Post Publication Independent Review of
"Gaps in India's preparedness for COVID-19 control"
Table of Contents:
Part XXV. Post Publication Independent Review of "Gaps in India's preparedness for COVID-19 control"
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Post Publication Independent Review of
Gaps in India's preparedness for COVID-19 control
Published: April 17, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30300-5
1. The opening sentence of the article is given herewith
Quote "Under-investment in public health-care system poses a challenge to India's COVID 19 containment plans. Patralekha Chatterje reports." End of Quote
There needs to be some correlation between the title and the highlight (as quoted above).
If this is an article dealing with preparedness for COVID-19 control, it has to discuss the strength or weakness of the current healthcare system in handling COVID-19.
If this is an article dealing with investment and related topics, then it cannot have such a title, and the title may have to reflect investment or any other related phrases.
Title and highlighting statement do not seem to relate to each other.
1a. Apart from the highlighting opening statement, the word investment is used in the article twice, that is, the word investment is used in the manuscript three times in total.
Under-investment is used in the manuscript only once, and that too in the opening highlighting statement alone.
Author has not provided any discussion on investment or under-investment to support the statement.
2. Quote "India is not among the worst-hit countries, but its grossly under-funded and patchy public health system, with huge variations between different states, poses special challenges for the country's disease containment strategy." End of Quote.
Defense or discussion absent for "under-funded", "patchy public health system", "huge variations between various states".
When defense or discussion absent for the above, then "poses special challenges for the country's disease containment strategy" loses merit and is unable to be accepted.
Citation/Reference not provided for "patchy public health system". Definition not provided.
3. Quote "These are worrying developments in the backdrop of India's latest containment plan, a 20-page document, which specifically talks about “non-pharmaceutical interventions”. "End of Quote.
Reference not provided for "India's latest containment plan, a 20-page document". Consequently, the "worrying developments" mentioned by the author is unable to be verified.
Further "which specifically talks about “non-pharmaceutical interventions”" also is unable to be verified.
Noticed that Reference Section is absent. However, it is noticed that there is a photo of a door closed with a green background. Not sure how it is related to this article.
4. Quote "“Quarantine and isolation are important mainstay of ‘cluster containment,” the document states. Quarantine refers to separation of individuals who are not yet ill but have been exposed to COVID-19 and therefore have a potential to become ill. Isolation refers to separation of individuals who are ill, suspected, or confirmed COVID-19 cases." End of Quote.
The author is observed to have started a discussion on Quarantine and Isolation, but it stops with these lines. The next line "There have been repeated reports of people escaping hospitals or quarantine in the past week" seems unrelated to discussion on Quarantine and Isolation.
5. Quote "There have been repeated reports of people escaping hospitals or quarantine in the past week. How can this impact the ongoing control measures for COVID 19? One key issue is the trust deficit in the public health system in many parts of the country. Other important factors include fear of isolation and stigma attached to those who are being quarantined and isolated." End of Quote.
Since no references are present in this manuscript, unable to verify the repeated reports of people escaping hospitals or quarantine. Further unable to ascertain which time duration does "past week" indicate.
Author is mentioning trust deficit in public health system in many parts of the country. Defense/Discussion absent.
Factors mentioned by the authors are fear of isolation and stigma. Defense/Discussion absent.
6. Quote "Epidemiologists and public health experts say that increasing expenditure in the public health system is key to building trust." End of Quote.
Since references are not provided, unable to verify the basis on which the unnamed "Epidemiologists and public health experts" have related "increasing expenditure in public healh system" and "building trust".
7. Quote "“[Escaping quarantine] is mostly out of fear and stigma, and wanting to be with one's family since it is for a prolonged time as well as lack of income. It is difficult for people in India to understand the importance of isolation and quarantine, even though it is a response to a pandemic. The faith in the public health system cannot emerge immediately as a response to the pandemic” said Giridhara Babu, Head-Lifecourse Epidemiology at the Public Health Foundation of India." End of Quote.
References are not provided, hence the statements are unable to be substantiated. Further, it is not mentioned what prompted Giridhara Babu to say this at the Public Health Foundation of India. Context of the statement by Giridhara Babu missing. Consequently, this statement by the authors citing Giridhara Babu loses merit.
