Impact of Monsoon on India's fight against COVID-19

Healthcare workers need to treat every case like a COVID-19 patient during monsoon. What does this mean for healthcare facilities and patients? Will it get worse?

With the rapid rise in the number of cases in India, various cities have declared Rapid Action Plans to curb the surge in COVID-19 cases in their neighbourhoods. But, experts warn that the gamut of diseases brought by South West Monsoon will cause fresh challenges for the health sector.

Take the case of Assam, for instance. Assam State Disaster Management Authority (ASDMA) announced on Monday that around 13,197 people had been hit by floods triggered by a torrential downpour across districts like Dhemaji, Lakhimpur, Nalbari, Barpeta, and Jorhat.

Further, the flood control measures have been suspended due to the lockdown enforced by the government. Certain parts of the country like Bihar are inundated nearly every year, and here social distancing remains a challenge. The state disaster management department has already ordered every district magistrate to make necessary preparations like masks and sanitisers at flood assistance centres.

Monsoon brings rainfall but also desolation and disorders for thousands of beings. Every year, maladies like dengue fever and malaria attack half a million citizens and annihilate hundreds.

Monsoon Nightmare

Monsoon brings two types of problems, says Dr. Mathew George, Professor, Centre for Public Health, TISS. "First is the possibility of other vector-borne diseases like Dengue and Leptospirosis that can present symptoms similar to that of COVID hence pose a problem in clinical diagnosis. Second, is the need to have more stable and permanent health care infrastructure need to be developed as a response to COVID and has to be integrated with existing health care facilities as ensuring infection control need more meticulous efforts during monsoon."

Mumbai does have a mechanism to monitor monsoon related illnesses. Urban primary health centres of Brihanmumbai Municipal Corporation, Navi Mumbai Municipal Corporation have staff who looks after vector-borne disease control programme and does this monsoon preparedness every year. It is confined mainly to slums and other pockets where they regularly work.

Locks Down!

But lockdown has led to a shortage of sanitation workers, who do fumigation in several parts of Mumbai. Many are also worried about contracting the virus, while they do their work in crowded slums.

What about the Southern States?

Lt Gen D. Raghunath, former, Director General of Armed Forces, Medical Services, Karnataka has a different view. He says that there are higher chances of infection rate going up, as people might huddle together in limited spaces during the rainy season. They would be in a position where they would be transporting the virus actively. If the mask gets wet, during the rains, then they don't protect the person anymore; therefore mask becomes inefficient. As the temperature is low and moisture content in the atmosphere is high, the viruses persist in the atmosphere longer, than when it is dry and hot."

Bengaluru is now considered as one of the successful models of fighting COVID-19. Would the city be able to manage the pandemic during the rainy season? "Bengaluru has managed to contain the spread of the disease by quarantining infectious persons and doing contact tracing very well. But the city might have a sharp increase in the number of cases due to the relaxation of lockdown and citizens resuming their activities," Raghunath explains.

Human Behavioural Patterns vs Seasonal Changes

SPThyagarajan, Dean Research, Sri Ramachandra Institute of Higher Education and Research, Chennai has a different take on the issue. "The general belief is that viruses will have reduced potential to survive in hot and humid conditions, as we have seen in influenza and SARS outbreaks. But in India even during summer months, we didn't see any reduction in the number of cases, but saw a spike," says Thyagarajan.

"Even though South West Monsoon has set in, the number of cases hasn't dropped. Any viral infection should be analysed not just based on seasonal changes, but human behavioural patterns as well as the viral characteristics. All three factors are dependent on each other. For example, spitting is one of the significant reasons for viral persistence in the environment. Another complicating factor is that a recombinant strain of COVID called Clade A3i has started coming. Currently, the percentage of mortality across India is increasing now. It looks like this strain of COVID has a bearing upon this."

According to Thyagarajan, the focus should be more on creating awareness, counselling, health promotion information. Another small hope that he points out that heavy rainfall can deposit the virus out of the atmosphere. "People might stay inside the house and might act as a natural lockdown and might prevent the chances of spread of the virus. Rain alone is not going to solve/aggravate India's COVID woes. We need comprehensive and integrated disease prevention measures," he explains.

Cyclical Model of Vector-Borne Diseases

The usual disease pattern for monsoon in India is dengue, chickungunya, leptospirosis because the density of vectors is high during the season. Most experts admit that there is a risk of higher mortality rate during the season. "Another critical quandary is that many monsoon ailments have traits that are practically similar to coronavirus. There is also a strong possibility that if COVID-19 is not reasonably controlled, and if someone with dengue contracts COVID-19 or vice-verse, the risk of mortality is much higher," adds the Dean.

Whom will the crisis hit hard?

Communities that reside in mixed settlements of the cities bear the brunt of both COVID-19 and monsoon ailments.

Take the case of *Mahira Khan, who stays in Tunga Gaon, an informal settlement in Chandivalli. She typifies the struggles of residents of Mumbai's slums during monsoon. Her husband drives an autorickshaw. Describing how she has to fight for survival in the rainy season, she says, "We suffer incredible hardships during the monsoon every year. When you live in a 150 sq ft home, you are concerned about rainwater leaking inside our home, filthy drinking water and illnesses like dengue and malaria during rains. But we have learned to survive in the most adverse of situations. No one should have to endure such conditions."