Rising coronavirus cases no cause for panic, will fall by April end: Dr Reddy
Locking down 1.35 billion people for three weeks to enforce social distancing will prevent community transmission of Covid-19 and buy India time for public health measures and potentially, summer heat, to slow the epidemic. India will continue to report more cases, but it’s no cause for panic as all countries experience an upswing before cases plateau off and subside, said Dr K Srinath Reddy, president, Public Health Foundation of India.
The lockdown will help reduce the rate of the increase and get it to plateau as soon as possible, he said in an interview to Hindustan Times. Covid-19 is likely to become a seasonal virus like the flu and common cold viruses, said Dr Reddy, but by then, we would have the tools like adequate health systems and potential drug therapies or a vaccine to help us live in spite of Covid-19. Edited excerpts:.
Q. Do we really need a lockdown at this stage in India? The coronavirus disease (Covid-19) numbers are nowhere as high as China, Italy, Iran or the United States?
A. We have to take this precaution because this is a highly infectious virus, the likes of which has never been seen before. If it goes into a community at multiple locations, it can engulf the whole country. We have to seal as many points of exit as possible to prevent its entry into the community. This lockdown is necessary to reduce this kind of person-to-person transmission, and ensure that the spillage in the community is greatly reduced. It also gives us the time to trace the cases and contacts and isolate or quarantine them effectively, so they don’t become sources of fresh infection.
Q. What’s ahead for us? Can we stop the virus? Or can we slow its spread?
A. We have to look at the possible factors that can help us. Firstly, strong public health measures that are already being taken and can be further intensified to strengthen the healthcare system to cope with the serious cases that may need admission and intensive care, which some of them will need.
It is also possible that the advent of summer – we do not know yet for sure – could help us in some ways if the virus is actually heat sensitive. There are some reports emerging that the virus is likely to be thermo-sensitive.
So hopefully our public measures and potentially some help from the climate will help slow down the epidemic by the middle of April, or by the end of April. But certainly we have to be on our guard for at least a month or two and hope we can contain the epidemic by then. And then prepare for winter, in case it comes back, but by then we will have enough time for preparation.
Q. Do lockdowns work in the long term? Is there evidence it slowed transmission of other viruses in the past?
A. The speed of transmission of this virus is unprecedented, it has not been seen before. For less agile viruses, we have past experience with some partial success. But this is a virus with a greater speed of transmission, and there is greater need for such containment measures. The Imperial College of London, which actually models many of the public health measures to counter epidemics, has given a considerable amount of credit to lockdown as a potential public health measure that will bring success.
Q. Does it spread faster than H1N1 (swine flu)?
A. Yes, it’s certainly spreading faster than H1N1.
Q. What precautions should we take, during the lockdown and once it is over?
A. During the lockdown, we must ensure we stay secluded as much as possible and avoid all social contact. If we do have to have social contact, maintain a safe distance and ensure the hygiene precaution of washing hands. The most important measure is to avoid travel within the city, town or neighbourhood, and have no person-to-person contact except with (immediate) family. Even at home, there should be a certain degree of social distancing.
Q. How worried should we be?
A. All countries have experienced an upswing of the epidemic, which lasted for a varying number of days in each country before it started plateauing off and subsiding. So India will also experience an upswing and the cases will increase, but we should not be panicking because that is the experience of every single country. Our task is to reduce the slope of the upswing and try to get it to plateau as soon as possible. So even if we see more cases in the next two or three days, that does not signal a huge wave of the epidemic sweeping us out.
Q. Do we need hand sanitisers to protect ourselves, or is soap and water enough?
A. Soap and water is actually better than hand-sanitisers, which is useful when we don’t have ready soap and water, as in offices or while travelling. Otherwise, soap and water is preferred. Handwashing for 20-30 seconds is more helpful rather than rubbing our hands with hand sanitiser.
Q. Do most people recover from coronavirus disease? What is the threat to life?
A. It appears that while the coronavirus spreads very rapidly, it is relatively a mild virus. The mortality rates are variably reported to be between 1% and 3%, so probably it’s somewhere around 2%.
It’s lower in countries where effective measures have been taken early on, as in South Korea, where it’s 0.6% mortality. So let us say between 1% and 2% is the likely mortality if adequate public health measures are taken.
Deaths too are likely to happen in older people above 60, with risk rising further above 70 and 80 years. But people with co-existing disease conditions like diabetes, heart disease or respiratory disease, people who are immune-suppressed or smokers with some degree of lung damage, all these people are at higher risk at younger ages. But taking the overall population into consideration, the risk appears to be 2% or lower.
Q. Are children safe?
A. Children somehow appear to be protected. There have been a few cases of children being affected in a few countries, but there is virtually no fatality. They seem to escape with minor illness even if they are infected
Q. Is there a danger of migrants carrying the infection to rural areas?
A. It will be a problem if migrants from urban areas go back to rural areas carrying the virus with them, but since there is no evidence of major community spillover, these migrants would not be infected in the first place. They pose no danger. Those who pose a danger are people who have come home from abroad or their immediate contacts, if they have got infected and they are travelling back to their village or visiting relatives in rural areas.
Migration itself is not a threat, it is the nature of the migrant that is the issue that needs to be considered.
Q. And that’s why all overseas travellers, even without symptoms, must stay home-quarantined for two weeks?
Absolutely. We have not been able to test everybody at the airport. That has not been logistically possible. They have tested for fever but even people without symptoms have been asked to isolate themselves at home on the grounds that if they are carrying the virus, we will know in two weeks time when they become symptomatic. And if at the end of two weeks they appear to be safe, then they pose no threat.
A. It is good advice for everybody back from travel to follow, but sometimes people don’t accept it and common sense fails.
Q. Is coronavirus disease here to stay? Will it become a seasonal infection, like H1N1, and the seasonal coronaviruses that cause symptoms of the common cold?
A. I don’t think it’s a casual visitor. Like most of the influenza viruses and the seasonal coronaviruses that have been around for a while, this new entrant will possibly also gain a foothold over a period of time. A large number of people across the world who would be exposed, most of them innocuously without ill effects. By that time our public health measures, as well as potentially a vaccine and possibly an effective drug, would have come into play to prevent a large number of deaths.
I have a feeling that once it has been released into our environment, it is bound to be a permanent visitor. But by then, we would have possibly learnt from the visit and lived in spite of it.