India saw over 10,000 new COVID-19 infections on Friday and moved above the United Kingdom to be the country with the fourth-highest number of cases across the world. States like Maharashtra and Tamil Nadu, as well as the national capital Delhi, have continued to witness steep rises in infections every day. The Delhi government recently stated that it is expected to witness 5 lakh cases by July and Health Minister Satyendar Jain indicated that there already is “transmission via the community.” Though the Indian Council of Medical Research explicitly stated on Thursday that there was no community transmission in India, experts say that some cities may already be in that stage.
“The cases in India are rising, which means the containment strategies are not working,” renowned epidemiologist Dr Jayaprakash Mulyil tells TNM. “The number of positive cases is higher than what we had planned to control via containment. And this happens in cities where there are a lot of cases. I am not surprised that it is going up, it is very typical of the disease when there is community transmission,” he says.
“So, when you are unable to contain, you must accept that there is community transmission and move on. It is a part of an epidemic. It is not your fault, it is the fault of the disease,” he adds.
Vellore-based virologist Dr Jacob John feels that India has gone beyond containment measures and must focus on preventing those who are vulnerable.
“Since the lockdown was announced, the number of infections have been increasing. So the numbers now should not be a surprise. The epidemic is beyond containment now. You have to accept that fact. What you must now do is to protect yourself. Protect all the senior citizens and those who are vulnerable, by home reverse quarantine, wherever possible. Those with diabetes, hypertension etc, should be protected from getting infected by staying at home with strict precautions so that the death rate will come down,” Dr John says.
Dr John says that India should also focus on the places that have not reported any cases and make sure that there are no infections reported there.
“In places where there is no outbreak right now, in many rural and tribal areas where no outbreaks have been reported, in these areas, outbreak control should be practised. So that they can be protected. In rural places, where population density is not high and people can have some space between houses and two feet distance between themselves, you do not have to stop social interactions to prevent infection, you make social interaction safe to prevent infection,” he says.
These measures would include making sure everyone wears a mask and they should be told why they are wearing masks. “This requires behaviour change education. That is the best strategy. Teach people how to protect themselves, that is the best strategy. That is called a social vaccine, as the Health Minister said a few days ago. There are places with low prevalence like ICMR discovered. That is where the social vaccine is a must, immediately.”
Some of the measures the virologist suggest are: reducing mortalities by protecting the vulnerable and implementing reverse home quarantine, by behaviour modification education throughout the country, wearing a mask outside at all times and concentrating on hospital management of disease cases.
“It is also important to train the doctors, many doctors tell me that they are not trained. This is a new disease and nobody has taught them anything. Containment is ambitious and not possible. The time for containment has far gone. It is like tumbling down a mountaintop, and in the middle of the fall, you can't tell him hey stop falling. We have brought ourselves to this stage by a false sense of confidence and not taking enough planned strategic measures,” Dr John says.
The virologist’s advice that people now concentrate on protecting themselves is also echoed by Dr Mulyil.
“When there is a high level of infection, I think the emphasis should be slightly shifted. In the containment phase, we tried to isolate people who are infected or have come into contact. That helps to reduce the infectious people in the community. That will protect the others,” he says.
The focus now, he says, should be on individuals protecting themselves and families protecting their elderly.
“Elderly people should start wearing a mask in the house and maintain physical distancing and follow standard rules. That can slow down the infection to an extent. We have to focus mainly on hospital care and how well you can look after the patients, and encourage people to bring those who are sick to the hospitals so that we can help them recover. Four out of five people who are sick with pneumonia can recover if given good care. So when you have that kind of situation you have to encourage people to go to hospitals,” he adds.
Experts say that some cities have already started witnessing community transmission, the whole country will not witness the stage together. And even if India does declare community transmission, they say the nation’s approach may not be very far from what we are witnessing now.
Anant Bhan, Researcher, Global Health, Bioethics and Health Policy, tells TNM that whatever measures India has had to take, the government has already brought them in.
“We have been working on containment and physical distancing. Some sections of the government will say there is limited community transmission and others will say there is community transmission but only in clusters or containment zones. So at the most, we can accept that there is community transmission and we can move on because the response is not going to radically change, right? It is just an aversion to definitions, is not helping in any way in the response, so I think we should just put it to rest and move on, and say that let's assume there is community transmission and work ahead on measures and concerted response,” he says.
More infection is natural, adds Dr John, and says that India will most likely witness a peak between the first week of July and second week of August. “That is a six week period and when it will come, we do not know because we do not have data to be used for prediction. The data that we have is not very useful,” Dr John adds.
But different cities and districts will peak at different times, depending on the population and prevalence of the infection.
“Because many districts do not have any or very few infections, the national peak may come before those districts get infected. Some districts may not reach their peak until India's peak is over. So there will be an asynchronous epidemic in India. So this is a time for every single city and district to take stock and plan. It is their duty right now to form task forces and plan for the epidemic. That is what the Centre should have done three months ago,” he says.