8. Quote "An overstretched public health-care system forces millions of Indians to turn to the unregulated private health-care sector. The Indian government's expenditure on health as a percentage of GDP still hovers around 1·5%, one of the lowest in the world. For around 52% of households in urban areas, and 44% of households in rural areas, the private sector is the main source of health care when they are sick, according to government data." End of Quote.
Discussion/Defense absent for overstretching in public health-care system.
Reference absent for the above quote and hence statement unable to be accepted.
Author's attention is drawn to article https://www.ukessays.com/essays/economics/gdp-failure-to-measure-standard-of-living-economics-essay.php which states that "real GDP is increasing criticized for its alleged failure to adequate measure the standard of living".
Further, author makes a statement that private sector is the main source of health care, based on govt. data. However, it not mentioned which Nation's Govt., the author is referring, and hence unable to verify. Further, exact document is not cited and again unable to verify.
9. Quote "“Infectious disease surveillance and in particular, the timely detection and early warning of disease outbreaks are a function of strength and capacity of the health system. This is the time to win the trust of people with a thoughtful approach. This can only be done by increasing the health expenditure by government as a percentage of GDP compared to what it is now and not just through health insurance. Creating a reliable system with a public health cadre will address these problems”, Babu told The Lancet Infectious Diseases." End of Quote.
Reference absent. Hence unable to find out which Babu told the above to The Lancet Infectious Diseases. If it is the same Babu referred earlier as Giridhara Babu, then it should have been mentioned/indicated in the first instance itself that Giridhara Babu and Babu may be interchangeably used in this article.
Further unable to verify which were the actual problems that Babu referred as "these problems".
10. Quote " Thiagarajan Sundararaman, a global coordinator of the Peoples' Health Movement—a worldwide network of grassroots health activists, points out that fear-based messaging can make a person feel that he or she is responsible for his and her disease. “Stigmatisation hampers persons from coming forward. The messaging should be emphasising that most persons would recover, but since there is a small risk, one should take some extra precautions to keep safe. Those who recover would be the greatest corona-warriors for the community”, Sundararaman told The Lancet Infectious Diseases." End of Quote.
On what basis can this be done? :- "The messaging should be emphasising that most persons would recover" and "but since there is a small risk, one should take some extra precautions to keep safe".
Wont it be feeding lies to the society instead of giving them the real picture, if whatever has been suggested in the above quote is done.
Reading together with Review Comment 7 & 9, why is the author relying on whatever people spoke, and not relying on any research literature?
Just because someone said something to someone else under some circumstance/context, will that become a ground truth for any individual/multiple processes in COVID-19 handling?
11. Quote "The state of Kerala, which successfully dealt with a Nipah outbreak 2 years ago, offers useful lessons. “COVID 19 treatment is currently focused in government hospitals. In most parts of the country, these hospitals have been underfunded, not patronised by the rich and powerful; their staff are demoralised. This does not change overnight. Trust in government is an important component in an emergency health response. We saw what trust can do when we managed the Nipah response. Kerala has always been proud of the technical quality of its government hospitals. Since 2005, the state government investment has gone up considerably. Kerala government's The Aardram project has further raised the profile of government hospitals; substantial investments have been made“. Rajeev Sadanandan, Chief Executive Officer, Health Systems Transformation Platform, told The Lancet Infectious Diseases." End of Quote.
This is unable to be verified due to absence of references. Further, this paragraph seems to be going out of its way to heap praises on the state of Kerala. Didnt the author start writing this article about Gaps in India's preparedness for COVID-19 control?
Further, if this paragraph by the authors is accepted, then it goes against the title of the article, coz the authors state that Kerala has done it well. Kerala is a state in INDIA, and if Kerala has done it well, then isnt that a sufficient sample that India's preparedness for COVID-19 control is good? Have the authors stuck down their own title and article with this paragraph, without realizing it?
12. Quote "With limited information coming from the rural parts of the country, only the coming weeks will show the real impact of the current measures." End of Quote.
If so, how could the author give a title for this manuscript as "Gaps in India's preparedness for COVID-19 control" ?
Was there any necessity for this article?
Further, why was the author in a hurry to write this article, which is found to be in such bad shape as evidenced by the review comments above?
The author could have atleast waited for sometime, gathered some good reference articles, instead of relying on the words of a few people, made a good literature survey, understood the concepts well, and then perhaps attempt to write an article.