial role in faster recovery. Given the challenges in finding a vaccine that can entirely prevent the disease, it is crucial to acknowledge that living amid surges in Covid is a reality today.

What are state health department’s efforts to monitor every pregnancy test after an abortion racket was exposed recently?
Despite robust laws in place, the abortion racket has raised concerns, prompting an investigation into the underlying causes. Efforts are under way to understand why these abortions occurred, particularly examining whether gender bias, such as a preference for a male child or the presence of a second girl child, played a role. By analysing pregnancy termination data alongside the distribution of ultrasound scanning facilities, significant insights have been gained. The proactive monitoring of abortion data now extends to all districts, with ASHA workers instructed to report any pregnant women not attending their scheduled check-ups. Behind this issue lies a broader social concern where mothers, at times, are compelled to undergo abortions. We are collaborating with relevant departments to address this issue more effectively.

Has every pregnancy been under surveillance?
We have set a mandate to comprehensively track the lifecycle of pregnant women. If a woman discontinues pregnancy at any stage, we conduct thorough cross-checks to determine the reasons for the abortion and where it took place. The abortions should only occur in registered clinics, with mandatory documentation requirements, in line with the MTP Act. More awareness is also needed.

Among migrant and labour class populations, how are monitoring and enforcement measures for pregnancy-related procedures being implemented?
Illegal abortions were observed across diverse backgrounds during our examination. In the case of the migrant population, tracking poses challenges due to their transient nature, with many not residing consistently in a specific place or state. This mobility makes monitoring and tracking more difficult in certain instances. However with better inter-state and inter-district coordination, this issue can be better addressed.

Do campaigns and restrictions related to abortions inadvertently impede a woman’s right to terminate a pregnancy?
The current legislation explicitly outlines the conditions under which abortions can be performed, specifying factors such as the time frame, with a maximum limit of 24 weeks. Exemptions are granted for reasons like congenital abnormalities or teenage pregnancies or pregnancies where marital status has changed etc. It is crucial for people to be well-informed about the law and ensure that proper documentation is in place when seeking and undergoing an abortion. The illegality arises when one determines the sex of the foetus and then opts for an abortion.

Is there active monitoring in place to prevent instances of deception and fraud related to surrogacy, considering the prevalence of numerous surrogacy advertisements?
The IVF & Surrogacy sector, once unregulated, is now governed by the ART & Surrogacy Act, bringing oversight to both IVF / Surrogacy centres and also intending couples seeking surrogacy. Certification processes are now in effect to determine the eligibility for couples who wish to engage non-related surrogate mothers. These measures aim to prevent rampant commercialisation of surrogacy. Additionally, while technology can help in infertility issues, it can potentially be misused for gender determination and hence a legal frameworks are in place to address and regulate such issues.

Surrogacy ads are being displayed and many have become victims. Is the government doing anything to monitor it?
This used to be an unregulated sector. Assisted Reproductive Test (ART) and Surrogacy Act came into force recently. There is a regulation on such centres, be it (in-vitro fertilisation) IVF or an intending couple who want to have a child through surrogacy. The health commissioner is the designated authority for approving intending couples and surrogate mothers. A process is in place now. There is an upfront declaration to ensure it does not become ‘commercial’. Even this technology can be misused in sex determination i.e. in choosing the gender of a child, which is illegal and that is where the law comes in.
The Act has recently come and we are in the process of registering all the centers. This is the area we have to prioritise on a big scale. The public hospitals do not have IVF facilities and hence people opt for private institutes. The need for regulation of this sector requires more attention.

What about mental health services in Karnataka?
We have a robust mental health programme, far ahead of any other state. We have implemented DMHP in all districts since 2016 and we are also probably the first state to move into taluk mental health programme. We give about 10 lakh consultations in PHIs for mental health issues. We have collaborated with premier institutes like NIMHANS, which have converged their efforts with state mental health initiatives especially innovations like e-Manas, suicide prevention programme, Kishor swavalamban programme, assisted home care, Maathruchaithanya, brain health initiative and so on.
We also have a special flagship program  the ‘Mano Chaitanya’, which we have named as Super Tuesday clinics. In this programme, people with mental illness come to Primary Health Centers and taluka hospitals and avail Counselling and treatment. The government of India launched ‘tele manas’ -14416 and handling cases in a big way. People have access to mental health because of the platform available today. Post-Covid, many people reached out and started to open up about their mental health issues. We had a lot of celebrations speaking about the issue. The state is supporting mental health programmes and a lot of NGOs are also working. In 2024, people will hear about more mental health initiatives.

How is the telemedicine programme in Karnataka?
It is a very important component. For all kinds of cardiac care, people had to come to either Jayadeva or major medical hospitals. Now the ‘Hub and Spokes STEMI management model’, where the consultation of a cardiologist is available over a video call, has helped in timely cardiac services at taluks. Under another model now, we have 10-bed ICUs in taluk hospitals being monitored from the hub hospital in Mysuru. Soon, another batch of 10-bed ICUs across taluks will be launched by the state government with Hubballi as hub. We will use medical colleges as hubs to rope in cardiologists and other specialists. The unnecessary referrals that used to happen from primary health centers / taluk hospitals are reduced as the hospitals can do consultations over video calls. A camera is fitted and all vital parameters are reflected on screens of specialists sitting at district hospitals and hence patients can get treated at taluk hospital ICUs, instead of coming to district hospitals.

People with medical backgrounds become top bureaucrats and this can be an added advantage, what is your take?
The higher echelons in administration are all about understanding and grasping ground-level issues and personnel management, ensuring an effective managerial structure is put in place and delivering the outcomes expected. This can be done by a person with reasonable common sense, good personnel management skills and one who understands the system at the ground level. But yes, in my humble opinion, bureaucrats with medical or technical backgrounds have reasonably done better. If you see in this department too, 90 per cent would comprise doctors, nurses, paramedical and technical staff. Even at Arogya Soudha, the Commissionerate of Health, we have able administrators among medical professionals. Public health specialists and clinical specialists handle administrative charges and this helps delivery of department schemes better.

How long we may have to live with Covid fear?
Covid is one that we cannot wish away soon. We will always have to be cautious to remain one step ahead of the evolving virus. You don’t lose anything by being cautious. But one may lose out a lot if they are careless as we have seen during the earlier Covid waves. Almost everybody has lost a near or dear one or has been hospitalised. Repeated exposure to Covid-19 is not good for one’s overall health as we do not know what impact it has in the long term, on the quality of life and our life span as a whole. Hence lets be aware and cautious and dodge the virus.

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