Dr. Basab Ghosh

March 27, 2020, 15:36:14   

[Dr Basab Ghosh, Diabetologist, Dr Basab's Diabetes Care, Opposite Ramnagar 3, Krishnanagar, Agartala, Tripura. email: ]

Recently COVID-19 crisis has introduced new words like 'Self-quarantine', 'Social-distance', 'Lockdown', etc in our common people vocabulary! Since last many years our common man ear drum is synchronised with cancer, diabetes, hypertension, hear attack, kidney failure, etc; in medical science we call them non-communicable diseases, means they are not spreading from one person to another. Suddenly since the beginning of 2020, all attention is captured by COVID-19. This a highly infectious viral disease which is infecting people very fast, also rapidly spreading in the community or even beyond community to different country and disease beginning to severity to ICU to ultimate death is also very fast. It is the new member in the communicable disease group of viral infectious disease.

On first week of January 2020, I first noticed in news that coronavirus outbreak is a serious concern in China. Frankly speaking not even paid much attention to that news, might be because I am not a virologist or a microbiologist! Within a month, when I realised this new viral infection from Hubei province of China travelled to more than 20 countries by 30th January 2020, it was not digested in my little brain; got to know very serious viral contamination happened in the Huanan Seafood Wholesale Market in Wuhan City of Hubei province in China during mid November 2019 which thought to be the beginning of this viral infection! So gradually started following the subject in scientific literatures and journals.

In the mean time, on 11 February 2020 World Health Organization (WHO) announced "COVID-19" as the name of this new disease caused by corona virus Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2). The CoronaVirus (CoV) family is not new. They are certain type of zoonotic virus family that causes respiratory illnesses in animals and zoonotic diseases from animals to humans.  Zoonotic diseases are an infectious disease caused by bacteria, viruses, or parasites that spread from non-human animals to humans. Sometimes coronaviruses that infect animals can change in structure and character to become a new human respiratory virus and make people sick. Once it is human virus it will spread from human to human by droplets which are discharged through our coughing and sneezing. Human coronaviruses were first identified in the mid 1960s. There are seven wild coronaviruses that become human coronavirus, SARS-CoV-2 is the latest one and four types already exist as mild flu type viruses in our daily cough and cold. Other two SARS and MERS viruses caused outbreaks in 2002-2005 and 2012-2015 respectively.

I got shocked when WHO on 11th March 2020 declared the rapidly spreading COVID-19 a pandemic, acknowledging the virus will likely spread to all countries on the globe. Pandemic is not a word to use lightly or carelessly, I thought my grey matter requires some exercise and get involved in more scientific literatures and journals to know the facts and its way outs!

SARS outbreak of 2002-2005

We are in a situation which is closely related to SARS virus outbreak of 2002-2005, because new virus SARS-CoV-2 has some similarity with SARS virus. Like that crisis this time also we have no specific treatment or vaccine. In the similar situation, the remarkable achievement of SARS 2002-2005 outbreak control was only possible because of meticulous implementation of traditional public health measures to control disease spread. Progression to severe disease and death was more aggressive in SARS 2002.

Enforcement of community-wide control measures to control the virus outbreak is far more complex than isolation or quarantine of individual because of the larger number of people involved in community-wide control. During SARS 2002-2005, China best demonstrated 'Social –distancing' by large-scale quarantine first time by declaring epidemic zones and placing people under collective quarantine in villages, cities, or institutions. The strict control measures included 'Social-distancing' with school closures and closures of all universities and public places, as well as the cancellation of the public holiday from May 2003. Immediately, the fresh cases decreased greatly and consistently. The world was able to completely interrupt human-to-human transmission to halt the epidemic and SARS virus is now eradicated.

