SHILLONG: There is still a lot of confusion about the number of days of quarantine required for high risk and low risk contacts of COVID patients. To clear these doubts, The Shillong Times posed some questions to epidemiologists, Dr Rajiv Sarkar and Dr Eliza Dutta at the Indian Institute for Public Health (IIPH), Shillong. Dr Rajiv is the lead infectious disease epidemiologist.
Here are some excerpts:
ST: As public health experts, how is your reading of the COVID situation in Meghalaya?
RS/ED: The trajectory of the pandemic in Meghalaya is one of the lowest in India. This can largely be attributed to the control measures adopted by the Meghalaya government such as border monitoring, aggressive testing protocols, involvement of communities for management of COVID within their localities, etc.
Additionally, the model of considering all individuals as ‘asymptomatic carriers’ and the ‘behaviour change model’ is a positive step towards minimising the spread of COVID within the state. These efforts, coupled with community support and participation have helped control the spread at the community level. But it has also led to increased fear and stigma, many of which are illogical but related to this pandemic. It is now time to adapt to the new normal and move forward, while adhering to the prescribed precautions and preventive measures.
ST: Is the government and health authorities prepared to deal with the rising cases in view of the community spread? Where do you think there is need to ramp up interventions?
RS/ED: In managing the COVID pandemic in Meghalaya, the government and the health authorities have involved experts and actively sought their advice and guidance. The case fatality ratio of Meghalaya is lower than the national average currently. At the beginning of the pandemic, a mathematical model of COVID spread in Meghalaya was developed, which informed the initial preparedness in the state. Following the spurt of cases in July and August, a statistical model was developed to predict the disease trajectory for the next few months, considering the current trajectory of the disease.
The random testing in market places, the behaviour change model, setting up local COVID management committees, all point towards a resolve to minimise the spread of COVID cases in the state. It is now largely up to the residents to adhere to the preventive measures such as wearing face masks, hand hygiene, respiratory etiquettes and physical distancing to minimise the spread of the disease in their communities.
ST: What would your suggestions be to the public in terms of quarantine and isolation as there seems to be a lot of confusion as to when a person should ideally be tested after having come in contact with a person who tests COVID positive?
RS/ED: After coming in contact with a person who has tested positive, the person should first isolate himself/herself and follow strict self-imposed home quarantine (even from the family members) and keep tracking their symptoms. In case of any respiratory distress, he/she should contact the local health/community worker/helpline immediately.
Prescribed precautionary measures should be followed by other family members as well and, ideally, everyone should follow self-imposed home quarantine and tracking of symptoms. It is best to test after about five days of exposure to a patient and the recommended quarantine period is 10 days. However, testing is not mandatory; often the purpose of testing is for isolation and reduction of risk to others.
ST: Is it alright for anyone to just go to a testing centre and get tested without a doctor’s prescription?
RS/ED: Test positivity depends on many factors, such as the sensitivity of the diagnostic test (probability that the test will diagnose true positive), the test used as well as the timing of the test in relation to the exposure. Taking this into consideration and the current trajectory of the pandemic in Meghalaya, it is not necessary to go to a doctor and get tested because:
a) A negative test result does not guarantee that the person is infection-free. b) Crowding at testing centres may increase the risk of acquiring infection. c) Sensitivity of the Rapid Antigen Test is 50-60 per cent, which can lead to many false-positives. d) Indiscriminate testing will put additional strain on the health system and contribute to delays in processing.
In such scenarios, self-imposed home quarantine with regular tracking of symptoms for 10 days along with the prescribed precautionary measures is more effective.
ST: Also please remind us who is (a) a primary contact and (b) a secondary contact.
RS/ED: A primary contact is a person who has come in direct contact with a COVID-positive case. Secondary contact usually comprises family members/friends who have come in contact with the primary contact. At this stage of the epidemic, it is best to avoid these terms. A better terminology is to use high risk and low risk exposure. High risk implies close contact with a COVID proven case who is not using precautions such as face mask and physical distance. This includes coming in contact with bodily fluids of patients without protection of gloves and/or other hand hygiene measures.