Covid 19 has taken the world by storm. We have all watched one or other movies where the world is stuck by a disaster and is in a state of emergency, but no one ever thought we would be a living part of it. Covid 19 is the most crippling pandemic, after Spanish flu in 1918, which has hit the world, cross cutting socioeconomic and demographic profiles, crippling nations and economies all over the world. Till the herd immunity develops, the disease can spread like fire in non-immune populations through early asymptomatic and mildly symptomatic Covid 19 positive cases.

Social distancing, Respiratory hygiene, home quarantine and isolation are the new preventive mantra being advocated to combat this disease. The rationale being that stringent following of these preventive measures will stagger the onset of Covid positive cases to more manageable numbers till there is a cure or vaccine in hand. Most countries are in partial or complete lockdown and awareness generation about these measures is being done on a war footing. All these to “Flatten the curve”.

Many of my friends ask, “What is this flattening of the curve?”  As one friend remarked absence of helping hands is definitely not flattening but making the curves sinuous……!! She has achieved the kind of curves which required months of gyming!

On a serious note and without getting too technical “Flattening the curve” is when we prevent the explosion of the number of cases and reduce/stop transmission by breaking the chain of transmission. The disease which spreads mainly through the droplets and surface contact has a transmission rate which varies from. 2.5 to 4.2 per person. That is one person is capable of infecting two to four persons at least in the given time frame Simply by decreasing/distancing (in the current scenario) the availability of susceptible hosts to the prevalent virus within its life span is how we try to control the infection. The underlying assumption is that by not getting any susceptible hosts over a prolonged period of time will make the virus extinct in that geographical area. The flattening refers to the decrease in number of cases. The curve in the absence of any preventive measure would have a steep hump flattens out because of the measures adopted.  

Now I have come across many articles and opinions where it says that Covid 19 surrounds itself with unnecessary pandemonium. The disease has a fatality rate of 3.5-6.2% depending upon different geographies which is much less than mortality due to dengue, malaria and other diseases affecting our countries. It may be noted that though the disease is mild in 95% of the those affected but it is associated with severe complications including death in 5% of the cases esp. those with co morbidities and above 60 years of age. India with its large population base increased burden of diabetes, hypertension and Tuberculosis is especially vulnerable and is sitting on a time bomb which on explosion will overwhelm the existing healthcare systems, and these systems even with enhanced capacities will not be able to provide required emergency healthcare to the needy.  

That is why we as nation are strategizing on containment rather than mitigation measures. The developed nations like USA and UK who initially didn’t focus much on containment measures were shook out of their lethargy by the enormity of sheer numbers being affected and requiring critical care. No country has the required infrastructure to cater to these patients and the additional burden put on the healthcare staff is quite daunting. Not only the healthcare personnel are at high risk of being infected, but also the patients with other morbidities, forcing the system to defer treatments to only emergency cases. It requires strict isolation and protocols to prevent infection of the others. All this requires large number of dedicated hospitals, isolation zones and manpower at hand.

Though across the country administrations are gearing up to mitigation measures and developing the mitigation plan with identification of resources and training of manpower to cater to the tsunami of cases when it strikes, but no one can predict accurately the course of the pandemic. The predictions vary from few lakhs to few thousands. One is learning about it as the ship is sailing.

In view of its un-predictable course “Flattening the curve” is what we can work best at!  Reducing the chain of transmission till there is vaccine or cure in hand is what will save the healthcare systems from drowning in COVID 19. So friends stay safe and stay healthy and practice the mantra of social distancing, hygiene and quarantine.

Dr Suparna Khera