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LETTER TO THE EDITOR
Year : 2020  |  Volume : 13  |  Issue : 5  |  Page : 570-572  

Lessons from COVID-19 in India: Extended lockdowns: At what cost? A counterview


Technical Adviser, The Maharashtra State Anti TB Association, Mumbai, Maharashtra, India

Date of Submission27-May-2020
Date of Decision08-Jun-2020
Date of Acceptance03-Jul-2020
Date of Web Publication7-Sep-2020

Correspondence Address:
Yatin Dholakia
2B Saurabh, 24E Sarojini Road, Santacruz West, Mumbai - 400 054, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_289_20

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How to cite this article:
Dholakia Y. Lessons from COVID-19 in India: Extended lockdowns: At what cost? A counterview. Med J DY Patil Vidyapeeth 2020;13:570-2

How to cite this URL:
Dholakia Y. Lessons from COVID-19 in India: Extended lockdowns: At what cost? A counterview. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Sep 29];13:570-2. Available from: http://www.mjdrdypv.org/text.asp?2020/13/5/570/294360



Dear Sir,

Dr. Atre, in his guest editorial[1] has highlighted the issue of the unprecedented early full country lockdown in India having a negative impact on the nation's economy and the socioeconomically underprivileged section of the society especially the daily wage earners and the migrant population. He argues of low positivity rates in a scenario of “active case finding” and low case fatality rates. And questioning of prioritization of Covid-19 over tuberculosis (TB).

Dr. Atre is justified in raising his concerns. However, an alternative viewpoint deserves attention. Health is defined as the physical, mental, and economic well-being of an individual and society. As rightly mentioned by the COV-IND-19 study group,[2] a lockdown for a country of the size as big as India has to balance between the collateral damage due to the lockdown and the efficacy of the lockdown itself to stop the virus. Managing the situation arising from the new severe acute respiratory syndrome Cov-2 (SARS Cov-2) infection pandemic has to be prioritized based on the available knowledge of this new disease, which is unfolding constantly and the preparedness of the health systems.

Dr. Atre rightly raises the issue of near suspension of activities for TB diagnosis and management. However, this phenomenon is not restricted to regions or countries which have implemented lockdowns, and it is a near-global phenomenon in high TB burden countries as the entire focus globally is on the SARS Cov-2 pandemic. The global TB community already has a roadmap to tackle the consequences arising out of this.[3] On the other hand, COVID-19, being a new disease, with a shorter natural history and as described hereinbelow, with no wherewithal as to its prevention and management merits urgent and priority attention.

SARS Cov 2 is a novel coronavirus. It is transmitted through droplet nuclei and fomites. The incubation period of Covid-19 is short and we now know that infected individuals are already infectious at least 2–3 days before developing symptoms.[4] The basic reproductive number, R0, is dependent on the growth of an outbreak, the incubation period and period of infectiousness.[5] The R0 for this infection is 2.5 (1.5–3.5)[6] and transmission is known to occur within 30 min of a close exposure and is additionally transmitted through infected fomites.

The natural history of COVID-19 is yet unfolding. We are slowly understanding how infected individuals develop varied pathologies depending on their age, comorbidity (s), immunological, and other associated factors.[7] This is the main reason why guidelines for the management of COVID-19 are dynamic and almost daily amendments/alterations are being formulated. It is, therefore, important to keep the population safe till such time as major advances in management are validated and implemented.

The reported positives are low, as, due to the paucity of infrastructure and test availability, not all those who need to be tested may undergo testing. A weak public health system and poor resource allocations, as acknowledged by Dr. Atre, prevent actively searching for infected individuals. Active case finding is restricted to symptomatic cases who have travel history, contact with an infected case, have severe respiratory illness either in hospitals or in the community. The initiation of syndromic screening will definitely improve early case detection. Once antibody tests are validated and approved, we can get an estimate of the prevalence of infection.

A modeling study based on Indian data has predicted that an effectively implemented lockdown from April '20 of 28-, 42-, and 56-days to prevent approximately 238,000, 622,000, and 781,000 cases by June 15, respectively.[8] These benefits are accrued only when a lockdown is imposed early during the course of the pandemic as has been done in India.

As per the worldometer,[9] as of June 7, 258,090 cases are identified with 7207 deaths and 124,095 have recovered identified. At this moment, social lockdown is the only preventive which is effective and feasible[10] and has been acknowledged as a very early, timely, and scientific decision.[11] Case fatality rates for Covid-19 in India are decreasing, however, it is predicted that if the restrictions are lifted around 2 million elderly people and 70,000 young persons will succumb to COVID-19 in urban areas and since 66% of the population is rural, mortality will be higher.[12]

With 1.3 billion population having a density of 382/km2, a literacy rate of around 74% and a new airborne-fomite transmitted virus having a short incubation period, being infectious in the asymptomatic stage, an R0 of 2.5, unraveled pathogenesis, no approved treatment or preventive vaccine, a “weak” unprepared public health system, it is logical to have a complete lockdown to curb transmission. Human life is precious, the economy can revive, life cannot.

