With the festival season nearing and cinemas and restaurants opening up, the next cycle of the pandemic could be upon us. Just one super-spreader in a large gathering can trigger an explosion of new cases.
By Dr KK Aggarwal
WE are almost a year into the pandemic, yet Covid-19 persists in its relentless march across the globe with no signs of stopping. Many countries are struggling with a surge in cases as the coronavirus continues to propagate in waves. The number of cases increases, reaches a peak and then declines. This cycle constitutes one wave of the infection.
A new rise and peak in a different group of people indicates the beginning of another wave. Europe is in the middle of a second wave due to relaxation of lockdown restrictions coupled with public complacency towards the recommended protective measures due to “pandemic fatigue”.
In India, the festival season is on the horizon. Navratri, Durga Puja, Dussehra, Diwali, Chhath Puja, Christmas and New Year will be celebrated in the coming months. This is a time when cases are expected to rise as people will step out of their homes for shopping, visiting friends and relatives and gather in large numbers in public.
This has been the experience following the recent festivals of Ganesh Chaturthi and Onam. According to a State Bank of India research report titled “Four Months after Unlock: Silver Lining among slowly dissipating dark clouds” dated October 8, a sharp increase in the number of cases was seen in states which celebrated these festivals. Kerala added 1.38 lakh cases after Onam, which is almost 65 percent of the total cases in the state. After Ganesh Chaturthi, Maharashtra added 3.7 lakh cases, which is 46 percent of the total cases in the state. Telangana recorded 62,000 cases, nearly 50 percent of its total cases, while Andhra Pradesh had almost 3 lakh cases, which accounted for 67 percent of the total cases in the state. The number of deaths also increased.
The presence of just one super-spreader in a large public gathering is enough to trigger an explosion of new cases. Clusters cause a surge in infection. The Tablighi Jamaat congregation in Delhi in early March 2020 was a super-spreader event. It was associated with 4,291 of the total cases of 14,378, according to some newspapers.
Another worrying factor is that under Unlock 5.0, the Delhi government has allowed seating at bars and restaurants which will stay open 24×7. But the moot question is whether this will bring in the crowds which have preferred to stay away. In an effort to boost the economy, the centre has already issued guidelines for opening up of more activities in areas outside containment zones.
Cinemas are also gearing up for occupancy as the centre has allowed a maximum of 50 percent of the hall capacity to be filled from October 15, with a ceiling of 200 persons. Wearing of face masks, social distancing, thermal scanning and use of sanitisers will be mandatory at cinemas. In addition, all weekly markets in Delhi will be opened as opposed to the earlier rule of only two markets being allowed to be opened per zone.
A pre-print study from Hong Kong analysing the clustering and super-spreading potential of the SARS-CoV-2 virus found that 20 percent of the cases account for 80 percent of the local spread. A Nature report estimated that 44 percent of transmissions of the infection occur within 5-6 days before symptoms develop when the infected person is most contagious. Several people in the gathering may, therefore, be unknowingly infected.
The role of “Patient 31” in escalating the number of cases in South Korea is well-documented. Till then, South Korea had been able to contain the outbreak. But following the detection of this patient, the numbers increased 30 times in just a week.
Covid-19 is mainly transmitted from person to person via respiratory droplets. In crowded and poorly ventilated enclosed spaces, there is a possibility of airborne transmission of the infection. Hence, the more number of people a person interacts with at a gathering, the closer the physical interaction is and the longer it lasts, the greater is the risk of the infection spreading. According to the Centers for Disease Control and Prevention, a national public health institute in the US, 15 minutes is the minimum contact time for the infection to spread.
Mass gatherings are hotspots and augment the transmission of the virus. New clusters may emerge if precautions are not taken and the sudden spike in cases may disrupt the already overburdened health system.
It’s not just the festive season and the anticipated rise in the number of cases that is a cause for concern; winter is round the corner. This is the season for respiratory infections. Cases of pneumonia, which can now be called “non-Covid pneumonia”, increase in the winter.
The Ministry of Health and Family Welfare has issued guidelines to contain the spread of Covid-19 during festivities. These guidelines emphasise strict adherence to protective measures (physical distancing, face masks, hand hygiene and respiratory etiquette) by all, the event managers, the organisational staff and the public visiting the festivities. Masking (three-layered, correct and consistent use) should be mandatory. In addition to physical distancing and meticulous hand hygiene, public toilets should be avoided.
If precautions are not taken, the cases may double after the festive season is over. This will truly be a setback to the efforts to contain the pandemic. An NCDC-NITI Aayog report has cautioned that Covid-19 cases in Delhi may increase by 15,000 every day during the winter season. Around 20 percent of these could need hospitalisation.
At present, India is next only to the US in terms of the number of infections. Close to 80,000 new cases are recorded every day and soon, India will be at the top of the table, a feat that is undesirable. This situation should make us all pause to think. It is not just the government, but we as citizens who should share the responsibility of controlling the pandemic.
—The writer is President, Confederation of Medical Associations in Asia and Oceania, and former National President, IMA