Fight against Covid-19 needs renewed thrust

THE Covid-19 pandemic has devastated the world in the past nine months. Many countries in Europe are witnessing a recurrence and the numbers are still not showing a downward trend in the US. In India, we are seeing a continuous surge. Recently, there were reports of shortage of oxygen supplies in some states. The country has fought the virus bravely with one of the lowest case fatality rates in the world. The deaths per million of population has been a cause of some solace, but the caseload has breached the 60-lakh mark.

The spate of new cases in September has been a worrying trend with about 13 lakh patients being added in the first fortnight. A study at the Hyderabad campus of BITS-Pilani has projected 70 lakh cases by early October.

In the absence of a definite treatment for the novel coronavirus, the WHO advocated containment and preventive measures. As part of these, India also imposed a lockdown which helped prevent the initial spread. It also gave time to improve the health infrastructure, increase ICU beds and add more ventilators. From a stage of importing PPE kits, we have reached a stage of exporting them. Similarly, testing for Covid-19 has been ramped up with over 11 lakh tests being conducted every day. Testing remains one of the mainstays of containment as positive individuals need to be isolated. In the field setting at the community level, a check is also possible with rapid antigen test which is cost-effective and takes around 30 minutes. In a hospital setting, rapid antigen testing is proposed for patients requiring admission to ICU or Emergency. Those testing positive can be triaged early and the negative cases need to be reconfirmed with RT-PCR. We believe flattening the curve is possible by testing, treating and tracing.

The medical fraternity has also learnt how to treat the disease better. There being no effective antiviral drugs, treatment is primarily supportive. We have learnt that hydroxychloroquine is not useful, the role of plasma therapy is not yet established, that the use of anti-coagulants and steroids is helpful in specific stages of the disease, and drugs like Tocilizumab and Remdesivir help some and that ventilator is not the panacea it was thought to be. The ICMR has updated its proposed algorithm of treatment. Resultantly, more patients can be effectively treated if the guidelines are followed.

A vaccine for Covid-19 has been in the offing for some time now. Despite over 200 candidate vaccines, only a few have reached the stage of clinical trial, including two from India. It is projected that though one or more vaccines may be cleared for use by the end of 2020, it will be only in the first quarter of 2021 that they can be available for mass usage. This implies that for the next many months, we have to rely on measures other than vaccines to prevent the virus from spreading.

That brings us back to the three basic tenets of fighting Covid-19 — use of a mask, social distancing and hand hygiene, besides isolating those testing positive. Unfortunately, the emphasis on this basic protocol has been getting diluted. With a rapid upsurge in cases, it is time to reiterate these measures strongly. Most people feel they need not wear a mask with their friends as it would be safe, or with relatives because they would be non-infective or even with colleagues, for the same reason. For our own and others’ safety, each one of us should wear a mask. A group of researchers in the US has suggested that wearing a mask even helps in building immunity against the virus.

The mask scales down the viral particles filtered out of it, reducing the inoculum. Thus, the low viral load transmitted to the other person acts akin to a live vaccine. Notwithstanding this hypothesis, wearing a mask definitely protects the wearer. In that sense, a triple layer mask is the best, but a home-made cloth mask is also quite effective, provided it is washed daily. Masks like N-95 are to be used by high-risk individuals like health- care workers. Wearing a handkerchief or a bandana-type wrap is not that effective, and in fact, they have been shown to be counterproductive.

The importance of social distancing is easy to understand, but often ignored. There are instances of attendees in marriages turning positive. Similarly, attending meetings has been followed by a spread of the virus. A few months back, many officials in the health department of Madhya Pradesh got infected from a single employee who had tested positive. When the lockdown was lifted, most people observed the two-metre-distance norm quite regularly, but not anymore. We cannot ignore the fact that Covid-19 spreads through close contact and proximity. Hand hygiene is the other preventive measure.

One issue, which has been ignored, is the role of healthcare facilities. In May this year, many Mumbai hospitals had been shut down, as they had become hotspots for the spread of infection. As tricity hospitals get a lot of patients from the neighbouring states, it is imperative to test the patients. There have been instances of the spread of virus in healthcare facilities linked to the attendants. At many hospitals, including government institutes, only those attendants are allowed who have tested negative.

We have to fight Covid-19 with renewed vigour. The State and the individual must pool in for this purpose. Social and religious organisations also need to step forward. There has been a fatigue of sorts among all of us in the past six months, which needs to be shed. Even the print media has pushed the Covid news to obscure corners and the TV news does not highlight the gravity of the situation adequately. People should be warned through various measures like hoardings, announcements and proper vigil at busy public places.

It is time for us to pause and think of how best we can fight the pandemic.