[Lobogris]

All people can do is take the same precautions whether the number of cases is 1000 or 1 million. We are already at a lockdown which is the most drastic step possible. In a way we have jumped the gun by directly going to the last resort rather than a graded response. We needed to stress social distancing until 5k to 10k cases followed by closing some crowded areas and perhaps some businesses after that mark. Only around 15 to 20k mark should we have instituted a lockdown if necessary. Now most people would be tired of the 21 day lockdown on April 14th and would be desperate to go out. However our cases by then might be 10 to 20k and we might need to extend the lockdown. I am afraid many people won't be able to abide by it and many would be desperate to earn money, open their business and so on.

There are people who would argue that having an earlier lockdown is needed as it would lower the total number of cases. However I am not quite sure. I have a feeling that this things spreads regardless and in any case our lockdown is at most 50% effective. All we have done is buy a few weeks time but at a great cost to the economy. We might have been better off simply banning long distance travel to keep things away from smaller towns and villages.

[Sankar]

Originally Posted by sgiitk

I am worried about the outbreak in Dharavi. How good can the isolation be there? Unfortunately the victim expired.

We are still in Stage II while Japan has entered Stage III. How far are we from Stage III?

Originally Posted by DCEite

I think we are already in Stage 3 now. Dr. Vivek posted about a person with no travel history acquiring the virus. And the Dharavi slum dwellers are no international travellers either.

Which means community transmission has already happened and we are well into stage 3. The numbers, unfortunately, will only go up from here, exponentially.

We might already be in stage 3, authorities might be in denial to prevent a panic. There are reports of Covid19 in people with no travel history and with untraceable exposure. Authorities say they will consider community transmission a possibility when 20 to 30 percent of the cases turn up with unknown exposure. Imho by then it might be a bit too late to admit that we are in stage 3 for any preventive measure then taken to be effective.

[nagr22]

Originally Posted by Sankar

Imho by then it might be a bit too late to admit that we are in stage 3 for any preventive measure then taken to be effective.

Isn't lockdown the ultimate preventive measure to stop community spread? Is there anything more than lockdown to help us becoming part of stage 3? If any, we should not wait for the government to announce and start those measures right now.

[mvadg]

We've all figured out quite a while ago that there was something amiss about the numbers and that we are in stage III. This realization will hit the masses also, but will trickle down for a while and then explode with the the TV anchors and WhatsApp groups going wild. But like some of you observed, there is nothing much we can do, except respect the lockdown as sincerely as we can and hope for the best.

I am still wondering about how long the lockdown will last, how much our bureaucrats' and politicians' ego is entwined with this position, because the virus doesn't care. It might be better for our bureaucrats to prepare the systems for a life after lockdown

[kozhissery]

Originally Posted by ninjatalli

+ 1 to this.

National level it seems to be true, but in my state (Kerala) it seems to be more transparent. Every evening our CM holds a press conference (televised) in which the office presents the condition district by district with emphasis if there is any special pockets (E.g. Last day the place called pothengode - suburb of Trivandrum was highlighted)


I really would like to know the actual status rather than hiding facts, which would give me an idea where we are heading

[SmartCat]

WHO and their silly predictions:

WHO predicts 1 million coronavirus cases worldwide, 50,000 deaths in next few days
https://www.timesnownews.com/interna...ew-days/572700

We are already there!

[sunilch]

All these thoughts about fudging numbers, hiding details, etc is nothing but either a media (TV, Internet, WhatsApp, ClickBait articles, etc.) fueled fancy of those folks who would believe anything that isn't positive/hopeful. Or it is their nature to just criticize everything that our government does or our country has to offer. All this is done while sitting on their sofa, sipping their favorite drink and using their fingers faster than their mind. These are the same people who would take all benefits that they can enjoy while in India but criticize the country across the globe the moment they get a chance. They just don't think about the actual effort that is put in by the government and also about the constraints that each country/government faces.

Think about it this way - every case or death reported has to be 100% accurate and hence needs to be verified at-least twice before it is put on for the world to know. This takes time and effort. Government servants may not have their job on the line but they have their credibility on the line and also are humans just like us. We do the same in corporate world. Before reporting anything or committing to anything, we always double ensure that the underlying data is accurate to the best of our ability.

No government wants its people to suffer due to panic. So over reporting is no solution. No government wants people to undergo treatment for a condition they may not have and hence go overboard with all measures will not work. No government would want people to suffer beyond capacity and hence over burden the healthcare system and hence accurate reporting is essential.

Governments are dependent on collaboration and these things move slowly, face many constraints and are also dependent on us - the general populace, for support.

[vivek95]

We all are aware about the resource constraints of our country. However, what's annoying to me is, in various media reports, some officials talk about how India is doing well. There was a declaration a few days back how Maharashtra is faring better and since then there have been 50 new cases in Mumbai alone on an average per day !!

I think we should humbly accept the fact that we are under testing and refrain from making any tall claims. Probably just declare the everyday statistics and stop boasting about how we are doing better when half of my friends in govt. set up do not even have access to full gear PPE. Some 47000 odd tests in India till date, so whom are we kidding ??

--Dr. Vivek



Check this--

[racer_ash]

Well. Its like the case of the Chicken and the Egg.

While the ICMR argues that there is no point in testing unless people show any symptoms and that they are ensuring all primary and secondary contacts are traced and put under observations. They feel this step will help them keep tab of the transmission.

Now on the other hand, some are saying, unless we test more, we will not know whether people not being tested are actually carrying the virus, but remain asymptomatic and still carry the risk of transmission.

