Riding The Second COVID-19 Wave

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Since April 1, India has added over 13 lakh new COVID-19 cases to its tally. In the two-week period since then, more people have tested positive for Covid than in March and February put together. In January and the first half of February, the reproductive rate (R) for India was significantly below 1, which meant that each Covid positive person was infecting less than one person – in effect, that transmission rates were falling.

Today, the situation is very different. R stands at 1.48, which means that each patient is infecting one and a half other people – and that the epidemic is spreading exponentially.

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R is influenced by three factors – the duration for which a person is contagious after getting infected; the frequency of contact; and the probability of infection each time a Covid positive person meets a susceptible person.

Climbing down from our current COVID-19 peak will mean all those factors need to fall. Physical distancing through “do gaz ki doori”, night curfews and shutdowns reduce the frequency of contact. Contact tracing, testing and isolating, and containment zones help the Covid-infected complete their contagious periods with minimum interaction. Masks and handwashing and other practices of ventilation reduce the probability of transmission upon contact.

If the last year has taught us anything, it is this – there is no silver bullet to end the pandemic. There are ebbs and flows, sure. There are challenges on multiple fronts: the battle to break the chain of transmission; the race against time to stop geographic spreads; the fight to manage hospitalizations and cure patients; and the mega war to prevent deaths. Each of these battles is difficult enough – but in our current situation, we are having to fight them all simultaneously.

There are six broad categories of action that will help us win but as in most wars, tactics and strategic cooperation work better than brute force.

First, vaccination is critical to prevent serious illness and death from COVID-19 in the short term and to prevent future waves of infections in the medium and long term. We need more vaccines, a broader variety of vaccines, and a ramped up distribution system. The government’s efforts in this direction, especially the recent decision to approve a larger pool of vaccines, are welcome. As of April 10, only about 30 per cent of the population above the age of 45 years had received at least one dose of the vaccine (and only 1 per cent had received both doses). At an accelerated pace of 5 million doses a day, and assuming there are no supply or stocking constraints, it will take just under 3 months to cover this population alone. But this is a stretch goal. We are facing manufacturing constraints, localized stockouts, and vaccine hesitancy. A massive community mobilization effort is essential to address the latter, with a public message focusing on the importance of vaccines to prevent hospitalization and death. Adults with serious co-morbidities (regardless of age) should be eligible for Covid shots – they are most at risk of severe illness.

Second, our own behavior will determine if we prefer to be foot-soldiers or allow ourselves to be weaponized. Physical distancing, limiting interactions and avoiding mass gatherings – all this is in our hands. A renewed call for proper mask-wearing is critical. Masks are essential in indoor spaces (shops, restaurants, offices, factories, other people’s homes), as well as outdoors. We need to stop meeting groups of people in closed spaces (especially air-conditioned confined spaces now that summer is upon us). These measures are important even after vaccination. The fundamental trade-off each of us as individuals is making is this – do we maintain some semblance of normal life by practising safe behavior (masks, distance, handwashing), or do we prefer to let the virus circulate unchecked until we have to submit to more extreme, formal lockdowns? It is now urgent to immediately ban all mass gatherings and close all possible venues for them. Where such events have already happened, the government needs to try its best to trace and isolate the participants.

Third, decentralization is essential to manage the current wave. Centralized contact tracing is impossible when numbers are this high. But localized, community-led organized efforts at tracing, testing and isolating are possible. We have seen many successful examples within India of local ward or panchayat level teams that led contact tracing and isolating efforts (as the example from Kerala demonstrates). Community centers must serve as dedicated isolation facilities, particularly in densely-populated areas where home isolation is not possible. Another advantage of community-led efforts is that it leverages community bonds and inspires trust in a way government bodies cannot. Boosting private and public testing infrastructure with a focus on RT-PCR tests is key to making these community-led efforts effective.

Fourth, local containment is vital. Where cases are concentrated, micro-containment zones are essential to limit the spread of infection. Effective local containment needs community participation; it needs transparency on numbers, data, timelines; and most importantly, it needs an empathetic administration that prepares for the fallout of such shutdowns, particularly on the poor.

Fifth, the health system needs support to deal with such high rates of infection. We forgot, especially during the deceptively sunny days of February and early March, that our doctors, nurses, and hospital staff had been battling Covid for a year. That they are stretched to the limit. That they are now tasked with vaccinating the rest of us. That now, again, they are back to triaging patients and working round-the-clock to save lives. They need emotional and psychological support, more training, more resources, and an organized effort to minimize elective medical care during this wave.

Sixth, and finally, we must do everything we can to avoid blanket lockdowns (in contrast to localized restrictions). The lessons of last year are vivid: the poor, the self-employed, the small business owners, and the daily wage earners suffer catastrophic job and income losses in blanket national or state-level lockdowns. Unfortunately, if the numbers continue to rise at this rate, such lockdowns may be considered necessary to break the chain of transmission, even with the human and economic costs they would entail.

This current COVID-19 wave is already devastating the economy, families, and individuals. We need to support each other through it and especially, support those who count as the urban working class (vendors, delivery staff, municipal workers, daily wage earners) and are at the receiving end of COVID-19 as well as its economic consequences. It is up to each of us, along with the government, to decide if we ride the wave or if it drowns us all. We can win the battle against COVID-19 but given the numbers, we need to dig in for a long, difficult fight on many fronts. There are no simple answers anymore.

(Chandrika Bahadur is the Chair of the Lancet Commission COVID-19 India Task Force. A full set of recommendations of the Task Force can be found here.) 

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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