Increase coronavirus tests, improve surveillance

Strategies, preventive measures and behavioural changes have to be designed to ensure the safety of those who are at high risk

Age is a non-modifiable risk factor and comorbidities are a result of several health determinants. Studies suggest both are significant risk factors and constitute a high proportion of coronavirus patients and its fatalities. With increase in age, people have higher comorbidities and are susceptible to infection due to poor immunity. In Karnataka, as of June 2, although only 6% of 3,796 cases were above 60 years old, at least 58% of deaths (33 out of 57) were observed in this age group. Out of 57 deaths, 38 had comorbidities.

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Strategies, preventive measures and behavioural changes have to be designed and implemented by policymakers and society to ensure the safety of those who are at high risk.

Going forward, the government policies in ensuring the safety of those at high risk should be guided by evidence. Behavioural attributes are significant in the case of a pandemic like this. Wearing a mask and maintaining physical distancing, while ensuring social cohesion, is imperative to ensure the physical and mental health of the elderly.

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In the initial phase of relaxations, the reopening of religious institutions will put the vulnerable population at high risk. There is a higher chance that the elderly would visit religious institutions. Similarly, one in three children are undernourished in the country and it is not a good idea to start going to school. There can be graded response based on the increase in caseload.

Policymakers should focus on interventions to prevent crowding, managing closed spaces and minimising close contact. Most importantly, super-spreading events, where some clusters spread more than the others, are to be identified. In addition to this, reverse quarantine should be followed, where the healthy people give special attention to protect the elderly, taking care not to move close to them without a mask.

Vigilant monitoring of cases and prompt reporting is of vital importance at this stage.

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Also, preventive aspects and policy actions should target minimising risk factors of noncommunicable diseases. People with underlying health conditions such as obesity, diabetes, hypertension are more prone to COVID-19. Healthy lifestyle practices will be helpful. Also, strategies to remove unnecessary fear and anxiety among the public should be scaled up on priority.

Finally, it is time that policymakers invest more resources in training the health workers and creating a specialist workforce consisting of public health professionals, starting from the taluk level. Each one should invest greater amount of time in getting healthy and remaining fit with good food and exercise.

It is imperative to critically examine the current strategies as a majority of these people will be moving out after June 8 to earn a livelihood.

After the relaxation of lockdown, a majority of people are coming from other states, where there are a higher number of cases. In such cases, institutional quarantine is not feasible for each person, it could be limited to only those who do not have a home in the state. Home quarantine can be advised for others.

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As much as possible, we need to limit our travel and visit places only for essential purposes. More people should be encouraged to continue to work from home. Additionally, all potential super spreader events need to be postponed.

It is preferable to postpone any form of social gathering for a few months. Increase in the number of tests as well as improvement in surveillance, serological surveys will go a long way in tackling the crisis.

(The writer is Professor and Head, Lifecourse Epidemiology, Public Health Foundation of India, Bengaluru)