Large parts of India are now implementing ‘Unlock 1.0’ as India begins to limp to a state of partial normalcy. However, it is clear that this cannot be back to business as usual.
By now, most of us are aware of the three basic mantras for preventing COVID-19 transmission: a) masking, b) social distancing, and c) hand and cough hygiene. Simple as these may sound, their actual implementation still remains far from the extent desired. People continue to crowd outside shops despite there being ample space. Similarly, people often pulldown masks while talking (masks have to cover the nose, mouth and chin all the time and especially while speaking), and hand sanitisers are usually applied cursorily without following the 20-second and 7-steps hand-rub rule.
This leads to the fourth basic mantra that Atul Gawande, the noted American surgeon and writer, has talked about — changing culture or attitudes. Thinking just about oneself does not work in protecting communities from COVID-19. USA is the perfect example, with many obstinately refusing to wear masks. Remember that masks are meant not just for the user’s protection, but also for others. This is especially important because even asymptomatic patients can transmit COVID-19. Thus, we have to become more altruistic and develop the attitude that masks will protect others, particularly the elderly and weak. This attitude ensures that we also mask ourselves when the house-help comes home, because he or she is as much at risk from us as we are from him or her. It makes us not step out of the house nor let anyone step in if we have fever or a cough. It allows a subordinate or stranger to politely remind us to adjust the mask hanging around the chin without any offence being taken. And it ensures that offices provide webinars, safety training and appropriate protective gear not just to white-collared workers, but to housekeeping staff and security as well.
Finally, we need to start making sustainable non-impulsive decisions based on science and deliberation rather than fear and panic. This is the fifth mantra; that of ‘rational decision-making’. Globally, it is clear that one size doesn’t fit all while fighting COVID-19. Attempting herd immunity worked for Sweden but failed miserably in UK, and Japan beat coronavirus without following South Korea’s policy of mass testing. The same holds true at an individual and local level. Thus, a model that worked in Bhilwara may not work for Mumbai or Tamil Nadu. Rational decision-making involves making nuanced scientific decisions tailor-made to the current ground reality and needs of every city, locality, and individual.
The prerequisite for this is to develop a scientific temper and know the basics regarding COVID-19 transmission. It primarily spreads by respiratory droplets, which tend to transmit within six feet. Hence, social distancing and masking are of utmost importance.
In addition, the duration of contact is equally important. As long as the patient is masked and not coughing, brief contact of a few minutes will not transmit a sufficient number of viral particles to infect others. For example, the infamous COVID-positive Delhi pizza delivery boy did not transmit to any of the 72 homes he delivered. Also, the WHO and CDC have recently clarified that fomites (infected surfaces) are not a major mode of transmission. Thus, we need not fear getting COVID-19 from elevators, doorknobs, groceries or newspapers, especially if we maintain proper hand hygiene and avoid touching the face.
One’s actions must be based on these fundamental scientific facts rather than on sensational myths and claims propagated on social media. For example, many housing societies still do not allow house-helps or technicians to enter. Paradoxically, some residents of these very societies have restarted working in offices cleaned by housekeeping staff! Given the brief duration of any interaction, no one in the society is at risk from such visitors apart from the homes they visit. Such decisions should hence be left to individual flat residents rather than imposing blanket restrictions. Societies could however screen visitors for fever, cough, and masking; this will strike a good balance.
Similarly, at a personal level, we need to get used to taking daily decisions balancing the risks involved with our needs, be it while hiring a house-help, visiting a hair salon, or hailing a cab. Remember that as long as the basic mantras are scrupulously followed, the risk is minimised. For example, the evening walk is not very risky for anyone, but lunching together in the office is, as this is unmasked and the duration of interaction is longer.
Local authorities will also have to make sustainable and sound decisions. This is already happening, with Mumbai moving from a blanket lockdown of entire societies to only locking the floor on which a COVID-19 patient was detected. Cities need to similarly decide whether imposing a night curfew is sustainable, or could we instead encourage people to possibly work in two shifts with greater social distancing and staggered commute times. Likewise, pillion riding is currently blanketly banned. We could however allow people of the same household to ride together rather than risk taking a cab.
As we start reopening, our potential exposures are bound to increase. We now have to get into the habit of rationally assessing everything we do with regards its risk, benefit, and sustainability. Is this really needed, is the risk high or low, are the mantras being properly followed, is avoiding this for many months viable? Most doors at homes have a safety chain. With the metaphorical unlocking, these five mantras are like the safety chain; we must use them all the time to remain protected from unwanted visitors.
The writer is a radiologist at a leading hospital in Mumbai and a visiting adjunct faculty at Dept of Body Imaging, University of Washington Medical Center, Seattle. Views are personal.
Through Foundation of The Billion Press
e-mail: editor@thebillionpress.org
