The news coming out of India during the pandemic just shows the massive disorganization there is between the Centre and the states. While States, UTs and the Centre have made Twitter their official platform for putting up information heap on heap, they have not considered making a central database of information related to hospitals and treatment.

In effect, where there should be one portal with the list of hospitals and treatment centers by state and city for easy navigation, there only statements by Ministers claiming the number of hospitals, treatment centers or isolation beds in the country. If one has to access such information, one has to be ready to dig in on news reports, Twitter or websites of various states and their municipal corporations. However, this is not possible for people looking to get admitted on an emergency basis and most of the patients are left hunting and going from hospital to hospital, with some eventually losing their lives.

In light of this, after an RTI application filed by Venkatesh Nayak asking the Ministry of Health and Family Welfare (MOHFW), to furnish the list of designated COVID Hospitals and treatment centers across the country failed to evince a satisfactory reply, he approached the Central Information Commission (CIC) which issued an advisory to the MOHFW to fill the information gap and furnish the required information for the benefit of the citizens of the country, reported Nayak, writing for the Commonwealth Human Rights Initiative (CHRI).

Nayak said that during the second phase of the lockdown, various media reports pointed out to the difficulties people faced in finding the designated Covid-19 hospitals. He said that the list of the same was also not published on the MOHFW website. In light of this, he filed an RTI application on April 17, 2020 asking the MOHFW for the following information.

1) The district-wise number of hospitals and healthcare facilities called by any other name, designated as COVID-19 treatment centres as on date;

2) The postal addresses and telephone numbers of the hospitals and healthcare facilities referred to above; 

3) The criteria applied for determining whether or not a hospital or a healthcare facility should be designated as a COVID- 19 treatment centre; 

4) The district-wise names of hospitals and health care facilities whose designation as COVID-19 treatment centres has been withdrawn as on date; and

5) The reasons for withdrawing the designation of every hospital and health care facility referred to at para no. 4 above.

Back and Forth

Since the information dealt with life and liberty of individuals, he requested the Ministry to publish the same on its portal within 48 hours. However, unfortunately, his application was passed on by the MOHFW to the Directorate General of Health Services (DGHS) and the Indian Council of Medical Research (ICMR) who didn’t give him any reply. In light of this, he wrote to the CIC. Meanwhile, his application was sent back by the DGHS to the hospital section of MOHFW which transferred the application to the Public Information Officers of the Safdarjung Hospital, Ram Manohar Lohia Hospital and Lady Hardinge Medical College and Associated Hospital (LHMC) in Delhi. A week later he received a reply from LHMC to look up the list on the MOHFW website.

CIC intervention

Seeing this, Nayak sent an additional submission to the CIC stating that the public authorities were only going back and forth on his request. Apart from the media reports that carried information of people who passed away waiting for hospitals, Nayak also mentioned that different ministers had furnished details of number of Covid-19 hospitals at different times. This, he said was only possible if there was a list of such hospitals available with the public authorities. He also stated to the CIC that the ICMR had displayed a list of country-wide COVID testing centres on a Google map with their addresses so there was no reason for them to comply and publicly furnish the list of the hospitals for the public.

In light of this, the Chief Information Commissioner, Bimal Julka held a hearing on June 1, 2020 through a WhatsApp call where the public authorities responding to Nayak’s RTI were also present. All of them denied having information about the list of dedicated Covid-19 hospitals and treatment centres and also said they didn’t know about the statements of the Union Ministers.

Expressing its disappointment in the way the matter was handled and the matter was shuttled from one department to the other, the CIC advised the MOHFW to –

“…the Commission advises the Secretary, M/o H&FW to designate an officer of an appropriate seniority as a Nodal Officer to examine the matter and suo motu disclose the information sought in the RTI application on the website of the Public Authority within a period of 15 days from the date of receipt of this order in the larger public interest.”

He also said, “It is essential that the decisions themselves and the senior decision makers involved are thoroughly documented in order for the Governments to remain accountable both during and after the crisis for future generations to be able to learn from these actions.”

Julka also pulled up the government actors for their incapability to provide the necessary information, saying, “Information seekers are to be furnished what they ask for, unless the Act prohibits disclosure; they are not to be driven away through sheer inaction or filibustering tactics of the public authorities or their officers. It is to ensure these ends that time limits have been prescribed, in absolute terms, as well as penalty provisions. These are meant to ensure a culture of information disclosure so necessary for a robust and functioning democracy.”

Reminding PIOs of their duty, Julka stated, “The undersigned is directed to say that the responsibility of a public authority and its public information officers (PIO) is not confined to furnish information but also to provide necessary help to the information seeker, wherever necessary.”

Julka also stated that there was an urgent need to compile, collate and consolidate the information sought in the RTI application and publish it on the website of the MOHFW as this would be mutually beneficial not only for the government but also scientists, researchers, academicians, historians and law makers among others.

The complete advisory by the CIC may be read below.

