Successful intervention will also mean that the overall infections get spread over a longer period of time, lowering the peak, than happening over a short period, with a much higher peak, and overwhelming the health infrastructure.
The Indian Council of Medical Research (ICMR) warned last week that India has 30 days to limit stage III (infection spreads through the community, just before it becomes an epidemic) of the SARS CoV-2 outbreak. Indeed, as Adam Kucharski, an epidemiologist with expertise in contagion, from the London School of Hygiene and Tropical Medicine, tweeted, with each Covid-19 case in the early stage of the outbreak infecting 2.5 others (average replication rate, or Ro, of 2.5) and a new infection lagging a previous one by ~5 days, halving transmission through measures such as social distancing will lead to just 4 more cases instead of the 244 expected in the normal course.
Interventions like social distancing, contact tracing, etc, could help bring down cases and linked fatality. For perspective, a New York Times epidemiological model developed with scientists shows that if the contagion is allowed to progress in the US the way it is doing currently, there could be as many as 9.4 million infections at the peak and nearly 1 million could die, with as many as 100 million infected overall, versus a peak infection of 3 million and 320,000 deaths if “additional interventions” were put in place last week. Successful intervention will also mean that the overall infections get spread over a longer period of time, lowering the peak, than happening over a short period, with a much higher peak, and overwhelming the health infrastructure. It is, therefore, welcome that the Centre has issued an advisory on social distancing to the states and UTs. While ICMR, as per an Economic Times report, deems community transmission inevitable, the government, both the Centre and the states, is moving on measures such as quarantine, home isolation, hygiene awareness, etc. One of the crucial steps that seems to be on a relatively weaker wicket is testing. South Korea has shown the efficacy of massive, widespread testing efforts—with nearly 10,000 tests run a day—in detecting cases early. Though ICMR has now increased random testing to check for community infection, the fact is just 52 laboratories with capacity to test 90 samples daily have been designated for testing and 57 laboratories for sample collection. This may not be enough when it comes to preparing for the pandemic. The testing strategy remains based on contact tracing and testing of those who showed symptoms during the home isolation period of 14 days, but given there are reports from elsewhere of individuals remaining asymptomatic for more than the 14-day quarantine advised by the WHO for high-risk individuals, India should rethink this. This would mean that there will be a need for a large number of testing kits—the ICMR laboratories have 100,000 kits, another 200,000 have been ordered from Germany.
While preventive measures have to be the frontline of India’s strategy to fight SARS CoV-2, pharmacological solutions are also key. To that end, the ICMR isolating the SARS CoV-2 strain is good news, as is the fact that doctors at the Sawai Man Singh government hospital in Jaipur have come up with a treatment protocol, involving antiretroviral drugs used in HIV management, antimalarials and swine flu drugs. The Centre has done well to look into the protocol, and the sooner it is formalised as a part of the pan-India treatment protocol, the better. At the same time, the government needs to rope in the private sector immediately. Testing at a research laboratory at Manipal University had helped Kerala fight Nipah. Both South Korea and the US have harnessed private sector capabilities; given India has a large network of private labs, some of which already conduct high-risk-level testing, it would be unfortunate if this resource is passed over.