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India has jumped past 4.5 lakh coronavirus cases and 14,476 people have succumbed to the viral infection so far. In this backdrop, speaking to IANS in an exclusive interview, AIIMS Director Randeep Guleria said India is also vulnerable to second wave of coronavirus and people should continue to follow social distancing, wearing mask and other precautions, after cases begin to decline.

He added that in order to contain the outbreak of Covid-19, a limited lockdown in hotspots, where volume of cases is very high, may be considered along with a micro-plan to prevent leakage of cases from these areas to other non-containment areas. Excerpts of the interview are below:

Q: Reports say China and South Korea are witnessing a second wave of coronavirus infection, what is this second wave, is India also vulnerable to this?

A: When cases come down significantly, people tend to drop their guard against the viral infection, and this leads to the second wave (which means a sudden increase in the number of cases). After cases begin to decline, people should continue to follow the precautions -- continue to maintain social distancing and wear masks regularly. See what happened in Singapore, it was struck by a second wave of coronavirus. Look, what happened in the 1918 pandemic, people dropped their guard and the second wave of viral infection struck back. If people do not follow social distancing then the spike in cases is apparent. We need to take these precautions at least for one year. India is also vulnerable to this second wave.

Q: If Covid-19 cases continue to rise rapidly, do you think we need another lockdown in areas where volume of cases are very high?

A: A large volume of cases is concentrated in specific areas like hotspots, and in order to maintain things in order, we may need a limited lockdown in these areas. This should be followed by a micro-plan which entails extensive testing of people and also extensive contact tracing of people who have got in touch with positive people. Need to ensure there is no leakage of cases from these areas. People from these areas should not mix with others in non-containment areas. This will aid in containing the outbreak of the virus. People who have developed symptoms should get themselves tested, especially in the containment areas.

Q: With more than 4.5 lakh cases and close to 14,500 deaths, do you think India has reached its peak and a decline in cases is prominent?

A: The cases will continue to increase for some time. The doubling time of cases has also increased. But, the cases will also begin to flatten. Though, it is difficult to give an exact time period in this viral infection, it seems, the growth in cases will flatten in the end of July or beginning of August. A decline will come to this viral infection, but it does not mean that people should drop their guard. As a measure, we need to decrease community participation and citizens should continue to follow social distancing. People should get themselves tested. All these efforts will help in preventing people from contracting this virus. These precautions will also prevent us from the second wave, and we must continue to take precautions. The virus has not gone away, it is still lurking.

Q: India has crossed the 4.5 lakh coronavirus cases so far, although our recovery rate is good, but still 10,000 to 15,000 cases are reported daily. Why do cases continue to spiral, what is the reason?

A: We have to remember a few things -- the bulk of cases are in 10 cities, nearly 70 per cent, and if we take into account cases per million population, the number is not very high, as compared with countries including countries in Europe. Many European countries put together still do not add up to the Indian population. Do not compare India to countries like Italy, Spain etc. We need to focus on hotspots, which contribute to between 70 -80 per cent of cases, and we have to identify cases in these areas at an early stage. The population density is very high in these cities. People in lower socio-economic status are highly vulnerable to the viral infection, as many live together in small spaces and there is a lot of mixing of people happening there. Look at the market places, people are not following social distancing and not wearing masks. In fact, many are in close vicinity of each other.

More than 50 million people in India do not have access to effective handwashing, putting them at a greater risk of acquiring and transmitting the novel coronavirus, according to a study.

Researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US found that without access to soap and clean water, over 2 billion people in low- and middle-income nations -- a quarter of the world's population -- have a greater likelihood of transmitting the coronavirus than those in wealthy countries.

According to the study, published in the journal Environmental Health Perspectives, more than 50 per cent of the people in sub-Saharan Africa and Oceania lacked access to effective handwashing.

"Handwashing is one of the key measures to prevent COVID transmission, yet it is distressing that access is unavailable in many countries that also have limited health care capacity," said Michael Brauer, a professor at IHME.

The study found that in 46 countries, more than half of people lacked access to soap and clean water.

In India, Pakistan, China, Bangladesh, Nigeria, Ethiopia, Democratic Republic of the Congo, and Indonesia, more than 50 million persons in each country were estimated to be without handwashing access, according to the study.

"Temporary fixes, such as hand sanitizer or water trucks, are just that -- temporary fixes," Brauer said.

"But implementing long-term solutions is needed to protect against COVID and the more than 700,000 deaths each year due to poor handwashing access," Brauer said.

He noted that even with 25 per cent of the world's population lacking access to effective handwashing facilities, there have been "substantial improvements in many countries" between 1990 and 2019.

Those countries include Saudi Arabia, Morocco, Nepal, and Tanzania, which have improved their nations' sanitation, the researchers said.

The study does not estimate access to handwashing facilities in non-household settings such as schools, workplaces, health care facilities, and other public locations such as markets.

Earlier this month, the World Health Organization predicted 190,000 people in Africa could die of COVID-19 in the first year of the pandemic, and that upward of 44 million of the continent's 1.3 billion people could be infected with the coronavirus, the researchers said.