Tularam Yadav
The world is paying close attention to the outbreak of novel corona virus (COVID-19), following it emergence in December 2019 in Wuhan city of China. With the outbreak of novel corona virus declared a public health emergency of international concern (PHEIC) by the WHO, people worldwide are working to address it.
Many countries are currently in entirely or some degree of lockdown with restaurants and bars, shop, schools and gyms closed citizens required or at least strongly encouraged to stay home to avoid catching or spreading COVID-19. Researchers are well on their way to discover vaccines & treatments for the virus, but even in a best case these are likely to be 12-18 months away. Until then extreme social distancing is pretty much the only intervention available to help individuals stay healthy and break the chain of transmission, giving more vulnerable population a fighting chance of surviving this pandemic BUT how exactly does lockdown work? & why it is important for even younger and healthier people who face a lower risk of severe illness to remain in their home as much as possible.
The purpose of lockdown explain is to reduce the reproduction – in other words, to reducethe number of people each confirmed case infect & keep its rate below one on average. According to a journal published by imperial college of London there are two routes to try to get there.
1) Mitigation: slowing but not necessarily stopping epidemic spread, reducing peak health care demand while protecting those at risk of severe disease from infection. This is done by isolating suspected cases & their household; & social distancing the elderly and people at highest risk of serious illness.
2) Suppression: or basically lockdown which aims to reverse epidemic growth, by social distancing the entire population indefinitely & closing schools and universities.
Some study model of imperial college’s show that that – without any lockdown or social distancing measures, we can expect peak mortality in approx. 3 months. In this scenario, 81% of the UK & US population would be infected with 510000 dying in the UK & 2.2 million dying in US.In contrast isolating confirmed & suspected cases and social distancing the elderly and vulnerable would reduce peak critical care demand by 2/3rdand halve the number of deaths.
To get closer to the goal of R<1 they say “a combination of case isolation, social distancing of entire population & either should quarantine or schools, universities closure are required. The study finds this “intensive policy is predicted to result in a reduction in critical care requirement from peak approx. 3 weeks after intervention are introduced & a decline there after while the intervention policies remain in place. While the word “indefinitely isn’t one we want to hear, it’s possible long term suppression could be the best way to reduce infections & deaths – at least a vaccine is available.
So, have the lockdown worked? Starting 23 Jan 2020 the Chinese gov locked down Hubei province including Wuhan the city of 11 million where the outbreak started. This unprecedented lockdown of tens of million people was considered a vast experiment – but it may have worked following the lockdown cases began to slow. On 19Th march China National Health Commission reported no new confirmed infection in Hubei.
How Nepal government can utilize this interval of lockdown?
Asking people to stay at home &shutting down population movement is buying time & reducing the pressure on health system, but on their own these measures will not extinguish the pandemics. The point of these action is to enable the more precise & targeted measures that are needed to stop transmission and save lives. There are some key actions that Nepal government can take
1. Expand, train & deploy our health care and public health workforce.
2. Implement a system to find every suspected case at the community level.
3. Ramp of production capacity & availability of testing
4. Identify, adapt and equipt facilities we will use to treat patients.
5. Develop a clear plan & process to quarantine contacts
6. Refocus the whole of government on suppressing & controlling COVID-19.
These measures are the best way to suppress & stop transmission so that when restrictions are lifted, the virus doesn’t resurge.
Tularam Yadav
MBBS 4Th year ( Jinnah Sindh medical University Karachi Pakistan)