Success in conquering SARS-CoV-2 is best defined in terms of ensuring that there is no community spread. The nature and scale of the effort calls for fresh thinking, as it reverses established approaches. The messaging from the Central and State governments must bring this out, and not leave it to the local bureaucracy and police to interpret as a curfew.
The Prime Minister has taken a bold political decision. However, India faces an unprecedented implementation challenge and must combine the lockdown with community involvement, and technology-based interventions.
Wuhan provides lessons, but not a template. The United States, European countries and even Singapore have not instituted a complete lockdown. Their focus is on those who need hospitalisation. Earlier, China relied extensively on technological tools to enforce the lockdown. India’s comparative advantage lies in the fact that the District Magistrate has the legitimacy and authority to mobilise the local population. Changing public behaviour, from one defined by panic and anxiety to one characterised by acceptance will not be easy without community involvement.
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Catching them early
The key takeaway from the experience of Wuhan is quite obvious but the devil, as always, is in the detail. Dr. Zhong Nanshan, a leading epidemiologist, emphasised a few “earlys” — early protection, early detection, early diagnosis, and early isolation. The goal of the lockdown should not just be to keep the people indoors but to ensure that patients with symptoms are hospitalised and not just placed under home isolation, to make sure that the virus does not spread to the members of the infected individual’s family.
Second, we need all the support we can mobilise from the healthcare workers. In Hubei, some 42,600 healthcare workers from all over China were deputed. Among them, 19,000 were from the critical care department, which was 10% of the country’s ICU doctors.
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The spread of the virus also provides important lessons, in view of the migration patterns in the country. Around five million people left Hubei to other parts of China to celebrate the New Year just prior to the lockdown of Wuhan on January 23. Thereafter, the number of confirmed cases doubled every three days and the numbers reached 30,000 cases in a fortnight, by February 9. The spread peaked at 70,000 cases on February 16.
The experience of Wuhan, a city of 11 million, is relevant for our hotspots. The city was shut down on January 23. Residential complexes were sealed-off on February 8, and transport was put off the roads. With intensive testing, next week, Wuhan registered over 15,000 positive cases in a single day. In response, more than 20,000 health workers were deputed from outside, providing free testing and putting the infected people in quarantine. Doorstep delivery of essential supplies was ensured, with residential complexes monitoring body temperatures. A telephone-based app reported the vitals. Four weeks after the lockdown, the number of new cases drastically dropped. This is an optimum strategy for our hotspots.
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The media, especially local media, should be encouraged to highlight successful and replicable community action to build public confidence. District Control Room numbers for each local area to communicate all concerns must be widely announced, including by the health workers and NGOs.
Infectious disease is in the Concurrent List and the Government of India has invoked the National Disaster Management Act, devolving the national duty onto District Magistrates. While the Army and the police forces are ‘deployed’, the District Magistrate has to identify, bring together the needed resources and ‘improvise’. They would require real-time sharing of emerging good practices by the Central Government, and even hand-holding, as they have no training for this kind of war.
Mukul Sanwal is a retired diplomat and was in Wuhan in early December on an official invite
