Covid Prophylaxis & Management through Ayush Interventions

Rajib Kumar Sen

Shobhit Kumar

The COVID-19 pandemic is one of the major health crises of recent times, affecting nations across the globe. The magnitude of the crisis has demanded stakeholders - local, international, and global - to join hands and pool available resources in order to contain the pandemic with more precision. India's response to COVID-19 has been distinct in the sense that the pandemic not only necessitated innovations in modern medicine and health infrastructure, but also propelled the popularity of the country's ancient practice of medicines. India has six recognized ancient systems of medicine - (i) Ayurveda, (ii) Yoga and Naturopathy (iii) Unani (iv) Siddha (v) Sowa Rigpa (vi) Homoeopathy collectively called the Ayush. The Ministry of Ayush is the nodal ministry dealing with the Indian systems of medicine and healing practices. The Indian System of Medicine (ISM) has a long history of usage in our country. An independent Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established under the Ministry of Health & Family Welfare (MoHFW) in 1995. Later in 2003, the department was rechristened as the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy with the acronym Ayush. Sowa Rigpa was added further to this acronym. On 9th November 2014, the Department of Ayush was granted the status of a ministry. The Ministry of Ayush (MoA) thus came into existence with the mandate to ensure optimal development, propagation, and popularization of Ayush systems at national and international levels. The MoA has taken several initiatives to strengthen the fight against COVID in India right from the beginning of the pandemic. The MoA nudged the States and UTs towards utilizing Ayush resources such as Ayush services, infrastructure, and modalities for containing and managing COVID-19.The Ministry has issued various advisories, guidelines, protocols, and notifications related to self-care, prevention, management of COVID-19 and post-COVID cases, telemedicine, Ayush industry, research, and so on. The Ministry conducted several COVID-related awareness programmes, webinars, and training. Ministry of Ayush joined hands with the Ministry of Health and Family Welfare (MoHFW) and various State and Union Territories to mitigate COVID-19 from time to time. Ayush COVID community support helpline, Ayush Sanjeevani mobile App, and "AYUSH for Immunity" campaign are some of the other important initiatives of the MoA. The MoA has undertaken several R&D initiatives to harness the potential of Ayush systems to contain the impact of the COVID-19 pandemic.

The Indian States and Union Territories have taken various initiatives and adopted practices based on the directives issued by the MoA from time to time. Further, several states have also taken various new initiatives and innovations. The State Ayush Departments partnered with the Department of Health & Family Welfare to mitigate and manage the COVID-19 pandemic. The broad areas of intervention and initiatives undertaken by the States/UTs include the utilization of Ayush Human Resources, infrastructure, digital platforms and telemedicine, Ayush prophylactic and therapeutic intervention for COVID and Post-COVID cases, research studies, and facilitation of Ayush industries.

Utilization of Ayush Human Resources & Infrastructure

Infrastructure and Human Resources are the key pillars for efficient healthcare service delivery. It was evident during the first and the second wave of COVID-19 that there was a significant burden on all healthcare facilities, resulting in greater resource requirement. The MoA collaborated with the MoHFW to increase the pool of available HR and to utilize Ayush HR as COVID warriors for managing COVID-19 with various identified roles. The two ministries jointly provided training to Ayush master trainers. Further, Ayush personnel also obtained training at the Integrated Government Online Training (IGOT) portal. Approximately 28,473 Ayush HR were deployed for COVID-19- related healthcare services by various States/UTs. The MoA advised the States and UTs to utilize available country-wide Ayush infrastructure, including more than 50,000 beds, 750 hospitals of Ayush colleges, 86 clinical facilities of Research Councils, and National Institutes (under the MoA), by appropriately converting them into COVID Care Centres or hospitals. The State health authorities utilized Ayush HR and infrastructure as per the situation and need. Ayush HR fulfilled various roles, including surveillance, contact tracing, testing, telephonic consultations, distribution of medicines, counselling, vaccinations, and duties in various capacities at COVID facilities, quarantine centers, helpdesks, post-COVID clinics, and other facilities. Ayush HR was also a part of rapid response teams, district vigilance committees for monitoring bed and oxygen supply, district surveillance teams, and involved in physical and tele-triaging in various States. The State and UT Governments utilized Ayush infrastructure as fever clinics, vaccination centers, COVID Care Centre (CCCs), COVID Health Centers, and PostCOVID Clinics. Ayush HR was deployed at various levels of the healthcare system, including civil hospitals, CCCs, Dedicated COVID Hospitals (DCH), Dedicated COVID Health Centers (DCHC), Tele-counselling centers, and mobile healthcare service delivery in different capacities in Gujarat. Ayush hospitals were also converted into CCCs. Maharashtra converted 182 Ayush facilities into CCCs and 144 into quarantine centers. Ayush HR was deployed at CCCs, shelter homes, isolation wards, and COVID hospitals in Goa. Kerala formed the State Ayurveda COVID Response Cell (SACRC), and a total of 1206 Ayur Raksha Clinics were opened to tackle the pandemic. Post-COVID complications management was also done through 45+ Siddha hospitals and clinics. The Himachal Ayush Department formed Quick Response Teams (QRTs) at the State, district, and sub-divisional levels as well as in regional Ayurvedic hospitals and educational institutions. Uttar Pradesh Government established Integrated COVID Command and Control Centres in all districts headed by the district nodal officers. The Delhi Government established dedicated Ayush COVID Healthcare Centres at hospitals of Ayush teaching institutes and established 175 Ayush post-COVID Centres. Siddha CCCs were operationalized across the State in Tamil Nadu. General OPDs and IPDs were equipped specially to tackle post-COVID-19 cases in Bihar.

