Published: April 2, 2020 12:20:14 am
On March 24, Prime Minister Narendra Modi announced a 21-day national lockdown. “The opinion of experts,” he argued, had proven that “there is only one way to effectively deal with coronavirus,” which is to enforce social distancing. It is imperative to appreciate why this lockdown was deemed necessary from a health systems perspective.
Initially, the cases detected in India were those that had a direct history of travel to countries where COVID-19 was spreading (stage 1). Over time, cases started to be detected in people who had direct contacts with those with a travel history (local transmission or stage 2). Over the last week, multiple reports suggest that a proportion of people infected with COVID-19 do not show any symptoms (or asymptomatic) but are infectious.
These people would not have been detected when they entered India and could have initiated the spread of the disease in the community, also known as community transmission (stage 3). That India has entered stage 3 is without doubt, based on patterns seen in other parts of the world. This has also been re-confirmed by the Indian Council of Medical Research that has alluded to limited community transmission in the country. Yet, overall testing numbers continue to be very low. As of March 31, India had conducted only 42,788 tests, an abysmally low testing rate of about 32 per million people.
The lockdown is essential to slow the transmission cycle, especially in the absence of vaccines and therapeutics to fight the disease. If implemented and followed rigorously, this will help us “flatten the curve” and provide our health systems with precious time to prepare. The quarantine will ensure asymptomatic people are less likely to spread the infection. It will let us increase the capacity for testing to ensure diagnosis and case management of symptomatic cases. We can put in place aggressive contact tracing and ways of protecting the elderly and other high-risk groups from the infection. For a country with a weak health system, these measures are timely and needed.
While the lockdown is expected to slow transmission and not overburden our health systems, it will not end the spread of the disease. Flattening the curve will slow down the rate at which new infections develop. We will need to invest in developing community testing strategies to assess the spread of both symptomatic and asymptomatic cases.
The 21-day period will also allow us to more clearly analyse data, get a better idea of our numbers and their breakdown by severity. According to data from China, 80 per cent of the people infected with the disease experience relatively mild illness, 14 per cent experience severe disease and approximately 5 per cent are critically ill. The severity of the disease is associated with age and the presence of underlying other conditions. We need to know what these numbers look like for India. These three weeks are also an opportunity for India to make available and plan for hospital beds, ventilators, testing kits and reagents, personal protective equipment, train staff, and test, test and test. While the government has announced a Rs 1.7 lakh crore package for the poor and a Rs 15,000-crore budget to strengthen the health system, these need to be effectively implemented to ensure that the poor and the disadvantaged are able to endure through the lockdown.
The disease trends and Indian data that emerges at the end of the lockdown will shape future policy decisions. In the months to come, we will need to test more aggressively, continue to follow cases and their contacts and build robust surveillance systems. Based on the findings, we will need to update our strategies, including the reintroduction of intermittent social distancing measures.
In the absence of any curative and preventive countermeasures, over time, more people will become infected. However, the majority of these infections will be mild. There is growing evidence to show that re-infection is unlikely in the near-term (1-2 years). Once recovered, the once-infected population will contribute to “herd immunity”. At the same time, controlling the rate and management of more severe cases will become easier and feasible. Our battle against COVID-19 will not end in 21 days, but we will have time to prepare better for the long-term.
The writer is a consultant with the Translational Health Science and Technology Institute (THSTI), Department of Biotechnology, Government of India
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