‘Small cities can be new COVID-19 hubs; shore up testing, tracing’

After exploding in most populous cities like Delhi and Mumbai, COVID-19 is now rearing up in large and small cities, which experienced migration from these megapolises. The concern rises, as the concentration of health personnel and infrastructure is only limited to large urban centres, and this is apparent in Delhi's next-door neighbour Uttar Pradesh, where many cities continue to struggle in tackling COVID-19.

Doctors suggest since the epicentre of the viral infection is likely to shift, it would be appropriate to replicate successful large-scale testing and contact tracing models in small cities.

For example in Agra, the state Health Department will conduct an extensive sero-survey to find the percentage of population with antibodies against COVID-19. In the region, Agra has reported 36 new cases in the past 24 hours, Mathura reported 100, Firozabad 42, Mainpuri 31, Etah 31 and Kasganj 21. In Agra, the total number of cases so far is 2,481, and it has 152 containment zones.

Jyoti Goyal, Head of Internal Medicine, Nayati Medicity in Mathura, noted: "Big cities like Delhi controlled COVID-19 very well through robust testing. Be it RT-PCR, antigen, antibody tests, Delhi has done testing widely. On the contrary, in Agra and Mathura, testing is extremely restricted. The authorities concerned have not evolved their strategy, as COVID-19 has evolved. They need to replicate Delhi's testing and contact tracing in small cities."

Jyoti added that against the backdrop of the ongoing rainy season, healthcare workers in small cities may get confused whether an illness is COVID-19 or any other form of tropical illness, as he insisted on upgrading healthcare infrastructure.

Uttar Pradesh, with 182,453 cases, is also amongst the five most-affected states by total tally, accounting for 7.2 per cent fresh COVID-19 cases. The total number of cases in UP is 6.1 percent of the national burden and 2,867 lives have been claimed by the infection.

Professor K. Srinath Reddy, President of the Public Health Foundation of India, said as the large cities where the virus entered and spread first are recovering from the epidemic, smaller cities and towns are becoming the zones of active infection.

"If the initial experience of being relatively free from the virus leads to complacency and careless behaviour, the virus will spread rapidly even in these areas. We need to step up public health measures and motivate people to adopt safe practices like physical distancing, avoiding crowded events, using masks outside home and frequent hand washing. Engaging local community networks and influencers will help in promoting safe behaviours," he added.

On testing, Reddy said wide-scale testing may pose challenges, however, clinical assessment as well as history of close contact with a COVID-19 affected person or history of recent travel from a highly infected region will help to assign high, medium or low probabilities of the infection.

"Because of false negatives and false positives associated with test results, even laboratories advise that the diagnosis should not depend on testing alone but take into account clinical and contact information," he added.

While 769 cases were reported from state capital Lucknow, there were 363 cases in Gorakhpur and 300 cases in Prayagraj, as the state recorded 5,375 infections on Saturday. As many as 1,24,274 samples were tested on Friday, which took the total number of COVID-19 tests done to over 44 lakh.

Deepak Dewan, Director, Renal Sciences at Regency Superspeciality Hospital in Lucknow, said the number of COVID-19 cases in Lucknow, as compared to its close to 30 lakh population, is extremely alarming, and it is apparent that migration from big cities to small cities has contributed towards the spread of the infection.

"In small cities, people are not following infection prevention measures, and social distancing guidelines. If this continues, then chances are very high that infection will like a wildfire in small cities. A combination of large-scale testing and contact tracing is the need of the hour," he added.

Neeraj Nischal, Assistant Professor at Department of Medicine, AIIMS added that diagnostic modality for COVID-19 is RT-PCR and antigen tests, and as the testing capacity in the country is being upgraded, it may be possible to replicate successful models of testing in small cities too.

"It is essential to continue to diagnose as early as possible. Test, treat and trace all contact, this will help in breaking the chain of infection transmission," he added.