COVID-19: Causes, Concerns & Way Forward

COVID19 Causes

The COVID-19 pandemic has gripped the world with as many as 212 countries and territories affected. It is an ongoing outbreak triggered in response to the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). It is sweeping through the globe with the tally of confirmed cases standing at 3,747,504 and more than 2,58, 974 deaths reported as on May 6, 2020. Officially, the World Health Organization (WHO) recognized the spread as a Public Health Emergency of International Concern (PHEIC) on January 30, 2020, and a pandemic on March 11, 2020.

Exposure & Transmission

So how does the disease spread? Droplets produced during sneezing, coughing or talking by an infected person transmit the coronavirus to a healthy person if they are in close contact. A single human cough can produce up to as many as 3,000 droplets. However, owing to their heavy weight, the droplets mostly do not hang around in the air and fall off to the ground or onto surfaces. People catch the infection when they come into contact with these contaminated surfaces or potential carriers of infection and subsequently touch their face.

Lifespan of SARS‑CoV‑2 on Surfaces

The duration for which SARS‑CoV‑2 survives differs from surface to surface, depending on humidity, temperature and type of surface. Over time, the amount of the virus detectable on surfaces diminishes until it becomes totally non-infectious.

Research suggests that SARS‑CoV‑2 can survive for up to three hours in the droplets that an infected person coughs out. However, the smaller finer droplets between 1-5 micrometres in size can remain airborne for several hours if the air is still. Also, Sars-CoV-2 survives for up to a day on cardboards and up to 2-3 days on stainless steel and plastic surfaces.

Contagiousness

Following the onset of symptoms, the first three days are critical for spread as the disease is most contagious during this stage. Yet, note that the infection can transmit in the later stages or even before the symptoms manifest.

Fatality Rate

Globally, more than 1,251,032 people have recovered from COVID-19 as per statistics on May 6, 2020. The WHO Director-General Dr. Tedros Adhanom Ghebreyesus in his opening remarks on March 3 media briefing had estimated the worldwide fatality rate to be around 3.4%, much higher in comparison to seasonal flu that “generally kills far fewer than 1% of those infected.” For India, the mortality rate was projected at around 2% in a press conference on January 29 and February 10 with the disclaimer that the prediction was an early and provisional estimate that might change in the times to come.

Common Symptoms

Typically, fever, fatigue, dry cough, loss of smell and shortness of breath have been observed as the signs and symptoms of COVID-19 in patients worldwide. Some people also report aches and pains, runny nose, headache, chills, nasal congestion, diarrhoea and sore throat as additional symptoms. However, the disease may produce different symptoms for different individuals, ranging from mild to severe.

Stage-Wise Symptoms Breakdown

The Centers for Disease Control and Prevention (CDC) notes that it can take anything between two to 14 days for the symptoms to appear following the exposure. Characteristically, the first signs to occur are cough, fever and difficulty in breathing.

Usually, the time between exposure and onset of earliest symptoms is around five days. Often, patients are not aware of their symptoms as COVID-19 shares many commonalities with the common cold.

Here’s a day-by-day progression of coronavirus signs and symptoms for better understanding:

  • Stage - 1 (Day 5): Patients report dyspnea or difficulty in breathing, if they are elderly or suffer from a pre-existing medical condition.
  • Stage - 2 (Day 7): Patients with signs of dyspnea are likely to be hospitalized. However, this is also the point for the majority of patients, around 85 percent, to experience a disappearance of symptoms and see hope of coming out of isolation.
  • Stage - 3 (Day 8): Patients with a severe condition experience symptoms of acute respiratory distress syndrome (ARDS) with the lungs increasingly failing to meet the vital organs’ demand for oxygen. As per the Chinese Center for Disease Control and Prevention, approximately 15 percent of the total cases reach this stage.
  • Stage - 4 (Day 10): Intensifying breathing difficulties may cause some patients to be admitted into an intensive care unit.
  • Stage - 5 (Day 12): An early coronavirus symptom, fever is likely to go away at this point although cough associated with the disease tends to stick around for longer.

The average time to death is estimated to be around 18.5 days whereas dyspnoea tends to cease in survivors after around 13 days.

Asymptomatic COVID-19

Research around the world is emerging as a fresh challenge to the medical professionals already grappling to contain the pandemic. It is being suggested that the coronavirus infection could spread through unidentified sources or “silent spreaders” who are more difficult to trace and isolate, hence posing a far more dangerous risk of transmission. Raman R Gangakhedkar, Chief Epidemiologist at the Indian Council of Medical Research (ICMR) has observed: “Of 100 people with infection, 80 do not have symptoms.” Public health experts have emphasized that these unknown sources of contagion must be factored in while considering when to roll back social distancing norms as part of government directives.

