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As of the 21 July 2020, India reported 870 cases per million population and 21 deaths per million population. Compared to 25 April 2020, the increase in cases per million on 21 July 2020 is 50 times. The increase in deaths per million population is 35 times.
Eight States have reported higher cases per million population compared to the national mean cases per million – Delhi, Maharashtra, Tamilnadu, Telangana, Jammu & Kashmir, Karnataka, Haryana and Andhra Pradesh. In terms of deaths, compared to the national mean of 21 deaths per million population, only four States have reported rates higher than the national mean – Delhi, Maharashtra, Gujarat and Tamil Nadu. The death rate per million population in Andhra Pradesh, Haryana, West Bengal and Telangana seems to be following similar trajectories. Deaths generally tend to be more accurately reported compared to cases.
Telangana is in the fourth spot in terms of the confirmed cases per million and the ninth spot in terms of the confirmed deaths per million. The confirmed case load per million population has increased by 45 times between April 25 and July 21 in Telangana, while the death rate per million in the same period has increased 15 times. Both are lower trajectories than the national mean, especially the deaths per million.
This is because evidence shows that substantial transmission occurs at the household level rather than among casual incidental contacts.
Telangana reported its first positive case on 5 March and almost all the initial cases were linked to international travellers and their close contacts. Later, in April, internal migration of home-bound workforce fuelled a rapid increase.
In terms of deaths, till the week of 26 May, 5-6 new deaths were reported per week and this increased nearly 4 times in the week ending 27 May. The peak in new deaths per week seems to have reached 62 on 15 July and has shown a16% drop in the week ending 22 July. All these computations are based on reported data and looking at these trends, it appears that COVID-19 may have peaked in Telangana. Of course, we will have to study trends over the next 2-3 weeks to see whether the trend is sustained.
Interestingly, the Greater Hyderabad Municipal Corporation limits were reporting 75% to 90% of all the reported cases in Telangana. This dropped to below 60% for the first time on the 10 July and this proportion has been steadily decreasing and on 22 July was less than a third of the reported cases in the State. This shows that the pandemic is now spreading to other districts in the State, including rural areas.
As new cases are showing a reducing trend in the Hyderabad city limits but increasing in the other districts of Telangana, the response has to switch into the top gear now.
To be successful COVID-control strategies have to adopt a twin track approach:
The health system’s prime responsibility will be to prevent COVID related deaths. An added responsibility would be to enact policies and implement guidelines that will provide an enabling framework to reduce transmission.
The community’s prime responsibility is to act cohesively to reduce risk of transmission by adoption of positive behaviours. The organised formal leadership at the village level through the panchayati raj system is more robust compared to the mostly informal leadership at the urban level. Therefore, it may be more challenging to enforce guidelines through concerted community action in urban areas.
Apart from this, community engagement is critical for success of COVID-19 control efforts in the state. Appropriate information should be provided to local community leadership using inter-personal channels led by community health workers like ASHAs and ANMs and RWA representatives.
The importance of early detection and its role in preventing deaths has to be stressed. People have to be convinced that the risk from surface contamination is miniscule compared to risk of parties at home with large gatherings. COVID transmission is mostly indoors and is spread rapidly when an infected person is in close contact with those uninfected for more than 15 minutes.
The risk of this has to be highlighted citing instances where it happened. This behaviour change is in people’s hands and if they indulge in indiscriminate behaviour they should be held liable for their actions.
Finally, the importance of S (Sanitizing), M (Mask Use) and P (Physical distancing) has to be enforced only by people themselves and with their full understanding and participation. Housing societies should insist on regular use of masks for all their members. Offices and shops should enforce this.
(Dr GVS Murthy is Vice President (South), Public Health Foundation of India; Director, Indian Institute of Public Health, Hyderabad; and Professor, London School of Hygiene & Tropical Medicine. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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