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Covid-19: control measures must be equitable and inclusive

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1141 (Published 20 March 2020) Cite this as: BMJ 2020;368:m1141

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Dear Editor,

With considerable interest I have read this editorial by authors from the John Hopkins School of Medicine and various other leading institutes of our world [1]. May I submit that just for once there is a definite need to see beyond the absolute numbers of all those getting infected by COVID-19 to really understand the main point. This virus is a novel corona virus, which is highly contagious, but isn't it correct that 90 % and more of all those infected by this virus have mild symptoms and will recover well.

Of interest is an article from JAMA that has reflected upon the characteristics of patients dying in relation to COVID -19 in Italy [2]. So far, with all the worldwide data and research available, we all are sure of the fact that it is the elderly frail population, who have some underlying co-morbities, would be facing the brunt and taking the maximum damage. No one is immune to this virus, not even the VIPs of the world or their family members, or any of the staff assigned at their service. Therefore they too would need a redoubled effort at isolation and quarantine unless this pandemic comes to a halt. Doctors and healthcare staff, as well as all those individuals with weak and lowered immunity status due to any cause, are at greater risk of mortality. Hence they too would require redoubled protection.

Simply stated, shouldn't the efforts at isolation, quarantine and provision of adequate healthcare be redoubled for these groups that have been identified and who are at unusual risk of dying due to COVID-19. In healthy individuals, sickness due to this virus seems to be quite contained, and as is usual in most viral catarrh, it is over in a week or so in most otherwise healthy patients. Secondary infection needs to be prevented. This percentage of patients with mild illness is roughly 90 to 95 % of all those infected by this virus. All that these majority of healthy people will require is perhaps adequate rest, take fresh air, and an occasional Paracetamol / Acetaminophen (Tynelol) over a few days, besides avoidance of social contact till afebrile and asymptomatic for a continuous period of three days and falling back on their own doctor or emergency whenever needed, Ideally they should not pass on their infection to anyone else, but owing to its very high infectivity rate and difficulty in detecting with the present wherewithal, is that practically possible even with a total lockdown?

According the Director General of the World Health Organization, this pandemic is accelerating giving out the numbers as well [3]. But would locking up a complete town or district, stopping travel, business, work, etc, be really helpful, when our intention remains to prevent mortality in a group that is so easily identifiable? We don't have a cure as yet, or a vaccine for this viral disease. In this situation, wouldn't a rapid increase of 'herd immunity' be of considerable help in the long run, and specially so when we know that at most this disease is a mild flu like illness that clears off on its own in a week or so in nearly all healthy individuals.

Complete lockdowns for extended period of time of nearly of the whole world really doesn't stand to reason. Shouldn't our limited and finite resources and energies be more fruitfully channelized for basically the elderly, and the population with lowered immunity and who are weak and frail? Why generate unnecessary panic and anxiety, and why create conditions which can craft long term problems related to economy and growth, as also problems related to law and order which could throw up challenges of peculiar nature.

Locking up all the youth and healthy individuals just for preventing this COVID-19 reaching the weak and frail elderly population who have other underlying health issues is not what the pioneers of modern medicine would have contemplated. This, especially when the number of infections we might be anticipating are colossal and can't be easily managed without grievously hurting the economy and earning Therefore, we really need to take a fresh look at equitable and inclusive containment strategy, so that we might get out of a logjam situation when practically the whole world has been brought to a standstill due to this COVID-19

So now we know who all are at risk of dying due to COVID -19. Even the best economies and countries with best healthcare resources may not find complete lockdown for extended periods of time truly viable and in the best interests of their country. As a solution, with life going on as usual, why can't the frail elderly with co-morbidities and other individuals at risk of contracting severe illness be identified, and given a redoubled healthcare facilities, along with appropriate isolation and quarantine so that they all may escape COVID-19. This way the resources can be channelized for those who require them the most and not frittered away in vain. These people on high risk of dying must not be allowed travel by public transport of whatever form, and must not be allowed to mix up with anyone, besides their own care givers and healthcare professionals, who would have to redouble their personal protection so that they may not pass on this infection to anyone thus identified at risk of having a severe disease or of resultant death. Why lock up towns and cities for everyone for an illness that is highly contagious and already so many people have already been affected, and many more will be affected by the time I finish writing this letter to the editor and dispatching it online.

Best regards.

Dr (Lieutenant Colonel) Rajesh Chauhan

MBBS (AFMC), Master in Medicine (CMC Vellore), PGDGM (Geriatric Medicine), PGDDM (Disaster Management), AFIH (Industrial Health), DFM (Family Medicine), FISCD, ADHA (Hospital Administration) & LLB

References:

1. Berger Zackary D, Evans Nicholas G, Phelan Alexandra L, Silverman Ross D. Covid-19: control measures must be equitable and inclusive BMJ 2020; 368 :m1141

2. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683

3. WHO Director-General's opening remarks at the media briefing on COVID-19 - 23 March 2020. Available at https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re... Accessed on 24 March 2020

Competing interests: No competing interests

24 March 2020
Dr (Lieutenant Colonel) Rajesh Chauhan
Consultant Family Medicine, Geriatrics,Industrial Health, Disaster Management
Family Healthcare Centre, 154 Sector 6-B (HIG), Avas Vikas Colony, Sikandra, AGRA -282007. INDIA.