Interview

‘COVID 19 curve will begin to flatten by mid-August’

Dr Girdhar J. Gyani

Dr Girdhar J. Gyani, Director General, Association of Healthcare Providers India (AHPI) and convenor of a task force on COVID-19 hospitals in a conversation with Prathiba Raju, Assistant Editor, eHealth informed that COVID-19 curve will begin to flatten by mid-August as the fatalities are falling gradually and the recovery rate are increasing rapidly.

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What is the current scenario of the COVID 19 will India be able to bend the curve?

The recovery rate has been increasing rapidly. As a daily trend is shown below. As this trend increases to 70-75 percent, the curve will begin flattening – a good estimate would be mid-August. The cities of New Delhi and Mumbai bear testimony to the fact that if recovery rates rise beyond 75 percent, the curve begins to flatten rapidly. The recovery percentage for Delhi stands at 90 percent (the highest in the country) and Mumbai stands at 74 percent.

WhatsApp Image 2020-08-04 at 1.40.08 PMStatistical data provided by Prof Balaji Reddy

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As far as the purpose of the lockdown is concerned it was to identify zones of greater and lesser need for testing and contact tracing, and prepare hospitals and COVID centres beds and also to ramp up manufacturing of testing kits for testing, and manufacturing and assembly of PPE kits locally. For the record, India now assembles 4,50,000 PPE kits per day today as against 2,00,000 PPE kits annually.

By May 31st, it was decided that the containment zones and non-containment zones would be monitored and managed differently. The containment zones would be isolated by barricades, and testing in these areas would be carried out more aggressively. Moving in and out of these zones was prohibited, unless absolutely essential, and done under strict supervision.

The non-containment areas would have lesser restrictions (movement to procure essentials, etc) along with precautions that would need to be followed strictly i.e. wearing Masks, using Sanitisers and maintaining Distancing norms and a curfew ranging from 7am to 7pm or 9am to 5pm. Testing would continue in these zones on a need-to or sampling basis.

Phase Average Tests per day Total Tested Total Positive Positives as % of Total Tested Fatalities Fatalities as % of Total Positive
End Lockdown 1.0 (15th April)    11,800   24,4893   11,485       4.68%    396         3.4%
End Lockdown 2.0 (May 1st)    41,993   902,654   35,340       3.91%    1,159         3.27%
End Lockdown 3.0 (May 15th)   82,108  2,134,277   85,809       4.02%    2,741         3.19%
End Lockdown 4.0 (May 31st)   105,720  3,837,207  190,448       4.96%    5,414         2.84%
End June   160,948  8,826,585  583,760       6.61%   17,409         2.98%
End July   339,744  19,358,659  1,676,173       8.66%   36,478         2.18%

 

Month wise data

Month Tests Conducted Positive Cases % Positive Recovered % Recovered
March 42788 1635 3.82% 150 9.17%
April 873998 34221 3.92% 12254 35.81%
May 2934553 155108 5.29% 83142 53.60%
June 4989378 393312 7.88% 257200 65.39%
July 10532074 1092413 10.37% 742462 67.96%
Total 19372791 1676689 8.65% 1091870 65.32%

 

One can see how the average number of tests have gone up from 12,000 per day to over 3 lakh tests per day. The 30th of July recorded a total of 6,42,588 tests in a single day. This also recorded a total of 37,425 recoveries in a single day.

The total positive percentages have risen on account of the fact that testing is being carried out even more aggressively in containment zones where the incidences of infections are bound to be higher. As mentioned above, the incidences in the non-containment zones are few and far in between.

The fatalities are also falling gradually. Currently, the fatality rate stands at 2.18 percent of total positive cases, but 0.2 percent of the total tests carried out.

WhatsApp Image 2020-08-04 at 1.40.27 PM

So far how the people have responded in mitigating the country mitigating the COVID 19?

As seen from the table, the percentage of positive cases has oscillated between three to five percent with occasional isolated spikes of seven and eight percent being recorded while India executed this strategy through the end of May. This is largely due to the untiring efforts of the police, the paramedical professionals, the medical professionals and providers of essential goods and services during this phase. Most of the citizens have been observing the precautions, otherwise we would have seen a virus run riot.

What are the major challenges that await India once a vaccine is available for COVID 19? How is the government trying to tackle this?

Distribution will be a major challenge. But given the fact that if we could ramp up the production and distribution of testing kits from 5000 per day to 700000 per day in 90 days, it’s obvious the distribution system has ramped up accordingly. A good idea would be to use post office premises as vaccination centres in rural areas. This will also ensure that the vaccine reaches the absolute interiors of the country.

Also read: India Israel COVID 19 rapid trials commence at RML hospital

What will be the criteria of distribution – will it be frontline workers, old people or other vulnerable groups?

The frontline workers need to be given preference since they’re ‘in the line of fire’ for every moment of this war. The rest of the preferences would follow in the order of the most vulnerable to the least vulnerable.

So far, the major leanings this pandemic has taught us?

Our health system has come under real test. We have experienced how shortage of critical care doctors and beds impacted us. Luckily the heavy onslaught was in those cities where we had comparatively better health infrastructure like Delhi, Mumbai, Chennai, Bengaluru, Ahmedabad etc. India has the capability and resources to handle a pandemic of these proportions. Closer cooperation between the private and public sector became evident and needs to be cemented. India will now aggressively focus on bridging the gap in our health system. Management of existing capabilities and resources need to be sharpened and nurtured. Management of Risks need to now become an integral part of managing industry, government, education and healthcare. These four sectors need to work together as a system to take any country out of a crisis.

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