Coronavirus | Opeds and editorials

COVID-19 and the path ahead

A health worker checks the body temperature of a passenger before the departure of a special train to New Delhi at Sabarmati Railway Staion in Ahmedabad on May 12, 2020.

A health worker checks the body temperature of a passenger before the departure of a special train to New Delhi at Sabarmati Railway Staion in Ahmedabad on May 12, 2020.   | Photo Credit: AFP

India needs to blend acute disaster management strategies with longer-term public health measures

COVID-19 has caused severe disruption across the world. However, there are variations both among and within countries in the number of cases and in case fatality rates. In general, Europe and the U.S. have borne the brunt of the infection, while Asian and African countries have been relatively less affected so far. It is not yet clear why such geographical differences exist; they cannot be explained by healthcare facilities alone. India had reported its first case on January 30, 2020; as of May 12, it has reported over 71,000 cases and more than 2,300 deaths. In comparison, the U.S. and the U.K., which also reported their first cases around the same time, recorded over 13,47,930 cases and over 2,24,330 cases, and over 80,600 deaths and over 32,100 deaths, respectively.

Interactive map of confirmed coronavirus cases in India | State-wise tracker for coronavirus cases, deaths and testing rates

The relatively young population of India has been suggested as a possible factor for this stark difference. However, while older people are at highest risk from the more severe consequences of COVID-19, there is no evidence to suggest that younger people are immune to the infection. Differences in case ascertainment may explain some of the patterns: South Korea and Germany tested widely in an effort to identify cases, whereas some countries including India offered testing (at least in the initial stages) to only those with a history of foreign travel or with close contact with a known case. However, this does not explain differences in mortality. Also, case fatality rates may even be an underestimation in India where a number of asymptomatic cases may go undetected.

Possible reasons for differences

Low temperature and low absolute humidity have been suggested as factors influencing transmission. But this theory needs further proof. Genetic variations may be a possible explanation. During the 2003 SARS epidemic, specific genetic variants that provided resistance or susceptibility to infection were identified in different populations. Population-specific differences such as ACE2 (which permits virus to enter the body) may partly explain the differential infection rates of COVID-19. It is also possible that some Asian and African populations have been exposed to a multitude of coronaviruses previously, which has provided some cross-immunity. The SARS epidemic did not affect South Asian and African countries significantly. The West Asian countries which bore the brunt of Middle East Respiratory Syndrome (MERS) do not appear to be significantly affected by COVID-19.

Early adoption of countrywide preventive measures may have also played an important role. While European countries reacted with restrictions and closures, it remains a question if these measures were taken too late. India closed its doors to foreign travellers early on in the outbreak and has not seen the surge that could potentially have been expected for a population of 1.3 billion people. However, Sweden for example, has still not adopted major restrictions and not seen a large surge in cases.

Easing of lockdown

If the epidemic does spread with generalised community transmission, the healthcare, social and economic implications will be significant.The lockdown in India has played a role in preventing an exponential surge in cases. However, a measured public health approach is critical in controlling this epidemic. Current approaches are largely urban-centric with little focus on rural dynamics. A decentralised approach is required to manage the large rural population, and the success in Kerala may serve as a useful model. Governments may consider mobilising and training a range of healthcare providers (including providers of primary care, and traditional healthcare systems) in responding to this situation. Crucially, the current practice of isolating all cases in hospital settings is not sustainable if cases increase.

Coronavirus | Modi says a new-look Lockdown 4.0 beyond May 17 is in the offing

As it would be impractical to test everyone with symptoms, a case definition based on symptoms and local epidemiological context may be used to diagnose suspected COVID-19 cases. Those with mild symptoms (and their household contacts) should be advised to stay at home. If cases cannot be managed at home, community centres may be deployed for isolation. This approach will ensure that hospitals are available to those who really need them. The lifting of the lockdown needs to be undertaken in a phased manner. One approach would be to ensure that the vulnerable (such as the elderly and the immuno-compromised) are protected beyond initial lockdown periods, while restrictions are lifted for the majority of the healthy population. The disease has generally been mild among most people affected in the subcontinent, and it is possible that herd immunity may develop through gradual exposure among healthy individuals. While lockdown measures are lifted in a controlled manner, government public health agencies need to continue to promote hygiene measures. Physical distancing will need to be continued. Public health messages need to be locally tailored and consistent. They require not only awareness, but also resources as these are largely middle-class concepts and not easy to practice in crowded areas where there is no running water. In conclusion, the approach to the management ofCOVID-19 needs to blend acute disaster management strategies with longer-term public health measures including economic measures.