Complications

COVID-19 can develop into pneumonia or cause acute respiratory distress syndrome (ARDS).

Preventive Measures

  • Frequent hand washing: CDC recommends washing hands properly for at least 20 seconds with soap and water, particularly if they’re visibly dirty. Hands must be washed on a regular basis and especially:
    • Before cooking or eating
    • After coughing, blowing the nose or sneezing
    • After touching an animal, animal waste or animal feed
    • After handling pet foods
    • Before and after caring for anyone sick with diarrhea or vomiting
    • Before and after treating a wound or a cut
    • After visiting the toilet
    • After changing a child’s diapers or cleaning up the child who used the toilet
    • After coming into contact with garbage

    Use alcohol-based hand sanitizer containing at least 60% alcohol, if soap and water are unavailable.

  • Respiratory hygiene: Cover your mouth and nose with a flexed elbow while coughing or sneezing.
  • Physical distancing:Avoid mass gatherings, standing in groups and crowded places. Maintain a distance of about two meters or 6 feet (2 arms’ length) from people in outdoor settings. Stay at home and step out only for essential or unavoidable circumstances with full precautions.
  • Face mask: CDC recommends wearing homemade cloth face coverings when going outdoors. The face mask should have multiple layers of fabric, fit snugly against the side of the face and be secured with ear loops or ties. Select a fabric that can be laundered and machine dried without damage to its material or shape.
  • Self-isolation: It aims to separate an infected individual from those who are healthy in order to prevent the transmission of disease.
  • Self-quarantine: It is advised for individuals who suspect a potential infection due to close contact with a COVID-19 positive person. For example, people with a travel history to coronavirus-hit areas in the past 14 days.
  • Surface cleaning: SARS‑CoV‑2 can be inactivated by disinfecting contact surfaces with products containing at least 62-71% alcohol, 0.5% hydrogen peroxide bleach or household bleach containing 0.1% sodium hypochlorite. CDC recommends regularly cleaning high-touch surfaces like door knobs, phones, tablets, remote controllers, touch screens, light switches, hard-backed chairs, desks, sinks, toilets, keyboards, handles and tables.

Global Socio-Economic Disruption

The socio-economic disruption due to COVID-19 pandemic has resulted into the most significant global recession after the Great Depression. The International Monetary Fund’s Managing Director, Kristalina Georgieva has predicted a negative global growth eyeing "a recession at least as bad as during the global financial crisis or worse." She has warned that the world growth in 2020 would plunge below the 2.9 percent rate seen in 2019. Countries worldwide are tackling the coronavirus crisis by implementing lockdowns, facility closures, travel restrictions, quarantines, workplace hazard controls and curfews which has considerably brought economic activity to a standstill.

Timeline of Events

  • An unidentified pneumonia detected in Wuhan, China and reported to the WHO Country Office, China on December 31, 2019
  • WHO starts working day and night to analyze data, issue advisories, coordinate with partners, and provide all possible assistance to countries for preparing, improving supplies and managing expert networks
  • On January 30, 2020, WHO formally declared the outbreak as a ‘Public Health Emergency of International Concern’
  • On February 11, 2020, WHO decided a name for the novel coronavirus disease - COVID-19
  • The world tally crossed the 1,00,000 mark on March 7, 2020
  • WHO recognized COVID-19 as a pandemic on March 11, 2020
  • March 15, 2020 marked a notable statistical milestone as the tally of confirmed cases outside of China surpassed the Chinese total

Flattening the Curve: Containment & Mitigation

Essentially, the measures to control the spread of a pandemic involve the dual-pronged strategies of containment and mitigation. In the early stages, containment is undertaken that works by tracking and isolating the infected individuals, and adopting vaccinations and other infection control mechanisms. The target is to protect the uninfected population from potential community transmission.

On the other hand, the next step, mitigation, is undertaken when it becomes increasingly difficult to contain the transmission, and the goal rather becomes to slow the progression and mitigate its effects on the community and healthcare system at large.

Related to these strategies are efforts to delay and bring down the epidemic peak which is popularly known as – ‘flattening the epidemic curve.’ It aims to make more time available for the development of vaccines and treatments, and prevention of public healthcare services from being overstressed.

COVID19 Case Curve

Has India Flattened its Epidemic Curve?

As India enters into the third phase of its nationwide lockdown, let’s try to analyze the present situation with some statistics.

