MAY 06 EDITORIAL

AGAINST EXCESS

In Maratha case, SC holds fast to quota ceiling and requires special reasons to exceed it

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Context:

1. A five-judge Constitution Bench of the Supreme Court  unanimously declared a Maharashtra law, which provides reservation benefits to the Maratha community taking the quota limit in the State in excess of 50%, unconstitutional.
2. The court said there was no “exceptional circumstance” or “extraordinary situation” in the state which needed to break the 50 percent ceiling established by the honorable court in Indra Sawhney case of 1992.

Issue at hand

1.  The Supreme Court has underscored the importance of adhering to the 50% limit on total reservation, as well as the need to justify any excess by showing the existence of exceptional circumstances.
2. Court found the Maharashtrian govt’s claim without merit and at the same time said the community is “adequately represented” inn public services.
3.  The “Maratha quota”, given by Maharashtra through a 2018 law, did not survive judicial scrutiny by a Constitution Bench.
4. The 16% quota in admissions to educational institutions and jobs in public services — later brought down to 12% in admissions and 13% in jobs through a 2019 amendment — took the total reservation in the State beyond the 50% ceiling imposed by earlier verdicts.
5. The court found no exceptional situation in the state to justify the breach of the ceiling of 50 percent.
6. SC also set aside the ruling of state HC which gave the reason that denial of reservation was pushing the Maratha community deeper into social and educational backwardness.

Potential challenges

1. Supreme Court’s refusal to reconsider the 50% limit set down by a verdict in Indra Sawhney Case (1992) may threaten the continuance of different kinds of reservation in States.
2. Interpretation of the 102nd Constitution Amendment, by which a National Commission for Backward Classes was created, has proved right fears that the national body’s role and power may impact the rights of States.

Conclusion

1. The Court has ruled that, there will only be a single list of socially and educationally backward classes with respect to each State and Union Territory notified by the President of India, and that States can only make recommendations for inclusion or exclusion, with any subsequent change to be made only by Parliament.
2. The Court has now ruled that Parliament’s intent was to create a scheme to identify SEBCs in the same manner as SCs and STs. The President alone, to the exclusion of all other authorities, is now empowered to identify SEBCs.

2. A CT scan for COVID merits a word of caution

Going by data and the risk factors, its widespread use in diagnosing the infectious disease needs to be questioned

Background:

1. Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.
2. There are broadly three reasons clinical tests are performed : diagnosis (what is the disease?), etiognosis (what caused a disease?), and prognosis (how will the disease evolve?).
3.  It is important that the outcome of a test should guide treatment in some way, especially when it is being used as a monitoring test that provides unique information that cannot be obtained by easier means.
4. Considering how widespread the use of computerised tomography (CT) scans of the thorax during the novel coronavirus pandemic has been, one would assume that the test would satisfy one, if not all the above criteria, for an accurate diagnostic test.

Data from studies

1. The Cochrane (previously known as the Cochrane Collaboration) pooled together all the available data from studies conducted over the last year to test the accuracy of CT scans in diagnosing COVID-19.
2. It included 41 studies with a total of 16,133 participants. It was found that a CT scan accurately diagnosed COVID-19 in about 88% of individuals with a positive RT-PCR.
3.  Since an RT-PCR itself misses 30% of people who have COVID-19, a chest CT is likely to diagnose only 62% of all individuals having COVID-19, making it a relatively inaccurate test for diagnosis.
4.  In these difficult times in obtaining RT-PCRs due to overworked laboratory services, the use of a CT chest as a surrogate needs to come with a caveat. Thus both the tests needs to be done simultaneously if the need for CT scan arises.

Mislabelling the cause

1. An accurate test for etiognosis would be one in which a result would make the cause almost certain.
2. Cochrane study found that when radiologists convincingly labelled a CT pattern as being consistent with COVID-19 disease, they mislabelled 20% of the samples getting the etiognosis wrong in a significant proportion of individuals. Thus subjecting the individual to the psychosocial consequences.
3. Another reason cited to do a CT is for prognostication: a CT that appears worse is likely to lead to worse outcomes than a CT that appears better.
4. But the counter argument can be put forward as the severity of lung involvement as seen on a CT is reflective of the status of the lungs at that point of time, and we know that this is a dynamic process, i.e., a limited involvement at an early stage could progress with time to a severe involvement;
5.  CT scan revealing severely affected lungs while oxygen levels remain high and unchanged is an extremely improbable event, suggesting that a CT is unlikely to give a treating physician more information than a simple tool such as an oximeter.
6.  In case of research settings, certain patterns of lung involvement (and not the mere quantum as reported by a score) have been associated with worse outcomes , but unfortunately, these have not been widely validated, and are not the reason why CT scans are presently being performed.

The risks

1. The major risk associated with CT scan is getting a cancer from radiation. A study published in The New England Journal of Medicine in 2007 postulated that “0.4% of all cancers in the United States may be attributable to the radiation from CT studies”, and further speculated that the current estimate could be in the range of 1.5%-2%. 
2.  There are other risks associated with it like risk to radiology technicians, staff and doctors .Moreover, considering the fact that CT scanners need to be kept in closed air-conditioned spaces, the risk of transmission of the virus is also high.
3. What’s more worse is the risk of secondary infections and thus increasing the out of pocket expenditure on health.

Raise queries

1. A few questions must be answered before going for CT scan.
2. RT PCR being more accurate should be preferred over CT scan.
3. If it is being done despite COVID-19 being proven, ask whether a minimal involvement on the scan guarantees an uneventful clinical course, or whether a more than minimal involvement (when the oxygen levels are high, and the patient seems to be getting better) is a sign of impending deterioration.

Conclusion

Thus an informed choice keeping all the factors in mind will help the people in long term. The potential risks associated with CT are more thus what’s needed is an informed choice thus averting the danger.