A ‘Contain, Control and Cascade’

Context: From a safe haven in May to become the state with the fourth-highest caseload of COVID-19 in India, Karnataka’s situation seems to be spiraling out of control. Yet, this state has important lessons for the rest of India.

Top Priorities in handling the COVID-19 crisis: 

• Contain the spread:
• Strict enforcement of the 5T model of “test, trace, track, triage and treat”.
• Relook testing guidelines: given the Indian Council of Medical Research’s (ICMR’s) estimate that 70-80% of coronavirus patients are asymptomatic.
• Quick implementation of nationwide Sero-surveillance.
• Comprehensive Contact racing is the key to the slowing of the spread:  For E.g. before the recent rise in cases, Bengaluru was tracing 47 contacts, compared to Mumbai’s ratio of 1:3.
• Seal off active clusters on the lines of the Dharavi slum pattern.
• Use of technology: data mining and analysis to predict the likelihood of the next outbreak.
• Control Mortality Rate: 
• Mortality rate needs to be reduced to below 1%. (mortality rate has dropped from 3.28% at the beginning of May to 2.64%).
• Hospitalization should be reduced from currently at 15% to 5%.
• Segregate COVID-cases into mild, moderate, and severe categories:
• Patients with mild symptoms can be home quarantined.
• Moderate cases should be treated in government quarantine centers.
• Only severe cases should be admitted to designated COVID-19 hospitals.
• Update clinical management guidelines: E.g.:
• Hydroxychloroquine and Favipiravir can be used in the initial asymptomatic and mild treatment.
• Remdesivir and Methyl-Prednisolone can be administered immediately after hospitalization.
• Immunomodulatory drugs like Tocilizumab and Itolizumab can be used to treat moderate to severe patients.
• Cascade Responsibility: Responsibility needs to be cascaded down to the smallest administrative unit.
• Ward Councilors/Sarpanches of gram panchayats should be tasked with preventing any resurgence.

Conclusion: Time is running out, and India will need to adopt technology- and protocol-led approach, with stakeholder collaboration and administrative accountability.