By Dr. Arun Mitra
Continuous increase in number of COVID 19 cases in the country is a pointer to its community spread. Even though the ICMR does not agree with this, but several Epidemiologists have different opinion. No community transmission of Covid-19 is a falsehood, says Dr Jayaprakash Muliyil, a noted epidemiologist and former Principal, Christian Medical College Vellore.
Community spread means that we are not able to trace the source of infection. It is now well known that asymptomatic people who have caught infection but did not develop any symptom can spread it to others as they can be potential carriers. It is true that the virus did not originate in India. It came to our country from other countries when the travellers from those places came here. Whereas first case was reported on 30th January, universal screening of travellers started from 4th March only.
There are reports that many travellers did not care to follow the instructions after landing into India. They concealed their travel history and even participated in the gatherings. This lead to spread of infection to others. There is no record to give us data about the COVID status of 4000 personnel who accompanied President Trump in the last week of February. This is important since America is having the highest number of cases and deaths due to corona infection. Possibly some of those who came with Mr Trump were infected and left the infection here in India.
Since the spread of infection in the initial stages was very slow, it was felt that probably India will not have many cases. So much so that Dr Vinod Paul, full time member of NITI Ayog announced that there will be no case of COVID in India after 16th May. But the Epidemiologists, virologists and those in Social and Preventive Medicines kept on giving warnings that the number of cases will rise soon and that we must prepare for the worse. We have already entered that stage. We have crossed 5 lakh cases. Even though the number of cases may be as small proportionate to the population but with the present doubling rate, we may be in for worse soon. At present we have more cases in Mumbai, Delhi Chennai, Ahmedabad and big cities but some states have already sounded alert fearing increase in the number of cases.
We have to take effective measures to put check on the rate of community spread. For this we require community participation. Most important in this is strengthening of trust between state and community. For this to be possible it is important that the state realizes that it is a health emergency and not a law and order problem. Use of force should be limited and should be empathetic. Any excesses by the security forces adds to trust deficit. We have seen both the aspects. At some places the security forces have been seen helping the people, while there are incidents where security forces have been found beating even those who have been starving for days together on way to their native places. Such actions may vary from person to person, but there have to be strong general directions for this.
At some places the community has done a wonderful job by giving ration, food and fulfilling other essential needs of those in distress. Much more needs to be done now. Private doctors at some places have now come forward to help government in containing the disease by early detection and sampling of suspicious cases. Even though belated such gesture is a welcome step as the state health services have been overburdened all this time.
Unfortunately, during the crisis many doctors closed their clinics because of fear of catching COVID. This is an unexpected behaviour from a doctor who is supposed to be the frontline fighter in case of a health emergency. This led to increase in pre-existing diseases and suffering of patients with co-morbid conditions. There are however many who have been working very hard during the on-going crisis. Some doctors have resorted to telemedicine; it is a good step but it cannot be alternative to the direct conversation with the patient. Direct conversation and examination of the patients not only helps in early detection of the disease but also in allaying the fears and reduce anxiety tension which has gripped the minds of the people.
Awareness is the key component and for this the local communities must act. In almost all the localities one can find a doctor who can be asked to give information about the disease and its prevention. Such direct interaction is always helpful. The Mohalla committees can meet maintaining physical distance or discuss even through webinars. Simple things like how to use masks or wash hands are very important. Many people have become careless due to easing of lockdown.
There is fear among the people that their helpers if let into the house will spread infection. Such fear can be allayed by informing necessary steps to be taken. Many elderly are suffering because of lack of help due to denial of entry of helpers in to societies. Whereas this will be of great help to the super seniors it will also give employment to the poor who are in dire need of it. (IPA Service)