With full lockdown ruled out, how will Kerala check community spread

With full lockdown ruled out, how will Kerala check community spread
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Now that the dreadful effects of a complete lockdown are known, reintroducing it is unthinkable.

But with signs of silent community spread detected in several parts of Kerala, what else can the government do to achieve two crucial outcomes. One, cases are kept down to less than a fraction of the astounding number (over 1 lakh by August) predicted by the State Disaster Management Authority in a worst-case scenario projection. Two, the health infrastructure does not collapse under the burden of expanding COVID-19 cases.

To keep the cases down, monastic habits like social distancing, wearing of masks and washing of hands are still considered the most potent combat stance against Sars-CoV-2 worldwide.

Of course, tests have to be ramped up. Kerala Chief Minister Pinarayi Vijayan has said it would be increased to 15,000 a day from July; at the moment, it is 4,750 tests a day on average.

In places where it is feared that disease clusters have formed, like in Edappal in Malappuram, larger number of samples will be collected. This will help detect secretly expanding local clusters so that remedial action could be taken swiftly.

Revised understanding of risk

By now the government is convinced that people moving out of their homes is no big threat as long as they are masked, sanitised and keep a 'tall man' distance of six-feet from each other.

The US government's Centre for Disease Control (CDC), whose studies are relied upon by Indian Council of Medical Research, has recently revised its earlier apprehensions and has declared that there is “very low risk” of transmission from outdoor activities and from surfaces and fomites (objects or materials which are likely to hold the virus such as clothes, utensils, newspapers and furniture). Even then, since studies are still on, the CDC has designated public bathrooms and common areas as 'high risk'.

“This finding squared with our understanding that the transmission does not generally happen by touching a hard surface like a shop counter or holding a newspaper,” said a member of the expert committee advising the government on COVID-19.

The CDC has termed as 'low risk' even grocery shopping if the purchasing could be done quickly.

Avoid person-to-person contact

It is now understood that person-to-person contact is the quickest and the easiest path for the virus to keep on hopping. This realisation is the basis of the latest advice given by the government's expert committee on COVID: Prohibit anything that would result in close and sustained person-to-person contact.

This will mean that schools, cinema halls, gyms and sports stadiums will remain shut for a longer period. Business and networking conferences, too, will have to be conducted online for some more time.

Offices with employees closely packed are also dangerous. The government has been asked to continue with the 50 per cent attendance norm for at least a month more.

Places of worship have opened, though strict social distancing norms are in place and festivals are still barred. Certain groups have found it safe to keep places of worship under their control closed. The Sabarimala annual festival was also cancelled.

Reckless politics and health, the Mani example

But such good sense appears non-existent among political parties. Take for instance the public response of the Jose K Mani faction of Kerala Congress (Mani) after they were suspended from the UDF.

When Jose arrived to address the media at the party headquarters in Kottayam on June 29 there was such a crowd around him that it looked like a scramble was about to begin to get a ticket for the 'first day first show' of a superstar film. Many, including Jose, were not even wearing masks.

This will easily qualify as a 'very high risk' scenario, a situation that should be sternly prohibited.

When is the virus dangerous

The CDC, after months of research, has found that to successfully infect a person, the virus needs a load of 1000 viral particles (vp). Normal breathing releases 20 vp per minute, which is no risk. Speaking would release 200 vp a minute.

So talking to a person with a mask on from a distance of six feet and not for more than four minutes will be 'low risk'. Anything more will be 'medium to high' risk.

Flouting both distance and time barriers can make a one-to-one conversation dangerous even with a mask. The Jose K Mani press conference on June 29 was once more a demonstration of what should not be done.

Dangers of beard masks

Though Mani managed to get a mask, he had pulled it down to cup his chin, and was seen whispering to, and whispered to, by leaders on either side, Roshi Augustine MLA and Thomas Chazhikkadan MP, both of whom like Mani were using the mask as a chin shield.

This behaviour, too, would be categorised as 'high risk'.

If any of these unmasked leaders, or anyone cramped together in the stuffy press conference hall, had coughed or sneezed, the potential for trouble was extremely high.

A single cough or a sneeze, the CDC says, would eject not 200 or even the 1000 vp required to cause the infection but 200 million vp, a deadly knockout dose.

And the effects of a cough or sneeze bomb will be lasting. The droplets they scatter will remain in the air for hours if it happens in a poorly ventilated place.

Strategy of last resort

If, as a result of carelessness, COVID-19 cases shoot up and the health infrastructure is put to extreme distress, the government would implement a 'home care' plan it has in reserve. The expert committee has already recommended such a plan if the situation worsens.

Under the plan, Category A and B patients, asymptomatics and those mildly symptomatic, will be treated at home. It is said that nearly 70 per cent of the positive cases in Kerala have mild or no symptoms.

This can reduce the burden on hospitals but still would require close monitoring. “We need to closely watch the oxygen saturation (level of oxygen in the haemoglobin) of these patients at home. For this, simple instruments like pulse oximeter could be used. The savings from non-hospitalisation could be used to purchase more such instruments,” a member of the COVID expert committee said.

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