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Covid-19: India imposes lockdown for 21 days and cases rise

BMJ 2020; 368 doi: (Published 26 March 2020) Cite this as: BMJ 2020;368:m1251

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Lockdown a gamble: But it's not too Late

Dear Editor

I am quite relaxed knowing that India finally imposed complete lockdown for 21 days on 24th March 2020 but I argue with the timing of the Lockdown. Being one of the biggest democracies in the world, India is also home to many scientists, researchers, academicians, epidemiologists and public health specialists. I believe, India failed to initiate appropriate steps which were required to adjourn the immediate effects of the growing pandemic.

As the Covid-19 epidemic broke out in Wuhan Province of China, India was just a mute spectator. The borders India share with China, International business relationships, foreign trade and travel should have been suspended for the time being till the initial outcome of the local epidemic in China was known. Instead, nothing such was done, which led to the entry of travelers to India fleeing from China to save their lives. A sort of initial screening was done at international ports which were mostly escaped by many being asymptomatic at the time of screening. The healthcare infrastructure system of India was not such tailor made and prepared to quarantine all those with a travel history from China. At later stages, many were quarantined, but the quarantine facilities were themselves prone to epidemic outbreaks due to lack of space and poor sanitary and hygienic conditions. Most cases reported from India had an International travel History.

On 31 January, 2020, when India reported its first case from Kerala, that was the second chance India had in hand to call off further International trips both ways but again failed to do so. Instead, more and more Indian travelers were invited back home to safety. Not knowing that Covid-19 had already conquered and put its traces on many countries, with each International flight the virus was unknowingly imported from other countries more and more within the home. Further, the delay in cancelling visas to foreign travelers was a key point decision and a final chance for India which could have averted this tragedy as the initial spread of the Covid-19 was found among 17 international travelers from Italy, the country this time in most agony and pain. Cancellation of all International flights and visas would have restricted the entry of SARS Cov-2 virus in the population. As we know, India is one among the most populous country of the world, finding a Covid-19 suspect is like finding a needle in a haystack. This not only made the job tiresome for the authorities but easier for the virus to spread.

Many days recorded no new Covid-19 positive cases but actually the virus was multiplying from two to four, from four to eight and so on. Slowing the virus enhanced its grip in some states and people started migrating from these to other states to save themselves. The news from many countries was devastating and scientists were clueless with no treatment or vaccine in hand. The tension and anxiety was growing with news of covid-19 deaths everywhere. Calling off interstate trains and domestic flights and sealing interstate borders could have still offered a last chance to India, but unfortunately they misinterpreted the silent nature of the Covid-19. India should have forecasted those numbers at the first instance what they predict today, like incidence and deaths from covid-19. People were rushed into lockdown with no prior preparations, knowing that most of the people belong to socio-economically poorer sections.

Complete lockdown is a gamble, and India has dared to play it. A bit late, but still I believe it will be somehow useful in containment of the virus and will prove to be an effective strategy only when coupled with active surveillance, contact tracing and rigorous testing of suspects. After the lockdown, there has been a sudden surge in positive cases which has a mixed kind of reaction from the experts. Some are of the view that the lockdown may just flatten the curve, others that the burden will be there. I believe, lockdown if observed with letter and spirit, the already covid-19 suspects and their contacts will turn out with symptoms within the longest incubation period. Which is most likely happening this time, resulting in the surge? Surging Stage “S”. Another Peak Stage “P” will follow, when the cases will peak, depending upon the infected covid-19 cases in the community (which will depend on the initial spread before the lockdown). That will be followed by another deflate Stage “D”, when the cases will slowly reduce.

For this to happen, India has to follow complete lockdown and maintain social distancing as much as possible. Authorities need to home deliver basic food stocks, support work from home initiatives, enhance IEC activities through electronic media and engage people in health promotional activities. Meanwhile, the frontline workforce doctors, paramedics and other essential departmental employees must be equipped with personal protective equipment, hospitals be ready to face any emergencies, and facilities be furnished and hygienic to board people for quarantine.

Competing interests: No competing interests

27 March 2020
Sheikh Mohd Saleem
Demonstrator/Senior resident
Shah Sumaya Jan
Department of Community Medicine
Government Medical College, Srinagar, J&K, India