25 Mar 2020: UPSC Exam Comprehensive News Analysis

D. GS 4 Related

Nothing here for today!!!

E. Editorials

Category: HEALTH

1. Ironing out wrinkles in India’s pandemic response

Context:

• Covid-19 pandemic and India’s efforts to control its spread and effect.

Background:

• The current social distancing and lockdown measures in place are directed at restricting the large scale transmission of the coronavirus. However, the mathematical models and the experience of China, Italy, and the United States suggest that COVID-19 is likely to infect a significant number of Indians.
• Notably, wealthier countries with stronger and better financed health systems such as Italy and China have struggled with containing COVID-19.

Details:

COVID-19:

• The vast majority (80%) of COVID-19 cases will be mild, requiring no hospitalization.
• The estimated mortality rate varies considerably between 3% to 0.25% of cases, and is much higher among the elderly.
• Despite the above observations, given India’s high population, a significant number of people may still be affected by the coronavirus.

Doubts over the number of cases:

• Given the fact that in India only a small number of people have been tested, there seems to be very little knowledge of the exact extent of the spread of the epidemic in India.
• Some medical experts have claimed that the higher number of confirmed COVID-19 cases in States such as Kerala and Maharashtra could be due to more testing in these states.

Likelihood of regional hotspots of diseases:

• Given the fact that many mild cases go undetected and the continued movement of people before the current lockdown, there are doubts over whether India’s ongoing efforts to control COVID-19 using physical distancing and isolation will be successful or not.
• It is likely that, as in other countries like Italy, China, the U.S. and Spain, there will be regional or sub-regional disease hotspots, rather than a nationwide outbreak.

The criticality of health system capacity:

• The above observations highlight the importance of approaching India’s COVID-19 response from the perspective of State health system capacity. Given the global spread of the disease and it being unclear as to how long this disease will persist, it is necessary to evaluate how well India’s health system can respond to COVID-19.

Concerns:

• Worryingly, there are some critical weaknesses in India’s health system that can prevent a credible response to COVID-19.

Low testing capacity:

• As per WHO recommendations, providing full and free testing to all those who need it is critical for effectively controlling the spread.
  • China, South Korea and Singapore, as noted by WHO, adopted a strict shutdown and followed it with testing at the population level to get a grip on infections.
• The number of sample testing centres is very low in India. These testing centres are also not evenly distributed among the states.

Low capacity of the health system:

• India has around 70 hospital beds and 2.3 ICU beds per 100,000 people.
• Notably, China and Italy with much higher capacity struggled to care for the severely sick.
  • China and Italy have 420 and 340 hospital beds and 3.6 and 12.5 ICU beds respectively per 100,000 people.
• Based on estimates from recent studies, the calculations reveal that the ICU beds and hospital beds would fill up very quickly given the current rate of spread of the disease.
• Without flattening India’s COVID-19 epidemic curve, our current hospital capacity is so low that it will be quickly be overwhelmed if infections surge.

Shortage of health personnel:

• Health-care workers are a critical resource for the COVID-19 response.
  • The success of countries such as South Korea and Singapore in controlling the spread and mortality due to COVID-19 has been credited to the ability of health workers to locate, test and treat cases.
  • The health-care workers go into communities to carry out preventive care, trace potentially exposed people, and treat the infected. This requires a substantial number of health workers for the fight against COVID-19.
• India faces an acute shortage of health-care workers.
  • India has around 3.4 qualified doctors and 3.2 nurses and midwives per 10,000 population. China and Italy have 18 and 41 doctors respectively per 10,000 population.
  • Importantly, nurses have been in the forefront of caring for infected people in the affected countries. India has far fewer nurses than both Italy and China (23 and 59 nurses respectively).

Regional disparity in resources:

• The state public health resources, apart from being insufficient, are also unevenly distributed among the different regions.
  • Health workers in India are mostly concentrated in the urban areas.
  • There are huge disparities between States. While Bihar has 0.3, Kerala has 3.2 doctors per 10,000 population.
• This disparity will affect India’s COVID-19 response, particularly in rural India and in States with fewer health workers.

The weak links in the health system:

• In India, a vast number of poor people depend on public healthcare. The polarization of healthcare facilities between the private and public sector does not provide the right framework to channel timely medical services during a pandemic.
• Given the limited capacity of public healthcare services, they will be hard-pressed to provide the requisite support to low-income groups.
• This needs to be urgently addressed, in the absence of which the poor will become the weakest link in any effort to contain the virus.
  • The experiences of Italy, France, Switzerland and the U.S. highlight that COVID-19 tests and treatment should particularly be available and accessible to people in high-risk groups and from low-income backgrounds.

