What does the end of the Covid-19 blockade in India mean to you?

05/09/2020 Health, India, Sports, World



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India’s national closure is coming to an end.

Starting Monday, May 4, the country moved to what’s called Lockdown 3.0. In some ways, this phase is more of a Reopening 1.0, as certain activities are now allowed in all zones (green, orange, and red) with full restrictions that only apply to containment zones.

For example, even in red light areas where the number of Covid-19 cases remains high, private facilities can operate at 33% staff strength, and non-essential movement is permitted between 7 am and 7 pm. Here is a list of what is allowed and prohibited in Lockdown 3.0.

After more than five weeks of a complete ban on the movement of anything other than essentials, India is slowly returning to normal. The massive crowds that gathered outside the liquor stores, as well as the increase in traffic data, were clear signs of a change.

Delhi Prime Minister Arvind Kerjiwal echoed the voices of many leaders across the county when he declared it was time to reopen the capital and said: “We will have to be ready to live with the coronavirus.”

But what does that really mean?

What did five weeks achieve from one of the world’s toughest blockades, announced with just four hours notice? And does this mean that your life is back to normal?

Here is what we know.

No decrease despite blockage

When he announced what was originally supposed to be a three-week blockade in March, Prime Minister Narendra Modi said the goal was to break the chain of transmission of the virus, warning Indians that if they were not vigilant for the next 21 days, It could delay the country in 21 years.

India blocked the spread of the new coronavirus in the country very early, with around 500 cases and 10 deaths. As of May 8, it has 56,342 cases and 1,886 deaths.

The numbers have not grown as fast as many expected, an indicator suggesting that the crash may have helped reduce the spread of the virus.

But worryingly, the blockade does not appear to have led to a downward trend in the number of new cases, as noted by the Director of the Indian Institute of Medical Services, Randeep Guleria, who is part of the Covid-19 core team of the country.

“The main problem at the moment is that we are not seeing a downward trend,” said Guleria. mint. “After 40 days of a strict blockade, which was extended even further, the case count should have dropped. Many other countries have recorded a downward trend on their covid-19 curve. ”

If you compare the number of daily new cases in India with other countries that entered a blockade, often much less restrictive than those in India, they have tended to see an initial peak in cases followed by a peak after which the number of new cases begins to drop.

The Indian chart shows a steady increase in new cases.

Trends are somewhat difficult for India to read, especially since each state has its own approach. But what is clear is that the numbers of infection, and the growth rate of new cases, continue to increase.

“According to figures shared by the Union Ministry of Health, the 7-day compound daily growth rate of Covid-19 cases began to drop on April 8,” the Indian express. “The general downward trend continued until May 1, when the curve started to climb again. Since May 3, the 3-day CDGR curve has remained above the 7-day CDGR. ”

What this means is that, even when India withdrew the nuclear option, a national blockade that would mean the entire economy remains closed and leaves millions in trouble, the virus has continued to grow.

Why is the blockage being relieved?

Modi’s initial explanation for the crash was that it was intended to “break the chain of transmission” of the virus. If, by that, you meant to eradicate Covid-19 from India making sure it doesn’t spread beyond those that already had it at the time, that clearly has not happened.

Over the past five weeks, the declared objective of the blockade has also constantly changed. First was to break the chain of transmission. Then on April 17, more than three weeks after the closure was announced, the government said it had reduced the “doubling time” of infections, meaning the number of days to double cases.

Although that number has been reduced since the first days of the blockade, the government never identified a set level it wanted to reach before beginning to relax the restrictions.

India cannot claim that it has reached the peak of new infections, or even a good sense of when that peak could arrive, as it moved into closure so early.

What that means is that the easing of restrictions seems to come mainly because the country simply cannot afford to stay closed for much longer. The effects on livelihoods and indeed lives would be too much, even if there is a clear explanation of what has changed now compared to, say, three weeks ago.

However, this lack of a clear focus leaves open the possibility that what are now conglomerate containment zones, areas with a large number of cases where complete blockages remain, will continue to grow if case counts increase.

A blockade was never going to kill Covid-19

It’s worth remembering: no matter what WhatsApp sends about sunlight and noisy pots and pans, and despite the scandalous graphics presented by Indian authorities, the blockade was never going to be a way for India to cut its bill infected to zero. That is simply not how highly infectious diseases work.

The idea of ​​flattening the curve through social distancing, as we explained in early March, is to reduce the number of people who become infected at the same time, so that the health system is not suddenly overwhelmed in a way that could lead to preventable deaths.

A blockade is the most extreme version of social distancing, since it is a government mandate and has a considerable cost for the economy and people. His goal is to save time for authorities to prepare for a new outbreak and for health departments to prepare hospitals and infrastructure for a deluge of patients.

Has this happened?

Authorities across the country have begun preparing hospitals and care facilities to treat patients with Covid-19. Some of this appears to have happened later than expected, with the Center only listing district-level health infrastructure in week five of closing.

Similarly, although the internal crisis of migrants was evident from the first days of closure, the Union Minister of Health spoke to states just five weeks later about a strategy to prevent the spread of the virus to rural areas by of migrants, who are finally being allowed to move. It is unclear why the government did not take this action before ordering that migrants be allowed to return to their homes.

Bureaucratic flaws in both the acquisition of personal protective equipment and rapid test kits have wasted the time purchased by the blockade. This has meant that, even without a massive increase in numbers, hospitals in Mumbai, the worst hit city so far, already seem overwhelmed.

Down to earth He took a close look at what the country did during the shutdown, with conclusions that do not inspire much confidence.

Now, as cities and states open up, and people start to get together and mix again, the numbers will inevitably increase. The blockade was meant to prepare India for that second wave. Unfortunately, the first wave has probably not yet receded.

