We Need A Lockdown. What Are We Waiting For?

Who would have imagined that our news would be dominated with stories of large hospitals in the capital running out of oxygen? Or the apocalyptic scenes of mile-long lines of ambulances and the eerie orange haloes from burning pyres that light up the night sky. This, however, is the tragedy unfolding in hospital after hospital, city after city.

The bad news is that worse is to come if we don't deal with the burgeoning rates of infection.

India has seen one of the fastest rates of increase in cases in the world. New cases have grown 25-fold since March and we are above 3 lakh cases a day, reaching new peaks. (1) Worryingly, case positivity is high; nearly one in five in the country and one in three in Delhi are positive. This signifies the extent to which the second wave is infectious. As opposed to 2020, we are now dealing with much more transmissible variants.

In one study, 80 per cent of cases in Punjab were positive for the highly transmissible UK Kent variant. There are newer double and triple mutants which are keen to make their mark while we scramble to understand their behaviour. The sheer speed of the rise would have caught anyone unawares (the warnings in February notwithstanding). Combine that with public fatigue and disregard for social distancing measures and you have a perfect storm.

Over 2,000 people are dying every day per official estimates. There is underreporting of deaths in many states, making the actual mortality much higher. As the hospitals get overwhelmed, the milder cases who could have improved with just oxygen therapy are unable to get treatment. The young and other low-risk patients who were never expected to die are succumbing in numbers.

Vaccination is a medium to long-term solution. Some seven per cent of the Indian population has received their first dose of the vaccine through an ambitious nationwide programme. Achieving 60 % vaccination to achieve herd immunity levels will take a year (with replete supplies). Forty per cent vaccination may flatten the curve, though this may still take 8 months at the current rate. However, those advocating that we should achieve herd immunity by letting the virus rip through a community are fantasists. It is true that 3% of the people with COVID -19 fall seriously ill - but 3% of a 3 lakh new case count is 9,000 new ill patients per day. This is enough to overwhelm robust health care systems in the West, let alone the poorly-equipped hospitals around the country.

The need of the hour is to break the transmission.

"Lockdown" is a trigger word that invokes memories of economic misery and human suffering epitomised by fleeing migrant labourers and sinking GDP numbers. It is a blunt but necessary instrument designed to cut high rates of transmission. When people don't mingle with other people, the virus spread slows. It does not rid a community of the virus. An important short- term aim is to prevent hospitals becoming overwhelmed. We have crossed that rubric a couple of weeks ago.

It facilitates a break in the chain of transmission so that a test, track, trace (TTT) and vaccinate program can be embedded or reinvigorated. We have just begun to impose restrictions piecemeal while the WHO recommends that the per cent positivity rates be below five per cent for two weeks before restrictions are lifted!

Reinforcing face-masking and social distancing is important but no country with a high case load has regained any semblance of control over Covid without restrictions being placed on movement. The virus will outrun the expansion of healthcare facilities and improvement in vaccination rates. The only way is to clamp it down with strict containment in areas of high prevalence within cities followed by a blitz of testing, tracing, tracking and vaccination. Inertia in action will not only cost lives but will also make the inevitable lockdown/containment longer and more painful economically. Mumbai was forced into it; Delhi entered a containment state soon after. Many cities in Uttar Pradesh and Gujarat are simply burying their heads in the sand.

Time is running out.

(Dr Amit Gupta is a Neonatal Consultant, John Radcliffe Hospital, Oxford. Views are personal and do not reflect those of Oxford University.)

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