K. Kumaran, G.V. Krishnaveni, Kumar G.S. are public health epidemiologists & Giriraj R. Chandak is a physician scientist

A letter from the Editor


Dear reader,

We have been keeping you up-to-date with information on the developments in India and the world that have a bearing on our health and wellbeing, our lives and livelihoods, during these difficult times. To enable wide dissemination of news that is in public interest, we have increased the number of articles that can be read free, and extended free trial periods. However, we have a request for those who can afford to subscribe: please do. As we fight disinformation and misinformation, and keep apace with the happenings, we need to commit greater resources to news gathering operations. We promise to deliver quality journalism that stays away from vested interest and political propaganda.

Support Quality Journalism
This article is closed for comments.
Please Email the Editor

Printable version | Jun 1, 2020 10:00:13 AM | https://www.thehindu.com/opinion/op-ed/covid-19-and-the-path-ahead/article31568078.ece

In This Package
Open with caution: On Unlock 1
It’s time for a universal basic income programme in India
The waning of subaltern solidarity for Hindutva
Export blocks: On India’s trade amid the pandemic
A moment to trust the teacher
The echo of migrant footfalls and the silence on policy
Enjoying the fruits of their labour
Helping supply chains recover
The heavy burden of social suffering
An effective lockdown
The lockdown has highlighted stark inequalities
Will sport be the same in empty stadia?
Cinema after COVID-19
The eternal longing for the distant home
Working safely: On workplaces during the pandemic
A hole in the whole: On health sector woes
China, better prepared for the post-COVID world
How public health boosts an economy
Keep it retrospective
Backing the ‘angels in white coats’
Standstill: On opening of stadia for training
Flawed stimulus is justice denied
We need social physicians
A callous response
Peaking: On India’s coronavirus tally
Farm gate in focus: On amending Essential Commodities Act
A question of quarantine: On migrant workers and other travellers
TASMAC tribulations: On Tamil Nadu liquor sale
The pandemic and the challenge of behaviour change
One for the poor: On Centre’s corona package
Lockdown syndrome: On virus-induced economic crisis
Are India’s labour laws too restrictive?
Stop the return to laissez-faire
States cannot be left to the Centre’s mercy
Local motif: On Modi’s call for self-reliance
Liquidity lifeline: On Nirmala’s MSME package
A plan to revive a broken economy
Provide income support, restore jobs
Perilous state: On State finances
You are reading
COVID-19 and the path ahead
Reaffirm cooperative federalism
Riding roughshod over State governments
Tragedy on the tracks: On the killing of 16 migrant workers
Coming to terms: On India refusing to admit community transmission
The trends shaping the post-COVID-19 world
The epidemic and ensuring safety in courts
Responding to COVID-19 at the grassroots
The face of exploitation
Contempt for labour: On dilution of labour laws
Slower growth and a tighter fiscal
Back home: On return of Indian expatriates
Blame game: On Donald Trump’s anti-China rhetoric over COVID-19
Resuscitating multilateralism with India’s help
A war-like state and a bond to the rescue
Fear and loathing in the land of the free
Everyone wants a good stimulus
Rent control amidst pandemic
Slow release: On lockdown 3.0
No comfort in numbers: On Bengal’s coronavirus cases
Pandemics without borders, South Asia’s evolution
India’s disease surveillance system needs a reboot
No relief for the nowhere people
BRICS against COVID-19
Recovering early: On India’s COVID-19 patients
It’s about food, nutrition and livelihood security
Taiwan’s coronavirus protocol shows how it is done
Needed: a pandemic patent pool
Getty Images/iStockphoto
Plasma therapy is no silver bullet
Take care of yourself too, fellow journalists
Strategic shift: On home isolation of mild coronavirus cases
Coping with today, planning for tomorrow
No end in sight: On India’s coronavirus strategy
Vividly imagining the life of migrant workers
A task for South Asia
Privacy concerns during a pandemic
Unlocking justice in the lockdown
Safe return: On migrant worker distress
The outline of another pandemic combat strategy
Pandemic and panic: On Tamil Nadu’s five-city lockdown
