Mitigation Of Covid-19 Depends On The Success Of The Lockdown: Dr Harsh Vardhan

How do you assess the effectiveness of the lockdown in containing the spread of covid-19?

It is being globally acknowledged that India has made timely strategic interventions because of which we have been able to contain the spread of the disease. The World Health Organization (WHO) has also praised India’s strategy, especially the decision with regard to two consecutive lockdowns, as well as its stringent implementation. We have already moved ahead towards containing the spread of covid-19. Our data, both in terms of number of cases and of mortality, is much better than that of many other countries, including developed countries.

Before the first lockdown began, India’s doubling rate of covid-19 cases was about 3 days. If we calculate the growth rate as days in which India’s total case count is doubling (calculated using growth over the past 14 days), it is 6.2 days. The same growth rate is 7.2 days when calculated using growth over past 7 days and is 9.7 days when calculated using growth over last three days. The global average fatality rate is 6.9%, whereas in India it is 3.3% which is less than half as of 18 April 2020.

These figures somewhat reassure our citizens that the government is really trying its very best. Similarly, an average growth factor of 1.2 is observed, since 1 April 2020, as compared to 2.1 in the two weeks preceding that, 15 March to 31 March, suggesting a 40% decline. Further, persons who were in incubation prior to lockdown period, developed the disease and contributed to an increase in the absolute number of cases as observed immediately after the lockdown period.

According to the existing knowledge and global experience, it is evident that the transmission dynamics of covid -19 are such that it may take few weeks to bend the curve of absolute number of cases, despite stringent social distancing and public health measures in place.

Asking people to stay at home and shutting down population movement slows down the pace of transmission and spread of disease, thereby restraining a sudden uncontrolled rise in number of cases. This also allows time to take effective containment measures preventing rampant cases. I definitely believe that control and mitigation of covid-19 depends on the success of the lockdown.

The government has been reluctant in admitting community transmission in India despite several cases without contact history.

It will be inappropriate to say that the government has been reluctant in admitting that there is any community transmission happening in India. The country has still not reached stage 3 or community transmission phase of covid-19, despite a climb in the numbers of positive cases. Right now, India has cases mostly related to international travel, or their contacts.

Some sporadic cases have also been seen in some clusters because some travellers concealed information, to avoid quarantine, moved freely in society till they developed symptoms, by which time they had spread infection to many.

Further, even when the nation was placed under a three-week lockdown, a large number of attendees, having history of foreign travel, defied social distancing norms and continued to stay at the Tablighi Markaz in Delhi.

Many of these participants travelled to various states and became a key source of transmission and spread of covid-19 across the country. Containment strategies are being undertaken in such clusters.

However, these few sporadic cases do not indicate a community-wide spread of infection at the national level. With the current level of understanding, there is no evidence to predict that India has reached stage 3. Further, there is no clear globally-accepted definition of community transmission, making it even more difficult to say whether India has really moved from stage 2 (local transmission) to stage 3 (community transmission). The WHO South-East Asia region also said that currently cases in India have been traceable so there is no community transmission. However, the issue is under constant watch and strong surveillance is being maintained.

How does the government expect social distancing to be practised in highly congested areas such as Dharavi in Mumbai? What are your plans for these areas and till when do we need social distancing to get rid of covid-19?

Mere social distancing interventions will not kill the virus, but they will help to break the chain of transmission and prevent the spread of the disease. As regards the plan for overcrowded areas, disease containment strategies with comprehensive public health measures such as testing, detection, isolation, dedicated contact tracing, and house to house surveys are being undertaken. Social distancing interventions will go a long way in arresting the spread of the virus in such areas. I don’t think anyone can predict how long it will take to get rid of covid-19 from India. This is a global pandemic and the entire world is fighting a new virus for which we have no cure and about which we know little. Deaths are really unfortunate. It all depends on success of containment interventions, optimal use of public health measures, and societal cooperation. We continue to tweak the strategy according to developments.

How is the government ensuring essential health services during the covid-19 pandemic?

Unprecedented demands on our health system because of the covid-19 outbreak may compromise health systems. Considering the risk of covid-19, the government has reorganized basic health services to optimally use the available resources. However, all health services will become fully functional from 20 April 2020. We realize well enough that while focusing on covid-19 health activities, essential health services other than covid patients have to continue.

India has been doing the lowest testing for covid-19. Even when we have enough testing capacity, why are you not increasing the testing numbers? Do you plan to increase the testing rate in future?

The virus of covid-19 was first identified on 7 January 2020 and testing began thereafter. The current strategy of testing is customized, based on the transmission typology in India and priority of testing of individuals who are primarily at risk. Further, we need to ensure that quality of the testing kits and the biosafety of testing laboratories are maintained to avoid any problems related to unreliable results or iatrogenic transmission of the infection in health care or among laboratory staff. Given the population of India, we need to scale up in a manner that can be sustained while simultaneously augmenting capacity for testing and management of positive cases. We have started rapid antibody-based blood test for covid -19 for areas reporting clusters, containment zones, and in large migration gatherings or evacuee centres.

All symptomatic cases of influenza like illness (ILI) in such areas are to be tested at facilities using rapid antibody tests. As of now, our present capacity of testing is 50,000 every day and we have done 3,86,066 tests till 18 April. In one day on Saturday, we did 37,173 tests. With the scaling up of testing capabilities, we visualize that we shall reach optimal levels of case detection.

There have been concerns over shortage of PPE and testing kits by state governments and the private healthcare sector.

As on date, 3.89 lakh (389,000) PPE are available with states and orders for 166 lakh have been placed as against a projected requirement of 153 lakh, of which 4.33 lakh has already been supplied. In addition, 20 lakh will be supplied on 25 April and 5-7 lakh every week thereafter.

Further, with the help of the ministry of textiles, 59 domestic manufacturers have also been identified for in-house production. Similarly, 11.70 lakh N95 masks are available with states and orders have been placed for 2.29 crore masks. Of this, 28.52 lakh have been supplied and 7 lakh units will be supplied every week after the last week of April. As many as 10 domestic manufacturers have been identified. We have issued rules on the rational use of PPE, clearly defining who should wear which PPE, depending on the nature of job and placement. This will ensure rational use of PPE and will prevent wastage.-Livemint