COVID-19: Currently, the authorities are aiming that even if there is some community spread, they should be able to contain it and localise it.
Coronavirus in India: India’s top pulmonologist and Director of AIIMS Dr Randeep Guleria, who is also a member of the technical committee which is guiding the strategies for the prevention and control of COVID-19, talked to IE about India closing its borders and what has surprised him about the pandemic so far. Dr Guleria said that he was surprised at how some countries took the pandemic lightly, thinking that they were immune to the virus, or how the virus would not travel to their country, even when they had the time to act after witnessing what happened in China.
Talking about what surprised him in India, Dr Guleria told IE that the response to Prime Minister Narendra Modi’s appeal for Janata Curfew disappointed him. Despite PM Modi making people understand why the curfew was important, some groups did not follow it and he was surprised by that reaction. He further stated that the fight against coronavirus is a citizens’ movement and has to be fought at the community level instead of at the hospital level. The hospitals would treat the people who fall sick, but it is actually the community which will be able to stop the spread of the pandemic, he explained.
COVID-19: On India’s plan to deal with community transmission
The IE report quoted Dr Guleria as saying that ultimately, the stage of community transmission will occur in all pandemics. He further said that even if India could contain the spread and prevent that stage at this point, later on when the travel opens up and movement of people picks up again, someone with infection could travel and cause the virus to spread.
He said it would not be correct to say that India would not have community transmission, because there will be some in any case. However, at this point, the authorities are focusing on flattening out the curve of the increase in number of cases so that the medical system and the health resources are not burdened with a lot of cases at the same time and can consequently provide better quality of treatment.
Moreover, currently, the authorities are aiming that even if there is some community spread, they should be able to contain it and localise it, so that it does not spread to other areas and the health resources can be deployed towards treating that small community more effectively.
Impact of higher temperature on COVID-19
Explaining the theory about impact of temperature on the coronavirus to IE, Dr Guleria said that as per the theory, the virus would not be able to sustain for long as the temperature rises. He added that the virus would probably not survive outside if the temperature exceeds 40 degrees Celsius. However, he said that two things need to be considered – one, the outbreaks of COVID-19 are still being witnessed in countries like Singapore which have a tropical climate and two, a lot of people spend quite some time indoors with air-conditioned temperature. So if someone is having a cough and cold, the virus would be able to survive indoors for a long time. It could be in places like shopping malls and offices, and so the virus could still spread. Summer can therefore contain the spread outdoors, but indoors is not highly possible.
Challenges regarding COVID-19 in India
Calling the COVID-19 pandemic a unique one in many ways, Dr Guleria told IE that most worrisome pandemic is one which causes pneumonia as well as respiratory failure due to a requirement of very high-end treatment and protection. If the pandemic is caused by a water-borne agent, it can be controlled in an easier way. However, he said that most of the pandemics are caused by droplet infections which spread very rapidly. They are often milder, he said, like H1N1, but in the case of COVID-19, health authorities do not know what the mortality is.
He also said that the disease is spreading very fast and the rate of mortality in high-risk patients is significant. Thus, any hospital is faced with the challenge of upscaling its critical care infrastructure, like figuring out how to procure more ventilators or how to make the existing ventilators free to use. Moreover, they are also faced with the challenge of ensuring the proper safety of their healthcare workers, which requires a large amount of personal protective equipment (PPE).
Even more important is that hospitals have to figure out how the fear and worries of the medical professionals can be put to rest, as they are worried for their own health, the health of their families and are afraid that they might be taking the virus home with themselves. He said that that is something they are trying to work upon.
He also asserted that India currently has adequate stocks of PPE, adding that they need to formulate proper strategies to solve the problem related to ventilators.
He further said that in order to contain the spread, there needs to be a separate hospital or building, learning from the experience of Italy, where COVID and non-COVID patients were kept in common wards and the infection spread was very rapid. If a separate facility is designated, the resources can be focused there, with the requirement for PPEs coming down and a decline in spread of infection.
Moreover, it is also important to have manpower that is especially trained in controlling infections and managing patients who are critically ill. Strategies also need to be developed to administer critical care through telemedicine as is done by some centres, he said, adding that they need to figure out if a method can be devised through which a specialist can look over two or three ICUs via telemedicine and advise the treating team on how to go forward. He said for this, AIIMS has already established a connect centre, using which doctors from across India can talk to them about management on critical care.