Several people have asked me why there is a sudden surge in the COVID-19 cases in Karnataka. Many are worried if we are destined for a worse outcome or whether our health system is bad. No, it is the complete opposite. Let’s rewind to a few weeks ago, people said the same thing about Kerala, and already the world is looking at Kerala as a role model. So let us demystify what this entails.
First, a good surveillance system will pick up a high number of cases. This is what happened in Kerala too, for a long time, they had the highest burden in the entire country. By detecting cases early, they could isolate every case and treat it early, thereby limiting further spread and deaths associated with it. On the contrary, it is the opposite of this scenario, which we should be scared of. Unlike the legal system, in epidemiology, we say that absence of evidence is not the same as evidence of absence (of infection). For example, Vijayapura district had no cases for long, and we did not worry then. But all of a sudden, there is a surge in cases.
There’s nothing abrupt or random about a surge in cases or disease causation. Epidemiology understands the systematic nature of the life course of an infection. In the incubation period, the virus can multiply and eventually cause symptoms; for around 14 days or more. Detecting more cases and isolating them, subjecting their contacts to quarantine is a good thing. By stigmatizing disease detection, we allow the virus to prosper.
Second, every death reported means that there are around 66-100 cases around death. If we do not detect enough cases, many more vulnerable people will succumb. To reduce the number of deaths, we have to detect more cases, admit them early, and do good clinical management. Finally, more than the diseases, what is more worrying is our inability to follow public health principles in disease control. It is time to initiate and strengthen the public health workforce in India. During lockdown (mitigation), we are trying to hide from the virus. The virus can hide better too. What we need instead is to seek the virus by finding every person with fever and cough. If we do not do that now, it will seek us faster and spread wider. Will you let the virus win?
Giridhar R Babu
(The writer is Professor and Head Lifecourse Epidemiology, Public Health Foundation of India).