3 reasons why India's current Covid-19 strategy should change
Combating Covid-19 is like fighting a war. And, wars are won with up-to-date strategy. Fresh researches on coronavirus tell that India's Covid-19 strategy must change.by Prabhash K Dutta
It is true that the novel coronavirus is on the top of everybody's mind everywhere in the world. But this coronavirus is still new to humans. Understanding SARS-CoV-2 is a work in progress even now when Covid-19, the disease caused by the coronavirus, has infected nearly 55 lakh people and killed 3.5 lakh of them around the world.
India got the first case of Covid-19 in January but the coronavirus outbreak occurred only in March. Before the end of March, India was in the strictest of lockdown anywhere in the world.
Screening of all incoming persons was being done at the airports, leading to longer times in exiting the premises. But the strategy back then was praised by experts. Back then contact tracing was rigorous and testing precisely guided.
Two months later, India's strategy to tackle Covid-19 is suspect. Covid-19 comprises of three aspects: understanding the infectivity of coronavirus, symptomatic treatment of those testing positive and ensuring a smooth exit from lockdown.
The central government, the ICMR and most experts advise a minimum of 14-day quarantine of a coronavirus suspect and isolation of Covid-19 patients. This is based on the understanding that coronavirus can transmit from human-to-human for up to 14 days. Recovered patients are also advised 7-14 days of institutional or home quarantine.
However, a study in Singapore last week has found that there is not enough viral load in a Covid-19 patient after 11 days of illness to infect a healthy person. Simply put, a Covid-19 patient cannot infect anybody on 12th day even though she continues to test positive for coronavirus.
This is in sync with a small study conducted in Germany in late March and published in Nature on April 1. The researchers in Germany found that viral shedding (release of coronavirus by a Covid-19 patient) was highest on Day-4 of contracting the virus. And, there was no live virus isolation in samples taken after Day-8 even though the patient continued to have high viral loads.
However, the 14-day understanding in India has led many states to render exit from lockdown practically ineffective. For example, states are forcing all incoming people into paid institutional quarantine or home isolation or a combination of both.
Now suppose, somebody flies from New Delhi to Bengaluru, she will end up paying for a seven-day institutional quarantine. If she flies to Patna, she will be paying for a 14-day quarantine.
Quarantine centres are likely to have more strands of coronavirus suspended in air than elsewhere except perhaps an isolation ward or a containment zone. Why would she take up the offer to fly unless she is in dire necessity to do so?
Secondly, the ICMR has recommended prophylactic use of hydroxychloroquine based on a small study in India. Hydroxychloroquine is the same drug that US President Donald Trump has been advocating for long. However, health experts and also the World Health Organisation (WHO) have been warning against its use.
The drug is known to have severe side effects, ranging from cardiac function and vision. A new research has found that mortality rate among Covid-19 patients appear to double in cases treated with hydroxychloroquine - in ratio of 9.3 per cent to 18 per cent.
These deaths have been found to happen on account of de-novo ventricular arrhythmia or newly arisen acute heart failure. This is the reason why the WHO served a fresh warning after the ICMR approved of the use of hydroxychloroquine on Covid-19 patients.
Thirdly, India was prompt in enforcing a coronavirus lockdown but exiting it is mired with confusion. The world imported the lockdown strategy from China much like the coronavirus itself.
But while China backed its lockdown strategy with door-to-door service delivery - aided well by a population trained to obey its government - the rest of the world including India failed to meet the basic needs of the most vulnerable and the poor.
This led to panic violation of lockdown, particularly by migrant workers, daily wagers and people stranded away from home. Many of these people were housed in camps, often poorly run, by government agencies or ill-equipped NGOs.
Now that India is exiting the coronavirus lockdown by opening offices, factories, railways, road transport and airways, the recipient states are not ready. For reference, China has been opening up gradually for last two months. India started easing up coronavirus lockdown in May.
Most of the recipients states - Bihar, Jharkhand, Uttar Pradesh, Odisha, Madhya Pradesh, West Bengal and the Northeast - have seen a surge in Covid-19 numbers with the arrival of migrants from more industrialised states which are also worst-hit by coronavirus.
The central government agencies suddenly appear not in control of things. Easing of lockdown in early May saw consistent record high of fresh number of cases.
India has been a global hotspot for being among top five countries with highest number of fresh cases every 24 hours for better part of May. It has now broken into top 10 countries with highest coronavirus infection taking over Iran.
Covid-19 is a war declared by a tiny virus on countries. And, to win any war, strategy must change with every fresh piece of information.
It may be time for the central government and agencies authorized to frame counter-coronavirus strategy to rethink what went wrong, study fresh volumes of research on the behaviour of coronavirus and progression of Covid-19, and come up with a clearer roadmap to tackle the pandemic.