By Prof. Sidhartha Das
Proactive steps taken by Central Government and many state Governments including Odisha has been lauded widely. The WHO and many international agencies have praised our country for the same. The lockdown is in continuum and on the whole the response and participation of people in maintaining lockdown and social distancing has been overwhelming till date.
I want to clarify that, more widespread testing for Covid 19 virus has to be done and had suggested the availability of equipment for testing by Rt.PCR in the State, suggested that all cases with respiratory complaints attending any hospital (Govt. and Private) need to be captured, collated and followed up. Fortunately Govt. of Odisha has officially implemented the same effectively.
In the course of this very challenging pandemic of Covid 19 infection, many disturbing facts have come to the forefront viz : In spite of the near successful lockdown all over India since 23rd March , 21st March in Odisha, the spread of Covid 19 infection has no been contained. On the contrary, the number of positive cases double every fourth day and death has touched 109 mark.
Still more alarming, the population infected are not senescent but young. 83% of patients are below 60 years of age. 50.49% are below 40 years of age. This is paradoxical to the global experience. (Times of India, 5th April,2020)
Most cases detected in the young population have travel history from abroad, countries where Covid 19 infection is rampant. In the present scenario, we are trying to trace the travel history as well as contact history of each such case retrospectively. In the process we are likely to miss many links and many contacts who are potential patients. Besides, it puts a huge human resources burden on the state of making multiple teams to track the contacts.
In a vast country as ours with huge young population and people living in many places with very very high density of inhabitants, newer or additional strategies need to be adopted urgently.
This is more so because there are many queer peculiarities in the epidemiology and natural history of Covid 19 infection (Lancet 2020; 395: 507–13), 10 to 15 days may pass before patient develops acute respiratory symptoms. One fourth of infected patients have near normal temperature. If the patient had taken paracetamol for fever, the percentage of false negative will be much more. For survivors ( who did not die of Covid 19) , the median duration of viral shedding (potentiality to infect others) was 20.0 days (IQR 17.0– 24.0) from illness onset The shortest observed duration of viral shedding among survivors was 8 days, whereas the longest was 37 days as per the thelancet report March 9, 2020. The possibility of a person getting second time infected with Covid 19, after recovery from first attack, is neither negated nor established till now by scientific research /epidemiological analyses.
Keeping in view the above dynamics of this disastrous pandemic of Covid 19 infection in INDIA it may be rationally suggested that, All persons who have entered India after 15th of March , through airport or seaport, have to be tracked. The M.E.A. and local immigration authorities of each international port of entry can easily give the details. The passport details and mobile number of each such person should be made available to the concerned State / U.T. Governments within 24 hours depending on the address of residence of the concerned person. Local police stations can easily verify the status of such foreign return person. Then testing for likely Covid 19 infection has to be done in the person and the contacts. Necessary quarantine measures or admission to Covid 19 hospitals can be decided by local health authorities.
After discharge, the patients cured of active Covid 19 infection are potential spreaders too , vide supra (c) , so need to be advised for confinement in house for three weeks more. As evidences are generated by keenly observing the natural history and spread of Covid 19 in India, more practical suggestions will emerge from persons/agencies involved in Medical Epidemiology Research.