Covid: Only masks, distancing and isolation can prevent a July-August surge
With coronavirus disease (Covid-19) cases projected to rise through June and July, enforcing the use of masks and social distancing norms and isolating everyone with cough and fever is the only protection against infection. Community participation in the enforcement of masks, self-quarantine and isolation of everyone with symptoms of Covid-19 even without testing is the way forward, experts say.
Increasing mobility and more cases being identified outside large clusters is making contact tracing and containment a challenge, which calls for an urgent change in strategy. “The numbers will spike. The only way you can decrease the numbers from spiking is by aggressive isolation, community participation in terms of very strict wearing of masks, social distancing and hand-washing. There’s lockdown fatigue now, people have got fed up, they don’t seem to be bothered (about infection spreading), and my fear is that people don’t realise what we are headed for. There are still people who are dying, and the pandemic is yet to peak,” said Dr Randeep Guleria, professor of pulmonology, and director of the All India Institute of Medical Sciences, New Delhi.
“My concern is more about mortality than the cases. Our population is such that we will have more cases than other countries, but if our hospitals don’t get completely overrun and mortality remains low, as is happening in Tamil Nadu, then we’re in a good place,” said Guleria. Despite a high number of cases, Tamil Nadu has a death rate of less than 1% because of the state’s aggressive testing and containment programme.
All states have to scale up testing and widen community surveillance. “When there are large numbers, along with mobility, containment is difficult. We can do symptom-based syndromic surveillance of households for community testing using community volunteers, but stigma has to be removed,” said Dr K Srinath Reddy, president, Public Health Foundation of India. Technology can help amplify the coverage and accelerate contact tracing where physical visits are not possible.
“In my mind, we have reached a stage where we will not be able to sustain the lockdown in its current form for a long period of time. People will now not be able to stay cooped up indoors. We will need measures like malls and restaurants still being shut, but gradually opening up for businesses. I don’t see schools opening in the next four to six weeks. Schools usually open in the first week of July, so most likely in the first week of August,” said Dr Guleria.
The biggest concern is what happens when things open up. “We need to aggressively work on asking people with even mild symptoms of cough and fever to quarantine and isolate themselves even if they don’t get tested. Of course, testing must be expanded because it gives you an idea of how things are and whether new clusters are emerging, but even if testing is low, the strategy must be that people self-quarantine if they have symptoms,” said Dr Guleria.
With most modelling studies saying the pandemic will peak in India in late July or mid August, protection measures must be closely followed for protection. “I think it’ll (pandemic peak) probably be a little earlier, I would say July, but most of the mathematical predictors have pushed it to August,” said Dr Guleria.
Experts say it’s tough to predict how cases on average will be recorded every day when the pandemic peaks. “Mathematical modelling is hard, but with Covid-19, it is even harder. There are too many unknowns and evolving parameters,” tweeted professor Madhukar Pai, Canada research chair in epidemiology and global health at McGill University, Montreal, Canada.
Among the challenges Pai has listed are Covid-19 being an unknown novel disease, the R-0 (R-nought is the basic reproductive ratio or the number of infections from a single case) not being static, changing testing rates, no clarity on natural protective immunity or percentage of population infected, varied durations of infectiveness, asymptomatic transmission, and other unknowns including the number of people who come in contact with a case, human behaviour and effectiveness of lockdowns and restrictions, among others.
“The number of cases will definitely increase, given our large population, and high mobility. Even if we touch a large number, if we are able to save the health system and isolate the majority of people with mild symptoms at home or in Covid care facilities, and the mortality is not high, we are fine,” said Dr Guleria.