As of March 26, the world had recorded more than 21,000 deaths among over 470,000 infected with the novel coronavirus. Around 15% have needed hospitalization, 5-7% ICU care, and 4% have died. So far, India has largely escaped, with 13 deaths among 675 infected. The numbers have risen in the USA, UK and Italy by nearly 50 times over the past four weeks. Had the government not pro-actively instituted decisive early containment measures in terms of travel restrictions and quarantine, followed by the unprecedented lockdown from March 24, India would have witnessed the same steep climb. At that rate, we would have run out of intensive care and hospital bed capacity anytime between now and the next two weeks. So the math was simple and the step logical: Lockdown for three weeks; all the infected people would hopefully recover by then and become non-infective as most stop shedding the virus by three weeks. The problem would be over as long as no one comes in later from overseas and starts infecting us again. Hopefully, all other countries would sort out their infected cases by then. Or soon thereafter.
However, there are several imponderables. Will the problem really be over in a month? Consider this. It took just one case to infect the world. Clearly, COVID-19 isn't going away anytime soon. It will surface again. Eventually, unless effective treatment and vaccine become available, herd immunity will play a big part in taming it. This means around 60% of the population needs to develop immunity to it by actually getting infected.
Not many would hazard a guess on how long the lockdown will be needed. While everyone acknowledges the economic setback, no one is sure of just how calamitous it will be. The longer it is, the worse the hit. When will it become unsustainable? The resource depletion will especially impact the already impoverished 60% and no doubt create a chain reaction of further public health issues. Eventually, the lockdown will become too bitter a pill to swallow. The cure could get harsher than the disease. My fear is we may pay an astronomical price and yet not be able control the contagion in the long-term.
So what should be our approach? A month of lockdown is essential to get the sting out of the bite. After that, for the next two-four months, we should pivot to a nuanced, targeted approach of containment rather than continue a blanket shut down. Efforts and resources should be then directed at the vulnerable groups which are now well known. The fatality rate is under 1% for those under 60, whereas it is 8-15% for high risk groups such as those older than 60, diabetics, those with heart or respiratory diseases, smokers and those with low immunity (for example, transplant recipients).
The ban on travel to and from countries with ongoing active cases and on gatherings of over 25-30 people should continue. Those with the above risk factors should continue to be quarantined. Social distancing, working from home and workplace distancing should continue. Hopefully, the younger, healthy population will get the Corona flu, much like any other seasonal flu, and become immune to it.
At all times, healthcare staff should be prevented from becoming patients themselves through strict enforcement of two levels of protection. Level 1 involves a strict hand wash routine, gloves and mask while dealing with patients, changing scrubs between patients, and cleaning all surfaces several times a day. Level 2 protection (gown, goggles, gloves and special masks) is for healthcare workers in high-risk specialties such as respiratory and ICU care, and those taking care of COVID patients. Those who have had unprotected contact (more than 15 minutes, within 6 feet) with infected patients should be quarantined and tested at two weeks. In addition, unrestricted, widespread testing should be allowed, especially for at risk or symptomatic persons, and contacts of those with proven infection.
The current lockdown is like carpet bombing, which we can ill-afford for long. And it may not get the enemy. A surgical strike is needed to focus scarce resources where they are needed most and prevent a socio-economic collapse that may take years to resurrect.
In April, we would do well to add another 'T' - target - to the 'Test-Treat-Trace' strategy advocated by WHO Chief Dr. Tedros Adhanom Ghebreyesus. As it becomes available, epidemiological data from around the world should be used to guide policy and time the 're-boot'. All this may change if and when we find a cure or a vaccine that works.
(Dr. Arvinder Singh Soin is a pioneer liver transplant surgeon, medical writer and innovator.)
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