The US’ Centers for Disease Control and Prevention has released a 60-page document revising its Covid-19 guidelines and offering suggestions on how the US can reopen. The CDC now says the virus primarily spreads from person to person, but not as easily from contaminated surfaces. According to CDC spokeswoman Kristen Nordlund, the revisions were the product of an internal review and “usability testing”. US President Donald Trump said Thursday, “We’re not going to close the country — we’re going to put out the fires.”
ThePrint asks: CDC new Covid guidelines: Was lockdown necessary or did epidemiologists get it wrong?
Revised CDC guidelines should prompt India to re-evaluate lockdown, which was more political than epidemiological
Giridhar R. Babu
Professor and Head Lifecourse Epidemiology, Public Health Foundation of India
We must remember that the CDC’s revised guidelines have been made on the premise of lifting the lockdown in the US. If you look at all the recommendations in the report, it is mostly geared towards re-opening the country and the social distancing norms required for it.
The 60-page document mentions that the virus can stay on surfaces for variable durations, but that shouldn’t make us underestimate transmission via surfaces, especially without scientific evidence. The CDC document only makes a comparative analysis between the person-to-person spread of the virus and transmission via surfaces, which is fairly obvious.
That said, it’s time India also comes out with its own guidelines on how to lift the lockdown. For starters, we need to focus on how to contain cluster spread. We’ve seen that clusters are a critical point of transmission. For example, Delhi’s Nizamuddin area and Tamil Nadu’s crowded Koyambedu market. We need guidelines on how to limit large congregations, whether it’s melas or weddings. Perhaps, Indian authorities will be inspired by the CDC revised guidelines in this direction.
Lockdown was necessary, but India got many things wrong — timing, planning, testing
Former health secretary
The CDC guidelines are for homes and public spaces in the US. The appropriate technical agency in India should review these new guidelines and decide whether it is applicable to India.
Epidemiologists, however, did not get it wrong. There may have been different assumptions and techniques, but all agreed that the coronavirus would spread, at an exponential rate, it would peak and then subside, and that the lockdown, depending on its restrictions, would both lower the peak and delay it, but that there certainly would be a peak. Lockdown was also clearly necessary. Without lockdown, travel restrictions and ban on public gatherings, there would have been havoc.
However, we got many other things wrong. The lockdown was imposed late. With India’s first Covid-19 case on 30 January, much quicker action was warranted. When it was imposed, it was done without warning, leading to unbelievable misery for large numbers of people who found themselves without jobs, income, food, or shelter — a situation that many governments seem unwilling to acknowledge. Further, lockdown should have been used to identify, test and isolate, and treat the most vulnerable — the elderly, those with co-morbid conditions, etc. This was not done. States should have been helped financially to rapidly strengthen district hospitals, beds in private hospitals should have been immediately requisitioned, additional health workers appointed, as was done in Kerala, and PPE secured at the earliest from reliable sources.
India’s lockdown was a political decision, not an epidemiological one. Extending it was counter-productive
Dr T. Jacob John
Former head, ICMR in Virology
While most countries take cues from CDC guidelines, India is quite unique because we initiated an early and prolonged lockdown, and continue to be under restrictions. However, the guidelines should prompt us to reevaluate our own lockdown.
Whether the lockdown was necessary or not is a matter of opinion. It is difficult to assess what was ‘necessary’ when the coronavirus outbreak began in India.
It was declared when the total reported infections in the country were about 500. India’s infection growth and epidemic was asynchronous. The lockdown, however, was synchronous.
Since the number was so low, it was most probably not an epidemiological decision. The necessity was to “buy time” to do ensure other preparations. The lockdown was expected to flatten the coronavirus curve. But people and the economy became collateral damage. So, it was a political decision, not an epidemiologically guided one.
Lockdown was neither imposed well (abrupt, disrupting lives and livelihoods) nor implemented well (numbers grew 20 times to 12,000 in 21 days, by 15 April). Collateral damage was as predicted; the curve was not flattened as expected.
The extension beyond 15 April was unnecessary, ill-advised and counterproductive. By 3 May (the end of the second phase), the Covid-positive numbers had grown nearly 370 per cent in 19 days.
Epidemiological commonsense was applied in the first phase, but epidemiological reasoning had no contribution in extending the lockdown.
Of course epidemiologists got it wrong. But lockdown was crucial to put anti-Covid systems in place
Professor of Health Economics at Indian School of Public Policy
The lockdown was needed, if only to get some awareness going.
Of course, the epidemiologists got it wrong. Some had predicted that there would be no new cases after 16 May in India. Then there were others who predicted a million cases by mid-May. Even now, opinion seems to be divided and various models show disparate forecasts. Some experts say that the cases will keep increasing till mid-July and only then will the curve slope downwards. In fact, it was primarily because of these dire projections made in February this year that most countries went in for a lockdown. India, with others like Rwanda and Syria, imposed the most stringent curfew, stopping almost all economic activity.
As we lift the lockdown in bits and pieces, it is obvious however that the closure of all activities was indeed important. Health infrastructure had to be ramped up, equipped with testing and rehab facilities, oxygen capabilities enhanced and isolation centres readied. People also needed to be educated, a little panic had to set in for everyone to adopt acute measures like maintaining distance, wearing masks and incessantly washing hands.
The new CDC guidelines acknowledge the need for lifting severe lockdown in the US. The CDC has recommended simple and long-term strategies for a gradual opening of offices, schools and other institutions, while ensuring that the infection does not spread through contact.
But in India, policymakers needed the lockdown to rework budgets, announce stimulus packages and increase outlays for public health programmes. With these in place, a carefully calibrated easing of the lockdown will be required. Else we will see a resurgence of cases, and this relapse will be far costlier than the first episode.
By Pia Krishnankutty, journalist at ThePrint