Mumbai: India is easing lockdown restrictions in phases, with some restrictions set to continue till the end of June 2020. But work is resuming, and in cities like Mumbai and Delhi, people are already on the streets--getting back to work in measured ways--and it is getting crowded.

As cases continue to rise and hospitals run out of capacity, how do we calibrate our lives in a manner that we do not get infected? How can we ensure reasonable-to-full protection, especially during travel, in confined spaces, and in large apartment complexes in the big cities? We speak with Giridhar R. Babu, professor and head of Life Course Epidemiology at the Public Health Foundation of India, to discuss this.

Edited excerpts:

As lockdowns are lifted, people are stepping out of their homes. But if they are not stepping out, what should they be waiting for?

I think the time has come now to start preparing in terms of how I would want to go out and start working. For that, there are three Cs which we should be taking care of: closed spaces, crowded places and close-contact settings. I need to follow precautions for all the three Cs, so that I am safe; and if I am infected, others are also safe from me.

With the rising number of cases, the fear is also going to rise. What are the precautions I can take to be satisfied that I am protected--short of going out in a full personal protective equipment (PPE) suit?

Obviously, we do not have to go out in a full PPE suit.

As we step out of the house, it is common practice to wear jewelry or a favorite watch etc. Now, we need to make a mask our best component to accompany us at every point of time. Whenever there is a crowd, or wherever there is any person whom I get in contact with, I should wear a mask, and ensure that there is physical-distancing.

Even when I am going to the office, if it is a closed space and if it is poorly ventilated, all I need to ensure is that there is enough physical-distancing and I am using a mask whenever I am in doubt. By following this and by ensuring that there is no close contact with any person--whether infected, uninfected, it does not matter--[I should be protected]. The best thing is to assume that everybody is infected and wear a mask, wherever you are in doubt.

Some people are very worried. A lot of apartment complexes, for instance, are not allowing anyone inside, and are equally worried about stepping out. Is there some turning point for such restrictions to be eased? What could that turning point be?

As I said, if we are able to follow ‘three Cs’ and wear masks all the time, there is not going to be great panic. The turning point has already been seen in Europe and the UK. After lifting the lockdown in Europe, they are seeing a steady decrease in the number of deaths and the number of cases. In the UK, the standardised national prevalence is around 8%. Yet, there is a decrease in the number of deaths and cases.

There are so many things about this novel coronavirus that we do not know. Earlier, people said nearly 60% of the people have to get infected to get herd immunity. But with 8% of seroprevalence, we are seeing a decrease in the number of cases and deaths [in the UK]. Therefore, either the virus is affecting only some people, and probably killing those who are mostly vulnerable... But once that is through and only a part of the community is getting affected, it is on a decreasing trend. Therefore, [though] there is an increase in the number of cases in India, but [there is] nothing to worry because our mortality rate is definitely very low. And our health systems are prepared well enough to take care of a surge in cases. And, a major proportion of people are asymptomatic.

You said that in many countries, despite their opening up--or maybe because they have started opening up--the number of cases started going down. So, is it a convergence of time and some other factor?

Once there is a peak in transmission, the cases will have to go down. When that peak happens is the most important thing. Arguably, most countries in Europe and the UK have already seen their peak in the past, whereas for India, the peak is yet to come. Based on several projections, maybe it will be around mid-July. But we are going at a pace where even the increase in the number of cases is handled well by the health systems. Therefore, I do not think there is any cause for panic. We need to get on with our work, but we need to ensure these minimum precautions.

Let’s say I am catching a flight. That involves going to an airport, standing in lines, walking inside the aircraft, and then sitting inside a pressurised container for 1.5-2 hours, or longer if flying long distance. What are the things that I should be thinking about? And how can I be sure that I am safe and protected?

I think one of the most safe settings is when you are within the aircraft, because the air condition system is such that it will probably get rid of the virus even if it is circulating there. But if you want to be doubly cautious, you can wear a mask throughout the transit, while you are in the flight, and whenever you are in doubt. A mask is definitely an essential accessory which each one of us will have to wear all the time.

In addition, as much as possible, we should ensure that there is minimum physical distancing. There are small airports where there can be overcrowding. As long as people are following cough etiquette... The only way the virus spreads is through cough and sneezing--that is, the secretions of the Mouth, Eyes and Nose (MEN). So therefore, avoid ‘MEN’. To avoid ‘MEN’, you need to use a mask all the time and ensure physical distancing.

In apartment complexes, as I said, people are worried about others coming in and out, taking elevators, and going down staircases. There seems to be a fear that drives everything: Shut all gates, do not allow anyone to enter, people should go out and get their couriers, etc. Does this response reflect a scientific understanding of what this virus can or cannot do? And if so, how should we be responding?

Again, let me repeat. The only way anybody can contract this virus is if you are staying for longer than 20 minutes and through respiratory droplets, which are either sneezed or coughed [out]. When you sneeze, the droplets can go upto 6 metres.

So, if everyone is wearing a mask in the common areas, and you are just walking next to each other and suddenly, let us say, somebody coughs... one will not randomly get the coronavirus transmitted from one person to another. The chances are less than having a road traffic injury within the apartment complex.

What should my philosophy be? What are the two or three things I should be always aware of? I think you covered it. But I am just asking you to encapsulate it once again.

I think I should be very careful about crowds. If I am seeing more than a few people (more than 5 or 10), I should ensure that when I am entering that [space], everybody is wearing a mask and there is physical-distancing; but for my safety, I should be wearing a mask. Even if you are going for a walk or a run, you should be able to ensure physical distancing.

When you go to the office, [or other] closed spaces, you have to ensure physical-distancing and use a mask whenever you are in doubt. Most importantly, in close-contact settings, if you think two-arm distance is what your privacy is, you should ensure that there is no other person in that space. If they are there, then both should be wearing a mask.

We spoke about a month ago and some things must have changed in our understanding of how things are progressing with the pandemic. What are your thoughts today?

What we know now, which we did not know a month ago, is that symptomatics are mostly known to spread the infection. Therefore, there might be many asymptomatic [people] who might be even testing positive, but as of now, the evidence does not suggest that they are key drivers of infection.

Number two, Japan could reduce their case burden just by following the ‘three C’ strategy that I explained--closed spaces, crowded places, and close-contact settings. In addition to this, using masks and physical distancing has shown to reduce the transmission by more than 50%. So, I am more confident now that India will be able to do well and also reduce our mortality, and sustain the gains that we have achieved over time.

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