Curve flattened, but no dip is a concern: AIIMS chief Dr Randeep Guleria

He was responding to a question on what further steps need to be taken, given that India has not been able to push the curve down even after 40 days of lockdown.

With the lockdown being extended by another two weeks, with easing of restrictions, Dr Guleria said the most important data point to watch out for, ahead of May 17, is the cases reported in the hotspots and reclassification of zones.

“The solution is to identify the areas where the maximum number of cases are coming, and focus containment to bring down the number of cases, and convert them to orange or green zones. At the same time, continue surveillance in green zones. You have to make sure there is restricted movement or no movement from red zones to green zones. What the lockdown has done is prepare our health facilities. It gave us time because the number of cases did not rise sharply. Because of that… we are better prepared than we were before,” he said.

This type of vigilance will require individual-level engagement, he said, underlining that the pandemic “has to be fought at the community level, not the hospital level”.

Emphasising that this is not the time to “relax our guard”, he recalled India’s experience with the Spanish Flu, saying that most of the 7 million deaths happened in the second wave.

“What we are doing today was what was done at that point in time. Schools were closed and stadiums were converted into halls. There was a lockdown and that lockdown was followed very well. But after the lockdown was lifted, they started going back to normal. People celebrated the fact that they were now out, and started partying. We have to learn from history,” he said.

To mitigate the economic impact of the lockdown, the classification strategy should be more granular, with focus on local hotspot areas rather than an entire district labelled as a red zone, he said. “Many districts have very few cases or no cases for two weeks to a month. (to say there is) community transmission all over India would not be correct,” he said.

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“There has to be micro-planning. You cannot look at India as a whole… I also agree that there has to be some degree of monitoring to make sure that testing is done properly and there is sincerity among those who are collecting the data. Being in the green zone gives you a lot of advantage as far as the economy is concerned, but if you call yourself a green zone when you are not actually a green zone, it can have a serious health effect,” said Dr Guleria.

It is crucial to maintain syndromic surveillance of influenza-like illnesses and severe acute respiratory illnesses in these zones to make sure they remain green, he said.

Dr Guleria underlined that while India’s case count and mortality rate remain relatively low, “we will have to learn to live with COVID-19 for quite some time. We will have to have strategies which will work with COVID being around. Whether it’s travel or work, it will have to be with COVID-19 being around,” he said. “I think there is a lot of work that needs to be done in terms of developing a new normal and seeing that the new normal is practical and the economy can grow,” he said.

On COVID-19 infection also affecting organs like the kidney and heart, Dr Guleria explained that atypical manifestations are now being observed. Also, there is an emerging theory on recurrent infections, he said.

While plasma therapy is considered a potential treatment, it cannot be the “magic bullet”, he said. As for drugs like Remdesivir, he said “it’s still early days but trying something is better than not having anything available.”

The e-Adda was moderated by Ravish Tiwari, Political Editor, and Kaunain Sheriff M, Principal Correspondent.