Indians must follow covid guidelines even if cases decline: Interview with AIIMS Director

New Delhi, Apr 16: South Delhi District Magistrate Brij Mohan Mishra on Thursday said that the administration is investigating how the pizza delivery boy contracted the coronavirus.

"In the last 15 days, we discovered houses he had delivered food. We contacted people living in 72 houses and they have been asked to stay in-home quarantine. No symptoms have been seen in people related to him. 

Testing of his roommate has been done and his reports are awaited. The rest of the people don't have any symptoms, they have been placed under institutional quarantine. Those in-home quarantines are also asymptomatic," Mishra said.

"Unless a positive case comes, we feel that transmission has not taken place. The boy told us that he was continuously wearing a mask while delivering the food. We are also finding out how he got infected. We are getting the information about the places he visited for delivery. He was tested on the basis of the doctor's advice. Later, he tested positive," he said.

72 families have to stay in home quarantine in the Malviya Nagar area after the delivery boy tested positive for COVID-19 on Wednesday.
Delhi Health Minister Satyendra Jain said that 17 other delivery boys linked with the infected person have also been placed under institutional quarantine.

"A pizza delivery boy has been detected with COVID-19 here. 17 other delivery boys linked with him have been placed under institutional quarantine and 72 people have been placed under home quarantine," Jain said.

Food delivery app Zomato said that the staff of the infected person's restaurant has delivered some orders which were placed on its platform.

"We've been made aware today that a restaurant's employee, who has been recently tested positive for COVID-19, had delivered food in the past to a few customers in the Malviya Nagar area in Delhi. All these customers have already been contacted by the govt authorities... We are not sure whether the rider was infected at the time of delivery," the company said in a statement.

Zomato also claimed that colleagues of the delivery boy have tested negative for COVID-19.
"This restaurant had instructed their riders to wear masks and follow strict hygiene to keep customers safe from any unintended mishap.

All co-workers of the said rider have been tested negative. And as a precaution, the restaurant where this rider worked has suspended operations," read the statement.

Kochi, Mar 30: Kerala High Court on Monday granted interim bail to the under-trial prisoners and remanded accused in the state till April 30 in view of the lockdown imposed to prevent the spread of coronavirus.

The court said that the accused should report to the local police station immediately after getting bail. Those released on bail must strictly follow the lockdown instructions, the High Court said.

"Those who have been convicted of imprisonment for less than seven years will get bail. Prison Superintendents will release the prisoners who are eligible. But regular offenders are not entitled to get bail," the court said.

After the bail period, the accused should appear in the respective trial courts, where a decision will be taken on their bail by the respective trial courts.

The Supreme Court had last week asked all state governments to release undertrial prisoners, who are facing charges attracting less than seven years imprisonment, to reduce overcrowding of jails amid the ongoing coronavirus scare.

So far, 194 confirmed cases of coronavirus have been reported in the state.

The country is under a 21-day lockdown to prevent the spread of coronavirus, which according to the Ministry of Health and Family Welfare has claimed the lives of 29 people and infected a total of 1071 people as on Monday morning.

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