A large section of our population is still susceptible at risk of COVID-19 By Kartik Lokhande : AS THE policy-makers Governments have started hinting at the likelihood of second wave of COVID-19 infections across the world India Maharashtra and NagpurThe Hitavada reached out to Prof Sanjay ZodpeyVice-President Public Health Foundation of India New Delhi and also Director at Indian Institute of Public Health Delhi. As an expert who has been instrumental in sero-surveillance in Nagpur district Prof Zodpey is the man in a position to offer scientific perspective with social message at this hour. Here are the excerpts: Q. After several months of COVID-19 pandemic things appear to be returning to normalcy in India. At the same time some quarters are warning about a likely second wave of infection. As a leading scientist what is your take on this? A. As you are aware that the COVID-19 situation is very fluid and dynamic in nature we are seeing new peaks in USA and Europe which are learning lessons for other countries. We are also experiencing rise in cases in Delhi in recent weeks. This disease spreads through population mixing especially through contact between susceptible individuals and infected individuals. As long as there are certain number of people harbouring the infection and certain proportion of the population susceptible the transmission will keep happening. Depending upon the population level mixing across households and small communities especially during the festival season the risk of disease spread remains high. Q. You have been instrumental in guiding the effort of conducting surveillance in Nagpur District. How was your experience in conducting the surveillance? A. It is indeed matter of great pride and pleasure to work with very efficient district and civil administration and other key stakeholders of the Nagpur on this sero-surveillance study. As you are aware that conducting serosurveillance requires timely investment of both financial and non-financial resources particularly human resources with technical skills to conduct sero-survery and data analytics; I was very pleased to see wide scale multi stakeholder collaboration put together by district authorities medical college community and other stakeholders to successfully complete this study in timely manner. Q. What are the results of sero-surveillance of Nagpur city as well as Nagpur rural? Please elaborate with data/statistics. A. As per the sero-surveillance results presented to administration there is a wide variation in sero-prevalence across Nagpur District. For example sero-prevalence in Non-NMC rural area was 19% whereas it was 24.5% in NonNMC urban area. Furthermore there is wide variability in seroprevalence across the non-NMC clusters - from 4% to 44%. Similarly in NMC area the sero-prevalence was 49.7%. Again there is wide variability across different clusters and wards - from 16% to 80%. This clearly highlights that a large section of our population is still susceptible and at risk for COVID-19. Hence we need to continue to maintain vigil and put our best efforts to ensure mask use avoiding closed spaces and crowded places physical distancing maintaining proper ventilation in markets work place and homes to keep ourselves and our family members safe in this festival season. Q. As far as Nagpur is concernedCOVID-19 death rate continues to be a cause of concern though the number of deaths recorded daily has come down of late. What can be done to reduce the death rate in your opinion? A. Well the clinical outcome is driven by many individual level characteristics such as clinical situation at the time of admission in hospital time lag between development of symptoms and seeking care and testing and admission to the health care institutions age co-morbidity immunity response to treatment and several others. Furthermore the death rate is a measure which comprises numerator (number of deaths) and denominator (number of cases). Sometimes the rates estimated are artificially high when large majority of cases are asymptomatic and mildly symptomatic and hence do not get themselves tested resulting into missing numbers from denominator. We can only urge and request people to get themselves tested as soon as they develop any COVID-19 related symptom and seek medical care at the earliest. The change in daily death counts over time is the best indicator for us to gauge whether the epidemic is waning in a district. We are performing better in recent weeks. Q. The doubling rate has improved to a great extent and recovery rate for COVID-19 also has surpassed national average in case of Nagpur district as a whole.Should the people treat this as a great relief and get back to normal pre-COVID-19 life or continue with precautions for some more time? A. Doubling time is the time taken for number of cases to double. This is variable over time and depends on several factors. Although improvement in doubling time and recovery rate are good signs of diseases control we cannot relax. Significant proportion of population of Nagpur District is still susceptible to COVID-19. We all must comply to disease prevention strategies mentioned earlier. (To be concluded)

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