COVID-19 Pandemic in India

We need to rely again on same old classical public health measures to curb the pandemic of this respiratory disease COVID-19. 'Social-distance' is implemented to reduce the frequency and intensity of people's exposure to the virus during an outbreak. While searching Google, I came to know in preventive and social medicine history Social-distance was first exercised during 1916 New York City polio epidemic and thereafter during every infectious disease outbreak the well proved protocol implemented successfully. The well established protocol of Social-distance consists of school closures, workplace closures, quarantine of possible suspects, isolation of confirmed cases, restriction of movement of people by controlling all transportation system, cancelling mass gathering, closure of community recreational centres like, swimming pools, gymnasiums, etc, implementation of personal protection by facemask use, promoting personal hygiene by hand washing, regular cleaning of surface and area, work at home policy of the offices. In India, our government gradually imposed all possible measures one by one under the guidelines of WHO.

In India first COVID-19 positive confirmed case was detected on 30th January 2020 in Kerala; he who was a university student from Wuhan travelled back to home and found positive virus infection. WHO declares pandemic on 11th March 2020; that day we had total 70 confirmed cases. But the great observation is that in India there was already awareness campaign for Social-distance by different state governments under the guidance of central health ministry with WHO guidelines. This respiratory virus is exported from outside India, so Social-distance with suspected travelers is the only solution to prevent its transmission. Our Prime Minister created history in prevented disease control protocol by declaring Janta-curfew on 22nd March 2020 from 7am to 9pm. On 19th March and 22nd March we had total 199 and 403 confirmed cases respectively. Again if we follow the numbers, on 30th January we got our 1st confirmed case and the number jumped to 403 on 22nd March in spite of strict measures of Social-distance implementation! Definitely next step Lockdown was in consideration. As a medical professional we are aware of the term 'Social-distance', but I was wondering when did I hear the word 'Lockdown' and what it means in prevented medicine?

Lockdown in India

lockdown is an emergency protocol that prevents people from a definite area leaving to another place. The protocol can usually only be initiated by someone in a position of authority. A complete lockdown usually means that people must stay where they are and may not enter or exit from that area. Still I was not getting record of complete lockdown of any area or province or city or country in medical history! According to literature "lockdown" tactics were developed in the late 1970's in Southern California, most probably in the Los Angeles Unified School District in response to drive-by shootings and street level crime occurring outside of school buildings; that was not for medical issue of disease prevention.

In my journey in search of my answers to those questions, I thought, I would end up in long history. But the result landed me in 2003 SARS outbreak control again; China 'locked down' Beijing and closed more than 3500 public places in an effort to control community spread and got success immediately in community control of the disease. Now I know, 'Lockdown' is implemented first time for actions related to mass quarantines in disease control by China in 2002-2003 SARS outbreaks. Lockdowns can limit movements or activities in a community while allowing most organizations to function normally, or limit movements or activities such that only organizations supplying basic needs and services can function normally. The speed of spread of COVID-19 is very fast. Despite massive control efforts, the spread of disease from the first documented case in early December 2019 in Wuhan to total cases of 1,18,000 in 114 countries by the 11th March 2020 is certainly much faster than expected, when compared with much similar SARS viral outbreak of 2002.

Might be with their previous successful experience, during peak of the crisis of COVID-19 China implemented Lockdown in worst effected first epicentre of pandemic in Wuhan city of Hubei province on 23rd January 2020, then gradually to other few more cities and ultimately massive quarantine of approximately six crores population was possible with Lockdown. Within eight weeks of Lockdown new cases of the virus transmitting within the area dropped to zero. China is now gradually lifting Lockdown. On 22nd March Wuhan loosens its Lockdown for few essential services; subsequently on 25th March Hubei lifts Lockdown outside of Wuhan. Lockdown in Wuhan is due to be lifted on 8th April 2020 after nearly 11 weeks and countries around the world will be watching closely whether infections surge again.