Related:

“I saw a man carry his mother on his back, I saw his bleeding feet”
Migrant Diaries: The story of Tinku Sheikh

The post Appoint Nodal Officer for publication of Covid-19 info: Central Information Comission to MOHFW appeared first on SabrangIndia.

On Friday, the Ministry of Health and Family Welfare (MoHFW) issued a revised advisory on the use of Hydroxychloroquine (HCQ) as prophylaxis for Covid-19 infection. The the prophylactic use of HCQ is now recommended in the following categories:

1. All asymptomatic healthcare workers involved in containment and treatment of COVID19 and asymptomatic healthcare workers working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks

2. Asymptomatic frontline workers, such as surveillance workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities.

3. Asymptomatic household contacts of laboratory confirmed cases.  

The move came after the Joint Monitoring Group under the chairmanship of the Director General of Health Services (DGHS), and including representatives from the All India Institute of Medical Sciences (AIIMS), Indian Council of Medical Research (ICMR), National Center for Disease Control (NCDC), National Disaster Management Authority (NDMA), World Health Organisation (WHO) and experts drawn from Central Government hospitals reviewed the prophylactic use of Hydroxychloroquine (HCQ) in the context of expanding it to healthcare and other front line workers deployed in non-Covid and Covid areas, respectively.

According to the revised advisory, “At National Institute of Virology (NIV), Pune, the report of the in-vitro testing of HCQ for antiviral efficacy showed reduction of infectivity /log reduction in viral RNA copy of SARs-CoV2.” Additionally, “A retrospective case-control analysis at ICMR has found that there is a significant dose-response relationship between the number of prophylactic doses taken and frequency of occurrence of SARSCoV-2 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection.”

The advisory also sites other studies conducted at hospitals in New Delhi. It says, “Another investigation from 3 central government hospitals in New Delhi indicates that amongst healthcare workers involved in COVID-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, compared to those who were not on it. The benefit was less pronounced in healthcare workers caring for a general patient population.”

As per another study mentioned in the advisory, “An observational prospective study of 334 healthcare workers at AIIMS, out of which 248 took HCQ prophylaxis (median 6 weeks of follow up) in New Delhi also showed that those taking HCQ prophylaxis had lower incidence of SARS-CoV-2 infection than those not taking it.”

However, this is advisory also warns that “It is reiterated that the intake of above medicine should not instil a sense of false security.”

This is critical in wake of several questions being raised about the efficacy of HCQ. According to a recent study published in The Lancet, a highly respected peer-reviewed medical journal, “Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.”

The methodology of the study by Mandeep R Mehra, Sapan S Desai, Frank Ruschitzka and Amit N Patel is explained as follows:

“We did a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19. The registry comprised data from 671 hospitals in six continents. We included patients hospitalised between Dec 20, 2019, and April 14, 2020, with a positive laboratory finding for SARS-CoV-2. Patients who received one of the treatments of interest within 48 h of diagnosis were included in one of four treatment groups (chloroquine alone, chloroquine with a macrolide, hydroxychloroquine alone, or hydroxychloroquine with a macrolide), and patients who received none of these treatments formed the control group. Patients for whom one of the treatments of interest was initiated more than 48 h after diagnosis or while they were on mechanical ventilation, as well as patients who received remdesivir, were excluded. The main outcomes of interest were in-hospital mortality and the occurrence of de-novo ventricular arrhythmias (non-sustained or sustained ventricular tachycardia or ventricular fibrillation).”

Here are their key findings:

96 032 patients (mean age 53·8 years, 46·3% women) with COVID-19 were hospitalised during the study period and met the inclusion criteria. Of these, 14 888 patients were in the treatment groups (1868 received chloroquine, 3783 received chloroquine with a macrolide, 3016 received hydroxychloroquine, and 6221 received hydroxychloroquine with a macrolide) and 81 144 patients were in the control group. 10 698 (11·1%) patients died in hospital.

After controlling for multiple confounding factors (age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity), when compared with mortality in the control group (9·3%), hydroxychloroquine (18·0%; hazard ratio 1·335, 95% CI 1·223–1·457), hydroxychloroquine with a macrolide (23·8%; 1·447, 1·368–1·531), chloroquine (16·4%; 1·365, 1·218–1·531), and chloroquine with a macrolide (22·2%; 1·368, 1·273–1·469) were each independently associated with an increased risk of in-hospital mortality.

Compared with the control group (0·3%), hydroxychloroquine (6·1%; 2·369, 1·935–2·900), hydroxychloroquine with a macrolide (8·1%; 5·106, 4·106–5·983), chloroquine (4·3%; 3·561, 2·760–4·596), and chloroquine with a macrolide (6·5%; 4·011, 3·344–4·812) were independently associated with an increased risk of de-novo ventricular arrhythmia during hospitalisation.

The study therefor concluded, “We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.”

The entire study may be read here:

The Health Ministry’s latest revised advisory may be viewed here

Related:

Fake machines, theft and apathy mar Gujarat’s Covid-19 fight
Gujarat reopens: Have economic considerations overtaken health concerns?

The post India revises stand on HCQ, concerns about efficacy remain appeared first on SabrangIndia.