India Today|May 25, 2020
As India reaches the cusp of a third lockdown only to prepare for Ver. 4.0, it is time to ask if the move has accomplished what it was meant to and laid the foundation for a future strategy for COVID-19. When Prime Minister Narendra Modi announced the lockdown on March 24, India had 564 COVID infections and 10 deaths. Worldwide, the global death toll had already crossed 10,000, and hospitals were fast running out of beds and ventilators. Italy was grappling with 69,176 cases, the US 42,164, and the UK 8,077. Going by their experience, India knew it had no choice but to go into lockdown. If the disease could overwhelm countries with healthcare systems far more sophisticated than ours, what chance did our fraught healthcare infrastructure have?
Eight weeks into the lockdown, set for further extension on May 18 with an entirely new set of rules, Dr. V.K. Paul, member, NITI Aayog, and head of the empowered committee on medical emergency management, believes it has made a difference. “Eight weeks ago, our doubling time was 3.4 days; this week, it is 11-12 days. The lockdown was focused on slowing the rate of transmission, to push our curve on a trajectory low enough for our systems to cope with. It had a clear purpose—slow down the spread of infection and equip healthcare.”
If we have indeed achieved the target, why Lockdown 4.0? “To maintain the gains made in the past two months. We cannot let infections get out of hand,” says Dr. Paul. It is almost certain that the COVID conventions of social distancing, hand hygiene, and mask coverage will continue into the next phase of the lockdown even if restrictions on movement are gradually lifted. “We will continue to grow health infrastructure—the goal is to build good hospitals: more beds, more ventilators, treatment facilities—and push for diagnosis as well as containment in red zones,” adds Dr. Paul. Geo-tagging COVID suspects through the Aarogya Setu app, drug and vaccine research, and public awareness campaigns are likely to be the other areas of increased focus, according to a health ministry official.
“Our peak is expected in June or July; we must continue being responsible,” says Dr. Randeep Guleria, director of the All-India Institute of Medical Sciences in Delhi and member of the empowered committee on hospitals and disease surveillance. With 70-80 per infections concentrated in metropolitan cities, he advocates micro-planning in the 130 national red zones, particularly the congested ones. “Tackling red zones will be a priority,” he says. While states can choose the restrictions they want lifted in Lockdown 4.0 (West Bengal, for example, plans to divide a red zone in three categories to allow public movement), the greatest fear public health officials have is that it is still too soon to reopen borders or allow public transport.
It is a valid enough fear. Ours remains an upward curve of infections. From May 10 to May 13, we saw around 3,500 cases a day. And even though the time taken for infections to double has come down, the infection rate—the number of those tested reporting positive—has gone up. On March 24, India had 564 infected people, and an infection rate of 1.9 per cent, or roughly two out of 100 people tested were Covidpositive. By May 13, total cases were 74,280, and the infection rate 4 per cent. Hotspots like Mumbai have an infection rate as high as 15 per cent. India, thus, is still a long way off from Covid’s downward trajectory in South Korea, Italy or China.
Community transmission also continues to be a threat. An April 9 study by the health ministry and the Indian Council of Medical Research (ICMR) had already hinted at community transmission in 36 districts across 15 states, as 40 of the 105 COVID-positive SARI (Severe Acute Respiratory Infection) patients were found to have no travel or contact history. More than a month down the line, the ICMR has begun a surveillance of 75 districts to determine community transmission.
It is imperative, therefore, that Lockdown 4.0 continue with an aggressive containment strategy. “Are we sensitised and aware enough to be responsible without a lockdown?” asks noted virologist Dr. Jacob John. “If we open restrictions, the public must not forget we are still at great risk. You cannot eradicate a virus so soon. What we can do is change behaviour and prepare for infections.”
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May 25, 2020