Ban gatherings of over 10 people to contain COVID-19 spread instead of lockdown, recommends Lancet's India Task Force

Amid a massive spurt in the COVID-19 cases in India, the Lancet India Task Force on Covid-19 has suggested a 'containment measures checklist' to the central government to contain the situation. It also asserted that these measures "must be done beyond the current binary discussion on a lockdown".

It also recommends that variables like new cases per day (7-day moving average), rate of increase in new cases per day (2-week moving average), test positivity rates per day (2-week moving average), number of tests per million per day, and utilization rates of ICU beds be considered to decide on containment strategies.

Recommending that all steps be taken, keeping in mind the economic consequences, in-depth consultations with all stakeholders in society the Centre should ensure that there are programs and safety nets in place for the most vulnerable and for those that will bear the brunt of the economic costs of closures.

Lancet has not given a nod to impose lockdown but it says that a series of actions are needed. It says there is targeted containment required and coordinated response. It suggested that the country must be divided into zones instead of lockdown.

As of April 25, India's effective reproductive rate (R factor) for Covid-19 stands at 1.44. At this rate, each infected individual is infecting another one and a half persons. For the month of April, the rate of increase in reported new cases averaged 6.8 percent.

In the low risk zones, the rate of increase of new cases is less than 2 per cent and the percentage of ICU beds unutilized is more than 80 percent. In such zones, there should be unrestricted movement, open schools and colleges, shops, restaurants, offices, places of worship, factories can open with distancing and with 50 per cent occupancy.

In the medium risk zones, the rate of increase of new cases is between 2-5 percent, the test positivity ratio is between 5 to 10 percent and the percentage of ICU beds unutilized between 40-80 percent. In such zones, it should be ensured there is an unrestricted movement with advisories issued. Here, schools can be opened. Indoor confined spaces should be closed (specifics to be determined locally by consultation).

Essential services (food, medical sector, local transportation, public works, administrative services) should be opened and social safety nets, food banks, and other support for the poor should be in place.

In high risk zones, the rate of increase of new cases is greater than 5 per cent and the test positivity ratio is more than 10 per cent. Tests per million in hot spots would be less than 140 and the percentage of ICU beds unutilized is less than 40 per cent. Here, too, there should be restrictions on movement (with some exceptions).

Undoubtedly, Schools and colleges should remain closed till numbers fall to the medium risk category. Shops, restaurants, offices, places of worship, factories should be closed for a minimum of 6-10 weeks.

Essential services (food, medical sector, local transportation, public works, administrative services) be allowed to open and social safety nets, food banks, cash transfers, and other support for the poor be disbursed. Besides, the panel also recommends RT-PCR testing for all symptomatic patients and family and other close contacts and rapid antigen testing for confirming new clusters.

While on medical grounds, the panel recommends suspension of elective procedures, and restrictions on out-patient care for the duration of the surge, to relieve the pressure on doctors, nurses, and the hospital staff in high risk areas.

As far as travelling is concerned, Lancet does not recommend restrictions on domestic travel, especially travel by train or road, which is the primary means of travel for the poor. It recommends testing be made readily available in low-risk areas at all bus stations, railway stations, and airports, with Rapid Antigen Tests (RATs) deployed for random testing.

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