Protecting the poor from becoming poorer
Did SARS-CoV-2 begin from a lab?
Protection for protectors: On safety of healthcare workers
Rapid failures: On antibody testing kits
The COVID-19 paradox in South Asia
Fishing in troubled waters during a pandemic
How will India emerge out of the lockdown?
Making doctors wash hands
Locked out of cities, homes and livelihoods
Script of unity: On coronavirus and social prejudices
Exploiting a pandemic: On Trump’s immigration policy
The village is still relevant
A time for planetary solidarity
There may be no going back
No transparency in West Bengal
Focus on the curve: On India’s COVID-19 numbers
Economy in lockdown: On India’s worst case scenario
A shot of hope with a game changing vaccine
Caught in the heightened arc of communal polemics
Singing the corona tune
Helping a lending hand: On RBI’s second lockdown stimulus
A season of change: On IMD forecast system
A virus, social democracy, and dividends for Kerala
Across the gulf: On stranded Indian workers
Virtual reality: On telemedicine
A blueprint to revive the economy
A case to use JEE-Main instead of JEE-Advanced this year
Will the aviation industry recover from the pandemic?
Data-driven reporting during COVID-19
Stress test: On revised lockdown guidelines
Disastrous decision: On Trump halting funds to WHO
Cease the distractions, seize the moment
Getting the containment strategy in India right
In India’s response, a communications failure
Harmonising with nature
End the harassment of farmers now
A narrowing window: On extension of lockdown
Corona bond: On Eurozone COVID-19 rescue package
Halting the march of rumours
Polls during a pandemic
The pandemic and the contours of a health response
Economic liberalisation and its faults
Invasive, alien, most fearsome
Trade in tatters: On the global slump
Wanted, a collective national endeavour
Disingenuous and no antidote
COVID-19 and the crumbling world order
Women’s safety during lockdown
Lives and livelihoods: On economy after lockdown
Stage fright: On denying community transmission
Team India and winning the pandemic battle
In time of need: On hydroxychloroquine export
Will COVID-19 affect the course of globalisation?
Finding a scapegoat in WHO
Curating news for children during pandemic
A time for extraordinary action
For better use: On MPLADS funds
Needed, greater decentralisation of power
A key arsenal in rural India’s pandemic fight
Preparing for exit: On lifting the lockdown
Sanctions and pandemic: On America’s Iran policy
‘A script of action, responsibility and compassion’: Chief Minister Ashok Gehlot writes on Rajasthan’s fight against COVID-19
Taking a long view of the pandemic fight
Ten questions posed by the virus
A different economic approach
Why healthcare workers above 60 should be ‘benched’
Enemy at the gates: On Kerala-Karnataka border row
Reducing farm distress during a pandemic
Why everyone should wear masks
The criticality of community engagement
A niggardliness that is economically unwarranted
The spectre of a post-COVID-19 world
Light and sound: On Narendra Modi’s 9-minute light ceremony
A million and counting: On global coronavirus spread
Safe forests, safe people: On diseases of animal origin
Quarantine and the law
Making the private sector care for public health
Looking east to contain COVID-19
Limits to rugged individualism
Uncritical endorsement: On exodus of migrant workers and the Supreme Court
Beyond the blame game: On the Tablighi Jamaat episode
A long road: On India’s 21-day coronavirus lockdown
The missing notes: On politics and the fight against COVID-19
China’s zero: On China’s lead in containing coronavirus
Unprecedented step: On Wuhan lockdown
The return of the expert
Lessons from Hubei
A pandemic in an unequal India
Faith can’t override public health
Devising a people-centric response to COVID-19
Karnataka CM writes on how the State is fighting the pandemic
Tamil Nadu CM writes on how the State is stopping the pandemic in its tracks
The hunt for a cure begins with telling the truth
COVID-19 and a city’s anatomy
Long live the nation-state
The COVID cycle
Coronavirus | The worst of times, the best of times
It’s also a fight against punitive measures
The age of the neoliberal virus
The deep void in global leadership
Thinking national, acting local
Every man is a part of the main
Beyond social distancing to fight COVID-19
Next Story