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'The most actionable thing is to expand testing. Nothing else matters'

Last updated on: March 17, 2020 10:53 IST

'We have to accept that the infection is now in the community and we can't isolate everyone who gets it.'
'Instead, what we need to do is to find out those who are most at risk of death, isolate them and save them from the rest.'

Doctors screen patients for coronavirus at a government hospital in New Delhi. Photograph: PTI Photo

IMAGE: Doctors screen patients for coronavirus at a government hospital in New Delhi. Photograph: PTI Photo

"We have to assume that infection is everywhere, contain them from the worst and mitigate as much suffering as possible by rapidly scaling healthcare facilities," Dr Swapneil Parikh, co-author of The Coronavirus: What You Need To Know About The Global Pandemic, which will be released on April 1, tells Archana Masih/ in the first part of the interview.

There are 107 positive Covid-19 cases in India and increasing. What should we be doing right now?

The problem in India is that we have detected 107 cases among thousands of undetected cases. We need to look for the undetected cases.

India has done 1/3 of the total tests that South Korea does in a single day. South Korea is doing 10,000 to 16,000 tests a day. We have done far, far less.

You can only find what you look for -- so whenever we start scaling up testing, we will see a spike in the number of cases.

What can India borrow from the South Korea model?

It is really important to learn from South Korea because it has battle-tested against the coronavirus. They have SARS in 2003, MERS in 2015 and Covid-19 in 2020.

Each time they dealt with an exploding outbreak, but controlled it rapidly. Everything they did cannot apply to India, but we need to do the best things they did and apply it to us.

The most important thing is testing that we can do easily. The 52 government-controlled labs are woefully inadequate for conducting the tests. The private sector needs to be pulled in.

I would go as far as suggesting what is happening in the top universities of the US where mails have been sent to graduate students to abandon all research and help with testing.

Even if we were to do that -- we don't have enough people in ratio to our population. The most actionable thing is to expand testing. Nothing else matters.

How can testing be scaled up?

The testing process is itself fraught with risk. While waiting for testing in a line people can also get infected. An infected person can infect others in a hospital while waiting for a test and outbreaks may start.

We need to think of innovative ways to scale up testing. South Korea had drive-through testing where people didn't get out of their cars, their sample was taken and results were e-mailed.

In India, we need to think how we can prevent people from infecting others during the testing process. Do we start using private delivery services like Swiggy, Scootsy to send a delivery kit to a person's door,

Or, dropping a bunch of medical staff at a building where an outbreak has happened to collect samples from houses?

The testing process will suffer, but we are at a stage where we do not have many options.

The question we need to address is how do we scale up testing while preventing infection of others who have come to be tested and others doing the test?

China also deployed mobile testing vans.

Absolutely. Wuhan city has 1,800 teams with at least 5 people. They would identify every single contact of a patient with Covid.

We are at a stage when we desperately need to reduce the number of infections.

While we have a great contact tracing apparatus in India, it is not geared for this kind of volume. We do not have the resources to trace every contact in a vast population.

We have limited resources and we can't throw all of it into battling Covid, we need to deploy these resources strategically.

Are there chances that one can be carrying the virus with no symptoms and pass the infection to others without falling sick herself?

You can be infected without even knowing and infect others. This is happening in young ages below 9. While they don't get sick, but spread it to others.

The second scenario is that you are going to get sick, but you are not sick yet.

You start getting infectious maybe on day 2-3 after the infection and fall sick on day 5. Between when you get infected and to the stage when you develop symptoms and go to a doctor, you might interact with 2,000-3,000 people -- that sets off a chain.

That is why social distancing in the context of decreasing mass gatherings is crucial, but this is not going to drastically alter the course of the disease in India. It will slow it down and is called 'flattening the curve'.

A huge number of patients can overwhelm the healthcare capacity, but if the cases are slowed down and distributed in time -- instead of happening in 3-4 months, they happen in 12-18 months, we will still be overwhelmed, but will have a better shot at managing it.

What measures need to be taken now? In China, stadiums were used as isolation centres and hospitals.

Unfortunately, we now have community spread. Earlier, containment was the best strategy, now we have to mitigate. They are not mutually exclusive.

Mitigation means protecting those who are most likely to die. We have to accept that the infection is now in the community and we can't isolate everyone who gets it.

Instead, what we need to do is to find out those who are most at risk of death, isolate them and save them from the rest.

We have to assume that infection is everywhere, contain them from the worst and mitigate as much suffering as possible by rapidly scaling healthcare facilities.

We need to set up 1,000 bed hospitals like China did in fully open stadiums. We need a system where there are 200 patients in one room, a doctor puts on a mask and works for 8 hours till the mask doesn't work anymore.

How long does it take for symptoms to show and what is the recovery process?

It takes at an average 5 to 6 days for symptoms to show, but it can range from 1 to 14. Three symptoms that we need to look out for are fever, cough and breathlessness.

Most healthy adults can recover in 2 to 6 weeks. It will be like a bad flu, but they can be managed at home -- paracetamol for fever, hydration, healthy food and not infecting anybody else.

20% of detected patients need hospitalisation, out of that 5% need ICU care. 50% of those in ICU, with the best care will recover.

If someone has a fever and cough, what should one do?

Call a doctor, don't just go to a clinic because you could infect other people.

Call the national help line so that they can start the process of containing the spread in the community and stay at home.

If you start developing breathlessness, you need medical intervention. At that point, call the hospital, tell them you are coming. If you have a mask, wear it, if not take a handkerchief and inform the hospital so that they can meet the patient outside the hospital and mask them.

After recovery and return from hospital, will one get more vulnerable to the virus?

Unfortunately, yes. We don't know about this virus, but with SARS and MERS that are closely related, a patient can have permanent lung damage after acute respiratory distress syndrome.

It may or may not lead to fibrosis, chronic kidney disease, but if you are a smoker and with such pollution in India, we already have some residual damage.

There was a report about a girl who returned from Iraq who went to get tested, but was refused. What should the mechanism be?

The reality is that not everyone who wants to get tested can get tested. I will get one step further to say that not everyone who needs a test will get tested, forget about want.

We do need to address that because other countries have done it. Our large population can be a detriment in a pandemic, but it can also be our greatest asset.

India's under 18 population is 40% and there are a lot of young people not likely to get sick.

We have a lot of people who can work and produce the goods we need. China will provide it to the highest bidder or to a preferred trade partner like the USA, so we have to evolve our own test kits and mechanism.

We need to involve private companies. One quote I read was that we should not scare people out of their wits, we should scare them into their wits.

The sad thing about pandemics is that when we are able to control them it is said that it was an over-reaction. Efforts are only justified if you fail, if you succeed there is no appreciation.

If we succeed, it would be great, but if we start responding only when it gets bad, we will fail for sure.

What are the dangers of it spreading to rural areas and slums?

It will be slower, but when it does hit those areas it will be devastating.

I worked in rural areas and slums during internship and realised there is not much trust in the State's health service. The medical staff is not seen as someone who can help them in a time of need. So why will they come forward when they are infected, they will continue mingling around.

For decades we have put out messages on TB, leprosy, polio, don't put cow dung on your child's umbilical stump. There is huge resistance in rural areas to medical information coming from outside. They are justified in mistrusting us because we have failed them for so long.