When doctors as well as bureaucrats work together!

Subba et al.[1] review ways to empower primary health care institutions against the COVID-19 pandemic, and they suggest a health system–based approach. They underscore a pressing need to empower primary health centers (PHCs) in COVID-19 preparedness and response as they conclude by stating that these institutions are going to play an indispensable role in this fight.

Under the heading of Health Information System (HIS), they write that verbal autopsy of severe acute respiratory illness (SARI)/influenza-like illness (ILI) cases into facility-level data can help to improve the quality of HIS reporting. However, we want to highlight that verbal autopsy can only reveal what we already know about an illness. In conversation with relatives of a deceased person, when some points appear in front of us, we can surmise and imagine only that sequence of events, which we have witnessed before. But in this pandemic when our colleagues conducted an analysis of the morbid -anatomy of expired ones suffering from the disease, novel facts were emerging.

A few months ago, while dissecting bodies of such cadavers, we came to know that there is a tendency for blood to clot inside veins[2] and that is why now we recommend anticoagulant drugs in this group.[3] What we want to underline is that study by any other method in these circumstances may not have provided such an insight into the pathogenesis of the viral illness. Hence, while verbal autopsy has its own value in discovering the cause of death when it is not known, it cannot replace the conventional knife.

Then, under the heading of Leadership and Governance, the authors write that governance at any level should be based on a proper Planning- Implementation- Monitoring- Evaluation framework. In this respect, we want to emphasize that issue of governance has been marred in the times of this pandemic by loss of trust not only in our own country but also at other places. While Anoop Saraya at the AIIMS, New Delhi vouches for expertise and transparency while making a decision at the top level of governance, we observe that several government orders leave a lot of relevant issues to be fixed.[4]

Similarly, across the oceans, we observed that time-tested agency having the stature of the Food and Drug Administration, the US was fighting to win the trust of its stakeholders at perhaps one of the most crucial moments of history.[5] Due to political meddling, when certain unscientific decisions were made at these federal bodies, we witnessed after-effects in the form of some of the record number of infections/deaths per day resulting in overwhelming of the health care system and for the first time after World War 2, erection of tents in grounds and stadiums to accommodate an excessive number of patients.

Hence, while leadership is necessary to give impetus to mitigation efforts, domain experts should be in harness to steer the wheel. While bureaucrats provide support by arranging resources, specialists provide an avenue for their best and maximum utilization. And both are complementary and indispensable to each other.

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Conflicts of interest

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