India is currently in the midst of Unlock 5.0. While a short lockdown may curtail Covid cases, implementing it without adhering to correct and consistent use of masks would be counter-productive.
By Dr KK Aggarwal
Covid-19 is a highly transmissible and contagious disease, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). It is compared to other coronavirus outbreaks such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). While SARS and MERS have been controlled, Covid-19 continues to spread in an uncontrolled manner even after eight months. It’s an insidious virus, evident from the high number of asymptomatic infections, which may unknowingly be passed to others.
The contagiousness of any infection is measured by the reproduction number (R0), which is the average number of susceptible individuals an infected person will transmit the disease to. When the pandemic first came to light, the R0 was 3, i.e. one infected person could spread to three uninfected persons. The R0 for India is now 1.09.
The World Health Organisation has identified four transmission patterns for any outbreak no confirmed cases; sporadic, where the cases are scattered and occur randomly; cluster or a group of cases; and community transmission which occurs when there are larger outbreaks of local transmission in a new community with no traceable source of origin of infection.
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More than one transmission pattern may occur simultaneously and the outbreak can rapidly progress from sporadic to a cluster of cases to community transmission. It is, therefore, important to plan ahead and be prepared for all possible situations, not just the current transmission pattern. Public gatherings and the ensuing cluster infections have played an important role in accelerating the spread of the disease.
The Centre for Disease Control and Prevention in the US has defined a cluster as “an unusual aggregation of health events that are grouped together in time and space and that are reported to a health agency”. Less than 15 cases in an area can be considered as a cluster, as per the health ministry.
A study published in The New England Journal of Medicine showed that the Covid-19 virus can survive for a few hours outside the host (human body), on cardboard for up to 24 hours, on plastic and stainless steel for 2-3 days and on copper for four hours. But to survive and propagate further, it needs a host. Humans are the primary hosts for the virus.
Containment of the human host is a strategy to contain the infection and is the rationale for various lockdowns to break the chain of transmission. The objective of containment strategies is to minimise the risk of transmission from infected to non-infected individuals. Hence, they are effective in the initial phase of an outbreak.
India adopted a cluster containment strategy to contain the disease right from the start of the pandemic. This can be likened to creating a barrier around the focus of infection. Under this strategy, every confirmed case has to be considered as an epicentre (the residence of the positive case or where he has been isolated). An area of 3 km radius is demarcated around the epicentre and this area is the containment zone. A buffer zone of an additional 5 km radius (7 km in rural areas), including neighbouring districts, is described in the cluster containment plan of the health ministry.
“Testing, tracing, isolation/quarantine, treatment” is the model that is being followed in the country. It has yielded the desired results and the gap between the percentage of active cases and recoveries has been steadily increasing. The total recovered cases have now outpaced active cases by more than five times. India’s recovery rate currently stands at 82.6 percent.
With the unlocking and opening up of the economy, India has now shifted to micro-containment zones to check the spread of the infection. Micro-containment zones are small areas which could be just one house or a group of houses in a lane or one floor of a building or just one building and isolating them instead of mapping out larger containment zones.
Opening up of the lockdown has seen a rise in the number of cases. Pandemic fatigue has set in and complacency about preventive measures seems to be driving the escalating numbers. Things are almost back to normal, but it is not the “new normal”. Many resist wearing a mask and crowds are increasing and physical distancing is not adhered to. This, despite the government and doctors regularly cautioning the population about this.
By now, almost everybody has acquired enough knowledge about the disease. The government has educated the public enough. What needs to change is the attitude which influences behaviour. Wearing a mask in public spaces has been made mandatory in many states under the National Disaster Management Act. Many states have instituted penalties for violating the terms of quarantine or not wearing a mask when in public or other such advisories.
But attitudes can change. While enforcing law is one way of achieving this, counselling is another way. There has to be a balance between the two to bring about the desired change in behaviour. Lockdowns have been employed as a strategy by many countries to break the chain of transmission.
India had a very stringent country-wide lockdown and the economic fallout has been substantial. This has had some benefits it gave time to prepare and build up resources, infrastructure, create awareness and educate the general public about the disease and for preventive measures to be followed. While it is very evident that the first phase of the lockdown saw the maximum containment of the infection, a lockdown is not the answer.
India has been unlocking in phases and the fifth phase of unlock has started from October 1. Strategies need to be changed or modified according to the changing situation. The economy cannot be shut down again.
A short lockdown, for instance over the weekend, may be required to curtail the rising number of cases. While it may help the economy, implementing a short lockdown without adherence to preventive measures may be counter-productive.
Remember, if you wear a mask in the daytime during public meetings, you need to wear it at home in the night and during weekends with or without lockdowns so that it is not spread to family members.
Asymptomatic or pre-symptomatic cases can spread the infection amongst their family. Therefore, a short lockdown with correct and consistent use of masks at home a “personal lockdown” is the answer to this conundrum. It is going to be a long-drawn-out battle, but fight we must.
—The writer is President, Confederation of Medical Associations in Asia and Oceania, and former National President, IMA