An Expert Explains: Restrictions eased, what Maharashtra needs to do to control Covid spread

Maharashtra accounts for more than one-third of India’s Covid cases. With restrictions relaxed in many areas, an immunologist looks at the way ahead.

Dr Vineeta Bal is an immunologist and a visiting professor at the Indian Institute of Science Education and Research (IISER) in Pune. She spoke to The Indian Express:

What needs to be specially done to contain the spread of the disease in Maharashtra now?

Nothing very special or different from what we have already been doing. Maybe, much more vigorously and doggedly. One thing that does need to happen is more decentralisation in decision-making and allocation of resources. A lockdown, the kind of which we saw at the national level, is no longer sustainable. Such strategies would now need to be implemented at very local levels, at the community levels, and the authorities who have to take these decisions need to be empowered suitably. In Mumbai and Pune specifically, there are lots of very crowded localities where physical distancing is very difficult to maintain. Therefore, home isolation is something that might not be very effective in these environments. We need to identify, or create, isolation facilities in nearby localities, where relatively milder patients can be housed, and these need to be equipped with things like ventilators, and also with healthcare staff. Keeping people in quarantine facilities that are nearer to their homes is not just easier and faster, but also psychologically comforting for the patient and the family.

And this may sound boring and repetitive, but we must continue to make all efforts to keep increasing our testing capacities, and our abilities to trace and isolate contacts of confirmed positive cases. We should try to trace and isolate every primary contact at least. I know tracing secondary contacts can require much more energy and effort, and we are all already stretched out.

But with travel restrictions considerably relaxed, would these containment strategies still work? We saw cases consistently rising in Maharashtra even during the lockdown.

The lockdown restrictions had to be eased. It was absolutely necessary, and it is welcome. We did benefit from the lockdown to a certain extent. My concern is that we still don’t seem to have been able to create adequate healthcare infrastructure in the time that the lockdown provided us. Not that we haven’t been able to do anything. There has been substantial scaling up of health resources, and a lot of work has been done. But I am not sure whether it is still adequate for the enormity of the problem in Mumbai. We are hearing there is already a shortage of hospital beds in the city.

Another thing that the state government probably can do is employ more and more surveillance staff. These are the people who have been going door to door to collect health information from the people. In many cases, these are the first ones to flag possibilities of infection in a locality. Currently, a lot of these people are teachers or other employees who are not trained for this purpose. But this is an important job that will help not just in containment of Covid-19 but also in other infectious diseases. At a time when several jobs are being lost, this is also an employment opportunity that the state can offer.

But will the numbers continue to rise, or is there any peak in sight?

I don’t think we are at the peak right now. We don’t even know where the peak is. We are still on the ascending curve. But we also need to take the fear out of the people. Political leaders, community elders, and other influential people need to keep reinforcing this message that a Coronavirus infection is not the end of the world. To most people, it would not matter more than a few days of sickness and isolation. But lots of fear persists. At the other extreme, we have seen some reckless behaviour as well, which does not care about physical distancing norms. Both these behaviours are problematic, and I don’t think there is enough happening on communication front.