Health, medicine and Covid 19

covid 19

The public health experts, or at least some of them, have begun to put the cat among the pigeons. And the latter are not exactly happy about it. We can witness all the fluttering and flapping in countries such as UK, USA and India.

In UK, the Scientific Advisory Group for Emergencies (SAGE) is up against the Boris Johnson government on Covid 19. The government’s scientific body recently recommended a short period of lockdown to slow the soaring rate of coronavirus infections in the country. The government instead rolled out a three-tier system of restrictions to tackle regional outbreaks of the disease. The experts said an immediate “circuit breaker” was the best way to control cases. Not acting now, the Group said, “will result in a very large epidemic with catastrophic consequences.” The government disagreed. Its Communities Secretary said that the government has taken robust action that balanced the impact on the economy.

On the other side of the Atlantic Ocean, in US, The staid New England Journal of Medicine has taken up cudgels against its government. The Journal is a serious peer-reviewed medical publication. It reputation comes not only from the quality of research articles it publishes but also its long history. Founded in 1812, the weekly has had an uninterrupted run chronicling the high and low of scientific journey for over 200 years. In its long and unblemished history, the journal has hardly ever taken a strong political stand, especially during presidential elections.

Its October 8 issue, however, is a departure from that nonpartisan record. Its editorial titled, ‘Dying in a leadership vacuum’ is a blistering indictment of US leadership’s mismanagement of the Covid 19 pandemic that has turned a crisis into a tragedy. The scathing editorial compares the death rate in USA to its neighbour Canada, an ageing Japan, and a lower-middle-income country such as Vietnam. Whichever country you compare with, it says, the United States has done worse. It is indeed intriguing that a country that boasts of best health infrastructure, excellent institutions and highly rated doctors and public health experts should have the highest number of cases and deaths in the world. The journal unequivocally puts the blame on country’s top leadership.

The editorial stands out for another not-so-well-known reason. It is the first time that more than 30 editors of the journal have signed it. The 2-page editorial ends on a sombre note: “When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.” The journal was not only condemning the current political dispensation but also calling for its ouster.

A similar disquiet pervades the medical fraternity in India. Not nearly as blunt and vocal as the Journal, the Indian Medical Association’s open letter to the Union health minister Harsh Vardhan, himself a medical doctor, questions him for giving the green signal to Ayurveda treatment for Covid 19. Specifically, it has not taken kindly to a document that the health ministry has released recently. The document prescribes protocol of prevention of Covid 19 infection and treatment of asymptomatic as well as mild cases of Covid 19 based on AYUSH and yoga.

Approved by a committee comprising of experts from various Ayurveda institutions, the detailed protocol allows Ayurveda practitioners to administer medicine to asymptomatic patients and those with mild symptoms of Covid 19. The protocol rests on the belief that strong immunity guards against coronavirus infection and the traditional system of Indian medicine helps build such immunity.

The prescribed regimen has forced IMA to ask some pointed and searching questions. Two of them stand out for their clarity and purposefulness. The first asks the proponents of the ‘claim’ whether they are prepared to subject themselves as volunteers to an independent prospective double blind control study in prevention and treatment of Covid. The second question asks the health ministry to share the nature of evidence it has collected on the efficacy of Ayurveda treatment. The IMA demands that the evidence should be in public domain and made available for scientific scrutiny.

Both the demands are in accord with what the allopathic medicine practices. An independent prospective double blind control study is a norm that drug and vaccine manufacturers follow. This procedure ensures that the drug and vaccines are safe and efficacious. The Integrated Medical Association (AYUSH) rebuttal ducks from addressing the questions IMA has raised. Both the government and the institutions involved in the drafting of the protocol are silent on them so far. Nor has any of them shared any concrete evidence for public scrutiny. Are the people supposed to accept such claims at their face value?

An open and enlightened discussion is an essential prerequisite for promoting the Ayurveda treatment for prevention and management of Covid 19. What is at stake, whether in UK, USA or India, is the kind of science and society its citizens envision.

Pradeep Krishnatray is former director, Research and Strategic Planning, Johns Hopkins Center for Communication Programs, New Delhi



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