Will Modi have courage to fight from Kerala, asks Shashi Tharoor

New Delhi, Apr 24: The trajectory of COVID-19 cases could have plateaued and might even fall for some weeks after the lockdown is lifted but India is likely to see a second wave in late July or August with a surge in the number of cases during the monsoon, say scientists.

The timing of the peak will depend on how India is able to control physical distancing and on the level of infection spreads after restrictions are relaxed, they said.

It looks apparent that the trajectory of daily new cases has reached a plateau and eventually it will take a downward fall, maybe for some weeks or even months, Samit Bhattacharya, associate professor at the Department of Mathematics, Shiv Nadar University, said.

Still, we may get a surge of new cases of the same coronavirus and this will be considered a second wave, Bhattacharya explained.

The second epidemic may come back in late July or August in the monsoon, although the peak timing will depend on how we control social distancing during that time, he said.

Rajesh Sundaresan, professor at Bengaluru's Indian Institute of Science (IISc), agreed.

“Once we return to normal activity levels, there is a chance that infection may begin to rise again. China is seeing this to some extent post easing of some restrictions on travel,” Sundaresan, corresponding author of a working paper by researchers at IISc and the Tata Institute of Fundamental Research (TIFR) in Mumbai, said.

On March 25, when the number of coronavirus cases was 618 with 13 deaths, the government announced a nationwide lockdown that was later extended to May 3.

On Friday, the death toll due to COVID-19 rose to 718 and the number of cases to 23,077, according to the Union Health Ministry.

In good news, officials said this week that the doubling rate of cases has slowed down in the period, going from 3.4 days before lockdown to 7.5 days, with 18 states doing better than the national average. The recovery rate has also almost doubled in the last 10 days.

"Looking at the new cases in the past few days, it seems the growth of new daily infection is much slower than earlier. This apparently indicates that we might have reached at the plateau of the growth curve, Bhattacharya said.

He noted that recent studies in China and Europe observed that the infection might relapse in those people who have already recovered from earlier phases.

So, there is no evidence that the earlier infection may help acquire immunity against the second infection. And in that way, the entire population may be vulnerable to the second wave to some extent, said the scientist.

In their study unveiled this week, IISc and TIFR researchers analysed the impact of strategies such as case isolation, home quarantine, social distancing and various post-lockdown restrictions on COVID-19 that might remain in force for some time.

The study modelled on Bengaluru and Mumbai suggests the infection is likely to have a second wave and the public health threat will remain, unless steps are taken to aggressively trace, localise, isolate the cases, and prevent influx of new infections.

The new levels and the peaking times for healthcare demand depend on the levels of infection spreads in each city at the time of relaxation of restrictions, they said.

The lockdown is currently upon us. It has given us valuable time. Let us test, trace, quarantine, isolate, practice better hygiene, search for a vaccine, etc. We should do these anyway, and these are being done. When and how to lift the lockdown is going to be a difficult decision to make, said Sundaresan.

It's clear that it's going to be phased. What our team is focusing on is to come up with tools to help the decision makers assess the public health impact of various choices, he said.

According to the experts, infectious diseases spread via contact between infectious and susceptible people. In the absence of any control measures, an outbreak will grow as long as the average number of people infected by each infectious person is more than one.

Once enough people are immune there will be fewer people susceptible to the infection and the outbreak will die.

However, when an outbreak is brought under control by social distancing and other interventions, it is possible only a small proportion of the population will have been infected and gained immunity, they said.

This means enough susceptible people may remain to fuel a second wave if controls are relaxed and infection is reintroduced.

Until the vaccine comes on the market, we have to remain alert Once sporadic cases occur here and there in the country, we immediately need to implement quarantine or social distancing locally for the people in that region, and also need to perform tests to identify positive cases irrespective of showing symptoms, Bhattacharya explained.

Note that these monsoon months are also flu season in many places of India. So, we should not ignore the early signs of the flu symptoms. Irrespective of symptoms, we need to increase tests in the hotspots to identify people and contain the surge, he said.

Sundaresan added that the timeline for a second wave will depend on a lot of circumstances which may change as the time passes.

Significant testing may have been underway, there may be behavioural changes with people becoming more careful about their hygiene, wearing masks may become more common, etc. All these responses may help restrict the second wave, he said.

A study published in The Lancet journal earlier this month modelled the potential adverse consequences of premature relaxation of interventions, and found it might lead to a second wave of infections.

