Dr Bevinje Srinivas Kakkilaya is based in the coastal Karnataka city of Mangaluru, where he has been practising as a consultant physician since 1992. Dr Kakkilaya has been involved in issues of public health throughout his career. He has been a co-investigator for projects on Malaria Research Training in southern India conducted by the Kuvempu University Consortium, Shivamogga, Karnataka, in collaboration with the Penn State College of Medicine of the United States, and also on FISH Assay for malaria diagnosis, run by ID FISH, California, U.S. He has been a regular columnist on issues of public health for leading Kannada newspapers for many years and has won several writing awards for his sage analyses. Dr Kakkilaya has been writing consistently on various issues relating to the novel coronavirus pandemic since March and has recently published a book in Kannada titled Corona Hedaradirona (Let us not Fear Corona) along with his wife, Dr Balasaraswathy Panambur. The book brings together his wide writing on the subject and has been widely appreciated for its clarity on the subject. In this interview with Frontline, Dr Kakkilaya expounds on some of the crucial themes regarding the pandemic in India with an emphasis on Karnataka.
The first death due to COVID-19 in India took place in Karnataka on March 8. You were initially satisfied with the response of the State government to the pandemic but increasingly began to disagree with its approach. Can you tell us where the Karnataka government erred?
There are two sides to this issue. I had expressed my satisfaction at the efforts of the government in identifying and tracking down the primary cases and their contacts during the initial days of the epidemic. Karnataka did well, and that helped in delaying community spread. But I did question the decision of the State government, on March 13, to shut down theatres and malls and restrict wedding ceremonies, etc., terming them as non-essential, when the entire State had had a total of 11 cases, and a single death. At that point, there was absolutely no indication of community transmission of the infection anywhere and therefore such a drastic shutting down of community activities was premature and unnecessary. It turned out to be a big blow to economic activities and of no help in stopping the transmission. During this time, I had also communicated to the State government many documents and reports regarding prevention and management of COVID-19, from the NHS [National Health Service] of the United Kingdom, and other countries such as Italy, the U.S., etc. But the government failed to develop a scientific, rational and pragmatic strategy, resulting in the prevailing confusion and lack of coordination at every level.
You have been critical of the 21-day national lockdown announced by Prime Minister Narendra Modi on March 24. Until that day, 564 cases and 10 deaths had been recorded in India. Central government spokespersons and ministers have insisted that this early precaution helped in preventing the spread of the deadly virus.
Those claims have clearly been proved wrong, and it appears that India is on its way to be World No. 1 in COVID cases and deaths. A senior adviser of the NITI Aayog had reportedly asserted that there wouldn’t be a single new case after May 16; but, on that very day, 53 days through the lockdown, there were 4,864 new cases and 90,648 total cases. The national lockdown failed because that, too, was premature, sudden and harsh, disregarding the demographics and the best of experts of our country. It’s clear that shutting down communities can have a very limited role in curtailing the virus that spreads mostly through close personal contacts. Also, the premature lockdown sent wrong messages, created unnecessary fear and stigma, and in addition, created severe hardships for stranded people and migrant workers and damaged the economy. Contrary to claims, it did not help in strengthening the hospitals for COVID care.
You have often argued that people should not become overwhelmed by the coronavirus. Even the title of your book is “Let Us Not Fear Corona”. With cases increasing every day, how do we tackle the spread of the virus?
I had stated in early March that the new coronavirus would stay forever; this fact is now being stated by the government and by every agency. It was also known quite early that severe illness and deaths due to COVID occur mostly in the elderly and in those with co-morbidities. Studies available from many countries have clearly shown the case fatality rate at 0.04-0.5 per cent, which could be further reduced with a rational plan to identify and treat severe COVID. Therefore, COVID is a mild, self-limiting infection in most of the cases, particularly among children and the young. It’s very necessary to create awareness about this fact, and it’s also necessary to create requisite facilities to identify and treat severe COVID; fearmongering and stigmatisation do not help, but only create confusion and impediments.
You have often advocated “reverse quarantining” and “mobile clinics” as a response to the spread of the pandemic. Can you explain these two concepts further?
With the initial reports of COVID from China of more than 72,000 cases, and also from Italy and the U.S., clearly indicating that severe COVID occurred in the elderly and in those who had co-morbidities, I had suggested that it was important to protect these vulnerable people from getting the infection so as to reduce the deaths and thereby the burden on the health-care system. Accordingly, I had suggested an action plan to protect these people, with the help of family members, wherever possible, or by the government, utilising the facilities such as hostels, hotels or rest houses. Kerala, and much later Karnataka, did issue some statements on these lines, terming the plan as reverse quarantine of the vulnerable. Protection of the elderly was also first among the seven mantras suggested by the Hon’ble PM on April 14 to control COVID. But that was it, nothing much happened thereafter.
Also, experience from Italy, the U.S. and the U.K. by March itself had indicated that COVID being a mild infection in most cases, patients could be asked to stay at home, so as to prevent them from spreading the disease to the community outside, and also to prevent the overwhelming of hospitals, which would otherwise become unavailable to cases of severe COVID. Patients staying at home could be checked by mobile units for early identification of complications, and if so, could be shifted to hospitals for further care. Such an arrangement could have allayed anxiety, while also helping to prevent spread and to identify and treat severe COVID more effectively. But these suggestions were not considered by our government.
There is tremendous fear among parents, which is delaying the opening of schools. You have constantly stated that schools must be opened immediately. Why do you say this?
There’s ample evidence to show that children are less likely to be infected and are very unlikely to develop severe COVID, and also that shutting down schools helps neither to stop the spread nor to prevent deaths. On the contrary, there’s evidence to show that such measures have adverse effects on learning, physical and mental health, and nutrition, and can increase physical and sexual abuse. When we find that the government is allowing the more vulnerable adults into all activities and is restricting the least vulnerable children and youngsters from their most needed schools, colleges and exams, it’s evident that the government is not being guided by evidence or experts. Therefore, parents and students should demand immediate reopening of schools and all the professional courses, because the benefits far outweigh the almost non-existing risks.
You had raised concerns about the COVID management protocol published on May 15 by the Karnataka government. What were your apprehensions then and what is the reality today?
The protocol had recommended a battery of investigations and several medicines for all cases of COVID, from asymptomatic to severe. Most of these recommendations were neither evidence based nor recommended by the Central government or by other national health agencies. The primary concern, apart from the above, was that this protocol would become the standard of care and would lead to unnecessary expenses and adverse effects. It has turned out to be so, and many patients are being subjected to expensive tests and multiple medications with doubtful or no benefits.
As hospitalisation due to COVID-19 increased in Karnataka, there were complaints that private hospitals were not cooperating with the government health authorities. As someone who has observed this tension between the government and private hospitals, do you think the private hospitals have stepped up in this moment of acute crisis?
Neither the government nor organisations representing doctors and hospitals have had a scientific, evidence-based strategy for management of COVID. Lockdown hampered health-care delivery, people couldn’t reach clinics and hospitals, and this adversely affected the management of non-COVID cases. In the absence of any support from the government, this led to severe financial constraints, particularly for smaller hospitals. The government’s order to reserve 50 per cent beds in every hospital for COVID escalated the confusions and problems. All these severe constraints have led to significant salary cuts for doctors, nurses and other staff, and also made them vulnerable not only to COVID, but also to attacks and other problems.