Indian immunity, heat and Aarogya Setu: there are no magic solutions

As the virus swept through China, western Europe, and then the United States, many wondered why India was not so badly hit by Covid-19, especially since nearby Iran saw a huge increase in cases.

Although some of that may be due to India’s decision to prevent people from entering the country and blocking themselves early in the spread of the virus, many theories suggested that Indians perhaps had some form of immunity to the disease, or that they did not it spread so easily in hotter places.

There is as yet no conclusive evidence to suggest that Indians have any kind of natural immunity to the virus. Other theories have not yet been substantiated, such as the suggestion that India’s lower numbers may have been helped by the BCG vaccine, aimed at protecting against tuberculosis.

A more pervasive trope was the idea that countries further north seemed to have more difficulty managing the virus, giving hope that the hot and humid conditions expected in India in the coming months will slow its spread.

Government promotional material for the Aarogya Setu app.

An existing research survey suggests the virus goes out faster if there is more heat and humidity, but academics caution against the presumption that this will be a silver bullet, especially since dense cities like India or the use of air conditioners could nullify those effects.

Finally, the government has launched Aarogya Setu, a contact tracking application, as a solution to the virus, just as it used the idea of ​​a blockade as a weapon with which to defeat Covid-19.

In addition to all the privacy concerns about the app, the simple fact is that it will, at best, complement existing approaches.

Contact tracking apps work by registering everyone you have close contact with for a specified period of time. If one of them tests positive, everyone who has been in contact with that person is notified, while authorities can work to isolate and test all those potential contacts. The applications are intended to complement the test-trace-isolation strategy to be performed by people on the ground.

However, in order for them to work, there must be a considerable amount of usage, which, even with India making the app almost mandatory, could be difficult due to the tens of millions who still don’t have smartphones. And the country also needs to carry out extensive tests. As it stands, no major economy is testing fewer people per million than India.

Also, the app itself doesn’t fix anything. While it may help a test-tracking isolation strategy, if Indian hospitals aren’t ready for a Covid-19 patient surge, the app will do little to help.

The density of cities in India can also make your ads meaningless, especially if their precision is as erratic as this post suggests:

This does not mean that contact tracking applications are not useful, only that the government seems to sell them as a solution to the virus, just as it did with blocking, instead of adequately representing them as one of the many tools they will have to work on. concert for India’s Covid-19 response to be successful.

Don’t expect a vaccine soon

A tremendous amount of effort and money is being devoted to vaccine research.

The Associated Press says about 100 research groups worldwide are searching for vaccines, and a dozen are in the early stages of human trials. The European Union conducted a global fundraiser that eventually saw $ 8 billion contributed to vaccine development. And several statements have been made about how, if everything works, there is hope for a vaccine later this year.

Given all this, it is important to remember that vaccines generally take years to emerge from the trial stage alone. And once testing is complete, there is still the question of doing full-scale manufacturing and distribution at a time when everyone wants a vaccine.

the New York Times It has a helpful explainer about what it really takes to make a vaccine.

Meanwhile, other approaches are also being explored. For example, the United States and Japan have approved the use of the drug remdesivir for patients with Covid-19, as it appears to reduce recovery time. India’s ministry of health is investigating the production of the drug in the country, although it is important to remember that it will only be used to speed recovery.

Other researchers have successfully isolated antibodies that can prevent infection. But antibody-based pretreatments have tended to be “high-cost, niche drugs available primarily in wealthy countries.”

In short, few expect some form of scalable medical solution in 2020. That means we have to spend the rest of this year, at a minimum, with the tools we already have.

So what happens next?

If it’s unclear from the weight of all those details, here’s what is likely: The number of cases will continue to rise in India, and the danger of contracting the new coronavirus will remain very real, even if the blockade ends.

Containment zones and contact tracing could try to slow down the spread of the virus, but these tasks will become even more difficult for authorities once the blockade has ended and people are much more mixed. Heat and humidity can have an effect, but the dense cities of India will remain vulnerable regardless.

That means we can expect the numbers to continue to rise in the coming months.

“Currently, cases continue to grow at a fixed rate, even more so at times, making it very difficult to predict when the peak will come,” said Guleria, director of AIIMS. “But a peak is expected around June or July. That is why we must be prepared for it and more vigilant to reduce the number of cases. ”

In fact, Guleria asks that the blockade be extended. Others have argued for increasing and decreasing movement restrictions, as numbers increase, to prevent hospitals from being overwhelmed.

It is still unclear what the government’s plans are for after May 17, when the third phase of the blockade ends. But even if the government stops calling it a blockade after that date, life is unlikely to return to normal.

The guidelines for social distancing will remain in force: in public spaces, on public transport, in offices, on airplanes and beyond. Many countries have banned large gatherings until later in the year, and question marks remain about the future of businesses like gyms, bars, cinemas, music concerts, and sports leagues, all of which are difficult to operate without large crowds. Traveling, especially across states and countries, will not be the same.

A global team of epidemiologists led by scientists from the US-based University of Minnesota. USA And the Harvard TH School of Public Health estimated three different scenarios for Covid-19 cases in the coming months.

Their conclusion suggests that we need to be prepared to live with Covid-19, and all the security measures it needs, until 2022.

“Whatever scenario the pandemic follows (assuming at least some level of ongoing mitigation measures), we must be prepared for at least another 18 to 24 months of significant COVID-19 activity, with critical points appearing periodically in various geographical areas. ” The investigators said. “As the pandemic decreases, SARS-CoV-2 is likely to continue to circulate in the human population and synchronize to a seasonal pattern with decreased severity over time.”

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