The ongoing Covid-19 pandemic has overwhelmed the healthcare delivery system in most of the affected nations. Globally, a total of more than 29,15,300 cases and over 2,03,000 deaths have been reported, amounting to a case fatality rate of around 6.8% (WHO Covid-19 Situation Report 90). In India, as on 26 April 2020, over 26,500 cases have been reported, while at least 825 people have lost their lives due to the infection, with Maharashtra, Gujarat and New Delhi being the most affected.
Controlling the spread of the disease: Considering the sudden upsurge in the number of reported cases, the Government of India had taken multiple steps to maintain social and physical distancing (such as closure of educational institutions, avoiding social gatherings, etc.) to ensure interruption in the chain of transmission. However, despite these initial measures, the number of cases continued to rise and thus, for the benefit of the citizens and for improving the preparedness of the health system, the prime minister declared a complete nationwide lockdown for 21 days from March 25 to April 14. This lockdown has been further extended to May 3.
Lockdown and its significance: This complete lockdown was implemented with an aim to isolate the infected cases to their household settings. In the absence of this lockdown,the number of cases would have increased at an exponential rate, which would have posed an immense challenge for the public health authorities as it would have become almost impossible to trace the source of the infection
In case the lockdown had not been extended, after the relaxation of the restrictions, it was expected that all people who had been confined to their households during this lockdown period would have come out and started mingling with their friends, family members and multiple other contacts. In addition, people would have resumed their work and been travelling in large numbers through various modes of public transportation.
These actions would have resulted in the initiation of multiple new chains of transmission of infection from different sources and this would have eventually resulted in a sudden rise in the number of cases, which would have been impossible for the health system of any nation or state to effectively contain
Extension of the lockdown: The findings of a study done in Wuhan in China concluded that owing to the imposition of strict and complete lockdown in the city, the doubling time of the caseload increased from two days to four days (Lau, et al., 2020). The findings of another mathematical model anticipated that imposing a three-week lockdown would not be sufficient to prevent the resurgence of the cases; instead, protocols of sustained lockdown with periodic relaxation were recommended (Singh & Adhikari, 2020).
All this evidence was in favour of the extension of the lockdown to more than 21 days and the same was emphasised by the chief ministers of various states.
In a densely populated country like India, if large-scale community transmission were to set in, it would be extremely difficult for the health system to effectively contain the infection. Thus social distancing seems to be the most cost-effective approach for the nation at present to fight against this highly contagious viral infection.
Actions to be taken during this extended lockdown period:
1) Intensification of the cluster-containment: During the initial 21-day lockdown period, some high-risk pockets have been identified and it is ideal to seal these buildings or areas and strictly restrict the movement of people in these locations with an objective to limit the further transmission of infection.
2) Strengthening health systems: The capacity of the health systems in terms of isolation wards, quarantine facilities, bed strengths, diagnostic capacity, arrangement of logistics, research activities, and infection prevention and control measures needs to be strengthened.
3) Expectations from the general population: It is expected that the people would continue to stay indoors, practice hand hygiene and respiratory hygiene, maintain social distancing, adhere to infection prevention and control measures, and not spread fake news.
4) Prepare for exit from lockdown: It is quite obvious that we cannot stay in lockdown for undefined periods of time, and thus, we should plan for phase-wise exit from the lockdown. However, such a decision should be taken in a thoughtful manner based on the progress made in objective indices.
The strategy of lockdown is a scientific method to contain the Covid-19 infection and reduce the risk of transmission. The decision to extend the lockdown was an effective approach to build upon the gains accomplished in the earlier lockdown phase through the isolation of the cases within the households, and it has therefore been adopted by the governments to avert the possibility of resurgence of cases.
Dr Subhash Chandra Parija
VC, Sri Balaji Vidyapeeth and former Director of JIPMER
Dr Saurabh Shrivastava
Professor of Community Medicine, Sri Balaji Vidyapeeth
(Email addresses of authors: subhashparija@gmail.com and drshrishri2008@gmail.com)