The COVID-19 would peak atdifferent times in states and there is not going to be uniformity across the country, a noted public health expert and epidemiologist said, suggesting heightened surveillance and forming district action plans to handle the pandemic more effectively.Professor and Head of Life Course Epidemiology at the Public Health Foundation of India, Giridhara R Babu said the coronavirus is in complete ascendancy stage in states such as West Bengal, Madhya Pradesh, Maharashtra and Gujarat, where it has gone beyond minimal containment.There, things will have to be completely different in terms of reducing the mortality rate, while in other states we are yet to see the surge and, therefore, our preparedness will have to continue, he said.But in both these categories we have to make sure surveillance is the only thing which will guide us, because if we lose our guard now, then we will no longer enjoy that success that we relatively have compared to the other countries, Babu told PTI.The only way forward is surveillance.On whether states would see the pandemic peaking at different times and it would not be uniform across the country he said: Absolutely, each State is like a country. We can postpone (the peak) in low transmission areas.Babu, who is trained in Epidemiology (MPH and PhD) from University of California Los Angeles (UCLA), said one should not get bogged down with the increase in number of cases, adding, the goal is to reduce the number of deaths.If your surveillance is good, then you will pick up more cases, and thereby you will reduce the number of deaths, that should be the focus.He said he is worried about silent districts, where there is not even a single COVID-19 reported case.Giving an example, Babu said a few days ago there were no cases in three districts in Karnataka (Davanagere, Chitradurga and Shivamogga) but they have now become hotspots.So, for me, the nomenclature of red, orange and green is completely artificial because it is dynamic and you cannot have such a categorisation for a dynamic process, he said.According to him, it is now known that the number of expected COVID-19 cases in the country is 54 per million (ten lakh) population.He said if a district has not reported coronavirus cases, it should be in the red because surveillance is not adequate. Even in a well-controlled state like Kerala, cases are coming back.He suggested drawing up district action plans, something similar to pulse polio campaigns (which are done three days in a year), for which preparations start three months in advance in terms of micro-plan, which lists every migrant population and temporary settlement.Then, teams are drawn to cover everybody, then there is logistics that are planned, we do not have district action plan for the country (to handle COVID-19). When you open up after lockdown, and if there is a surge in cases in a few districts, they dont know what to do. That terrifies me.Districts should have task force and action plans to handle the COVID-19 pandemic, added Babu, who has worked with World Health Organisation for nearly six years, during which his efforts included stopping polio transmission in Karnataka and initiation of measles surveillance.
