With the country heading for a lockdown to combat the spread of COVID-19, amid 500-odd cases and 10 deaths being reported, the phase remains crucial for India, point out experts.
“This phase is important for the mitigation stage,” says Dr G Srinivas, professor and head, Department of Epidemiology, Tamil Nadu Dr MGR Medical University.
He also spoke about the concept of R0 (reproductive naught), which in epidemiology stands for the number of new cases generated by one case. He says, “In this period, if the R0 is about 1.5, it can be contained by identifying and tracking the contact. However, in the case of R0 being above 2.5, 70 per cent of the contacts should be tracked effectively.”
Dr Srinivas explained that India could have missed people if they were not screened initially, as it has crossed the containment stage when people were traced and laboratory testing was carried out. “It takes about 14 days for the infection to show symptoms in cases, and the diagnosis for some could have been late as well. All these make the curfew and lockdown exercise important.”
As the Indian Council of Medical Research said while indicating that India has entered the second stage of COVID-19 (local transmission), the period assumes importance in order to restrict stage 3 – when community transmission begins. There have been doubts about the community stage beginning with cases like in Madurai, where a man without travel history tested positive.
With private laboratories getting the approval for conducting COVID-19 tests, the cases are likely to spike in the coming days.
Dr Kuganantham P, chairman, Indian Public Health Foundation, former director, Communicable Disease Hospital, says that this is also the time when the efforts to quarantine will show results. He said, “If they have refrained from mingling with others, we could be hopeful there won’t be a spurt. Wuhan in China, where the virus originated, has 1,800 people per sq km, whereas in a densely populated city like Chennai, there are 20,000 — this determines the importance of effective quarantine. We would have to wait for five more days to understand the actual impact of this disease.”
He also added that there should be an epidemiological investigation of the virus — where it is emanating and who is spreading the disease — or in other words find out the ‘driver of the epidemic’.
The concept of physical distancing is crucial even within family, observes Dr Srinivas, who also points out that social distancing is a misnomer, as people are connected virtually as well. “It is important therefore for many to observe physical distancing and avoid stepping out and being in groups to the maximum. This mitigation stage is important from the perspective of public health, as the attempt here is to flatten the curve and gain some control over the spread of the virus,” he adds.