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

Dear Editor
World Health Organization designated the coronavirus(covid-19) diseases a global pandemic. As number of cases in India continued to grow (as on 28.03.2020 up to 2 pm number of positive covid-19 cases 908 and death 21:while in West Bengal state number of positive cases 15 and death- 1) inspite of declared and imposed lockdown from 22.03.2020 midnight to 14th April 2020 so far announcements by the government of India and home quartine, practice of social distensing, frequent hand washing with soap and hand 70% alcohol based hand sanitizers to slow down the rate of transmission, so that flattening of curve of new infection, but the covid-19 positive cases raising steadily day after day. This will demand in very short duration (as India is very close to move from phase 2 to phase 3 when cases will be more and more detected from community if tests are done for every symptomatix cases ) numbers of beds equipped with ventilators,(for covid-19 cases), medicine, n95 masks, Personal Protection Equipment (PPE) as defined by CDC and FDA for the health care workers. But the country is in fact presently facing inadequate supply of n95 respirators, PPE which are very crucial for the first line health care workers including for all clinicians in OPD and indoor , pathologists, microbiologist and n95 masks for the patients who have bronchial asthma, COPD, chronic bronchities, Chronic heart failure and patients with other co morbid diseases like diabetes, hypertension, immunosupressed, cancer patients, transplants patients or taking immunosuprssive drugs, radiation etc
There was a great panic for buying n95 face masks to spread faster then corona virus just before lock down announced in 22nd March 2020 in Kolkata . Face masks had been sold out and now been in short supply throughout India including in West Bengal and probably in many countries in world, despite WHO remain stick against healthy peoples wearing any masks. The government hospitals (besides those who are in durect contact with covid admitted patients and related with RT PCR detection in biosafety lab) and common people are now wearing clothes face masks or medical mask
The use of face masks and N95 respirator for the protection of health care workers have renewed interest following 2009 influenza pandemic and emerging Infectious disease such as avain influenza, middle east virus and Ebola virus. Various types of masks are now been used to protect health care workers. These are disposable medical /surgical mask (bilayered or trilayered masks ), cloth masks and respirator masks. In high resources countris selling disposable surgical mask /medical masks replaced the use of cloth masks which are also in short supply there likely . But cloth masks are widely used globally including in Asian countries, West African countries particularly in emerging Infectious Diseases in the context of shortage of PPE and N95 masks for all health care workers
Wearing a medical /surgical masks is one of the preventive measures to combat soread of Infectious viron and certain respirator (N95) decrease spread of 2019 ncorona virus. It may act as protective measures when the infection is through aerosol generation . But masks alone is insufficient to provide adequate level of protection and other equally protective measures must be taken like PPE kit, hand washing with soap frequently for health care workers and for community N95 masks when covid-19 virus spreads in community. Will cloth masks be at all replace medical or surgical mask in community. I don't think it so.
A study by CRaina Macintyre(1)et all in a RCT trial cautioned the use of clothes masks that influenza like illness statistically& significantly higher in cloths masks (Relative risks 13% higher rate, 95%CI-1.69-100.7) and laboratory confirmed virus significantly higher in cloths masks group compaired with trilayered surgical mask. Penitration of cloths mask by particles was almost 97% and medical masks is 44%.
So adequate supply of N95 mask, quality PPE (not rain coats like or surgical gowns, instead of PPE), quality gloves, face shields for the front line health workers, laboratory personnel doctors (pathologists microbiologists clinicians) nurses, technicians, sweepers, carrying Viral transport mediums containg specimens are very important. Surgical /Medical/cloths masks are not protective for health care workers at least who are workings as front line soldiers in covid19 pandemic war. Both PPE and N95 are for once use and next to throw. A guide line from the WHO and CDC should be for consideration of re use of these PPE and N95 masks after gamma ray or UV rays radiation and sterilization for some hours and the government should dieect the manufacturing private /government companies those have expertise to make n95 masks, PPE, gloves as per criterion of FDA

Refrence
1)C Raina Macintyre, Holly Seale, Than chi Dung, NguyenTran Hien etal A cluster Randomized trial of cloth masks compared with medical masks in health care workers BMJ open 22nd April 2015 e006577 doi 10.1136/bmjopen-2014-006577