By Dr S. Saraswathi
More than five months have elapsed since we started the lockdown and we are now in the phase of relaxing restrictions despite a huge surge in cases of COVID-19 in many places. India reported 79,000 fresh cases on 29 August — highest number globally for a single day — when even USA recorded about 500 less number. In global comparison, India returned the highest number of COVID cases per week in the past week, and also the highest monthly cases in August, taking the total number of the affected to over 3.6 million.
Percentage of death to total cases and time taken for doubling of cases are technical details showing the virulence of the infection. For the common man, the number of cases, its spread, its status in the neighbourhood, workplace and other places/persons in their circle of contacts matter most. These factors determine his chances of catching the deadly disease and his reaction to the lifting of the lockdown.
Since the lockdown is being relaxed amidst reports of clustered outbreak of fresh cases of COVID-19 particularly in occupational settings, we have to believe that there are compelling reasons for this decision. The challenge with asymptomatic infection is said to be intensifying with removal of travel restrictions and opening of the public transport system. State Governments are aware that the vigil against the infection has to be intensified and health machinery is to be kept fully geared to meet exigencies. Truly, a novel experience of knowingly taking health risk under economic compulsions!
Authorities and people are visibly concerned about the inevitable consequences to be faced if people do not behave. Therefore, arrangements are being made particularly in workplaces and norms and guidelines are given with instructions to strictly enforce these. Unlock is accompanied with close monitoring of people’s behaviour.
Post-lockdown period is going to be tension-ridden with isolation, distancing, uncertainty, and inconvenience being thrust as normal in social life. Hereafter, following reports regarding the course of the pandemic must become a habit. Number of close face-to-face contacts has to be kept as low as possible and high risk activities as short as possible. Remote learning and work introduced during lockdown will tend to stay even after the demise of the pandemic. Under fear of the virus lurking anywhere, we have to reduce our exposure to the world around as a preventive method in the belief that the dosage makes the poison. Face-mask, gloves, and hand-washing have become common, but social distancing is often flouted even by some leaders expected to set examples. Houses may become more orderly with allotted space and time for different activity at least for those who can afford.
Social-economic conditions are such not only in India, but all over the world, that men and women have to learn to live with the pandemic around and simultaneously make every effort to fight its spread and virulence before it can be eliminated altogether. Our hope lies in finding a vaccine. Lockdown surely is an effective method of containing the spread of the disease provided it is followed. There are two sets of people – those in favour of and those against lockdown restrictions. But, all of them have to make adjustments in their daily life patterns enforced by the onslaught of the pandemic irrespective of imposition of lockdown.
First and foremost, lifting lockdown or relaxing restrictions does not mean that the virus is weakening. It means that hereafter we have to lead a double life struggling to continue with normal activities and adhere to pandemic restrictions. Unlock 4.0 guidelines scheduled to start from 1 September cannot be read as lifting of the road block to old and familiar patterns of life like lifting of curfew after a war and surrender of the enemy. Rather, they are crucial tests to assess what we have learnt about the pandemic, and how equipped we are to re-design our life to cope with medical emergencies. Unlock does not mean that we can run in the open as people do when heavy rains stop. Such unruly behaviour will invite re-imposition of restrictions in no time. Since there can be no activity without virus threat and the world cannot forever stop activities, we are cornered to take risky decisions.
Active coronavirus cases have crossed 3.5 million in India. It is not likely to abate soon in the opinion of medical experts. Epidemiologically, India presents a picture of a continent of many countries, according to doctors. This is evident from the way it has spread in different States. Mapping of districts, and corporation zones within districts, and within zones spotting hot spots have been possible and adopted to better manage disease control and patient care. It is an administrative strategy based on actual cases as the spread of the disease in different parts of the country is bound to be different. Lockdown as well as unlock guidelines and rules have to be different also. Multiple strategies are required to contain the infection.
It is almost impossible to restore complete normalcy in human life and activities in any one country in isolation in this age of globalization and more so in any one State or district within a country. Wholesale action and remedies are required for total eradication without which lasting solution is not possible. Protecting pockets of areas or people does not lead to eradication of epidemics. Vaccines, wherever they are produced should be made available to all countries. Ideally, immunity efforts have to be global and definitely national.
Routine health services, severely affected because of COVID-19 emergencies, may cause widespread damages as bad as the pandemic. Even the essential immunisation services for children are halted in many places. Institutional deliveries that have slowly been adopted in rural India are affected by diversion of medical attendants to COVID care. Routine check-ups for non-communicable diseases are postponed thus increasing the risk of patients. It is time to restore these health services without loosening our grip over treatment and prevention of COVID-19 cases. WHO has asked member-countries in South-East Asia to maintain essential health services and accelerate resumption of disrupted services hit by the pandemic.
The pandemic has stimulated a spirit of national self-reliance and has also pointed to the need for opening of supply chains and data flows for mutual benefit of nations. Nations must have realised the importance of collective action to fight the epidemic and build the shattered economy with local resources.
The gravity of the infection intensifying global search for remedies, the importance of international cooperation in medical research is acknowledged. Indigenous systems of medicine must also be encouraged and assisted to manufacture resistance-building and preventive therapies. COVID-19 has provided opportunities to learn about our immune system and seek advice on healthy lifestyle.
It is the virus which will be winning as long as we do not have a thorough knowledge of the disease, potent medicine for cure and a vaccine for prevention. We are still in the stage of restraining the destructive capacity of the pandemic. Lockdown or Unlock – everyone has to remain conscious of the presence of the pandemic. Eternal Vigilance is the price of health. –INFA
(The writer is former Director ICSSR, New Delhi)