Logically, if I take the situation in my house. We have people in the ages of 7, 32, 34, 61 and 64. Now, lets say that I (34) am the carrier of the virus however am asymptomatic. Now there is every chance that I transmit the virus to my family members. However, not all of them may be asymptomatic and one of them will definitely show symptoms. So there is no point in testing all 5 members of the family. Since one is showing symptoms, they should be tested and if results come out as positive, it is better to quarantine all 5 of us together. This is what the health authorities are currently doing.

Now since we are in a lock down, this is how the testing strategy should be in the 'ideal' scenario where families are confined to their homes strictly following the directives.

[AZT]

Some disturbing news out of Cambodia

[INJAXN]

From todays local newspaper in indore :

Headline translation:
Out of 75 , sources not known for 56 patients, it means there is community transmission.

i.e stage 3

[vijai]

Being at home and extensively bored, I made a dashboard for COVID-19. The data are crowd-sourced from verified govt sources and being vetted before making it to the API. Feedback are welcome and happy if you could share with others too

https://covidtrends.in

P.S: Though the data is from official sources, the dashboard is merely for representational purposes only and isnt the official source.

I hope a bit of self-promotion is allowed in this case

[CarJunki]

Originally Posted by DCEite

Guys,

All said and done, can we still Flatten the curve ? Atleast before the current lockdown ends ?

Given the recent developments (not taking names of any particular community or religion), howsoever unfortunate,shameful and criminal it was, the need of the hour is to keep our focus on containing spread of the disease further.

Where are we with respect to other countries in terms of rate of increase ?

Nope, no flattening of curve for now.

This could have worked if all people were following the lock down.

The realist in me is telling we will see very very dramatic numbers and 20/20 vision statements will come on the other side of this pandemic.

[PaddleShifter]

Originally Posted by racer_ash

Logically, if I take the situation in my house. We have people in the ages of 7, 32, 34, 61 and 64. Now, lets say that I (34) am the carrier of the virus however am asymptomatic. Now there is every chance that I transmit the virus to my family members. However, not all of them may be asymptomatic and one of them will definitely show symptoms. So there is no point in testing all 5 members of the family. Since one is showing symptoms, they should be tested and if results come out as positive, it is better to quarantine all 5 of us together. This is what the health authorities are currently doing.

Now since we are in a lock down, this is how the testing strategy should be in the 'ideal' scenario where families are confined to their homes strictly following the directives.

This is not the correct approach in my personal opinion but seems to be the one followed. I have been involved with diagnostics of such diseases for more than 8 years now. This is me from swine flu isolation ward in 2012. During those times, testing was limited to only those who were at risk of pneumonia or were already showing evidence of pneumonia (clinical or on X-ray). Specific treatment in the form of oseltamivir (Tamiflu) was started for many even without testing.






Consider an alternate approach. India has limited testing kits for a disease that has no specific treatment or medicine. There is no consideration of rationing limited stock of medicine for those who are truly positive either (since no such medicine exists). If the testing kits are utilized during stage 2, asymptomatic cases can be picked up better though a lot of kits will go waste in testing the negative individuals. This will, on the other hand, allow us to catch asymptomatic cases that would otherwise go on to infect more people, being unaware of their infection. The problem with your example is that if say in a hypothetical family, the asymptomatic one infects the elderly or at risk people, their chances of survival are lesser as compared to the healthy, asymptomatic index case in that family.

Since there is no specific medicine, the purpose of testing for COVID-19 goes down to a lot of extent once the healthcare infrastructure is overwhelmed as seen in Italy and US. At that point, any patient coming with symptoms is basically considered as positive and treated accordingly (again no specific medicine available so the treatment is generic/supportive). What I mean is that an explosive increase in cases with respiratory symptoms needing hospital care is more likely to be a result of the novel infection only. In countries like Italy, where they ran out of ventilators, was there any use of testing for COVID-19 when patients were simply dying as a result of non availability of the ventilators?

In such scenario, testing will only help in segregating the positive from negative patient. So, the ones truly infected can be segregated from others seeking treatment for respiratory symptoms. Maybe I am a very junior person with relatively very less experience and the ones in apex medical bodies with decades of experience see it the other way (testing more in later stages).


The Indian kit manufacturer has said that they can produce 10,000 kits per day. Hopefully, those can be deployed at the earliest and testing can be increased. India has a population of 1.3-1.4 billion and we can never achieve the tests/million numbers seen in some other countries such as Korea or Germany that have a much less population. But, hopefully we will test more and win the battle against this pandemic.

[vivek95]

Originally Posted by racer_ash

Logically, if I take the situation in my house. We have people in the ages of 7, 32, 34, 61 and 64. Now, lets say that I (34) am the carrier of the virus however am asymptomatic. Now there is every chance that I transmit the virus to my family members. However, not all of them may be asymptomatic and one of them will definitely show symptoms. So there is no point in testing all 5 members of the family. Since one is showing symptoms, they should be tested and if results come out as positive, it is better to quarantine all 5 of us together. This is what the health authorities are currently doing.

Now since we are in a lock down, this is how the testing strategy should be in the 'ideal' scenario where families are confined to their homes strictly following the directives.

Thanks for your perspective. But if you look up the MOHFW India website for the guidelines on whom to test, its clearly mentioned that all the household contacts of the confirmed case should be tested on day 5 and day 14 irrespective of signs or symptoms.



Secondly, WHO ideally recommends isolating a confirmed case in a healthcare facility or a facility which is specifically designated as an isolation unit for confirmed cases ( this could be a non-hospital setting ). However, if this is not possible, WHO has laid down guidelines on homecare management as well, whether this works in our country is highly doubtful.

Also, CDC is more a user friendly website than WHO. I am collating information from all three - WHO,CDC and MOHFW because CDC clearly mentions that testing criteria is country specific and their self-check online tool is only for US of A.

I am sharing some useful documents for the benefit of everyone.

--Dr. Vivek