## Sunday, March 29, 2020

### Isolation : A weak link in Indian public health

by Renuka Sane.

1. There are four parts to the public health response to an epidemic: 1) Trace, 2) Test, 3) Isolate, and 3) Treat. Once someone is infected, tracing involves identifying, listing and following up with all the people who have come in contact with the infected person to ensure that they do not further spread the disease.

2. While tracing is weak in most of India, some states such as Kerala and Karnataka seem to be doing a better job of tracing. This knowledge can be applied more broadly in India.

3. India's response to testing has been slow. Only recently have private firms been allowed to do tests for Covid-19. Most of the capability in testing in India is in the private sector, but the limitations of government contracting hamper the extent to which this capability can be brought into fighting Covid-19. Once these problems are solved, and testing is done at scale, we will have a clearer picture of infection hot-spots and will be able to design a appropriate health response.

4. Once a person has tested positive, or if a person comes in contact with someone who has tested positive, there is a need for isolation. This typically requires staying at home, in a room, separate from others in the household.

5. Such a recipe for isolation has been designed for countries where the number of members living in a dwelling unit is low. This will be infeasible for most people in India. For example, it is estimated that over 9 million people in Mumbai live in slums. The slums in Dharavi alone are estimated to house 1 million people, with a population density of 869,565 people per square mile. It is impossible to people in low-income housing and slums to self-isolate, especially when toilets are shared in a community. Hence, self-isolation at home will not work for most people in India.

6. Could the government run isolation facilities? A barrier here is the mistrust of the state. Public isolation facilities are generally found to be sub-standard. People have been seen to flee from public quarantine facilities. Hence, at present, the government is not useful as a mechanism for producing isolation services.

7. All four legs of the public health response -- trace, test, isolate, treat -- are weak in India. There is considerable interest in the problems of tracing and testing. There is a need for fresh thinking on the problem of isolation also. Once millions of people in India have been tested, what are we going to do with the persons who have tested positive?

The author is a researcher at NIPFP.

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