New Delhi: Amid the unprecedented surge in COVID-19 cases in India, the Lancet India Task Force has suggested a 'checklist' to reduce the number of infections across the country. 


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The report titled 'Country-wide Containment Strategies for Reducing COVID-19 Cases in India' published on April 30, 2021, said that the Task Force does not believe that there are binary choices to be made, or that there is 'one single policy option of a complete lockdown'. 


It said that a series of actions are needed and some of these require closures, some require targeted containment, whereas, others need effective public messaging to influence individual behaviors.


The Lancet India Task Force said that 'no state is safe until all states work together' and that the country needs a coordinated response across all states in a systematic, synchronized manner. 


"In areas where infections are spreading rapidly, short, severe closures may be required; where case counts are low, containment measures may be appropriate. Specific action may differ at the district level. But it is critical that all states act in unison, and as part of a coordinated strategy, spearheaded by the Government of India," the report said.


The Task Force also advised that states and districts should be categorized as low risk, medium risk, and hot spots based on the criteria it suggested. 



Complete ban on gatherings of over 10 people 


The Lancet India Task Force recommended a complete ban on gatherings of more 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. They also included family gatherings in view of the new COVID-19 variants with higher levels of infectiousness.


"We recommend that this ban be in place for as long as necessary to bring the epidemic to an end. For low risk areas, we recommend limited gatherings, subject to local situations, organized in the outdoors. We recommend continued closures of enclosed venues that can host such gatherings," they said. 


They added that the experience from across the world has taught them 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," the report stated. 



Closures of indoor spaces 


The Lancet India Task Force recommended that all districts in the country which are COVID-19 hot spots should immediately shut indoor spaces including offices, office buildings, schools, restaurants with indoor dining, shops, shopping malls and places of worship. They suggested that this should be done in a synchronized, coordinated manner, for the same, pre-announced duration of time, so that there is a systematic reduction in cases in the hardest-hit parts. 


They stated that the coronavirus is now also 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), we recommend the closure of all such spaces. Based on the experience of lockdowns from around the world, we know that such closures need to be in place for 6-10 weeks before case counts reduce," the report said.



Mandatory universal mask-wearing


The Task Force called for universal, mandatory mask-wearing in all confined, indoor spaces as well as outdoors, especially in crowded areas. 


They recommended the use of well-fitted N95 (or equivalent masks) or double masking with surgical and cloth masks, especially in high-risk settings and said that the cloth masks offer only partial protection.


The Task Force also said that coronavirus spreads most effectively in closed, poorly ventilated spaces and suggested a sustained campaign on the importance of cross-ventilation in all indoor spaces including offices, shops, transport hubs, restaurants etc.



To read the complete report, click here

To see the complete checklist, click here