Lockdown etc

First of all, let me define what is quarantine and what is isolation.

Quarantine: Compulsory separation, including restriction of movement, of people who potentially have been exposed to a contagious disease, until it can be determined whether they have become sick or no longer pose a risk to others. This determination could be made, for example, based on the time elapsed from their potential exposure.

Isolation: Separation of people known or suspected (via signs, symptoms or laboratory criteria) to be infected with a contagious disease from those who are not sick to prevent them from transmitting the disease to others.

The use of quarantine or isolation powers may create sensitive issues related to civil liberties. Individuals rights, and generally, isolation or quarantine must be carried out in the least restrictive setting necessary to maintain public health. Covid-19 which has already been declared as a pandemic is always a suitable candidate to exercise these extreme measures.

Lockdown is defined as another word for quarantine and is a compulsory separation, including restriction of the movement who might have potentially been exposed to a contagious disease, until it can be determined whether they have become sick or no longer pose a risk to others.

Now, the question is whether lockdown only can prevent covid-19 progression. Let’s consider few things here.

Even in a ‘total’ lockdown, you need to consider the following:

• there are already undetected cases in the community, and once in lockdown people who are uninfected may become infected by those they are living with.

• even in a lockdown there are people who HAVE to interact with other in the community – truck drivers who deliver food and medical supplies, supermarket/grocery staff who take delivery of these supplies, hospital/medical workers, including cleaners, administrative staff, etc who have to deliver medical services

• carers and service providers who need to look after the elderly, the disabled, etc

• law enforcement personnel who are required to ensure lockdown measures are being enforced

• essential services personnel to keep the gas, electricity and water running

…and so on.

A true, full lockdown, where NO-ONE is permitted outside their home, is

a) unenforcable (you can’t enforce this if police are also in lockdown).

b) likely to result in more misery and many deaths to causes other than COVID-19 (people dying from dehydration due to inability to access water, due to other conditions that cannot be treated – e.g. if you have a severe asthma attack of allergic reaction, if you can’t go to hospital because they are closed you will die, etc), as well as meaning that those currently in hospital would be left without food or water or treatment to die as well.

So, even in lockdown, transmission can still occur. The rate of their transmission will depend on how many cases were in the population at the time of lockdown – many countries appear to have waited until they were forced to implement lockdowns, and by that time the virus is already swirling throughout the community.

The other important thing to note is that it appears that non-symptomatic transmission can occur, which makes life much harder – you can’t necessarily tell if a person has COVID-19 or not, so you can have essential services personnel carrying and potentially spreading the disease unknowingly.

And of course there are always those who refuse to obey the laws – we had an examples of a man who was diagnosed with COVID-19 and told to go into self-isolation, who then deliberately went out into the community with the intention of spreading the virus. Hard to believe but true.

So, why everyone is rooting for lockdown? What gain can we achieve from it?

The best gain that we can achieve from lockdown is to slow the rate of transmission. As less people are mixing, it will definitely reduce the chance of transmission. So, our hospitals will be less flooded with cases and we will be better ready to deal with complicated cases with our limited resources. 

So, what should we do during this lockdown period?

As a general population, you will have to OBEY lockdown STRICTLY… That’s the most important thing you can do for the society, for your country and for human race as a whole. 

Follow the personal protection guidelines, like repeated hand wash, follow cough etiquette, avoid frequent touching of face, stay indoor and if you have to go out, then maintain social distancing and use a simple cloth mask to cover your nose and mouth (Don’t misuse N95 mask, keep them for the health care personnel.)

But the administration and health authority have more important role to play during this lockdown period.

More tests have to be done, first for the suspected population, i.e. persons with travel history to known Covid positive area or their contacts or persons who were in close contacts with known Covid patient and their contacts. Later on this tests must be done to all who reside in the locality of those suspected population, this is to detect unknown contacts and possible community spread. Further, tests should be extended to all cases of severe respiratory illness and to all aged population or with co-morbidity. This is to reduce the case fatality. And still further, if the resources permit, testing may be done from the random asymptomatic persons.

All positive cases must at once be isolated from the society to a designated place, like a Covid hospital and must be treated as per protocol.

Type of testing used for screening is also important. False negative cases must be minimum for a screening test. And a screening test must be easily done and easily available with fast result, like a card test. Although many card tests are day by day coming in the market for Covid-19, we are still in search of best screening test. All screening positive cases must be confirmed by more specific rRT-PCR testing from nasopharyngeal and oropharyngeal swab.

This lockdown will give the administration and health authority the time required for proper planning and implementation of necessary action. Otherwise only lockdown is not going to stop this pandemic.

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