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Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide

BMJ 2020; 368 doi: (Published 18 March 2020) Cite this as: BMJ 2020;368:m1090

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Factors affecting control of Covid-19 in India

Dear Editor,

The Indian Government has launched extensive measures to tackle the transmission of COVID-19 among the people at large. Besides complete shutdown and invoking the Epidemic Diseases Act our Hon' ble Prime Minister has personally monitored and convened several meetings with stakeholders to respond to the occasion both in the public and private sector undertakings who are actively involved in the containment of the infection. Complete imposition of curfew under sec 144 of the Indian Penal Code has been issued in the majority of states, including Delhi, Uttar Pradesh, whereby except for people involved in essential services such as Health, Police, Administration, etc., there is restriction of aggregation of five or more persons at one place and penalization of those not following the order is in place.

However, several factors of concern are emerging. One such factor is hiding the travel history even after symptoms appear, which misleads the health care provider and exposes them to the susceptibility of infection. Further, affected individuals are careless in taking preventive and control measures and they do not restrict their travel, socialization, which further increases the chances of transmission of the infection. Such irresponsible behaviour should be condemned.

Another factor which is emerging is racial attacks. The incidence of expressing frustration and discrimination against individuals having a Mongoloid appearance are of concern since this only leads to a division and not a combined effort in putting the war against COVID-19 spread wholeheartedly by every citizen of India. Other instances of discrimination have been reported even among the crew members of Air India who had actively participated in the rescue process of Indians stuck abroad where there was infection galore. Some of them have been asked to leave their residence by neighbours or the colony where they reside. Such instances should be curbed immediately and each one of us should appreciate the efforts put by anyone who has contributed his/her bit in controlling the infection.

Contact tracing of affected persons remains a herculean task for the Indian Government. Despite keeping track, some of the affected individuals left the country or disobeyed isolation in the hospital and left the hospital uninformed, posing a risk to the society at large. Such irresponsible behaviour of the affected individuals needs to be curbed with strict implementation of orders on isolation and quarantine measures.

Health care providers - doctors, nurses, paramedics - are at risk of the infection due to the non availability of an adequate number of personal protective equipment. There is a shortage of masks and other personal protective measures. Government should provide these on an urgent basis. The susceptible public (close contacts, family members, friends) are at risk of exposure due to non availability of masks which despite Government orders, are not available in the chemist shops or cost an exorbitant price which prohibits a layperson to buy. Government should start surprise checks of the shops and penalize them for selling these items as on the black market.

The chances of community transmission of the infection have already been in place. Vulnerable populations are those staying in slums, congested urban areas where transmission of the infection is high due to their low socio-economic status, unavailability of materials for hand hygiene (especially water, soap, forget about hand sanitizers), illiteracy, overcrowding, poor cough hygiene practices, etc. These susceptible populations need close monitoring with facilitation of testing for those at risk, or with influenza-like illnesses, which can help in immediate institution of isolation measures.

Preparedness of the health infrastructure besides the prevailing health care facilities, including the provision of community halls, schools, public facilities, etc., for caring for patients in the event of a large scale outbreak should be in place. Existing health care staff might not be able to tackle the situation and need to prepare volunteers for such an eventuality.

Competing interests: No competing interests

24 March 2020
Mongjam Meghachandra Singh
Director-Professor, Assistant Professor
Dr. Reeta Devi
Department of Community Medicine, Maulana Azad Medical College, New Delhi (India); School of Health Sciences, Indira Gandhi National Open University, New Delhi
Department of Community Medicine, Maulana Azad Medical College, New Delhi (India); School of Health Sciences, Indira Gandhi National Open University, New Delhi