In the medical journal, The Lancet, experts have outlined eight "urgent steps" that India must follow to combat any recurrence of COVID-19 infections in the nation, following fears of a potential and more violent third wave of coronavirus.

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The Lancet's 12th of June edition features an article co-authored by 21 persons, including surgeon Dr Devi Shetty and Biocon CEO Kiran Mazumdar Shaw. The article details how a fresh COVID-19 outbreak in India has expanded to rural communities, plunging the country into a health crisis.

The authors write,

“India is confronted with an urgent need to save lives and alleviate suffering. We make eight suggestions on behalf of the Lancet Citizens' Commission to the federal and state governments in India that share responsibility for the country's health... Our goal in providing these proposals, some of which have been lately expressed by authoritative voices in the country, is to highlight and synthesise what must be done immediately."

The expert group made eight "urgent" suggestions in The Lancet journal to help India deal with the COVID-19 crisis:

1. Just one strategy is unsustainable

The writers advocate for the decentralisation of the country's critical healthcare services. “A one-size-fits-all strategy is untenable", the authors write in The Lancet, “...because the number of COVID-19 cases and health services varies significantly from district to district” According to the authors, district-level working groups with the autonomy to adapt to quickly changing local conditions should be given the authority to receive funding and resources to coordinate efforts across health sectors.

2. Prices of critical health treatments should be capped

Experts believe that a transparent national pricing strategy is required, as well as price restrictions on critical health services. "Hospitalisation should not require any out-of-pocket expenses, and all expenditures should be covered by current health insurance plans. To guarantee that local governments have the resources to supplement COVID-19-related health services, the authors propose allocating funds as recommended by the Fifteenth Finance Commission."

3. Emphasis should be placed on the transmission of accurate information

The authors argue that clear and evidence-based information on COVID-19 management should be extensively distributed and applied. “This material should contain appropriately adapted worldwide recommendations for home care and treatment, primary care, and district hospital care in local languages, which take into account local conditions and clinical practise. The guidelines should also emphasise what not to do and only utilise evidence-based therapeutics. The information should also underscore the necessary non-COVID health services that must be fully accessible in specific facilities,” it states, adding that it should help prevent “increasingly alarming reports of additional COVID-19 consequences, including secondary infections". To relieve the pressure on hospitals, experts suggest that universal access to teleconsultation and care should be increased.

4. All resources are to be used to their full potential

The authors recommend that available human resources across the health system, including the private sector, be marshalled and adequately resourced for the COVID response, particularly with adequate personal protective equipment, guidance on the use of clinical interventions, insurance, and mental health support. “We applaud the decision to deploy final-year medical students and Ayush students in the COVID-19 response team. We believe that this strategy should be extended to nursing and paramedical students as well."

5. Central systems are required to acquire and distribute vaccinations at no cost

According to the writers of The Lancet article, central procedures for procuring and distributing free vaccinations should be developed. “This method will optimise pricing and minimise cross-state inequalities that may emerge from differing fiscal and capacity contexts”, the authors write, adding that vaccination is a public benefit that should not be entrusted to market processes.

6. Participation of the general public is essential

The authors write in The Lancet, “We suggest active collaboration between government and civil society organisations to produce and distribute correct information, enable home-based care, emphasise prevention, assist in navigating access to life-saving treatment, and promote vaccination. Restrictions on NGOs' access to international or local corporate social responsibility financial resources and human resource assistance must be lifted immediately."

7. Data collected by the government should be transparent

Experts believe it's critical for government data collecting and modelling to be transparent in order for administrations to plan ahead. “Data on age and sex-disaggregated COVID cases, hospitalisations, and death rates; community-level immunisation coverage and community-based tracking of the efficacy of COVID treatment regimens and long-term outcomes,” are needed by the health system employees.

8. Allowance for monetary transfers

Loss of livelihood is a health risk, which can be mitigated by providing arrangements for financial transfers to employees in the informal economy who have lost their jobs, as several state governments have done. “Formal sector employers must be obliged to keep all employees, regardless of contract status, by a government promise to compensate these businesses when the economy recovers. Lockdowns must be notified well in advance and include preparation for all critical services if they are judged required based on local epidemiological data." The authors also urged the national and state governments to solve 'one of the greatest humanitarian catastrophes' in India by acting quickly, in solidarity, and across sectors to stop 'the bleeding of life and misery caused by COVID-19'.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.