The Indian government’s endeavor has been to embrace a “cluster containment strategy" to check large-scale transmission of the virus at the community level. Early detection of infections is coupled with a ‘break the chain of transmission’ strategy to limit the spread within a given geographical region.

Commenting on the current scenario, Raman Gangakhedkar, the Head of Epidemiology and Infectious Diseases at the Indian Council of Medical Research (ICMR) observed, "Our doubling time of cases is increasing. The current situation indicates that a significant increase in the number of COVID-19 cases is unlikely." A study conducted by the ICMR indicated that India would have had more than 8,20,000 cases by April 15, 2020 in the absence of a lockdown and other containment strategies. With containment but no lockdown, the estimation stands at around 1,20,000 cases. This is drastically more than the actual number of confirmed cases at around 42,836 as on May 4, 2020.

Along the same lines, K Srinath Reddy of the Public Health Foundation of India (PHFI) noted, "There is a decrease in the rate of growth of infection in India and social distancing in India has been more effective than in many other countries."

Going by the statistics put forth by the Government of India, the projections between March 21 and April 23 stood at 8,51,505 cases without lockdown, travel bans and other containment mechanisms. The doubling rate was estimated to be 8.6 percent as on April 24 with expectation to reach 10 percent in the coming days. Dr. VK Paul, Retired Professor at AIIMS, Delhi and Member (Health) at Niti Aayog commented, "Decision of lockdown was timely, the curve has begun to flatten. The nation has shown that lockdown has been effective, saving lives, containing Covid-19 infection and slowing down doubling rate. We need to build on these gains."

The government’s projections point towards a trend that moves in a downward curve to zero till May 16. Moreover, despite India’s COVID-19 tally leveling off only slightly, its overall trajectory demonstrates a much steeper movement in comparison to many Western nations.

Confirmed COVID19 CasesTotal Confirmed COVID19 Cases

India’s COVID-19 Recovery Rate

As per a latest report dated May 2, 2020 from the Ministry of Health and Family Welfare (MoHFW), Government of India, as many as 9,064 individuals have been cured or discharged after the successful completion of their COVID-19 treatment.

The recovery rate of the country made a crucial improvement to above 25 percent in a span of 14 days.

Zone-Wise Demarcation of Districts

Aggressively pursuing its aim of eliminating COVID-19 from the Indian landscape, the government has classified all the districts across the country into Red, Orange and Green Zones as Lockdown 3.0 kicks in. Each of these lockdown zones has a varying set of restrictions mandated to effectively contain the spread of the virus. The zone-wise classification is dynamic and subject to revision on a weekly basis. It applies to 733 districts in the country, and includes 130 Red Zones, 284 Orange Zones and 319 Green Zones.

The parameter for the division has been factors, such as the incidence of new COVID-19 cases, doubling rate, and the extent of surveillance and testing. Red Zones are identified by a higher number of cases along with a higher doubling rate. Orange Zones report comparatively fewer cases whereas Green Zones are those that have not reported any case in the past 21 days.

The zone-wise classification determines the different kinds of restrictions imposed on the movement of people and supply of goods in a particular territory. The containment regions within Orange and Red Zones have to follow additional restrictions. Further, the state governments can increase the restrictions, depending on the outbreak situation.

Outline of the central government's directives for lockdown zones:

Nationwide prohibitions: Airlines, railways, inter-state bus services and metro are not operational. Inter-state movement of people is prohibited except for security or medical reasons. Cultural, social, educational and religious institutions like movie halls, hotels, restaurants, malls, gyms and swimming pools are shut bringing day-to-day life to a halt. Social and religious gatherings are completely banned.

Red Zones: Offices with one third of their workforce can remain open. E-commerce is allowed for only essential services and standalone shops can operate. Cabs, public transport, spas, barber shops, salons, cycle, auto rickshaws and taxis will remain shut. Four wheelers with a driver and two passengers, and two wheelers without pillion riders are allowed.

Orange Zones: There is no ban on e-commerce for both essential and non-essential services. Liquor shops can remain open. Four wheelers, including taxis can run with one driver and two passengers. Buses cannot run.

Green Zones: Buses can run at 50 percent capacity. All the other activities except for those banned nationwide are allowed.

Containment areas: Entry and exit of people is acutely restricted except for supply of essential goods and services. Everything else will remain closed.

You can check out the current list of zone-wise classification of districts for the week starting May 4 here:

https://www.deccanherald.com/national/coronavirus-full-list-of-red-orange-and-green-zones-in-india-state-wise-and-district-wise-832161.html