Intended for healthcare professionals


Covid-19: India should stop mass gatherings and consider postponing elections, say doctors

BMJ 2021; 373 doi: (Published 28 April 2021) Cite this as: BMJ 2021;373:n1102

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Open letter from Trustees of South Asian Health Foundation

Covid-19: Call to action on global inequalities

  1. Gareth Iacobucci
  1. The BMJ

A group of leading doctors has called for a raft of public health measures to support India as the country struggles to cope with a huge surge in covid-19 cases and deaths.

In an open letter published in The BMJ, trustees of the South Asian Health Foundation call for India to ban mass gatherings, impose strict lockdowns, and consider postponing the upcoming election to try to bring down numbers of infections, hospital admissions, and deaths.

The letter notes that India is currently in the “unenviable position” of leading global covid-19 numbers. As of 28 April it has recorded over 17 million cases and 195 000 deaths—as well as over 300 000 new cases daily, which “is likely to be a significant underestimate.”

“India invoked an exemplary lockdown during the initial wave of covid-19 and it is perhaps now a time to consider whether the benefits of a lockdown outweigh the benefits of an immediate election,” they write. “Mass gatherings need to stop urgently.”

Emerging needs

The letter notes that countries including Germany and the UK have responded to the Indian government’s call for international support by sending oxygen concentrators and ventilators.1 But it says that further needs will emerge and emphasises that criteria based access to hospital and intensive care beds will be “essential to make best use of limited resources.”

“Standardized protocols for access and step down to the most valuable resource of an ITU [intensive care] bed will enable the best chances of survival to as many as possible,” the doctors write. “It is time to share and standardize these protocols from across the world, including use of risk prediction models that are likely to benefit people the most.”

These actions form part a wider call for actions on global inequalities, including:

  • Up to date, evidence based treatment for all people with covid-19

  • Good governance to protect the most vulnerable citizens from impoverishment

  • Workforce planning to balance the forces of economic workforce migration with the needs of health systems

  • Coordinated action against non-communicable diseases such as diabetes and hypertension, to reduce illness and death both during and after the pandemic; and

  • Empowering patients around the world to preserve their own health through trusted communication and to harness social media in the medical community to rapidly share evidence, guidelines, and protocols.

The doctors conclude, “Total indirect deaths related to covid-19 due to disruptions in care, access to care and poverty are likely to kill more patients than the pandemic itself.

“Whilst history tells us that action and inaction has resulted in global inequity and iniquity, it is now time to define which actions and inactions we prioritise to drive equity and prosperity during and following the pandemic.”

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