Health system resilience: Ensuring TB services during COVID-19 pandemic in Kerala, India.

COVID-19 pandemic has affected TB case detection and continuity of care globally. Kerala, the southern Indian state has experienced a reduction in TB notification during second and third quarter of 2020. Through (1) causal analysis (2) meticulous planning and establishment of systems (3) locally customised guidelines (4) better management of resources (5) integration with other programs and (6) good partnership with private sector, Kerala was able to catch up the TB notification and ensure that TB services remain intact even during the COVID-19 pandemic. Approach to catch up TB diagnosis included (1) Field based active case finding among the vulnerable individuals, (2) bilateral screening for TB and COVID-19, (3) enhancement of biosafety in laboratories, (4) strengthening of specimen collection and transportation systems, (5) targeted advocacy and communication to find out missed cases and (6) effective partnership with the private sector. Current experiences also show that TB case finding could be improved and delay in diagnosis could be averted by integrating TB case finding into the screening and testing systems established for COVID-19. The experiences of ensuring TB services during pandemic in Kerala also affirms the importance of maintaining an integrated and strong TB control component in the public health sector and vesting ownership of the TB control programme with the primary health care team. Community-based and community-led responses that take diagnosis, care, and support to the doors of those affected have much potential in delivering TB services in the subsequent years of pandemic.

Implementing the Epidemic Diseases Act to combat Covid-19 in India: An ethical analysis.

Many states in India have invoked the provisions of the Epidemic Diseases Act, 1897, as a major tool in the fight against the Covid-19 pandemic. The current review attempts to discuss the ethical challenges in implementation of the Epidemic Diseases Act, 1897, to combat Covid-19 in India. Implementation of the Act in India has exposed its major limitations. It remains merely as a "policing" Act with no emphasis on coordinated and scientific responses to outbreaks and without provisions for protecting the rights of citizens. The Epidemic Diseases Act in its current form has the potential to cause more harm than good. Furthermore, the Epidemic Disease (Amendment) Bill, 2020, has not addressed any of these concerns. There is need for a rights-based, people-focused and public health-oriented law in India to deal with epidemics.