Team India and winning the pandemic battle-THE HINDU-11-04-2020
India has to chart its own strategy, whether it is in planning a staged release from the lockdown or in developing domestic capacity for medical equipment. There will be a need for scientific and economic cooperation with the rest of the world, but self-reliance is the rudder that must steer our ship as we sail through these rough seas.
The impact of a three-week lockdown on reducing infectivity cannot be gauged well till the third week because the virus has an incubation period that can extend up to 14 days, though the vast majority of cases clinically emerge by 11 days. Whether there are already infected cases that will spread outdoors after the lockdown will be gauged by clinical criteria and testing . House-to-house surveillance being implemented in Andhra Pradesh, even during the lockdown, involves accredited village and block level volunteers partnering front line health workers to identify symptomatic persons for later visits by medical teams. The involvement of designated volunteers and community-based organisations can greatly enhance case detection, isolation, counselling, severity-based care and social support.
Potentially favourable factors for India are the younger age profile and a higher rural proportion of our population compared to China, Europe, the United States or other highly affected countries whose populations are older, urban and highly mobile. Restricting urban to rural movement to essential goods and essential needs, for at least six weeks after the lockdown ends, will help. The health, nutrition and financial security of the poor must be ensured. Elderly persons too should observe social distancing and limit visits outside home for this period.
That would need a greater level of testing to detect both asymptomatic and symptomatic persons who have been infected, through random population sampling in different parts of the country. These should be ring fenced, with intense search for contacts and active spreaders, with further localised lockdown as needed. If COVID-19 is the batsman scoring freely, the health system is the bowler trying to tie him down and get him out. Everyone has to be on their toes, avoiding a poor health system response , supply chain delays and social distancing violations .
Focus on health services:
Considering the higher risk to older health-care providers, the first line of care should be formed by younger staff members who will have milder effects even if infected. This will prevent attrition of the health workforce due to exhaustion or illness. Temporary hospitals for treatment and isolation facilities for persons on quarantine may need to be set up at short notice. Industry must produce essential medical equipment and drugs to meet our needs and, if capacity permits, assist other countries.