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Social distancing is good. But get ready for a surge: analysis


We live in a state of anxiety fueled by coronaviruses. At those times, we try to build walls and fences to avoid danger. So India has imposed radical restrictions on foreigners entering the country, and rigorous testing for those returning from abroad. The government’s strategy to contain this pandemic is largely based on surveillance and restrictions on international travelers, and now, on a push towards social distancing. Will it work to prevent the virus from spreading in the country? Or is the enemy already inside, digging in slowly?

Evidence from other countries is mixed on the usefulness of travel bans to eliminate the virus. The United States (USA) was the first country to ban travelers from China on February 1. India followed suit a few days later along with Singapore, Vietnam, Russia and the Philippines. But this did not prevent the virus from entering any of these countries. The United States is seeing an explosion of cases, while other places, including India, are seeing slow and steady increases in the number of cases.

This particular coronavirus spreads easily from one human to another, carried mainly by respiratory droplets. It passes from human to human in transmission chains that are difficult to detect. This is because most cases have mild symptoms (barely detectable cough or fever) and may not realize they are infected, but can still transmit the virus to others. A recent study published in Science he estimated that mild and asymptomatic patients in Wuhan, who were never examined and did not know they were infectious, played an important role in the spread of the coronavirus disease (Covid-19). This being the case, restrictions on foreign travelers will only bring a brief respite since the virus is already in the country.

Once the virus is in a country, governments around the world have responded in three ways.

The first is an aggressive test, to quickly detect and isolate sick patients and trace their contacts before they have a chance to spread the virus. As the director general of the World Health Organization put it, the only way to contain the virus is to “find, isolate, test and treat each case to break the chains of transmission. Every case we find and treat limits the spread of the disease. ”

The second way is through social distancing, to the point of closing normal life. This is what Wuhan and other cities in China did, and what cities and regions around the world, including parts of Italy and the Bay Area in California, are doing. The “shelter-in-place” order that was imposed in parts of California required people to stay in their homes except for shopping or for medical emergencies.

This is what India seems to be moving towards, with the “Janata Curfew ”on Sunday. But more will be needed if you slow down the speed at which the virus spreads. Wuhan and other cities in China closed transportation systems, issued orders to stay home, and maintained only essential services for an extended period. In India, a prolonged Wuhan-type closure will be extremely difficult to implement, and the impact will be felt disproportionately by the poor, who need to work every day to survive and cannot afford to work from home. . Rich countries like the United States can afford to spread money to lessen the impact. Countries like India cannot.

The third and most important way that governments around the world have acted is by strengthening the hospital system. Most people infected with Covid-19 will have mild symptoms or may have no symptoms. But the 20% or so who become infected will require hospital beds, and the most severe cases will require intensive care beds. Once the virus really gets going, and the number of cases takes off, patients requiring hospitalization will not arrive in an orderly fashion, one by two, but in waves. Based on past experience of how this virus behaves, people over the age of 60 with other underlying medical conditions will be at the highest risk for serious illness.

Doctors, nurses, and other healthcare workers will also be at great risk, given the large numbers of infected patients they will examine and the long and stressful hours they will have to work. Infection control protocols become even more difficult to follow when healthcare personnel are stressed and overworked. Supplies of ventilators, oxygen, masks, gloves, disinfectants may be short. Any lack of preparation in the Indian health system will be cruelly exposed.

According to calculations by the Indian Council of Medical Research, the disease is not yet spreading in the community beyond the immediate contacts of infected people. But given the experience of other countries, it is very likely that the virus will spread in the community, with cases appearing across the country.

The walls and fences that were built have not prevented the virus. But they have bought the country time to prepare for its eventual spread. That time needs to be used wisely to prepare people and the hospital system for the full impact of a pandemic.

Thomas Abraham is the author of Twenty First Century Plague The Story of SARS. He is an adjunct professor at the Center for Journalism and Media Studies at the University of Hong Kong and worked at WHO during the 2009 swine flu pandemic

The opinions expressed are personal.

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