COVID Pandemic in J&K
Dr Rajneesh Kumar
First case of COVID 19 in J&K was reported on 9th of March 2020, and since then we have seen an increasing number of cases. On 9th April we had 184 cases, 9th May 836 and by 9th June 4346 cases were reported. With the announcement of country wide Lockdown on March 21, strict travel restrictions were imposed which prevented a steep rise in the cases. However, with the easing of restrictions on 17 May, cases have shown a significant rise on daily basis. We added 183 new cases in first month, 652 in second and 3510 in third month. Average daily cases in the month of May was 59 while in the month of June (till 18th June) it is 172. These numbers clearly indicate the rapid transmission and spread of infection in the Union Territory. However, we are doing good on two fronts one is mortality rate which is very much controlled and other is testing which has been ramped up significantly. Case fatality rate in J&K as of 18th June is 1.2% which is much below the national average (3.1%) and expected mortality rate (3%) due of COVID 19. As of 18th June. 2,82,268 tests have been conducted and J & K is among the top states in terms of number of tests done per lakh population.Recovery rate as of 18th June is 56% for J &K which is also more than that of national average (53%). Work done by health officials, doctors, nurses, lab technicians and other frontline workers is really commendable in response to the pandemic. Despite of numerous challenges J&K has fared well in its efforts to contain the situation, however the battle is still going on and sustained efforts and response is required to control the pandemic.
There are some unique aspects of COVID 19 infection which need to be considered while measuring its impact or burden. COVID 19 is a new disease and it is very difficult to tell as of now how long it will last. Many experts believe that it is going to stay for some time and is unlikely to go away soon. In such a scenario every effort should be done to contain it. Even though mortality rate of covid 19 is low but infectivity is very high, therefore by infecting a large number of people even with low mortality rate we can have a high number of deaths. It is quite possible that pandemic as of now is affecting more of young and healthy population, mostly those who are travelling and going out but with increased local transmission (stage 2) and subsequent community spread (stage 3) there are very high chances that our vulnerable populations like elderly, pregnant women, children, persons with underlying conditions like Diabetes, Asthma, COPD etc. will get infected and then we can see a sudden rise in case fatality ratio too like spike in cases we are witnessing now. Even though there is no official declaration of community spread by authorities as of now but many public health experts have expressed their views that community spread has begun in India. Health authorities and public health experts in UT of J & K should anticipate this kind of situation happening anytime soon, and be prepared to respond to such type of situation.
Also, the burden of a disease is measured in terms of DALY’s (Disability Adjusted Life Years) which is calculated as sum of YLL (Years of life lost) due to premature death and YLD (Years lived with Disability). In simple terms number of deaths, number of incident cases (new cases) and average duration of the case until recovery or death is considered to calculate the burden of a disease. So as the number of cases rise burden of disease will also rise.
To respond to any kind of situation planning is an essential step and in health planning data is everything. As of now data in public domain is just limited to numbers from which one can only describe the current situation, but there is little one can do with this data to plan any action. A complete data analysis including demographic characters and other relevant variables need to be looked upon in detail to develop a comprehensive understanding of the growing pandemic.
At state/district level we need to have a covid resource committee/center which should be doing deep data analysis for state and districts respectively which should not be limited to just descriptive but analytical to develop evidence base strategies. Such committees need to understand the local context and also look upon some of the success stories within the country and globally to design context specific response and action
We need to involve, engage and strengthen our primary healthcare system in our continued response to pandemic. Involvement of community leaders, panchayat members, health activists, social activists is crucial for contact tracing and surveillance. At Block and panchayat levels we can have Corona prevention committees to sensitize and aware general public not only about the prevention of covid but also educate people about stigmatization to prevent the untoward incidents like one happened few days back in Jammu with a deceased patient suffering from Covid 19 and also to allay the fear associated with covid 19. So now responsibility lies more on individuals and communities rather than on authorities to prevent rampant community spread.
There is a growing evidence about the use of face mask and maintaining physical distancing in preventing the transmission of infection. A recent study (systematic review and meta-analysis;) published in “The Lancet”, says that chances of transmission with Physical distancing of 1m or more and the use of face mask fell significantly that of without physical distancing and mask. Another incident that happened in a hair salon in US found that two hair stylists who were infected with corona virus saw nearly about 140 clients but all of them were wearing face masks and no secondary infections were found after contact tracing of all, testing 46 of them and quarantining the rest.
The battle is long and we have already lost a window of opportunity and exhausted our Brahamastra in the form of lockdown without much gain to contain the situation. Our healthcare system is strained & healthcare workers are fatigued. If we can’t stay indoors in our cozy rooms for too long, then imagine how can they fight such a battle for a long period in a stressful environment. They too need a break, after all they are no way different from us except in their commitment and dedication to their profession. In such a situation each one of us needs to become more responsible and follow simple preventive public health practices like wearing face mask, maintaining physical distancing and hand washing to keep ourselves and our community safe.
(The author is Programme Officer – Jhpiego, A Johns Hopkins University Affiliate)
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