Covid-19 case peaks won't be uniform across India, says expert

There cannot be a uniform peak in Covid-19 cases in a large country like India and each state has its own trajectory based on when people there were exposed to the infection, a public health expert said.

The peak could be witnessed in states like Delhi by this month end or early August while it may be around September in others such as Tamil Nadu, Maharashtra and Karnataka, Director of the Indian Institute of Public Health (IIPH) here Prof. G V S Murthy said. IIPH was set up under the aegis of the Public Health Foundation of India (PHFI).

In states such as Jharkhand it may take longer time as the spread has started only after the return of the migrant labourers, he said. "So, each state has its own trajectory based on when people were exposed to the infection in that particular state. There is not going to be a uniform peak for the country. There is going to be a number of peaks in the country," he told PTI.

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For example, Bihar seemed to be reporting a large number of cases suddenly after all those who migrated to other cities, specifically Mumbai and Delhi, started returning. It takes about 10-14 days for a Covid-19 person to infect others in their families and then the next wave of cases will happen, Murthy, who established and headed the first Community Ophthalmology Department in the public sector in the country at the All-India Institute of Medical Sciences till 2010, said.

Governments need to continue with measures to deal with the virus and the community also should strictly adhere to preventive guidelines such as washing hands and maintaining physical distancing, he said and stressed on taking intense steps in densely populated areas.

States like Jharkhand (present total cases 7,564), Chattisgarh (6,819) and parts in eastern Uttar Pradesh too had reported much lower cases earlier but the spread would start occurring as the migrants have returned now to their homes. "There, the peak will take much longer. It would be somewhere towards the end of September or October that those states which had low reporting earlier, will have a peak," he said.

But, states like Haryana, Telangana, Karnataka, Andhra Pradesh and Tamil Nadu should be able to achieve the maximum number of cases by mid-September, he said. All these states which were reporting very high numbers now, should not be getting the same numbers beyond mid- September. Some states should achieve the peak by mid-August also. For example, Delhi seems to be on a path where, by the end of this month or early August, it can be said that the peak has been crossed, he said.

The same could be the case with Rajasthan and Punjab, and other states, including Maharashtra, Karnataka, Telangana and Andhra Pradesh may reach the peak in September, he said. The peak should occur in Tamil Nadu by the middle or the third week of August, said Murthy, who had worked at the World Health Organisation (WHO) on Childhood Blindness programme.

He said the governments need to continue with measures to deal with the virus as the health system would be overwhelmed if there was a sudden rise in cases and if the states are unprepared. Such a scenario had been seen in Mumbai and others, the expert, who was a UNAIDS Consultant with the National Aids Control Organisation (NACO), added. "Kerala, you have seen now. They thought they had seen the end of Covid-19. Suddenly, in the last over 10 days, Kerala has had a much larger number of cases than before," he said.

Complete monitoring was required in densely populated areas and intense steps should be taken when there is a sudden spike in cases. The three Ts Test, Track and Treatment were important to reduce the infections and slipping into serious complications, he noted. The community should follow precautions, including wearing a mask, hand-washing and maintaining physical distance, the health expert said.

If somebody has any doubt of infection, they should immediately seek medical attention. Gatherings should be avoided. "As a community, we cannot put the entire onus on the government. As a community, it is our responsibility (to take the precautions)," he added. At the government level, Murthy suggested arranging mobile labs to collect samples (to avoid overcrowding) in a city like Hyderabad rather than people coming to certain locations to give samples.

The community health centres can be strengthened with a few beds having oxygen supply facilities dedicated to Covidcare to treat needy patients. Those having severe breathlessness should be transferred to bigger tertiary hospitals, he said, adding that the focus should be on saving lives.