Best Practices From The Delta Wave Can Help India Fight Omicron

Like most countries, India is experiencing a massive surge in Omicron right now. This is India’s third wave of Covid-19. The second wave was driven by the more severe Delta variant. It was devastating, with a massive spike in excess deaths during just 3 months (April to June 2021).

Although the Delta wave was a dark period, even during this crisis many individuals, in all walks of life, and all over India, had worked hard to make things better in exceptional ways. There were medical professionals who, despite the volume of patients, were managing Covid-19 in an evidence-informed, rational way. There were teams vaccinating entire villages once overwhelmed by hesitancy. There were workers ensuring even the remotest areas had adequate oxygen supply.

Lessons from these bright spots (promising practices) could be very valuable right now, as India battles a tidal wave of Omicron cases.

Identifying bright spots in COVID-19 management

After the second wave in India, India COVID SOS (ICSOS), an international volunteer group of over 500 scientists and advocates (including me), and Exemplars in Global Health (EGH) partnered to curate and share promising practices. Other partners involved in the effort included Evalueserve, Global Health Strategies, Sattva and Xynteo.

As I wrote in a previous post, EGH brings together experts, funders, and collaborators around the world with the mission of identifying positive global health outliers, analyzing and understanding what makes these countries successful, and disseminating the core learnings so they can be replicated in comparable settings. 

Purnima Menon, a global expert in nutrition, one of the volunteers in India COVID SOS group, played a key role in this initiative to compile bright spots. “Documenting some of those positive stories was a lot of work. Today, both the stories and the people and organizations behind them are available for those considering how to support India during the current Omicron wave,” she said.

“Despite the immense challenges posed by Covid-19 globally and within India, there are bright spots worth amplifying and celebrating,” said Becky Bartlein, Director, Health & Life Sciences, Exemplars in COVID-19 Response Topic Lead.

“We identified over 50 promising practices across a range of thematic areas from successful vaccination campaigns, to evidence-based patient management, to strong cross-sectoral collaborative initiatives,” said Pavan Ananth, Founder of Pravesh, a consulting group, and one of the EGH team members who supported the effort.

“We approached this effort through desk research and outreach through networks of policy makers, experts and administrators from across the country to identify promising practices,” said Fariha Choudhury, another EGH team member. “For the majority of the case studies, we spoke with government officials, NGO leaders, and the individuals who made exceptional contributions to the Covid-19 response effort to ensure that the case studies captured their work accurately and with enough detail to allow for replication. All our case studies are also reviewed by a team of technical experts to ensure accuracy and relevance,” she added.

While the entire set of bright spots is available online, a few promising practices are show-cased below.

Rational and Evidence based Management

Under this category, the Choosing Wisely for COVID-19 effort was identified as a bright spot. A task force composed of members from multiple areas of healthcare, patient and civil society representatives, senior government officials, and advisors came together with a single mission: To help patients and physicians choose care that is necessary, evidence-based, not duplicative, and not harmful. The 10 Choosing Wisely recommendations were published in Nature Medicine in 2021. They remain highly relevant for the current Omicron wave. The 5 recommendations for the public are shown below.

The COVID Guidelines India Project was another bright spot identified. To provide clinical guidelines on Covid-19 management, several institutions in India (coordinated by the Christian Medical College, Vellore), came together to use a rigorous, evidence-based approach to make recommendations and guidelines to support clinicians managing patients with Covid-19 in secondary and tertiary care settings in India. Again, all the recommendations are valid for Omicron, even as guidance on new treatments are being added.

Yet another bright spot was how the Mahatma Gandhi Institute of Medical Sciences (MGIMS), a rural medical school in Sevagram, Wardha, avoided using untested and potentially harmful treatments, to reduce costs and improve outcomes among patients with Covid-19.

In addition, the India COVID SOS group developed several useful resources during the second wave, including tips for home care of Covid-19, tips for care in low-resource (e.g. rural) settings, rational use of steroids, educational materials on use of pulse oximeters and oxygen. The team also put out several engineering solutions for improving oxygen supply & delivery.

