Tweak lockdown curbs in badly-hit Covid-19 pockets: Medical team

In a realistic change of approach, epidemiologists and other medical experts who held an over two-hour discussion with the Tamil Nadu Chief Minister Edappadi K Palaniswami, ministers and other officials here on the overall Covid-19 situation in the State, are now veering round to the view that it is time to modify the lockdown strategy.

With another general lockdown deadline to end on June 30 including an intense 'full lockdown' in place in Chennai and neighbouring northern districts besides Madurai and Theni, the experts, analysing the experience of the last three months, have indicated that government use 'lockdown' stringently only in areas highly affected by the prevalence of the disease.

"Total lockdown is a blunt instrument, not the best finishing," said Dr. Prabhdeep Kaur, deputy director of ICMR's National Institute of Epidemiology, Chennai, speaking to reporters after the review meeting here. The WHO representative Dr Sowmya Swaminathan, also participated in the review through video-conferencing from Geneva, she noted.

Stating that 'lockdown' is needed in the initial period as it helps to increase the 'doubling time' of the disease prevalence which slows down the spread of the virus, Dr Kaur said that by itself is not a solution. She recommended using WHO and ICMR parameters, to zero-in on those districts which report rapid rise in Covid-19 cases.

Dr Kaur said one taluk in such districts should be chosen and assessed in terms of "number of deaths, doubling time, test positivity, bed occupancy, reserved beds and contact tracing", and after making an overall assessment of the disease profile in that district, apply stringent controls only in those areas "highly affected by the infection spread."

Dr Kaur said a "total lockdown" covering all places was no longer necessary, nor feasible to get rid of the disease. However, public transport services should be restricted in the districts as more travel by people appears to be contributing to the virus spread, she said, adding, public gatherings and meetings should continue to be prohibited.

Taking a similar view, Dr V Ramasubramaniam, Infectious Diseases Consultant, said, "lockdown is the standard and broad weapon. Initially it is necessary and the benefits of it is seen now. But, now we have to look at other aspects; continuing the lockdown for another six months is of no use; we have to think of new strategies and we have said so to the government."

Dr P Kuganandam, Infections Disease Control expert, Chennai, said initially the lockdown was enforced to ensure the coronavirus chain was broken by observing social distancing, wearing of face masks, hand sanitizing and so on. "But now we cannot continue with this lockdown as there are also economic aspects and the focus should be to create greater awareness among the people on testing, self-isolation and quick treatment and keep the death rate low," Dr Kuganandam said.

GREATER CHENNAI SITUATION ENCOURAGING

Dr Kaur said the Edappadi Palaniswami-led government had heeded to their advice to rapidly increase the daily testing and it has shown results in greater Chennai, a hotspot, where 10,000 persons on an average are being tested every day now for symptoms of Coronavirus. "It is a good beginning," she said and added that people should not worry about the rising Covid-19 positive cases as it was a natural outcome of ramping up the tests process.

All over Tamil Nadu, the per-day testing for Covid-19 has gone up to 32,000 persons on average, and that was the only way to detect positive cases and treat them and save patients. This strategy which was being intensified in Chennai, through organising of 'fever clinics', with medical teams directly going to communities, screening and testing people, has helped, she said.

However, in the last two weeks with a rapid rise in Covid-19 positive cases in other districts, like Madurai, Tiruchy, Vellore and Tiruvannamalai, the 'doubling time' - time taken for the virus to spread- has reduced there, meaning more people were swiftly getting infected. There was also an upsurge in the number of in-coming persons from other states recently, said Dr Kuganandam.

So, the Chennai strategy of organizing 'fever clinics' at the micro-level should be replicated in those districts, Dr Kaur said, and expressed satisfaction at the Chennai trend 'stabilizing', even if the number of positive cases was rising every day. The benefit of strict controls is limited to the extent that the virus chain "is broken" and it is no substitute for timely detection, self-isolation and medicare.
The 'doubling time' has increased in greater Chennai and suburbs, which augured well in controlling the disease spread and health workers should sustain this favourable trend, Dr Kaur urged.  

To a question, Dr Kaur said there was no need to go in for 'rapid antigen tests' as the PCR confirmatory test was good enough. However, there was no room for complacency in Chennai and neighbouring northern districts of Thiruvallur, Kancheepuram and Chengalpattu and health workers should maintain the vigil, she added.

Pointing out that 80 per cent of the Covid-19 positive cases were "mild infections", Dr Ramasubramaniam called for shifting the focus now on quarantining and treatment once a positive case was detected. Several key antiviral drugs were now available which would help in the recovery rate, he said, adding, they have standardized a "clinical pathway" or "protocol" for effective treatment of coronavirus patients, including monitoring vital parameters like reduction in 'oxygen levels' in patients etc.

Dr Kuganandam said serious cases should be admitted to hospitals without any delay - ensure 'zero delay-, even as more awareness should be created about the greater vulnerability of hypertension and diabetes patients to an attack by the virus. Despite the constraints and the rising coronavirus positive cases daily, Tamil Nadu has been able to keep the mortality rate still low, he added.