Covid-19 in India: What after Lockdown

Covid-19 pandemic, which started from China in December 2019, rapidly spread to about 200 countries, affecting about 3 million people, resulting in more than 2,00,000 deaths. In India, the first case was reported on January 30th, 2020. Three months later, as on 26th April 2020, there have been a total of 26,500 cases, resulting in 824 deaths.

COVID-19 different from other known infections

Corona virus 2019 disease (COVID-19), caused by SARS-CoV2 virus is a new infection and hence there are a lot of unknowns about this. This mystery has forced governments to take extreme measures in order to halt the spread of infection.

The basic nature of an infectious disease is that it spreads from one person to another. For known infections, the person-to-person spread is lesser due to several reasons: Immunization, immunity acquired from a prior infection and by adopting measures to contain the spread. For COVID-19, there is no vaccine and only a small fraction of population has acquired immunity after getting infected from it. So, in these circumstances, lockdown seems to be the most effective solution.

Usually, the infected person is isolated. For example, a person with lung tuberculosis (TB) can spread the infection to others for almost a month, even after starting anti-TB treatment. So, a person with lung TB is advised to be isolated for at least a month. Common viral flu can also spread from person to person, so, the affected person is advised to be in isolation for a few days. In the case of COVID-19 the entire population has been advised isolation to slow down the spread.

Lockdown was timely and it has served its purpose

Today, we have completed 33 days (out of planned 40 days) of nationwide lockdown, which is supposed to end on 3rd May 2020. As per various estimates, lockdown has been very effective in containing the spread of infection. Doubling rate of infection has slowed down from 3 days (prior to lockdown) to 12.5 days now. Without lockdown, we would have had more than 10,00,000 cases of Covid-19 infection, which would have been about 44 times more than the current number of cases. We have lost less than 900 people to Covid-19 in our country, a number much lesser than countries far smaller than ours.

Why do we need to look beyond lockdown?

Lockdown has brought with it many hardships affecting multiple spheres such as financial losses, unemployment, poverty, and neglect of diseases other than COVID-19.

  1. Daily wage labourers have been unable to work for several weeks now. Their meagre savings have vanished and they are surviving with help from government and NGOs. However, this cannot go on indefinitely. They have other needs such as house rents to pay, school fees of their children and expenditure for treatment of chronic illnesses to name a few.
  2. Lower middle class too will get affected, as they still need to pay their EMIs and school fees of their children. Salary cuts are imminent and this group would find the going tough in the coming months.
  3. Rise in unemployment: It is a no brainer that hiring would be low this year. Moreover, there could be firing leading to job losses.
  4. Neglect of other serious conditions: Public as well as government are highly focused on Covid-19, and much of infrastructure and manpower are devoted to providing care for Covid 19 patients. Most hospitals have recorded a drastic fall in admissions from heart attacks, stroke and cancer, the three most common causes of death and disability. It is difficult to believe that the incidence of these diseases has come down so drastically just because COVID-19 has arrived! People are staying at homes despite having symptoms and the exact toll due to lack of treatment of these diseases would emerge in a month or two. People are also unable to take good care of chronic conditions such as diabetes, hypertension, heart diseases, lung diseases, which could result in greater risk of death and disability. Preventive health check ups have come to a standstill, which removes any chance of people being able to detect diseases in early stage. In fact, one need not wait for lockdown to end for seeking treatment for life-threatening emergencies. People with suspected stroke and heart attacks should seek emergency treatment, without the fear of contracting corona infection.

Strategy post lockdown

It is obvious that lockdown restrictions cannot be lifted at once. There has to be a gradual easing of restriction, taking into account the infection rate (new cases per day) and other parameters. Some general guidelines could be:

  1. Complete easing of lockdown in districts, where no new cases have been reported in the recent 2-4 weeks,
  2. Jobs, where a single person is involved (such as push cart vendors, mechanics, etc) may be allowed,
  3. Companies and business establishments may be allowed with fewer staff, and adequate social distancing,
  4. Permit all health-related activities, including master heath check ups, OPDs, routine and emergency treatment (with appropriate precautions).
  5. Most of the deaths due to Covid-19 occur in older people. So, we can also have an age-based criteria for lockdown restriction. Allow younger people to join work and keep older (>60 years) within the comforts of home.
  6. Presence of comorbidities also have a bearing on the outcomes due to Covid19. People with obesity, diabetes mellitus, high BP, heart diseases, lung diseases and cancer have a higher risk of death and complications due to COVID-19. People with these illnesses would need to be more careful and limit any outdoor activities.
  7. Restrictions can continue for- tourism & leisure travel, religious gatherings, marriage and other parties, etc. Restrictions on movie theaters, shopping malls, political or sports gatherings may also be continued.

What are your views?

Now that we are in the last week of 40-day lockdown, we need to think beyond that. What are your views about what should be done post lockdown? What should be allowed and what shouldn’t? Post your comments.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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