'Only get out of home for essential things'

'Even after this epidemic gets over, we know that there are going to be months of effects on the economy and poverty.'
'A lot of things are catastrophic for people from the lower socio-economic classes.'
'Social distancing is going to start killing their day-to-day wages.'
'We are not even measuring that impact.'

"This coronavirus comes with a silver lining. At least, it will pep up people to take normal civic sense to a higher status. So that besides coronavirus we actually end up also fighting other diseases like flu and TB. In India, more people are dying with TB than coronavirus or flu," Dr Trupti Gilada, infectious disease specialist, tells Rediff.com's Vaihayasi Pande Daniel in the concluding segment of a two-part interview.

• Part 1: 'We are in for a disaster in 2 weeks if we don't...'

So that doesn't really say whether which of these viruses was worse than the other.

It's worse in terms of numbers. Even if it's a small percentage of all the total number of cases, just because the quantum of total cases is so big, that even small percentages will translate into big numbers.

So it is still looking like something worse than what we've seen before?

A lot of countries have seen the epidemic evolve.

And there are some countries, like India, that are probably lagging just a few weeks behind. So it's very hard to say which one is going to be worse in terms of mortality.

But, you know, that's not the only impact an epidemic has. I mean, mortality is one impact. But the other impact is how overburdened the health system gets and what the country spends and how badly is economy hit globally.

So, even after this epidemic gets over, we know that there are going to be months of effects on the economy and poverty. A lot of things are catastrophic for people from the lower socio-economic classes.

Social distancing is going to start killing their day-to-day wages. We are not even measuring that impact.

In Mumbai, for instance, we are looking at a lockdown versus testing situation. And obviously we cannot test that much in India. So a lockdown looks like a better option.
What are some of the things that really need to be done in your view?

There are two things.

There is one (which is about) the government giving directives.

Then there is this entire thing of public awareness.

You know, a lot of directives are given by the government. And the people might just think this is advice and maybe it's like a panic reaction that the government is doing.

What the people really need to be made aware of is why these steps are being taken. They think that these cases are only in travelers and their contacts. Or 'I am not ill and no one at my home is ill, why should I stay home?'

It's very difficult to explain to a layman the concept of flattening of a curve.

Or what is India trying to do with social distancing for the next three weeks.

So it's actually not a panic reaction. It's a reaction to avert that panic that we might see three or four weeks later.

Having said that, the quantum of our population is just so massive. It's absolutely difficult to just stop everything.

We understand that if we if we actually were to stop public transport, we might be able to avert the epidemic. But we don't know what other adverse effects is going to have on other essential things that people have access to.

So the message that we really need to get to everyone is that at this point -- and for the next three weeks -- they should be getting out of their homes only for essential things.

And essential things means either getting food or groceries.

Two is accessing healthcare if you are ill.

And third, is if you need to get to work where your work doesn't allow you to work from home.

Something like if you are in healthcare. Or if someone is running the grocery shop, they have to get to work.

So, in practicality, if you are getting out of your home for anything other than these three things, then you just don't get out of the house. Just be at home.

I passed the Dadar vegetable market in central Mumbai. Of course, vegetables are essential. But the crowds at Dadar vegetable market are in the thousands...

I know.

It's very difficult.

We know that it's extremely difficult -- even otherwise the civic sense in the Indian population isn't great. Like why does it take coronavirus to tell people not to spit on roads. To cover your cough and stay home if you are ill.

We really needed such a bad epidemic to teach them that.

But that is how it works.

So we hope that, at least, this coronavirus comes with a silver lining. At least, it will really pep up people to take the normal civic sense to a higher status.

So that besides coronavirus we actually end up also fighting other diseases like flu and TB. We really suffer with TB.

In India more people are dying with TB than coronavirus or flu.

Forget a lockdown, one is still reading in the social pages of newspapers about the last party before social distancing stops the parties.

It's irresponsible!

I think we are also used to having this lathi rule. We don't stop doing things until there's a punishment to do it.

In general I think Indians don't stop doing something unless there's a disincentive. If you don't wear a helmet, you will be fined. So I am wearing a helmet because I will be fined not because it is for my safety.

So the first reaction is: 'I need to wear my helmet or I will be fined'. Maybe over period of time, they will also understand that they were wearing it for their safety.

So this time, we need to really do both.

We need to create awareness about why you need to do this for health reasons.

But at the same time, we might actually need to have disincentives like, you know, just make it a criminal offence for people to meet that in numbers like 60 and 70. And 100.

At least out of fear people will stop doing that.

Why is testing for COVID-19 in Mumbai -- given that already the figures for Maharashtra are high -- only at the Kasturba Hospital, central Mumbai?
Why is it not being given to private labs?
Isn't this testing an important element?

What happens with something which is an absolutely new disease is that there it needs a lot of calibration and training and making sure that the tests are run in the most appropriate way. Both false positives or false negatives will be a disaster.

Having said that, Kasturba has a capacity of running x number of tests -- I'm not exactly sure what that number is -- but I think it's 600 or 700 tests a day -- and Kasturba hasn't reached that limit.

The day Kasturba gets closer to that limit, they do have two other hospitals in Bombay, I think JJ hospital (south Mumbai) and KEM hospital (central Mumbai), which are being prepared to start doing the test. Now, that means that for the time being only Kasturba will be running the test.

What could actually help is -- even if Kasturba was the only place running the test -- to have other places in Bombay collect the samples, because what's stopping people from probably going there is the distance.

So someone who is in Thane doesn't find it convenient to go to Kasturba if he has a slight cough and cold and has been in contact with someone who came from (say) Dubai.

So you know, they will not even inform us.

So we probably are missing a lot of these cases, who are just not reporting.

Probably having say seven or eight or 10 just sample collection centres all over Bombay will: 1. Offload Kasturba from doing the testing, because I know of someone who went to Kasturba to get tested three days back. And they said that there was like a huge queue to get themselves tested.

So you have these people who are actually just suspected cases of corona. But they are probably in queue with someone who already has coronavirus. And they will get coronavirus just by standing in the queue.

So even though the systems are in place, I think the entire process of getting to that system needs to be streamlined.

Is there anything that you are reading about or hearing about COVID-19 which is wrong?

So the one thing that we are reading a lot is about prevention. And people thinking that gargling and steam inhalation and certain kinds of food or avoiding certain kinds of food is really going to help prevent coronavirus.

We really want people to understand that none of these things, other than hand hygiene, cough etiquette and social distancing is going to help coronavirus.

Good food, good sleep and good hydration is anyway good for immunity.

But it has no specific effect on coronavirus.

We have a lot of people who think that anyway coronavirus gets killed at high temperatures. I'm just going to take steam inhalation twice a day. By that logic you have 10 cups of chai every day but you will get coronavirus.

It doesn't work that way. So we really want people to understand that none of these -- food, exercise, homeopathy, ayurveda -- is going to help them from coronavirus.

Does warm weather have an effect on this virus? Will warm weather take it away?
Or only containment will finally do it?

It's very hard to know.

This is the first time we are seeing the virus

We hope that happens, but that is not something that we can rely upon at all. And it's very hard to say that's going to happen.

A lot of people think that the temperatures that will be required to actually bring it down is something close to 45 to 50 degrees, which is hot, really hot. You don't want the temperatures to go that high anyway.