The finding is critical to governments globally, because it warns against premature relaxation of strict interventions, the researchers said.

While interventions to control the spread of SARS-CoV-2 are in place, countries will need to work toward returning to normalcy; thus, knowledge of the effect of each intervention is urgently required, they said in the study.

According to a recent analysis by the Harvard Chan School of Public Health, the best strategy to ease the critical care burden and loss of life from COVID-19 might be on-again, off-again social distancing.

In the absence of such interventions, surveillance and intermittent distancing may need to be maintained into 2022, which would present a substantial social and economic burden, the researchers wrote.p

Thiruvananthapuram, May 22: Domestic flyers arriving in Kerala must undergo strict home quarantine as per the lockdown guidelines, in view of increasing COVID-19 cases in the state, Health Minister K K Shailaja said on Friday.

"Even if the domestic flight services resume, those coming in must remain under strict home quarantine as per the guidelines.

There is no change in that. Most people will be coming from the major hotspots of the country," she said.

Announcing the resumption of domestic flight services from May 25, the Civil Aviation Ministry had indicated on Thursday that it was not in favour of quarantining passengers on short-haul flights.

However, the Assam government has made it mandatory for all air passengers coming to that state to stay in quarantine for 14 days.

Apart from the health department and the local self government institutions, Shailaja said the people of Kerala must also ensure that every returnee to the state remained under strict home quarantine in order to curb the spread of the disease.

"We need to strictly keep under observation all those who come fromoutside the state and make sure that they do not come into contact with others including their family members.

They should be effectively remain under room quarantine at their residence," she said.

The state reported 690 cases after 24 more tested positive for coronavirus on Thursday.

As of now over 80,000 people are under observation across the state.

On the death of a 73-year-old woman, who came from Mumbai, on Thursday, the minister said, "Khadijakuttycame from Mumbai along with three others. She alighted at Chavakkad. Her son who picked her up from there took her to the govt hospital as she was tired. She was given good care."

"However, as her condition worsened, had taken a decision to sent her to the medicalcollege. Her swab test was taken and she was tested positive, but she passed away," Shailaja said.

The minister sounded a word of caution that there would be an increase in cases in the coming days as the influx of people coming from abroad and other states would continue.

"We cannot prevent anyone from coming. They are our brothers and were suffering there. We need to save those who come here and also those who are here," the Minister said.

Shailaja said the southern state had successfully managed the first two phases of the viral outbreak in January and March.

"There were three deaths. But we managed to save the rest of the people including a 93-year-old man," she said.

The Minister further said the situation in the state changed after flight services resumed and the border roads were re-opened after May 7.

"Our fatality rate is low and recovery rate is high.

After May 7, when the flight restrictions were lifted and people from other states started coming in, we reported 188 cases.

At least 90 per cent of the positive cases came from outside and the rest are their contacts," she noted.

Kanpur, Jul 11: "The Uttar Pradesh administration has done the right thing by taking action against my son," said an old and feeble Ram Kumar Dubey, father of gangster Vikas Dubey.

The father said his son killed eight police officials and it was an unforgivable sin.

"Had he listened to us, his life would not have ended this way. Vikas never helped us in any way. Due to him, even our ancestral property was razed to the ground. He also killed eight policemen, which is an unforgivable sin. The administration has done the right thing. Had they not done so, tomorrow others would have acted similarly," Ram Kumar said.

"It is the chief minister's duty to protect every individual. The police is an extension of that. He attacked them which cannot be forgiven. I will not even take part in his cremation," he added.

Ram Kumar Dubey said that his only appeal to the government is to allow him entry to his ancestral property now.

Vikas Dubey was cremated at Bhairav Ghat in Kanpur. His wife, younger son and brother-in-law were present and no other member of his family attended the last rites.

Vikas Dubey was arrested by the police in Ujjain on Thursday morning. He was on the run for the last six days and had come to the city to offer prayers at a temple, where he was identified by a security guard.

He was killed in an encounter by the Uttar Pradesh Police earlier today after he "attempted to flee".

The gangster was the main accused in the encounter that took place in Bikru village in Chaubeypur area of Kanpur last week, in which a group of assailants opened fire on a police team, which had gone to arrest him.

Eight police personnel were killed in the encounter.

Vikas Dubey managed to escape after the incident. Uttar Pradesh police had launched a hunt and raised a bounty on him for Rs 5 lakh.