Ayush Prophylactic, Therapeutic Interventions, R&D Initiatives

Prevention is one of the critical measures for battling COVID-19. States and UTs have followed the directives issued by the MoA and taken several initiatives to safeguard the community, COVID warriors/ frontline workers, quarantined individuals, and management of COVID/ Post-COVID cases. Further, Ayush interventions were utilized in many States/UTs in the management of COVID-19 cases as an adjuvant to standard care. States like Karnataka and Maharashtra have also developed state-specific guidelines for the prevention of COVID-19. States and UTs extensively distributed the immunity-boosting Ayush medications. It has been observed in the recently released report, namely "Mitigation and Management of COVID-19: Compendium of Ayush-Based Practices from Indian States and Union Territories" by NITI Aayog, that the number of cumulative beneficiaries of Ayush prophylactic medicines in 15 States/UTs is approximately 9.7 crore. Additionally, Andhra Pradesh and Gujarat have distributed approximately 22.17 crore doses of Ayush prophylactic medicine. Few States and UTs like Madhya Pradesh, Gujarat, Kerala, and Delhi also undertook research studies related to the prevention and management of COVID-19 through Ayush intervention.

Digital Platform & Telemedicine

Digital platforms and telemedicine services played a vital role during the testing time of the COVID-19 pandemic. They have emerged and served as a safe mode of interaction between healthcare workers, the public, and patients. The States and UTs extensively utilized digital platforms to disseminate information related to self-care guidelines and monitor COVIDrelated activities. Ayush-based prophylactic measures like daily regimes, diets, Yoga practices, and awareness about other preventive guidelines were disseminated through television programs, radio talks, social media, mobile apps, animation, and videography. Teleconsultation was provided to the general public for preventive measures, including counselling and reducing the stigma of COVID-19, to home-quarantined and COVID patients. Several States and UTs issued state-specific helpline numbers and developed mobile Apps for facilitating these services. For instance, Gujarat started a "COVID-19-related Ayush Health Lecture Series". The Telemedicine App "Ayush Qure" was launched to facilitate teleconsultation facility in Madhya Pradesh. The health institutions under the Department of Ayush were linked to this App for wider public utility. Uttarakhand established the COVID Ayush Desk, and in each district, teams were formulated utilizing Ayush Medical Officers for providing the National Clinical Management Protocol and Ayush-based teleconsultation to the COVIDpositive patients. A centralized Ayush Desk was also established at the Directorate for training, monitoring, data collection, and reporting. An Aarogya Sampark Dashboard was created for real-time tracking of COVID-19 related efforts of Ayush in Jammu and Kashmir. Bihar State Ayush Society made the Ayush Teleconsultation App to accelerate the tele-consultation services. Uttar Pradesh developed the Ayush Kavach App to provide direct consultation with specialized Ayush doctors. Additionally, live Yoga sessions were telecast every morning at 0800 hrs for patients and the community, and a live "AYUSAMVAD" programme was carried out every evening for the prevention of COVID-19 and other common diseases

Support for Ayush Industry

For successful implementation of prophylactic and therapeutic interventions, it was crucial to have an uninterrupted supply of medicines. Several States and UTs facilitated the process of licensing/approval and renewal of licenses for manufacturing Ayush healthcare products, especially immunity boosters, Ayush-64, and sanitizers. For instance, 100 private Ayurveda medicines manufacturers were issued temporary licences to produce hand sanitizers and Ayush Kwath, to meet the increased demand in Rajasthan. Himachal Pradesh issued approval for the manufacturing of sanitizers, hand wash, and Ayush Kwath to 60 firms for 382 formulations

Way Forward

The Central Government has played a vital role in mitigating and managing COVID-19. There was a need to pool the available resources as the healthcare system was overwhelmed during the pandemic. The States substantially utilized Ayush HR and infrastructure to manage COVID-19. The various States and UTs have followed directives issued by the MoA and implemented them in their States as per the feasibility, while many have also done some innovations. Some States have adopted State-specific policies and launched various programmes to prevent and manage COVID-19 and postCOVID-19 cases. In order to synergize the public healthcare system, the States need to review the policies further to strengthen the traditional healthcare systems in the country. Integrating evidence-based Ayush services with the modern systems can be a model to tackle the unique health challenges of the current century.

(Rajib Kumar Sen is Senior Adviser, NITI Aayog. Shobhit Kumar is Research Officer, NITI Aayog). E-mail: shobhit. kumar@gov.in Views expressed are personal.