|LETTER TO THE EDITOR
|Year : 2020 | Volume
| 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 Submission||27-May-2020|
|Date of Decision||08-Jun-2020|
|Date of Acceptance||03-Jul-2020|
|Date of Web Publication||7-Sep-2020|
2B Saurabh, 24E Sarojini Road, Santacruz West, Mumbai - 400 054, Maharashtra
Source of Support: None, Conflict of Interest: None
|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
Dr. Atre, in his guest editorial 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, 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. 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. The basic reproductive number, R0, is dependent on the growth of an outbreak, the incubation period and period of infectiousness. The R0 for this infection is 2.5 (1.5–3.5) 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. 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. 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, 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 and has been acknowledged as a very early, timely, and scientific decision. 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.
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.”
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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