Post-Lockdown — Protecting the Vulnerable in India

SARS-Cov-2 is a highly infectious virus, spread through the respiratory tract, via small droplets produced by sneezing or coughing. Such droplets also reach many surfaces such as tables or door handles. A person can become infected by inhaling droplets, or by touching contaminated surfaces and then touching their eyes, nose or mouth. Of the people infected, a small proportion of people will become unwell and an even smaller proportion of vulnerable people will die.[1, 2, 3]

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COVID19 : The India Story

6 min readMay 11, 2020

To contain the spread of Covid-19, successive governments across the world have adopted lockdowns as a medical as well as political response to the pandemic, although some nations like Sweden and Japan have remained outliers. The purposes of lockdown are to slow spread of Covid-19 within the community and to build intensive care capacity to treat and save vulnerable people, who may otherwise die without intensive care.

All lockdowns have a shelf-life. A balance between protecting lives and livelihoods must be struck. As a lockdown concludes, people will restart their daily routines, to work, to study, to earn, in effect to live. It is at this juncture, when normal life starts resuming, that the most vulnerable, must remain vigilant. Otherwise, the entire rationale of a lockdown would be defeated.

Who are the vulnerable?

Individuals above age 70 years are most susceptible. Nearly 90% of over 31,000 deaths in the United Kingdom, have occurred in those aged 65 years and above.[4] This is perhaps encouraging data for India as over half the population is aged under 35 years, with just 5.46% aged above 65 years, including only 3.28% above 70 years.[5]

The table below gives a list of conditions that can lead to a higher chance of becoming unwell with Covid-19. However, it is important to remember that not everyone with these conditions will become unwell, and most will survive the infection.

What can vulnerable people do to protect themselves?

The first step is identifying the vulnerable. This needs to be done by each individual and family by checking the list above and consulting their doctor locally.

Protective measures will differ at home, at work and in the community. At home, improved personal and domestic hygiene, and limiting visitors (who should be screened) would suffice. In the community, face masks and avoidance of large or dense gatherings are advisable. At work, measures to ensure social distancing and face masks could help.

The personal impact of social distancing

Social distancing is not easy. It has personal, financial and psychological consequences. Humans are social animals that thrive on connecting with each other. Social distancing can hence cause loneliness and depression.[6] Phone calls and social media tools like WhatsApp may help alleviate isolation to some extent. However, reliance on social media could also make individuals prone to alarming messages and fake news, which could add to angst. Post-lockdown, socially distanced vulnerable people could also feel frustrated, as others regain their liberty, even as they forgo theirs.

How to cope with social distancing?

Simple strategies such as a regular routine, regular safe exercise if possible, regular contact with friends and family via video calls, could help.[7] Self-help methods such as meditation, mindfulness and prayer could also provide comfort. Consciously filtering news to solely reliable sources of information such as newspapers and government news channels could help. Indulging in hobbies and developing new interests could be beneficial.

Role of society, media and industry

Everyone has a collective responsibility and role to play in safeguarding India’s vulnerable. The public, as individuals, families and communities need to collaborate to support those at risk. Assistance could include fetching food and daily necessities, helping avoid public transport, and reducing unnecessary face to face interactions.

Media houses could run educational campaigns focusing on the role of social distancing as well as community assistance for the vulnerable. Promotion of public and personal hygiene, could help every member of society, now and in the future, by reducing the burden of other infective diseases such as tuberculosis and diarrhoea.

Industry must support vulnerable employees, considering a variety of alternatives, such as working from home, redeployment to safeguarded areas with low footfall and provision of personal protective equipment.

How long will the vulnerable need to protect themselves for?

The short answer is, until the pandemic has run its course. Although, it is unlikely that a single curative medicine will emerge for Covid-19, treatments that reduce severity, prevent complications and optimise intensive care, are already being developed. An effective vaccine is hopefully likely to become available in the next 12 to 24 months.

Sensitive and reliable antibody tests for Covid-19 are also in the pipeline. These tests serve as markers of prior infection and possible immunity. More importantly, if a vulnerable person has antibodies, it suggests they have already had the infection, and may have less to worry.

The most important factor will be the emergence of herd immunity. Herd immunity develops when most of the population (the herd) develops resistance to a contagious infection, either through infection or through vaccination. When 60% of the herd is infected, this section of the herd is unlikely to get unwell again, in turn becoming less likely to transmit the virus to others. An encouraging factor in India is its high proportion of young people with a high degree of social mixing, which will help accelerate the development of herd immunity.

There is a paradox stated above — we need herd immunity to stop the virus, yet we want to prevent spread of the virus by social distancing. In a complete lockdown, we are slowing virus spread but without improving herd immunity. By segregating the vulnerable and protecting them through social distancing, the rest of the less vulnerable population can proceed to live, get infected gradually and thus build herd immunity. This will eventually protect the vulnerable.

What should the country do?

Once a lockdown ends, the number of cases will inevitably increase as asymptomatic positive people will spread the virus (it is impossible to prevent virus spread 100% even with all possible precautions). The key is to not panic and lockdown again, as long as healthcare facilities are not overwhelmed. In fact, a steady rising number of positive cases is a sign that the herd is building up the desired immunity that society at large needs.

Saif Razvi, MD, FRCP, is a neurologist in the United Kingdom with interests in telemedicine, neuropsychology and human behaviour.

Sai Praveen Haranath, AB, MPH, FCCP, is a pulmonologist and critical care physician in India and the USA with interests in telemedicine, tele-critical care and public health.

Vikram Ramakrishnan, FRCS, MBA is a qualified surgeon, management consultant and entrepreneur with interests in virtual learning and school education.

11th May, 2020.

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Disclaimer: The views and opinions expressed in this article are the personal opinions of the authors. They do not reflect the official positions or opinions of the organisations that the authors work for.

Post-Lockdown — Protecting the Vulnerable in India

Written by Sai Praveen Haranath