Unlock 1.0: The Threat of COVID-19 Super Spreaders

By Sharjeel Yunus

As India relaxes lockdown, how can we mitigate supers spreaders of COVID-19?

Bengaluru hotel housekeeping staff turns super spreader. Ahmedabad: 700 super spreaders found coronavirus positive in a week. From Local Vegetable Vendor to Kirana Store: New Breed of COVID-19 Superspreaders a Big Worry for India.  It’s common to read these impactful headlines daily. And with everyday peaks in positive cases, it's hard to imagine headlines like these reduce in number. What’s common among all of these lines? Superspreaders.

Dr. Sujith S. Nath, Research Fellow, Indian Institute of Science, defines it in a simple way. “A super spreader is a patient zero who can cause maximum infectivity.” At a mass level, society can be classified into two groups:

A.  Frontline healthcare and service workers

B.  B. Daily vendors, suppliers, migrants and commoners.

The core difference between the two groups is that most members of ‘Group A’ work in specialist frontline curative (healthcare workers) or preventive (law enforcement) ecosystems under which the rest of society operates. This means that when Group A gets infected, it reduces the available curative and preventive resources available at the country’s disposal, putting strain on the entire society.

The On-ground Situation

Simply put, both these groups are indispensable for daily livelihood. They also have the maximum potential to become super spreaders. Keeping frontline healthcare workers aside, individuals at the highest risk of becoming super spreaders include store vendors, delivery personnel, and mobile/cart vendors. This is because a large portion of society comes in contact with these vendors directly or indirectly for daily requirements which increases their ‘infectivity’ potential.

There’s also a few other commonalities among super spreader events— group gatherings. These can take the form of dry or wet markets, offices or institutions or any other private/public gathering. Yes, this presents a moral dilemma for the masses, but the stakes cannot be forgotten.

As Ashish Kumar Dubey, co-founder, Redcliffe Lifesciences puts it “While I am in great favour of starting services, owners and entrepreneurs have to find new ways to operate. I think there are measures and steps that we society members, team leaders, and entrepreneurs have to take to adapt our businesses and workplaces. Let’s accept the truth. COVID-19 is going to be the way of life.”

Although healthcare workers (HCWs) and hospitals have been one of the first to adapt, the lack of ecosystem preparedness means they continue to bear the highest risk of infection. When frontline doctors and nurses are tested positive for coronavirus, skilled resources deplete. Positive cases among HCWs compromise the environment they operate in. And current rough estimate puts this figure at over 500 HCWs in India.

Rahul Kadri, Partner and Principal Architect, IMK Architects said “Cross-infection and contamination can be tackled through design changes such as naturally-ventilated spaces that increase the rate of natural air exchange, segregation of different functions and creating buffer zones in between.” However all these are preventive and cautionary measures, and aren’t a hundred-percent effective way of eliminating the risk healthcare workers are at."

One thing is certain, opening up society at large, no matter the precautionary measures will definitely lead to an increase in the number of positive cases due to the very nature of the disease. It also makes all the open spaces potential venues for super spreading events as an asymptomatic individual possessing the virus might accidentally release among a crowd who may not be so immune. This is particularly true of migrants who are moving from more infected spaces, and carrying the virus with them across and to lesser infected areas.

How Does The Mass Migration Ordeal Affect The Spread?

To this question, Sujith says, “The migrant crisis is horrible and this could potentially have been handled much better. What should happen is pre-testing before they begin their movement. We hear reports of individuals cycling, walking or going by boats which makes contact tracing near impossible. And unfortunately, we do not have the manpower to deal with this and tackle the issue at its roots.”

Unverified data sources suggest that only 40% of those tested positive have undergone contact tracing. Unfortunately, contact tracing isn’t the only issue at hand. Ashish says “Let’s be ready to see the surge. We are not even close to the surge, and we might start seeing 8,000 - 10,000 patients a day. Maybe in another 15-20 days we might see the true peak. For instance, all the people who’ve migrated away from Mumbai will have a bigger impact on the numbers as they return home.”

As more migrants enter their hometowns and districts, the lack of PHCs and quarantine centres at the grassroots level becomes very apparent. Offering a solution, Rahul says,  “Biophilic and interactive design interventions will help in improving the standards of public healthcare, while regulating construction costs. Adopting simple processes to prioritise healthcare services can ensure public healthcare facilities have low maintenance costs and are affordable to the communities they serve.”

However, creating more quarantine centres without looking at their efficiency might not be the smartest move. Currently, quarantine centres lack an effective mechanism for segregating those present at the facility. Ideally speaking, different centres or zones depending on incubation history would have been the way to go as this prevents overlap of quarantined individuals and time periods. In the current setup, even one affected asymptomatic individual can quickly infect those at the centre.

In Conclusion

Both contact tracing and effective quarantine are a major challenge the government has to overcome. Local vendors and frontline healthcare workers are the lifeline of the community and ensuring these individuals don’t become super spreaders is a key factor in eliminating the virus from society. Although “we are in the process of developing a vaccine” is progress, effectively dispensing it across the country will be a time-taking process even with today’s sophisticated logistics networks. Till then, we must all do our bit in ensuring super spreading events don’t become a day-to-day reality.