By Dr Suresh Singh
In my various articles since mid-March on this platform about the present situation, I have advocated three things–vaccine choice including more vaccine brands, vaccination for all ages (above 18yr) and 24×7 hr. services where facilities are available. I have the satisfaction that many people-doctors’ associations, individual critics, CMs and political leaders are veering around what I pleaded in those articles.
Present Scenario: It is sure that the virus is criss-crossing throughout the country-from Maharashtra to J&K, to Assam and to Tamil Nadu. Consecutively, India has had new cases for > 90,000 since 4 to 11 April 2021 (2 days >90,000 & 6 days >1 lakh) since my first prediction plea on 14 March. The curve is indeed threatening and requires immediate intervention by our PM.
Curve predictions by various experts: Those experts in Epidemiological modelling are predicting that India’s new case curve will peak around April/May with decline starting around June. Some predict that the curve style will be a sharp increase followed by sharp decline based on European and other models. This is dependent on many unforeseen factors, they pleaded.
Follow India’s previous pattern: Instead of following an unpredictable foreign country pattern, I will advocate our own country pattern and plan accordingly. Daily New case increase of > 50,000 is since 25 March this year i.e. consecutive 16 days; >40,000 is since 20 March i.e. consecutive 21 days; >30,000 is since 18 March i.e. consecutive 23 days; >20,000 is since 11 March i.e. consecutive 30 days. January and February, the figure is < 20,000 with occasionally going to the 4 digit mark.
2020 : The range is 20-36,000 in December, 30-50,000 in November, 40-90,000 in October, 70-1 Lakh in September, 50-80,000 in August. Three months i.e. August to October is the peak which is 5-6 months after the beginning of the 1st wave with March as baseline.
2021: decline below 20,000 starts from 1st January to 10 March with < 20,000 per day. From 11 March there is a gradual increase with >50,000 from March 25. For the whole, March, the corresponding figure is 12-68,000. For April, the figure is between 70-1.31 lakh with the last 8 days nearing 1 lakh or more than 1 lakh. Hence, seeing India’s past trend, my guess is that- the curve is likely to continue for another 5/6 months i.e. up to July- September. Hopefully, after this, the curve should decline, or rather will decline. This means, sharp increase in the curve with > 50,000 is seen from 25 March in the 2nd wave. This is more or less the same pattern with the 1st wave.
Special characteristics of the 2nd wave: As yet there is no 2nd wave throughout the country. Maharashtra is definitely in 2nd wave. In other states-it is patchy; but for sure, the beginning of 2nd wave is seen and will strike with equal force as is done in Maharashtra. That’s why I have recommended a 14 day limited lockdown in red spots with strict adherence to SOP. Its three special characteristics are – the virus is highly infectious, very fast spreading and high hospitalisation rate as seen in many hospitals. Sudden occasional deaths are also reported from many areas though less in number. As on 24 March (source, GOI)-36 UK, 34 South African and 1 Brazilian variants were found as on 24/3/2021. In addition to this, another 206 double mutant variants (E484Q+L452R) have been detected in Maharashtra through the centre which maintains no direct link with the ongoing surge in the state.
Hiding under cover of genetic confirmation: GOI/State authorities always hide under cover of lack of genetic confirmation when asked about the relation of new variants with the 2nd wave. 1st of all, a practical doctor like me doesn’t require any genomic analysis to confirm this and will proudly declare that these new variants are responsible for the present 2nd wave. India’s newer variants are also to be found as per the characteristics of the virus. It is in front of our eyes and why the delay. Secondly, when India boasts of excellent lab facilities, one of the best in the world, why this delay in geno-analysis? Do not wait for other countries to confirm this and will act accordingly. It will be a huge tragedy! By the time results come, India will be flooded with 2nd wave.
PM’s speech vis-a-vis lockdown: Related to this article, PM in his speech after interacting with CMs on 8th April, has told the nation that lockdown is not required and emphasised to focus on micro-containment zones. Taking on a +ve note, I will presume that the PM’s reference is to total lockdown of the country. What I plead is a limited 14 day lockdown of selected red spots to avoid total country lockdown that means at micro-containment zones.
Final pleading: For the various reasons stated above – with discretionary power, PM should enforce selective 14 day lockdown in corona red-spots without waiting states’ responses. This will only save the nation from total lockdown and further spread. Already the mutant viruses have started spreading to other states at an alarming speed. If this selective lockdown is enforced earlier, we would have saved 1000s of +ve patients, unfortunately that ought not to happen thanks to theoretical PMO advisors. Three cheers to Raipur authority for declaring 10 day total lockdown. But I will plead for a 14-day lockdown. Hope some states follow the same suit.
Lockdown should be followed by standard infectious disease control i.e. i) find out corona by house to house survey and testing by RT-PCR ii) treat & isolate them accordingly –the poor at proper treatment centres and not at home, affordable people at home as they have facilities and iii) proper health education – use of mask, 6’’ physical distancing, frequent hand washing & cross ventilation by opening doors and windows. For Maharashtra- affected cities should be locked down with cancellation of metro, mini-trains etc. Maharashtra is the super spreader state now. As stated in earlier columns, night curfew, weekend lockdown, banning restaurants etc. are meaningless and useless. It will have very minimum/marginal effects. God knows from where GOI/States borrow this idea.
For all India- follow the previous strict SOP i.e. allow air passengers with –ve RT-PCR test, same principle in railways and surface transport entry-exit points. Individuals have to bear this burden of test cost for the sack of the nation. By this, one can plan their own journey safely and comfortably. This will also avoid hassle-free journeys with less burden on the states. Once you reach the destination, one can proceed directly to home.
It is again emphasised that 14 day lockdown be followed by proper infectious disease control measures stated above, restricting movements alone will not serve the purpose. The theme be-not test, trace & treat, it be-trace, test, treat & SOP.
(The author is former Director, Health, Manipur, a public Health Specialist and WHO Fellow (Holland & UK). Email: firstname.lastname@example.org Views expressed are personal and do not reflect the official position or policy of Financial Express Online.)