New Delhi: On March 24, Prime Minister Narendra Modi announced a complete lockdown in India for 21 days (starting March 25) due to the spread of the highly contagious virus – COVID-19 that started last December from the Chinese city of Wuhan and soon spread to over 180 countries (according to Johns Hopkins University, national public health agencies). Since then India has come to a standstill as 1.3 billion people practice social distancing in the hope to break the chain of the infection in the country. The novel Coronavirus has spread to many parts of the country and as of April 1, according to Ministry of Health and Family Welfare, India confirmed 1637 cases, of which, 38 people have lost their lives due to COVID-19.
Explaining the impact of the virus and why lockdown at this crucial time has become the only survival option, an expert from the Indian Council of Medical Research (ICMR) adds,
Think of your health care system as one car, which can only accommodate a certain number of people at once. What happens, if there is an emergency and you want to accommodate 100 people in one car, you won’t be able to do it, as a result, people will have to wait for their chance or their turn to ride. Similarly, if COVID-19 spreads and infect more people at once there will be a shortage of hospital beds, hospital facilities for example ventilators and other equipment which are needed. To avoid this surge of coronavirus cases the important thing is to break the chain of infection and flatten down the curve, which can only happen if public practice social-distancing and isolation from others.
Not just India, many other countries too are under lockdown. The worst-affected in the world – Italy that reported 10,779 deaths to date has also confirmed the positive impact of lockdown. According to Italian government adviser Luca Richeldi, the number of new people being taken into intensive care with the disease each day is dropping, courtesy Italy’s 3-week lockdown.
In China, which was earlier the epicentre of the virus, according to a paper by researchers in China, the United States and Britain, published in the journal Science, the lockdown in China may have prevented more than 700,000 new cases by delaying the spread of the virus.
As India goes through its 21-day lockdown, we speak to the experts to know about what “Flattening The Curve” being used in the context of this pandemic means and the role lockdowns play in the process.
What is Flattening The Curve?
Explaining what “Flattening the curve example of coronavirus” means, a spokesperson from Indian Council Of Medical Research said,
In Epidemiology, the idea to slow the spread of the virus or break the chain of infection in the community at one given time so that number of cases of the pandemic in a day gets reduced, which can then lessen the burden on hospitals, health care system in the country and healthcare staff is known as “flattening the curve”.
The spokesperson further explaining the term and added,
The crucial thing here to understand is that we all must know that no country in this world is prepared enough to treat all its population at one given time. Our health care system has a capacity, there is a certain number of beds, ventilators, resources and health care staff. If the pandemic becomes huge and there are more and more number of people infected with the virus, our health care system will result in selective servicing, meaning doctors or health care facilities will be limited. A tough decision from the system will need to be taken on who gets treatment and who doesn’t. Since this virus spreads at an exponential level (when the growth rate becomes ever more rapid in proportion to the growing total number or size), there might be a shortage of health care facilities and this gap between the people affected by the virus and facilities there in the country to treat them is where the curve comes from.
What Does The Curve Signify?
Explaining what the curve signifies, Los Angeles County Department of Public Health has recently come up with a visualisation depicting why the need of the hour is “flattening the curve”. The dotted line shows the capacity of the healthcare system, if there are more cases reported on a given day, the curve will move above the dotted line, which means the virus is spreading fast and is beyond the scope of current facilities to cope. A curve lower than the dotted line shows that fewer people are diagnosed with the virus and they all can be managed within the current capacity of the healthcare system.”
Together, we can “flatten the curve” by practicing social distancing, staying home when sick, and washing hands often. This will reduce the strain on our hospitals and emergency rooms, and literally save the lives of our most vulnerable residents. #COVIDー19 #NovelCoronavirus pic.twitter.com/6Yzvg3DONv
— LA Public Health (@lapublichealth) March 15, 2020
Why It Is Important To Flatten The Curve?
Highlighting why it is necessary to keep the curve flattened, Dr Daniela Cirilloa, Medical Microbiologist, Milano, Italy gave an example of her own country and said,
In Italy, what we have learned, the need to keep this curve down is very important. Because if the spread is higher, the load on facilities will be higher, as a result, the chances of getting your doctors affected become higher. We must learn to protect the doctors because if you start losing your healthcare workers or start quarantining them then your health system will collapse. We had TO face a lot of load in the health care system in the last few days and have lost a lot of doctors.
Dr Arvind Kumar, Chairman, Center for Chest Surgery and Director, Institute of Robotic Surgery at Sir Ganga Ram Hospital (SGRH), Founder & Managing Trustee, Lung Care Foundation adds,
Keeping the curve down essentially means diminishing the rate at which new cases occur. If there will be lesser cases, it will prevent in overtaxing the finite resources (which in this case is your hospital, health care system and facilities).
How Can The Curve Be Flattened?
According to the country’s apex health research body – Indian Council of Medical Research (ICMR), strictly-implemented social-distancing measures will reduce the overall expected number of cases of the novel coronavirus pandemic by 62 per cent.
Explaining the importance of social-distancing and how it can curb the spread of the infection, a spokesperson said,
Coronavirus is a disease that spreads from one person to another. The coronavirus infected person tends to give the infection to one or more others, who go on to give it to more people, and the chain continues. Now, to break the chain of infection, social-distancing becomes a key player.
Is India Effective In Flattening The Curve Of Coronavirus?
Expressing concerns over the lack of data and testing that has been done in India for coronavirus, Dr Sanjay Nagral, Surgeon Jaslok Hospital, Mumbai said,
First of all it is very early days of the coronavirus, so the trends, data and studies will change, as we still don’t know the denominator. My worry is that India did not test that much and adequately, if I talk about Mumbai, for at least 10 and 15 days, there was just one centre in central Mumbai and not in the suburbs areas. So access to testing it is still bit of a problem and therefore if you don’t test enough you will get certain data and based on that data you might see the positive signs but we need to know that this data present out there has some limitations to it.
Shamika Ravi, Director Of Research, Brookings India referring to the data (long term trend) from John Hopkins points out that India over the period of time has shown a downward trend and has flattened the curve slightly. She adds,
The actual number of cases will continue to rise, it is important that people understand this. If you look at pre-March 23 data, the rate at which the confirmed cases of coronavirus in India were rising, it was a rate at which we were doubling every three days. And from March 23 onwards that growth rate has declined, which means we are still growing but we are now growing at the rate where we are doubling every five days.
Further talking about the policies and lockdown that has come in effect in the wake of coronavirus outbreak in the country, Ms Ravi added,
The reason why we are seeing a huge expansion of coronavirus cases in US or EU countries is that those countries took the necessary steps after a certain time period. In India’s case, the government very proactively from the third week of January started airlifting students from Wuhan and other affected areas. The students were not brought in and let loose into the population, they were isolated and were kept in camps and then screening and surveillance started to happen. These were some proactive and very good steps we took at the start and because of that we started to see a slight flattening of the curve.
She further said, “Whatever the number of tests we are doing, the confirmed cases for every 100 tests is pretty low. We only have 2 per cent of positive tests for every 100 tests and this is remarkably low if you compare it with that of US, where it is about 15-18 per cent and Italy where there are some 18-20 positive cases per 100 tests. So, if we compare, I think the transmission has been slow, it has definitely bought us more time and what we do with this time is very critical right now.”