The report calls for urgent steps along two trajectories of action; one involving large-scale vaccinations to minimise the severity of the disease and the other by breaking the chain of transmission through Covid-appropriate behaviour.According to the Lancet Covid-19 Commission's India Task Force, the second wave is different from the first wave. The rate of growth in new cases is significantly higher in the second wave. The number of new cases increased from 10,000 to 80,000 per day from February to April in less than 40 days. In the first wave, it took 83 days.Also, in the second wave, the majority of cases testing positive are asymptomatic or mildly symptomatic, resulting in relatively low rates of hospitalisation and mortality.
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Lancet Covid-19 Commission's Recommendations* An accelerated vaccination drive with a target of 5 million doses daily. Awareness campaigns to reduce vaccine hesitancy.* Relaunching a massive public awareness campaign on mask-wearing. The message should convey the importance of wearing masks in closed spaces outside one's own residence and in the open, as currently advised. This would cover public transportation, office and workspaces, shops, religious sites, and visits to friends and family.* Temporary ban on gatherings of social, political and religious groups larger than ten people for the next two months.* Renewed focus on supplementing state and national efforts with a decentralised approach at the community level to trace, test, and isolate patients.
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* Amend the Covid-19 test registration form immediately to include information on whether the individual getting tested has received either one or both doses of the vaccine (with details of the type of vaccine). This information can help track the spread of post-vaccination infections and the spread of potential variants.* Mandatory 7-day institutional quarantine for all visitors arriving from other countries, with an RT-PCR test conducted on day 8, and the option of completing another week in home isolation if the test is negative.* No restrictions on domestic travel, either within or between cities. Advisories should be issued to promote safe behaviours and testing made available at source and destination sites. Individual states will need to determine their own protocols based on caseload and local circumstances.
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* State governments make a special effort to support migrant labour in these journeys, equipping them with masks, options for testing and vaccinations where eligible, and by setting up quarantine centres in host districts to manage the spread of the virus from cities to rural areas.* Vaccinate teachers and school staff on a priority basis. Use the next two months to prepare the education sector for a safe opening in July 2021 for the next academic year.* Focused effort to identify root causes of the surge, including an expansion of genome sequencing of the coronavirus to understand if mutants or variants are responsible for the current surge, and if so, the nature and type of such variants.
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* Minimise restrictions on the movement or work of the working urban and rural poor and locally determined through the creation of micro-containment zones in high caseload areas.* Avoid national or state lockdown. In areas of high infection rates, focus on breaking the chain of transmission through local actions like issuing advisories that strongly encourage anyone that can remain at home (white-collar workers, for example, who can work from home) to do so.* Address bottlenecks in the pharmaceutical supply chain to end shortages of essential drugs (steroids) and equipment.
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* Invest in medical facilities infrastructure, including enhanced ability to transport patients and overall preparedness, especially in tier 2 and 3 cities to cope with high levels of hospitalisation.* Strengthen ongoing programmes to support the mental, emotional, and physical needs of health care workers through access to resources, counselling, and care as needed.
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