From social distancing to testing, Lancet has this advice for India

The Lancet India Task Force on COVID-19 has suggested certain measures in order to fight coronavirus in the country. It has suggested a 'containment measures checklist' for the central government. It said that these measures must be implemented beyond the "current binary discussion on a lockdown". Among a host of suggestions, the panel said that lockdown is not an option.
The Lancet task force also said that saving lives was a priority and that there was still time to ramp up medical infrastructure in medium and low risk zones.

Here are 10 measures suggested by Lancet to combat COVID.

 

The Lancet India Task Force on COVID-19

1.  Medical Preparedness

Saving lives is the most urgent priority right now. Our medical system and staff are overwhelmed. Lancet strongly recommends that across all categories of states and districts, estimates are prepared to predict the demand for medical services based on projections of the rise in cases and proportions of severe illness, based on trends and variant information. A robust primary care system for supervised home care and triaging of patients is vital to ensure that hospitals are only receiving the most critical patients.

2. Vaccination Campaign

As of May 1, 2021, the Government of India has allowed vaccinations to be made available to the entire adult population. While this is a welcome development, this presents two practical issues: first, supply constraints; second, limited supply raises the question of prioritization and targeting, with a focus on the 45+ age group.
Prioritization is an important element of a successful containment strategy.

3. Complete ban on gatherings

Experience from across the world has taught us that superspreader events are triggers for waves of infection. Large gatherings (more so indoors, but also outdoors) bring people together in proximity. Where people travel long distances to congregate, such gatherings help spread the virus as people return home, raising prospects of spreading infection along the journey and back in their home community. Lancet recommends a complete ban on gatherings of greater than 10 persons at any given place, as well as closures of all venues that can host such gatherings for all medium risk and hot spot geographies.

4.  Closures of indoor spaces, barring those providing essential services

COVID-19 is now documented to be an airborne disease, spreading most effectively in confined, indoor spaces, where the virus can circulate for long periods of time. Confined spaces with poor ventilation, or air conditioning systems are riskiest for transmission. In those states where all the epidemiological parameters are high (COVID hot spots), Lancet recommends closure of all such spaces.

5.  Physical Distancing and Hygiene

Early in the pandemic, modes of virus transmission were known to be droplets, and to a lesser extent fomites. Measures therefore focused on minimizing interpersonal contacts and improving hygiene. Governments used measures minimizing physical contacts (including using barriers and visual prompts to facilitate physical distancing), screening for symptoms before entry into indoor spaces, and personal and environmental hygiene measures (making hand washing facilities and masks readily available).

6. Mandatory universal mask wearing in confined spaces and outdoors

Universal mask wearing is a documented, successful strategy to reduce transmission of infection upon contact. India has a mixed record on compliance, especially in the first few months of 2021, as fears of the pandemic receded. Lancet strongly recommends a renewed call for universal, mandatory mask wearing in all confined, indoor spaces as well as outdoors, especially in crowded areas. It recognizes that cloth masks by themselves offer only partial protection, and call on expanded use of well fitted N95 (or equivalent masks) or double masking with surgical and cloth masks, especially in high risk settings.

7. International and domestic Mobility

Most countries that successfully contained the spread of COVID-19 (including India) restricted access to international travelers in the early phase of the pandemic. Once the pandemic reached the stage of community transmission, these measures were no longer as critical in restricting transmission. However, as new variants emerge around the world, it is important to monitor incoming travelers. In COVID-19 hot spots, Lancet strongly recommends that all international travelers be expected to quarantine for seven days in institutional quarantine, upon entry, and on submitting a negative RT-PCR test on day 8, be allowed to continue another week of home quarantine (with daily follow ups from the local administration to check for symptoms).

8. Scaled Up Testing

Large scale testing is an essential element of the overall strategy to understand the state and the trajectory of the pandemic, as well as to get an accurate picture of whether ongoing interventions are working.13 The most reliable testing technology to date is molecular RT-PCR. Antigen tests have the advantage of delivering rapid results, are simple to use and low cost. However, these tests have moderate sensitivity, resulting in higher levels of inaccuracy of results.

9. Decentralized Contact Tracing and Isolation

Testing must be accompanied by rapid contact tracing (forward and retrospective), isolation, and quarantine of close contacts. Isolation of confirmed cases is a necessary step in the containment of the virus but it is not sufficient: quarantine of close contacts of cases is also strongly recommended for an evidence-based incubation period. Even a symptomatic case should ensure that they isolate themselves until the RT-PCR results are available.

10. Public Communication and Engagement for Collective Responsibility and Action

Building trust with the public is vital early in the pandemic to gain widespread cooperation, to avoid the need for coercion, and to generate the most effective local approaches for addressing the pandemic.