Ability of Indian states to handle the situation:

• There is the higher likelihood of regional or sub-regional disease hotspots of the pandemic in India.
• Worryingly, it is unlikely that the Indian States which experience a COVID-19 hotspot will have the resources to manage the outbreak independently.

Health worker safety:

• Health workers also take on a disproportionate share of infections.
• In China and Italy, the fight against COVID-19 has taken a huge toll on health workers.
  • Estimates from China’s National Health Commission show that more than 3,300 health-care workers have been infected as of early March and, by the end of February at least 22 had died.
  • In Italy, 20% of responding health-care workers were infected, and some have died.
• Health worker safety is particularly important for India because it already faces a shortage of doctors and nurses. This is even more crucial given that there might be a prolonged effect of COVID-19.

Way forward:

Ramping up testing:

• Given the need to formulate a public health response for the period beyond the shutdown, India needs to get a universally accessible testing system in place to prevent transmission when the lockdown is lifted.
• The recent decision to allow private sector to carry out testing is a welcome decision and needs to be further ramped up to cater to the likely large demand for testing.
• In a major development in the fight against novel coronavirus, Pune-based MyLab has become the first indigenous manufacturer to be approved for deploying its kits for COVID-19 testing. There is a need to ensure that adequate kits are available domestically for testing.

Ramping up hospital capacity:

• Addressing the scarcity of hospital and intensive care unit (ICU) beds in India is critical for providing clinical support to severe COVID-19 cases.
• It is important to put in place a strategy to ramp up hospital and ICU capacity, as well as provision for essential equipment such as ventilators and personal protective equipment for health workers.
• Given the lesser possibility of building new hospitals in the given short frame of time, it is important to consider alternatives, such as, extending current hospital capacity, usage of hospital trains that can easily move from one location to another, or converting university dormitories into treatment centres.

Involving the private sector:

• Given the limited resource base in the public health system, tapping the resources in the private sector is particularly important.
• India’s health system is highly privatised and most of the country’s health-care capacity in terms of human resources, hospital beds, laboratories, and diagnostic centres is in the private sector.
• There have already been some efforts in this direction, with several State governments enlisting private laboratories for testing and using the private hospital bed capacity to treat positive patients. This needs to be scaled up.
• Given the availability of skilled manpower and expertise in the private sector, private hospitals should also be involved in planning and coordinating the COVID-19 response.

State-to-State coordination:

• Given the scarce resources available, it is critically important to put in place a well-functioning between-States and within-State coordination mechanisms.
• Because it is highly likely that certain regions in India will become COVID-19 hotspots, to contain these outbreaks it is important that human and other resources can be flexibly shifted to these areas from other parts of the country.
• This should enable efficiently leveraging resources such as doctors, nurses, equipment, supplies from elsewhere and direct them to regional/sub-regional hotspots.

Skilling health workers:

• Given the fact that increasing the health workforce in the short term is difficult, it is important to consider task shifting and multi-skilling strategies.
• This will involve training a variety of health-care workers (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy doctors, nurses, as well as general and specialist doctors) in handling the COVID-19 cases.

Recognizing the importance of Primary-care providers:

• Engaging these primary-care providers in the COVID-19 response is important.
  • Primary-care providers involve a variety of medical practitioners. They can be formally trained (e.g. medical officers, nurses, auxiliary nurse and midwives, pharmacists), or lay workers (accredited social health activists) or informal workers (rural (not registered) medical practitioners, or RMPs, drug shops).
• Primary-care providers will likely be the first contact health workers for COVID-19 patients. They will encounter patients in early stages or with mild forms of the disease and hence can play a crucial role in treating and referring patients.
• The primary care providers are critical for contact tracing, a strategy that has been successfully used in South Korea and Singapore to contain the virus.
• COVID-19 response strategies should involve engaging these primary-care providers and providing them information on preventing the spread of COVID-19, danger signs or where to refer in case of serious illness.

Health worker safety:

• Protecting health workers in the forefront of the COVID-19 response will be critical.
• Procuring and ensuring the widespread use of personal protective equipment (e.g. masks, gloves, gowns, and eye wear) in the care of all patients with respiratory symptoms needs to prioritized.
• The recent decision of the Indian Council of Medical Research (ICMR) approving the use of hydroxylchloroquine (HCQ) as prophylaxis by healthcare workers taking care of COVID-19 cases is a recognition of the dangers faced by the health workers and a step in the right direction.

Ensuring requisite financial resources:

• Addressing the discussed health system issues will require much effort and financing. Given the criticality of the issue, the government, both the state governments as well as the central government should mobilize all the necessary financial resources towards this important sector at least for the time being.
• The required financial resources could be ensured by the restructuring of the expenditure plans and rationalization of the government expenditure.