Italy suffered badly for COVID-19 due to their international policy. Lots of Chinese are migrated in Italy for jobs due to both countries good economical relation. During 'Spring-festival' in China they all came home and got the infection and immediately after the festival returned to Italy and to other migrated countries. This time on 1st February, Italian Mayor urged citizens to 'Hug a Chinese' as part of a campaign to fight racism in the middle of coronavirus outbreak and immediately saw its first confirmed case of COVID-19. Within a short spun of time positive cases were increased at sky level in Italy. Before pandemic, on 28th February WHO had upgraded the risk of global spread by the COVID-19 virus to "very high", but Italy under estimated the situation. Within a short spun of time Italy has become the second epicentre of the pandemic after Wuhan. Ultimately Italy had imposed lockdown to the whole country on 10th March 2020.

In India as on 26th March 2020, total confirmed cases are 735 in 27 states and union territories; where as our first confirmed case was on 30th January 2020. If we see the number of new cases in last 10 days from 17th March to 26th March, they are 19, 25, 28, 59, 76, 69, 102, 66, 86, 78. Large scale community control was needed and our Prime Minister experimentally imposed Janta-curfew on 22nd March from 7 am to 9 pm to observe public response to his call for Social-distance and if you see slightly the rising number halted on 22nd March, though I know it's too early to comment like that! For drastic implementation of social-distancing next step of large scale community control was the need of the hour and form mid night 25th March nationwide Complete Lockdown for 21 days was imposed, limiting the movements of 136 crores population , which is the biggest ever in history as Wuhan Lockdown restricted about 6 crores movement in 2003 SARS outbreak time. Who representative to India Dr. Henk Bekedam praised the decision and described as "timely, comprehensive and robust".

What is next to 21 days complete Lockdown?

COVID-19 has already taken more than 13,000 lives worldwide. Nationwide complete Lockdown was a heroic decision and was ultimatum to control large scale community spread. In spite of huge socio-economical instability in India our Prime Minister might take critical decision of further extension of Lockdown beyond three weeks time; with our experience with Lockdown of Wuhan city and few more cities of Hubei province, we have seen it took eight weeks of Lockdown for new cases of COVID-19 to drop to zero.

Already the most drastic of all classic public health measures the complete Lockdown is implemented to control community spread by largest social-distancing; alongside successful execution of the followings are mandatory to achieve the ultimate success,

1.     Community use of facemask with easy availability in affordable price; alternate homemade facemask in the form of double layered handkerchief, gamosa in double layer, piece of cloth in double layer, etc must be used when exposed to community for essential services.  

2.     Tracking of all close contacts of COVID-19 positive patients and their viral screening and put them under quarantine for 14 days; availability of diagnostic kit should not be a huge challenge to the authority.

3.     Picking up all COVID-19 cases from the suspected patients with timely viral screening and then put them under isolation and medical care; availability of life supportive medicines and equipments should not be a huge challenge to the authority.

4.     Thoughtful extension of Lockdown duration beyond 21 days as WHO executive director, Mr. Mike Ryan cautioned India to get preparation to prevent second and third wave of infections!

5.     Gradual loosening of essential services in some parts during Lockdown of the country; if any part of India achieve early sustainable zero transmission of virus. This will reduce the socio-economical burden to some extent and help in future growth.

Let us know the positives in this critical scenario

A.   Within a time interval of three weeks from the first case identification on first week of December 2019, the virus is isolated on last week of December 2019; this is very fast in case of COVID-19.

B.   Even diagnostic tests were available globally within 2 weeks of reports of cases from China.

C.  In such a short period of approximately ten weeks from isolation of the virus a clinical trial of vaccine is undergoing which is unprecedented!

Those show the power of international co-operative science. With all the facts in hand government must have certain specific programmes, so in this medical emergency let us fights together by joining hand with the government machineries to come out from this extreme situation! Now all countries have higher medical standards, better educated health-care workforce, and more technical and scientific expertise in 2020, but awareness among common people is the key of the success in this global war and here is the important role of social workers and local clubs and they must come out of the shell to share the responsibility!


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