Bracing for COVID-19 surge in south India

Cityscape: Urban areas in India are particularly prone to most infectious diseases that propagate in close-contact settings.  

It’s like a relay race in India, with each State and city taking its turn for a COVID-19 surge. The States which seemed to have novel coronavirus under control when Mumbai and Delhi were surging are running in the next leg. For now, it is Karnataka’s turn to lead the pack with a high average growth rate of 8%. Bengaluru, once lauded as a model, accounts for 45% of the confirmed cases. The hard reality is that no city is immune to COVID-19 infection, and the virus reminds us that the battle in tackling the pandemic is still in the initial stages.

Karnataka, in general, and Bengaluru, in particular, was an exceptional performer among all its peers by implementing one of the most stringent lockdowns. Hence, implementation of lockdown was completely successful in limiting the speed of the transmission. As a testimony, most of the cases in Bengaluru were traced to other States after the lockdown was lifted. Each country and State will have an initial circulation due to import of cases from elsewhere. Citing that as a reason for the surge in cases is only reactionary. The other aspect of the lockdown was to prepare to be ready for handling the surge in cases. That is where the success of every model is tested.

Bearing the brunt

Urban areas in India are particularly prone to bearing the brunt of most infectious diseases that propagate in close-contact settings. Besides, urban areas have the disrepute for neglecting public health actions. The pandemic in the metros is a proxy for the devastating effects of most infectious diseases and inappropriate health system responses in urban areas. Bengaluru is no exception to this — centralisation of pandemic responses and use of technology could only mask this in the initial phase of the epidemic. This turned out to be inadequate as the cases started surging with no prior plans to engage and strengthen the urban primary healthcare system consistently.

With restrictions lifted, the public too assumed the worst phase was over. The newfound freedom was exercised with little attention to physical distancing or wearing masks, which resulted in the city corporation collecting more than half-million rupees in fines. It does not mean that calamity is waiting for Bengaluru city; it is among the foremost cities to detect cases, especially due to strong initiatives of improved surveillance for SARI and ILI during the lockdown.

Need of the hour

What is needed now is to reduce the gap in the time lag between the onset of symptoms and isolation of cases. Isolation of cases as early as possible, close to the day of symptom-onset, through better communication to the people and use of antigen testing should be the mainstay of decelerating the spread. This will be successful only if primary health care is supported by additional workforce and logistics. The success of quarantine, too, relies on a strong primary healthcare system. Reorienting the primary healthcare staff with immediate hiring or repatriating the health volunteers will be pivotal in the success of this phase of the relay. Use of technology can, at best, be complementary in nature and definitely cannot replace the presence of a strong public-health workforce.

Barring Telangana, the story in other southern States is similar to that of Karnataka, with some variance. Andhra Pradesh witnessed the surge due to import from other districts and foreign returnees, but local circulations seem to be sustained, including spikes in the temple cities. The State had the highest tests per million and the highest recovery rate compared with other States. In Tamil Nadu, Chennai accounts for 58% of the total cases, while cases in other urban areas are fast-increasing. Tamil Nadu’s surge is attributed to inter-State and inter-district travel, enhanced by super-spreaders, crowd and close-contact settings. The case fatality seems to be similar in all these States except Kerala. Kerala has an intricate task of sustaining its track record of 0.43% of reported cases ending up in deaths. Widely lauded for its management globally, Kerala’s infallible image is at stake due to spike in cases. With the return of a large number of non-resident people, Kerala has started taking precautionary steps for preventing super-spreading events in the State.

Act now

Once the metros start saturating, the next leg of the relay will be in other urban areas and dense settings. The natural progression will manifest as spikes in every neighbourhood. The pandemic necessitates phenomenal leadership; adamant or complacent systems will crumble faster and steeper. The public health system in urban areas needs rehabilitation, nurturing and strengthening to tackle the rest of the pandemic and future challenges. Having a primary health centre in every ward, recruiting two medical officers for each centre and strengthening them with required field staff and logistics is the first step. Developing the skills and competencies of workers is the next step to be battle-ready for managing any epidemic. Inability to act now will soon lead to running out of excuses during the next wave or the next pandemic.

(Giridhara R. Babu is Professor, Head at Lifecourse Epidemiology, Indian Institute of Public Health, PHFI, Bengaluru, and a member of the Karnataka COVID-19 Technical Advisory Committee.)

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Printable version | May 15, 2021 8:56:01 PM |

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