Conclusion:

• India, like other countries, faces important health system challenges in mounting a credible response to COVID-19. How India deals with these health system issues in the days to come will make all the difference in the fight against the COVID-19 pandemic.

Category: DISASTER MANAGEMENT

1. Death by fireworks

Context:

• 11 workers were killed due to a fire accident at a fireworks unit in Tamil Nadu’s Virudhunagar district.

Background:

• Police data reveal that in the past decade, at least 239 people have died and over 265 injured in 142 accidents in fireworks units in the state of Tamil Nadu.
• The tragedies have not been confined to Sivakasi, deemed the fireworks capital of the world, where most such units are concentrated, but have also been reported from illegal cracker units functioning in other parts of the State as well.

Details:

• Unsafe working conditions and improper handling of inflammable raw materials continue to endanger lives in the fireworks industry. The major causes for past accidents have been mainly:
  • The manufacturing of firecrackers generally happens in makeshift unlicensed units without any safety measures in place.
  • There is the rough handling of chemicals by untrained and unskilled workers which results in spillage or overloading of chemicals during the filling process. Mishandling of chemicals can trigger explosion.
  • These illegal units also work outside permitted areas, in the process risking the buildings and people around these illegal units as well.

Chaitanya Prasad Committee:

• The increasing number of fire accidents and the tragic incident leading to the death of 40 workers at Om Shakti Fireworks Industries in 2012 led to the constitution of the Chaitanya Prasad Committee.
• The Committee noted statutory and administrative shortcomings as being the major factors leading to increasing fire accidents. It noted the absence of proper inspection mechanisms at various government departments.
• The Committee also found a lack of coordination between Central and State authorities dealing with the regulation of fireworks industries.

Concerns:

High frequency of fire accidents:

• Though occasional accidents in an industry dealing in explosive materials may seem inevitable, the frequency at which these incidents have been occurring is a concern.

Mushrooming units:

• The number of players have exponentially grown since the 1980s with 1,070 licensed units employing an estimated 10 lakh workers.
• The unlicensed units, a parallel industry in itself has spread across a dozen villages in Tamil Nadu. Despite the committee recommendations, sub-leasing of works is still rampant.

Lack of compliance and enforcement:

• Despite the existing rules and the Central and State licensing and enforcement authorities, the continued instances of fire accidents point to a lack of compliance and effective enforcement.
• Crackdowns against violators have been few and far between. There has been an absence of proper inspection mechanisms at various government departments.
• Regulators understandably complain of a lack of manpower in checking violations.
• There has also been a lack of coordination between Central and State authorities dealing with the regulation of fireworks industries.

Non implementation of committee recommendations:

• The important committee recommendations of making sub-leasing of works by licensed units a cognisable penal offence has not been implemented.
  • Illegal sub-leasing of works to unlicensed cottage units has become a widely acknowledged practice in the industry.
• Safety recommendations like mandating inter-safety distances between sheds covered with earthen mounds and provision of a smoothened pathway with a width of 1.5 metres, as part of industrial safety measures have also not been implemented.

Way forward:

• The accidents and the associated loss of lives can certainly be reduced by adopting safe work practices, complying with rules and through cohesive monitoring by Central and State licensing and enforcement authorities.
• The governments must enforce rules in a hazardous industry and prosecute violators. The industry too must self-regulate in its own interest.

H. UPSC Prelims Practice Questions

Q1. Consider the following statements:

1. Ugadi – Karnataka
2. Sajibu Nongma Panba – Manipur
3. Gudi Padwa – Madhya Pradesh

Which of the following is/are correctly matched?

1. 1 only
2. 2 only
3. 1 and 3 only
4. 1 and 2 only

See

Q2. Consider the following statements with respect to ‘Mango Showers’:

1. It is the name of the pre-monsoon showers in Karnataka, Goa and parts of Tamil Nadu.
2. They are called Blossom Showers in Kerala.
3. The mango showers occur as the result of thunderstorm development over the Arabian Sea.

Which of the given statement/s is/are correct?

1. 1 and 2 only
2. 1 only
3. 1 and 3 only
4. 1, 2 and 3

See

Q3. National Disaster Management Authority’s National Executive Committee (NEC) is chaired by:

1. Prime Minister
2. Home Secretary
3. Home Minister
4. Chief of Defence Staff (CDS)

See

Q4. Consider the following statements:

1. Article 22 deals with both Preventive and Punitive detention.
2. Preventive Detention laws come under the Union List only.
3. A person may be taken to preventive custody only for 2 months at the first instance.

Which of the given statement/s is/are correct?

1. 1 only
2. 1 and 3 only
3. 2 and 3 only
4. 1, 2 and 3

See