‘We need to improve monitoring at home’: Randeep Guleria

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On a day India crossed 500,000 cases, Dr Randeep Guleria, director of All India Institute of Medical Sciences in Delhi speaks about how early lockdown helped, what could have been done to help migrants and what lessons can be learnt from other countries. Excerpts:

When will the pandemic peak?

My own feeling is it that will peak at different times in different areas of the country, as we have seen in the US. It will probably start peaking in the next few weeks in places like Mumbai and Delhi, but in other areas, it may take a little longer for the infections to stabilise. Herd immunity will take a longer period of time.

Rural India has the advantage of good social distancing, and in such areas, the cases will not rise dramatically and the numbers will come down. In the so-called hot spots with high population density, when (infections in) those areas get saturated, we will see the numbers coming down.

In the so-called walled city in Delhi and urban slums like Dharavi in Mumbai, for example, this phenomenon is already being seen and numbers have started coming down. That is where the aggressive containment strategy comes into play, which includes testing, tracing and isolation.

What did we get right?

We implemented the lockdown early and that helped a lot. We were able to prevent a sudden massive increase in cases, as it happened in Europe. We had a gradual rise post lockdown, which gave us about two months to prepare our facilities. For example, from 10,000 tests day, we have crossed cross 200,000 tests a day now, from 100 labs, we now have 1,000 labs testing for Covid. Similarly, from a few isolation wards in select hospitals, we now have Covid hospitals, Covid care centres, dedicated ICUs, ventilators, oxygen, personal protection equipment, procured medicines… protocols are in place, doctors have been trained. All the systems could be put in place for pandemic preparedness.

What could we have done better?

The involvement of communities, social leaders and others for promoting the use of non-pharmacological methods, such as social distancing or wearing masks, for greater public participation in protecting themselves and helping contain infection. It’s unfortunate that despite such a large number of cases, people are still not realising their responsibility in terms of wearing a mask and maintaining social distancing.

We could have better anticipated the movement of migrants and prepared a strategy to support them when they were in the city. This is also where social and community support comes in.

What do we need to do better?

We need an improved mechanism of monitoring people at home and rapidly shifting those who are ill from their homes to the hospital, and making sure hospital beds are available so that people don’t have to run from one hospital to another.

Also, there’s need for aggressive testing, tracing and isolation to prevent an increase in the number of cases, house-to-house monitoring so people stay at home, and aggressive diagnostic testing and containment in hotspots so infection doesn’t spread to other areas.

Why is it spiralling in some regions?

After lockdown, we have not realised our responsibility in terms of taking measures to prevent the infection. People with mild illness go out and spread infection. Everyone who comes into close contact of a positive case must quarantine themselves even if you don’t feel ill as you may be pre-symptomatic or asymptomatic. If you don’t do that, you become part of the chain (that spreads infection). Cases are also spiralling in some regions because contact tracing was not done aggressively and people did not use protective measures enough, especially after lockdown was lifted.

The graph that was stabilising in the US is now going straight up, they had 40,000 cases in a day, the highest single-day record. It is a classic example of people not realising their responsibility and whatever gains they had is lost. We need to see what is happening in other parts of the world and learn from that, rather than making the same mistakes.