While we gear up to live with COVID-19, it is of utmost importance to protect the vulnerable. Protecting the vulnerable essentially means ensuring that deaths don’t sweep through the concentration of high-risk people, especially in confined spaces. To that extent, epidemiologically, we should be as much guided by dispersion index as by Ro. Therefore, preventing the next wave of deaths should be guided by how well we can prevent large gatherings.
Preventing high-risk groups to cluster together is a luxury that India cannot afford easily. Take slums, for example, we cannot do anything to change the infrastructure. In urban slums, the actions should be guided by practically implementable solutions such as those practices in Dharavi, Mumbai. However, the potential surge in cases in India will have to be examined in the backdrop of clusters were induced by the ones such as Delhi’s Nizamuddin area and Tamil Nadu’s crowded Koyambedu market. As much we need to develop and implement the guidelines on how to limit large congregations, it is the jathres (melas) or weddings which can be turned into micro clusters due to recent imports to Karnataka. In the recent Nanded cluster, it turned out that the 306 pilgrims screened for the virus, 32 were tested positive.
In the short term, one of the potential ways to prevent in the immediate future is to simply stop the congregations, gathered for any purpose. For example, people who have travelled from other states have queued up near the palace grounds in Bengaluru. Holding groups of people in one area might be administratively convenient. However, from the perspective of containment, this is a potential disaster. This can result in an accelerated spread of disease. Stranded next to each other in the ques for a longer time will increase the propensity of the uninfected to get infected from the travellers harbouring the virus. With long travel and poor immunity, the overcrowded finite area is a perfect setting for the virus to find perfect hosts and spread.
Conducting serological surveys in these high-risk settlements should guide the kind of response that we should take at different levels. From an action point of view, the best thing is to decongest in whatever way possible and feasible without resulting in undue hardships. Easy things first, one, there should be a mandatory ban on large events for the next three months that requires a large number of high-risk people in confined spaces for a longer time. Two, the children are known to have lower rates of infection and fatality. However, one in three children are undernourished, and nearly half of all deaths in children under 5 are due to undernutrition. Undernourished children are at greater risk of infection due to lower immunity. Therefore, it may not be best advised to open schools too soon and too widely. Three, actionable plans for decongesting places having high-risk persons should be developed.
These include old age homes, orphanages, prisons and institutional quarantine. Extraordinary measures should be taken to protect the high-risk vulnerable people in slums and temporary settlements with migrants. The least we can do it is to map all these places and ensure the infection doesn’t affect them adversely. This can be coupled with mandatory use of masks and other physical distancing measures.
There is only a limit to which the governments can develop and implement policies regulating human behaviour. Government can provide the knowledge, but converting this into behaviours lie with the people. It is, therefore, very important for each person in the community to do their bit in responsible conduct. The educated also have the additional responsibility of informing and empowering the less privileged. Towards this, we should be starting off with actions that emanate from our behaviours. It might amount different things for different people.
For example, it might mean calling off a party that folks have planned after lockdown 4, postponing conferences, halting running in groups or marathons for some time and putting off any plans for reunions. There are several hardships that will result from such decisions. However, these hardships are relative inconveniences compared to the deaths that are induced in the vulnerable due to our behaviour.
(The writer is Professor and Head-Lifecourse Epidemiology, Indian Institute of Public health, PHFI, Bengaluru)