COVID-19 and Destination Zero

Destination Zero, our proposed program, is an integrated community outreach, patient engagement and clinical care program which will transform the prevention and management of diabetes and hypertension at scale. Destination Zero is built upon government health infrastructure, which continues to provide essential health services to the public even amidst the COVID-19 pandemic.

The pandemic has highlighted the urgent need for what we propose in the Destination Zero program. Destination Zero creates a platform to address the dual burdens of infectious and chronic diseases and train a workforce to utilize digital platforms and tools that are equipped to adapt to the needs of the time. We propose to modify our program to provide a stronger emphasis on this integration. We plan to learn from both what worked and did not work during the COVID-19 response globally and in India, and apply those lessons to Destination Zero. For example, leadership in our partner institution, the All India Institute of Medical Sciences (AIIMS), plays a central role in India’s National COVID-19 Task Force and has contributed to development of national testing strategy and guidance for a range of issues, including but not limited to prophylaxis of health care professionals, development of webinars for health professionals and the lay population, framework for redeployment of health care workers within a hospital preferentially for COVID-19 management, and staffing norms for health facilities for patients with COVID-19. Learning from this process will be used to inform dissemination of guidelines for diabetes and hypertension for Destination Zero. Furthermore, the concentrated response to COVID-19 is strengthening the already robust relationships between AIIMS and the various partner sites identified for Destination Zero.

In addition, we believe that the government health care system has even more reason to develop telemedicine platforms and strong data collection mechanisms in light of COVID-19. In several states, telephone outreach is being used to monitor people who have traveled or display symptoms. AIIMS faculty have been contributors to the development of the Telemedicine Practice Guidelines, which have been incorporated into the Indian Medical Council Act as an amendment. As a corollary, the Department of Endocrinology at AIIMS, has formally launched its tele-consultations to support patients during the period of lockdown. We believe that this experience will provide us information that will broaden the scope for remote evidence-based management of patients, adding a vital cog to the therapeutic armamentarium of chronic disease. We will leverage and enhance this capacity to address diabetes and hypertension care as we roll out Destination Zero. Lessons from the AIIMS experience will inform innovative approaches to routine care and management in rural, hard-to-reach villages through video-based patient visits, which may be especially needed if physical distancing recommendations continue and may also enhance the ability of patients to receive quality care without the need to travel. In this sense, the pandemic will have created a stronger public health, digital, and data infrastructure upon which Destination Zero is envisioned, and will have provided numerous lessons in implementation of mass scale programs involving testing, linkage, referral, and monitoring.

Finally, this pandemic has emphasized the importance of public health and also of chronic diseases upon leadership and policy makers at all levels, as well as the media and the population at large. Health has now taken center stage in the government’s administrative decisions. Concurrently, there is heightened awareness around management of diabetes and hypertension to reduce mortality from COVID-19, and vaccine uptake will be prioritized in adults with underlying chronic morbidities. The Indian media has been activated to cover issues related to health, and this too can be incorporated into the Destination Zero program. The response from major philanthropies and industry to COVID-19 in India has been impressive. We anticipate that the government will be sensitized to increase health spending, provide due importance to the health of the nation and its health systems, and also assist in focusing the public on critical issues through health promotion, preventive strategies, and systematic interaction with health care providers to ensure continued management of the disease. The pandemic may also help the political leadership to understand the role of health security in achieving economic security. This level of national sensitization to public health augurs well for the long-term collateral support for Destination Zero.