Mitigation vs. Suppression and containment for Covid-19 pandemic situation? Will voluntary community participation ease the way to combat the battle in a long haul?

By Siddhartha Sankar Roy.

The reverberations of sudden lock-down is apparent, – chaos, hunger, tough choices for migrant workers, harassment, hurting each other, problems for other emergent ailments and so on. So it seems to be million dollar question internationally in which way the responses to a public health emergency should be: mitigation and community participation or suppression. Community participation and suppression cannot go together. Probably containment may not understand in grassroots level in our country where food can’t be delivered into each house. So by applying drastic measures, people would take it in negative way where some are dying in other ailments, unavailability to reach health centres for delivering by thousands of pregnant daily or if they don’t have food and milk for their children.

But irrespective of any matters, we are likely to face the pandemic anyway. This is going to be long haul and we must be sensible for that. The virus is likely to come back again unless it is settled down on its own or the vaccine with proper medications comes through to wipe out this wave. So it’s time now for test kits with 100% sensitivity and specificity should be available in every corner for testing and testing. We expect the Government and ICMR are doing well.

Above sensible means: Voluntarily community participation in long term to stop large gathering or crowding in general in any places or hospitals , slow down the virus by voluntarily social distancing for at least 3 to 6 months, helping others with foods and essentials, awareness campaign for sanitation, hand washing and not to get panic over it. It is likely subset corona positive which has required supportive treatments must go to hospitals.  Everybody else should self-discipline and quarantines themselves voluntarily and for corona positive cases should follow the advice of local health Authorities/doctors as well as the Government directives.

It would be ethically culpable and politically suicidal if trade-off is taken for letting the pandemic multiply on its own and treat those who fall ill and compromise with millions of lives for avoiding huge economic loss without suppression and containment of the disease on the one hand (mitigation) rather than better accepting massive economic loss and to protect and treat all lives via protracted lock-downs (123 years old law under British colonial era, The ED Act, 1897) on the other hand. Could India afford the first situation?

  If we assume exponential growth of covid-19, and 10 percent requires hospitalisation out of which 5% requires supportive ICU, then according to our population it would require at least 65 lakh ICU.  Let us assume underlying patients with co-morbidity would require at least 14 days ICU care and the pandemic may spread throughout 2 months (some unsubstantiated reports claims summer heat may lessen the virus rapid growth), then at least 11 lakh ICUs are required and probably India might have below the required ICU at present.  So eventually where do they go?  Most of them might be in high risk.

Another analogy TB, India shares 27% of world’s TB population, and 4 lakh die every year, diarrhoea and pneumonia claims 2 lakh lives every year. So the Wuhan virus tolls a tolerable risk for India?

So far better to allocate some fund to tone down the upcoming damage that would cripple the economy especially for health care support and for the vulnerable section of the country where 94% working population are poor. So the objectives should be in both the way by supporting the pre and post epidemic periods with the key focus to reduce mortality by bringing down the cases of avoidable deaths.

Credit to our Honorable PM and Central Government for announcing 1.7 trillion rupee mega relief package as a stimulus to corona virus damage control which is intended at reaching out to the poorest of the poor, with food and money in hands and to protect interests of health workers by providing insurance coverage.

Our CM (WB) role is very laudable to alleviate and control the situation heartily with full-fledged involvements with necessary supports and proper actions.

But our country needs to prepare for future pandemic.  [As pathogens are surrounded by us since evolutionary algorithm including in our body (where 9 pathogen cells out of our 10 cells help to sustain our life process) but most of the outsiders behave hostile to us. Sometimes some of them penetrate into us by mutating (copying error naturally or made by our aggressive lust over Mother Nature) and become epidemic. Some of them over period of time become mild habitat to live with us or with other creatures for their survival with helping the hosts.]

So it requires invest in raising immunity levels (until consciousness moves toward self level), good diets for the poor, public health engineering including sanitation, safe drinking water, active life style, medical infrastructure, medical personnel including bioinformatics specialists and related systems and institutions for good governance and for better transparency.

For this we need a larger database on Indian/Asian samples not only from the Western and larger the pool, the better the artificial intelligence for identifying the proteins of pathogens with vaccines and proper drugs.  Otherwise India will not be able to face sporadic but new medical threats which could wipe out millions of lives in future like Spanish flu in 1918, wiped out 1.8 crore lives.

Last but not the least, it might be a long battle, hence community participation in long run will play an important roles including responsible social medias which should share/contribute unique and created ideas or help for distress a little bit that would be beneficial this time. Unfortunately, some of the social media users are not act accordingly by sharing unsubstantiated and unscientific conspiracy theory, harmful and malicious post, insensible and intolerant posts and satirical post having no beneficial intents, post related to risky behaviour or prejudiced or discriminatory post to any, not limited to race, gender, group etc.

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