By Glenn C. Kharkongor
The national media has covered our Chief Minister’s suggestion of a Rapid Response System (RRS). This RRS from the grass roots level caught the Prime Minister’s interest at the recent meeting with the chief ministers. Conrad has specified a turnaround time of 60 minutes for the health and civil administration to swing into action for detection of cases. The brilliance of this plan is that it is doable.
The benefits of such a system are immediately discernible. Firstly, it provides an action plan that will enable the closure of the lockdown period. Secondly, it will pick up data from the last mile. Thirdly, it is a call to responsibly involve all citizens. Finally, it can operate as a two-way system for upward data gathering and downward dissemination of awareness building.
Experts will say that we already have such a system, but it will be a bits and pieces claim. The term Rapid Response Systems has an immediate appeal because it packages all activities into a cohesive engine geared to a single campaign. Any number of expert committees, taskforces and management information systems don’t add up to an RRS. While an RRS should be a knee-jerk strategy in this national pandemic, Conrad has been the first to call for it.
Rapid response systems originated in hospitals to enable quick treatment of medical emergencies such as a cardiac arrest in the ICU. I was introduced to Code Blue during residency training in the US in the 1980s. Those who were on Code Blue duty in the hospital would immediately respond to an intercom announcement such as “Code Blue, Room 436” stated repeatedly and accompanied by a buzzer or siren. All team members would rush there and look for the blue light blinking above the doorway above of the patient’s room.
Medical rapid response systems are used in the field such as EMRI 108, which has radically improved the handling of medical emergencies in Meghalaya. Perhaps the EMRI control room could be the nerve centre of the Rapid Response System. Their geo-spatial system would provide immediate mapping of location, access and route. The NESAC (North East Space Applications Centre) station in Umiam could provide additional expertise.
Citizens must report directly
Presumably the RRS will be mobile-based so that every citizen can be roped in. They would be asked to report on two events: if he/she or someone in the immediate family develops the classic cluster of symptoms. If such a person is outside the family, it should be reported to the headman. The second event would be the reporting of a violation of the rules in force such as a prohibited large gathering. A simple list of dos and don’ts would guide the final decision to report or not.
Citizens must be encouraged to report directly to the call centre. Such empowerment will energise them. There will be false alarms and crank calls, but the system must be robust enough to deal with it. After all, even a small percentage of authentic calls is worth its weight in gold.
Health personnel have their own chain of reporting. The ASHA worker will report to the PHC doctor, who reports to the district medical officer and so on several rungs up the hierarchy. But this chain of events takes much time and anyone who tries to circumvent it may be hauled up by their superiors who have their own spin on the situation. This reporting will never happen within 60 minutes.
The call centre would have protocols to log, categorise and forward information to the relevant government agency as calls are received. It would now be incumbent on the health department, police station, DC’s office etc. to act immediately.
The high cost of indecision
It is easy to see from the news reporting that there is indecisiveness about the post May 3 scenario. Having kicked the can from March 24 to April 14 to May 3, how much more can the inevitable restoration of normalcy can be delayed?
Comparisons between countries and even between different regions of India break down after a point. Consultations with chief ministers are not yielding a consensus. In the end, over-caution carries the day, because it is the safe political refuge.
It is easy to understand the dilemma. When the health experts and the health agencies do not agree among themselves, wishy-washy briefings, with a lot of ifs and buts, are handed to politicians. An important feature of the scientific method is valuing doubt over certainty. Varying interpretations are common. What’s more an individual scientist is permitted his/her own cognitive dissonance. They go by time honoured aphorisms like, “Absence of evidence is not evidence of absence”.
Meanwhile collateral damage is mounting every day. Examples are seen in every newspaper now, almost every page. Students cannot return from Kota or from their colleges. Even school students on excursions are stranded in remote places.Migrant labourers who were the only wage earners in their family are jobless. Many have walked, cycled or taken a boat in the middle of night in choppy waters. Some have been waylaid and shunted into quarantine centres from where some have tried to escape. In times of crisis, the homing instinct is uppermost.
There are heart breaking stories of mothers unable to cuddle their newborn babies. Pregnant mothers and those in labour are not able to access timely healthcare. Suicides are beginning to mount. Families are separated. Suspicion and stigma are growing.
The rise in poverty and hunger is incalculable in a country like India. As previous cataclysms such as the Spanish Flu Pandemic or the Great Depression inform us, there is a long-term cost that is visited upon future generations. Decreases in income affect affordability for healthcare and education. These deprivations compromise the economic future of the younger generation. Millions of Indians already have low immunity from malnutrition, making them also more susceptible to adult diseases like diabetes. Their vulnerability to disease will rise. Epigenetics tell us that malnutrition in one generation contributes to ill health and cognitive development in succeeding generations.
National and state leaders must get out of this trap of indecision. The costs of indecision are spiralling upwards continuously.
Ultimately, it is the politician’s call. As Al Khalili said, “Doubt is essential for science, but for politicians it’s a sign of weakness”.Conrad’s plan is the way out.