COVID-19 spreads mainly by droplets produced as a result of coughing or sneezing of a COVID-19 infected person. This can happen in two ways: One can get the infection by being in close contact with COVID-19 patients (within one Metre of the infected person), especially if they do not cover their face when coughing or sneezing. And secondly, the droplets survive on surfaces and clothes for many days. Therefore, touching any such infected surface or cloth and then touching one’s mouth, nose or eyes can transmit the disease. The most important factor in preventing the spread of the Virus locally is to empower the citizens with the right information and taking precautions as per the advisories being issued by Ministry of Health & Family Welfare. Preventive methods of COVID -19 include: Wash your hands often; Wear a face mask; Avoid contact with sick people; Always cover your mouth while sneezing and coughing. Several precautionary measures have to be taken in order to contain the virus because the risk of transmission will certainly increase with the lifting of the lockdown. We must recognise that this virus is going to stay on for some time and we have to make sure that at least for the next one year, we try and keep the virus as slowly moving as possible by physical distancing and other protective measures like masks and handwashing.
Transmission of the virus
We all know that COVID-19 spreads from others who have the virus. A person catches the virus through droplets expelled when someone infected with coronavirus coughs, sneezes or speaks. But, what happens in case of asymptomatic COVID-19 patients? Can they spread the virus? The World Health Organization, in a recently released video, answers similar questions related to COVID-19 transmission. In the context, Dr. Maria van Kerkhove, COVID-19 technical lead, says that the majority of transmission that is known till now is that people who have symptoms transmit the virus to other people through infectious droplets. “But, there are a subset of people of don’t develop symptoms. We still don’t have the answer to understand how many people don’t have symptoms,
Concept of Asymptomatic or Pre-symptomatic
Asymptomatic COVID-19 positive means a person has been tested positive but has no symptoms, and does not go on to develop symptoms, says Dr Kerkhove in the video. “A number of people are reported asymptomatic, actually may have mild disease. They may go on to develop symptoms. They may not quite register that they are sick. They can feel just a little bit unwell or under the weather, or fatigued. Some of those individuals we would classify as pre-symptomatic,” Pre-symptomatic COVID-19 positive means that a person has not yet developed symptoms. Here we need to better understand what proportion is that contributing to transmission. This is one of the major unknowns. Explaining how asymptomatic people can spread the virus, Dr. Mike Ryan, EXD, WHO Health Emergencies Programme says, “For instance, if someone is in a nightclub, trying to talk to someone, and its too noisy, and you are too close to them, it’s like you are projecting your voice at someone. In this situation, if the virus is present your upper respiratory mucosa, then there’s every likelihood that you can project the virus.”Many people with COVID-19 experience only mild symptoms, especially in early stages of the disease. “It is possible to catch COVID-19 from someone who has just a mild cough and does not feel ill. Some reports have indicated that people with no symptoms can transmit the virus.
The current status
In terms of pandemic generation, we are still very much on the upward climb on this mountain, Dr. Ryan adds. “As some countries have shown, if you go at this with a comprehensive approach in a very systematic way, then there is enough stop ability for the virus.”.He also added that as a society, we have some choices to make. If we can identify cases and their contacts, and we ask those contacts to quarantine themselves, we support them in that quarantine, then that can be a very successful way of both stopping the disease and avoiding large-scale lockdowns in future. Because, if one looks at the spread to people without history of travel or history of contact, certainly there are several such cases, he said. “But most of them are concentrated around the original points of entry of the foreign traveler’s or the travel routes of their contacts. So, these people who are describing it as stage 2 still are saying this is traceable local transmission, it is not unpredictable community transmission.
Therefore, we are avoiding the term community transmission. It is a matter of definitions and language; we need not debate that really. But it should be recognised that community transmission has occurred in virtually every country which experienced this pandemic in a major form and India should also be prepared for it and act as though it is happening and take all precautionary containment measures. There is not only risk but actually threat of community transmission. According to him, nations in South East Asia, including Malaysia, and India in particular, have kept the COVID-19 death rates per million of the population low compared to countries where the pandemic broke out around the same time. The low death rate in India could be the benefit of multiple factors such as younger age group, more rural population, temperature and climatic conditions as well as the benefits the containment measures which preceded lockdown, and then got much more consolidated with the lockdown. Its quite possible that all of these factors have been helpful and we have seen that benefit. But we need to continue to consolidate that. There are some risk factors, when the lockdown opens there will be much greater mobility of people, there could be more widespread transmission of the virus, so we have to maintain as much as possible physical distancing, continue practices like wearing masks and hand-washing as precautionary measures.
However, these are going to be difficult in overcrowded areas, especially slum areas. We will have to try and provide as much facilities as possible, particularly for elderly people and to people with co-morbidities, whether they can be provided temporary shelters elsewhere with good social cares. Fortunately, most of the infections are restricted to large cities and areas radiating around them. Referring to return of migrant workers, care must be taken to see that they themselves will not be victims of the epidemic, and at the same they don’t infect others. But most important thing is to protect the rural areas (from COVID-19) because two-thirds of India is in rural areas, and the transmission of the virus is low there because mobility is low. Evolutionary biology of the virus says that when the movement is greatly restricted and its chances of transmission are greatly reduced, the virus actually can turn into a milder virus.
