Cluster management

Efficient tackling of COVID-19 at state and district levels and in individual hotspots will determine how India overcomes the crisis

- NAMITA KOHLI

For managers of COVID-19 in India, the next few days will be crucial. The backdrop of rising cases—5,274 as on April 8—has only added to the policymakers’ dilemma of extending the lockdown and handling the situation on the ground, given India’s unique medical, economic, social and psychological challenges.

Experts are closely following the movement of the epidemiological curve of COVID-19, but they say that it is still “too early” to comment on whether the curve had “peaked” or flattened yet. “The cases we are seeing now are of people who acquired the infection prior to the lockdown,” says Dr. Tarun Bhatnagar, epidemiologist, Indian Council of Medical Research-National Institute of Epidemiology. Data from the coming week would also be crucial in deciding on the lifting of restrictions. “The spike from one big cluster may not indicate a national trend,” says Bhatnagar, who is also a member of the national task force for COVID-19. “Besides, we would also need to analyse whether these primary cases have resulted in secondary and tertiary transmission, and if so, what is the extent of those cases.”

Dr. Giridhar R. Babu, professor, and head, life course epidemiology, Public Health Foundation of India, says that the “real curve” will be understood only when India follows a “syndrome-based” surveillance for COVID-19 throughout the country and expands testing. This approach implies that all cases of fever, cough, malaise and any other respiratory symptoms must be treated as COVID-19 unless proved otherwise, and home isolation of patients must be ensured.