CORONAVIRUS - What after 14th April, 2020? Would extended lockdown contain Corona infection?
Perhaps no single incident in recent human history has evoked so much of emotions and actions throughout the world as has the Coronovirus (Covid 19) pandemic. Starting from China, this virus has engulfed the globe rapidly resulting in a massive economic slowdown. The viral strain is new with no known cure or prevention, and has aroused anxiety and fear across nationalities.
In India, the government has come up with a complete lockdown of the country, initially up to 31st March, which was later extended to 14th April, 2020. The initial days of the implementation of this policy indicates that it has been successful in containing the infection or more aptly, preventing the rate of spread of infection. As of now, the total number of infected patients of coronavirus in the Country is about 1000 while the fatalities are 25. When compared to worldwide statistics depicting 6,80,000 infected cases with 32,000 deaths, the Indian data show the effectiveness of the lockdown policy.
One needs to look into what would happen after 14th April, 2020 when the current lockdown comes to an end. Will there be an extension? Or, would there be a window period permitting mobility before another lockdown is imposed? What exactly are the possible options?
- For NOT extending the lockdown, one has to ensure that all the infected persons are identified and isolated. In addition, all those who have been in contact with the infected patients have to be identified and put in quarantine. Furthermore, with research now suggesting that Covid 19 virus can be excreted through faeces for 28 days and also spread through faeco-oral route, one has to be certain that there is no such transmission in the community.
- If international movement of passengers is to be permitted, one has to make sure that no new infected cases enter the country.
- If you believe that by 14th April, all the infection would be contained and normalcy would be restored, you may stop reading this article any further and come back to this article on 15th April, 2020. We may agree to disagree and wait for a fortnight.
- While the shutdown has aided in reducing the rate of spread of infection, there is a time limit for which it can be continued in the country. Let us look into the effectiveness of the lockdown.
How effective is a lockdown?
A shut down or a lockdown is very effective in the ideal situation. However, a complete lockdown is practically not possible to execute. For maintaining essential services, some movement has to be permitted. As the incidents of movement of migrant workers has shown across different cities, it cannot be fully implemented, thereby reducing its effectiveness. With poor literacy levels, sending the message across to all is not easy. In diverse country with differing social and religious practices, restricting gathering of people is not easy to enforce.
For a large number of people, maintaining social distance or washing the hands is a luxury which cannot be put in practice. Some persons, with a sense of entitlement, do not wish to be a part of a common man’s plight. The fear of stigma or having travel limits imposed can lead a person to conceal the state of infection of self or family member.
A shutdown can create a false sense of security in the unaffected areas, thereby lowering the guard and distracting the officials from taking substantial measures. It also affects the commerce adversely and those with limited resources cannot sustain it for long. After a certain period of time, a fatigue is likely to set in among the people which would reduce voluntary compliance. Hence, lockdown can be effective if implemented only for a limited period.
One must keep in mind that containment is effective in reducing the rate of spread of infection but it cannot be the cure for the highly infectious Covid 19.
Will travel restrictions continue?
Countries have imposed restrictions on international travel to prevent the Covid 19 virus from entering the country. One must remember that travel restrictions cannot continue indefinitely.
But, for the restrictions to be relaxed, it is imperative that there is some change in the scenario.
In the best possible scenario, the infection may be controlled in India and globally. All the curbs can be eased in such a case. In the worst scenario, the situation might worsen Globally including India and some sort of restrictions would continue. There can be a situation where the virus will be contained in India, but the crisis would worsen globally or vice versa which may require selective travel restrictions. Therefore, the travel restrictions are unlikely to be removed in near future unless a full proof system is developed to screen the infected individuals.
An article in Washington Post refers to a review of studies published in 2014 which concluded that travel restrictions had limited effectiveness in preventing the spread of influenza. Another study has found that travel restrictions had limited effectiveness for two non-flu diseases, Ebola and severe acute respiratory syndrome, or SARS, which like Covid-19 is caused by a coronavirus. (https://www.washingtonpost.com/business/limit-travel-to-fight-coronavirus-the-pros-and-cons/2020/03/15/27075a86-6720-11ea-b199-3a9799c54512_story.html)
Can an outbreak happen in India?
Mathematical models indicate that the lockdown has stopped the import of Covid 19 and delayed the spread of infection thereby pushing the peak of infections to a future date. Models may not always be true or may differ from reality. But assuming that these models are true and the peak is postponed for an imminent date which may be days, weeks or a couple of months, what should we do? This window period can give health authorities the much needed time to prepare and be ready for the worst possible scenario. I wish and pray that there is no largescale infection of Covid 19 but it would be wise to be prepared for a possible outbreak. The least one can do today is to be ready for any possible hard times.
What can and what should we do?
Apart from some conciliatory voices, there is little information about the readiness of the health authorities to deal with the potential large scale Covid 19 infection. There should be a greater degree of transparency in sharing the actual preparedness with the public. Apart from promotion of the preventive measures in vogue, the following can be considered:
- India has a very poor doctor-patient ratio and it would be a good idea to prepare some paramedical workers who can attend to patients in an emergency. Only about 5% of the Covid 19 patients would require serious medical intervention and we must have a good fleet of people who can apply test measures and monitor such patients.
- The number of ICU beds and ventilators in the country are restricted. While hospitals and beds have been identified for taking care of Covid 19 patients, there is a need to involve the private sector. The private nursing homes beyond the capacity of 20 beds must be asked to keep 50% of their beds ready for any coronavirus patient in case of a possible outbreak. They should also be asked to conduct trainings for their staff.
- There should be a sufficient stock of medicines (antivirals, Chloroquine etc.), preventive equipment (gloves, masks, suits etc.) and machines like ventilators to attend to the patients in case of an outbreak. Those in the front line of prevention need to be adequately equipped to fight the menace.
- Human life is priceless and no monetary value can be placed to it. The Covid 19 infection is likely to put the decision-makers with the dilemma of taking a call as to which patient out of two or more should be saved first.
While the search for a treatment or a vaccine continues, these measures would ensure that even if there is an outbreak, we are not caught napping.