Ensuring Successful Vaccination Campaigns

Under this category, a number of bright spots were identified (and showcased in a webinar held in October 2021 ). For example, the cluster vaccination strategy developed and implemented by the Government of Uttar Pradesh demonstrated that collaboration across stakeholder groups, including government and NGO, civil society organizations and international organizations, is effective for achieving widespread coverage. The approach hinged on dividing every block in the state into clusters and conducting intensified vaccination campaigns in phases to saturate each cluster so that nobody gets left behind. Targeted micro-plans, communication to address hesitancy and bridging the digital divide were crucial steps.

The team identified several other inspiring stories of successful vaccinations in some of the remote tribal areas of our country- from Melghat in Maharashtra, Jhabua in Madhya Pradesh and Nilgiris in Tamil Nadu. Culturally appropriate and relevant communication, innovative methods of dissemination, empowering local leaders and collaboration with grassroot organizations are consistent learning across these successful stories to beat vaccine hesitancy and encourage adoption of COVID-appropriate behavior.

Although India has done well with Covid-19 vaccinations, only 65% of the population is double-vaccinated. So, there are still millions of people to vaccinate and the promising practices described above could be helpful in reaching the unreached.

Technological innovations

During lockdowns, virtual consultations and tele-health approaches became critical to ensure medical care. Project StepOne: a Volunteer-Driven Public Telemedicine System in India is one of the bright spots identified under this category. Collaborating closely with various state governments (most prominently the Govt. of Karnataka), Project StepOne provided Covid-19 telemedicine consultation, grief counselling, mental health support to millions of citizens. Their approach was to keep it simple with technology tools, recruit young medical professionals who could volunteer and develop standard protocols and SOPs (which were dynamic and evolving) for triaging and patient management.

Another bright spot is Swasth, a consortium that leveraged government and private sector partnerships to grow to its scope, while using non-profit partners to ensure efficiency at the last mile.

Operational excellence/Decentralized management

During the second wave, the Brihanmumbai Municipal Corporation (BMC) decentralized the central control room for disaster management to 24 COVID-19 response war rooms—one in each municipal ward of Mumbai. These war rooms were operated 24/7 by a group of doctors, medical interns, schoolteachers, and social workers, who work in 8-hour shifts. The war room staff oversaw cases arising in their ward, counsel and advised callers, and triaged patients based on severity of their conditions, recommending hospitalization as required. Easily accessible and reliable data is one of the key factors for the success of Mumbai’s COVID-19 model (graphic).

Another example of decentralized management is Coronasafe. In parts of Kerala, a centralized emergency control room at the district level with decentralized “war” rooms at the ward level helped health resources, hospital admissions and the flow of medical oxygen across the entire district. Leveraging real-time data analytics on available resources helped administrators allocate resources effectively.

Relevance for the Omicron wave

The Omicron variant is very rapidly spreading in India. India reported more than 100,000 new Covid-19 infections on January 6th, up 700% in one week. Although vaccinated people seem to have relatively less severe illness, the sheer number of people infected is already straining the health system. So, learning from the second wave and applying the promising practices quickly is one efficient way to control the Omicron surge.

“It’s critical that learnings from these bright spots from the first and second waves of COVID in India are replicated and adapted by others across the country to better manage this third wave,” said Prarthna Desai, Director, Health & Life Sciences, Exemplars in Global Health Partnerships & Impact Lead.

“These stories of innovation, resilience and commitment provide critical learnings of what’s working best on the ground,” said Anjali Nayyar, Executive Vice President of Global Health Strategies. “With the Omicron wave looming large, dissemination of these stories can help better address the challenges, inspire uptake of such good practices and also help inform policy decisions at the highest level,” she added.

“Stories are among the most powerful tools we have for sharing knowledge, and for ensuring the hard-won lessons of others contribute to a greater common good,” said Purnima Menon. “This library of promising practices, and the network of experts behind it, has the power to support patients, doctors, and decision-makers at all levels during the current wave,” she explained.

Disclosure: I have no commercial or financial conflicts with any group or organization listed above. I am an unpaid volunteer with the India COVID SOS group, and was engaged in supporting relief efforts in India during the second wave.

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