Apart from the secondary benefits accrued on the environment, change in life-styles and the political will demonstrated in the swift responses and effective enforcement of the regulations as mentioned by Dr. Atre, the lockdown has in fact bought time for the government and the public health system to rapidly enhance critical infrastructure, enlist appropriate human resources, formulate policies and train the staff. This time has been thus gainfully utilized in health system strengthening for the pandemic.

Finally, physical health should assume priority over the economy as the latter can well revive in due course; to quote Austan Goolsbee the economist, “the number one rule of virus economics is that you have to stop the virus before you can do anything about economics.”[13]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Atre SR. Lessons from COVID-19 in India: Extended lockdowns – At what cost? Med J DY Patil Vidyapeeth.2020;13:192-4.  Back to cited text no. 1
    
2.
Bhramar Mukherjee: Coronavirus Modelling, Impact on India's Pandemic Response; April, 2020. Available from: https://news.umich.edu/ coronavirusmodelingimpactonindiaspandemicresponse/. [Last accessed on 2020 Jun 08].  Back to cited text no. 2
    
3.
The Potential Impact of the Covid-19 Response on Tuberculosis in High Burden Countries: A Modelling Analysis. Developed by Stop TB Partnership in Collaboration with Imperial College, Avenir Health, Johns Hopkins University and USAID. Available from: http://www.stoptb.org/assets/documents/news/Modeling%20Report_1%20May%202020_FINAL.pdf. [Last accessed on 2020 Jun 08]  Back to cited text no. 3
    
4.
Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic transmission of SARS-CoV-2 – Singapore. MMWR Morb Mortal Wkly Rep 2020;69:411-5.  Back to cited text no. 4
    
5.
Johnson SL, Smith KW. The interaction of borate and sulfite with pyridine nucleotides. Biochemistry 1976;15:553-9.  Back to cited text no. 5
    
6.
Joseph Eisenberg. R0: How Scientists Quantify the Intensity of an Outbreak Like Coronavirus and its Pandemic Potential. The Conversation. Available from: https://sph.umich.edu/pursuit/2020posts/how-scientists-quantify-outbreaks.html. [Last accessed on 2020 Jun 03].  Back to cited text no. 6
    
7.
Dholakia Y. COVID19: The curious case of the dog that did not bark Some insights. Med J DY Patil Vidyapeeth. In print.  Back to cited text no. 7
    
8.
Ray D, Salvatore M, Bhattacharyya R, et al. Predictions, role of interventions and effects of a historic national lockdown in India's response to the COVID-19 pandemic: data science call to arms. Harv Data Sci Rev. 2020;2020(Suppl 1):10.1162/99608f92.60e08ed5. doi:10.1162/99608f92.60e08ed5.  Back to cited text no. 8
    
9.
Available from: https://www.worldometers.info/coronavirus/country/india/. [Last updated on 2020 Jun 08].  Back to cited text no. 9
    
10.
Paital B, Das K, Parida SK. Inter nation social lockdown versus medical care against COVID-19, a mild environmental insight with special reference to India. Sci Total Environ 2020;728:138914.  Back to cited text no. 10
    
11.
Kumar A. Coronavirus: WHO Lauds Modi Government's Social Outreach During Lockdown; 2020. Available from: https://www.indiatoday.in/india/story/who- coronavirus-lockdownindia-economic-stimulus-package- 1662392-2020-04-02/. [Last accessed on 2020 Jun 08].  Back to cited text no. 11
    
12.
Million May Die If Lockdown Is Lifted Substantially: Epidemiologist Jayaprakash Muliyil. An Interview. Available from: https://www.outlookindia.com/website/story/india-news-two-million-people-may-die-in-india-due-to-covid -19-epidemiologist-jayaprkash-muliyil/353240. [Last accessed on 2020 Jun 08].  Back to cited text no. 12
    
13.
Obama's Former Economic Advisor Says Trump is Ignoring the Most Important Rule of Virus Economics-and Warns the Usual Recession Playbook is Futile Against Covid-19. Available from: https://www.businessinsider.in/stock-market/news/obamas-former-economic-advisor-says-trump-is-ignoring -the-most-important-rule-of-virus-economics -and-warns-the-usual-recession-playbook -is-futile-against-covid-19/articleshow/74820040.cms. [Last accessed on 2020 Jun 08].  Back to cited text no. 13
    




 

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