Contain (identify, isolate and trace contacts): It is based on the fact that if it could be controlled in China it would be controlled everywhere else. They locked down the city with 5 crore people. But that has not happened anywhere else. Despite monumental contact tracing and screening efforts and prompt isolation and first-rate care of people with COVID-19, there is a continued increase in the number of COVID-19 cases across the globe. Only Kerala could do it in India. 

Delay: The phase aims at delaying the spread of the virus, reducing the impact and driving it away from the winter season. If the peak of the virus can be delayed until warmer months, it may decrease the risk of overlapping with seasonal flu and other problems that come with the colder months.

Public can take simple measures to assist with delaying the peak of the infection,  including adhering to the "catch it, bin it, kill it" strategy for sneezing, coughing, and hand-washing.

Other steps in the delay phase include the possibility of school closures, encouraging working from home, and reducing large-scale gatherings.

Research: Research involves looking into new diagnostic tests, drugs to treat COVID-19, preventative vaccines, and devising  the best course of care for people affected.

Mitigate: If the outbreak worsens, or takes the form of a severe, prolonged pandemic, the response will escalate and would shift the focus from "contain" and "delay" to "mitigate". This phase involves providing the best care for people who become ill, supporting hospitals, and ensuring support for those who are infected but do not require hospital treatment.

It also involves plans to minimize the impact of disease on society, public services and the economy. This could be followed by  emergency services focused on critical functions.  For example, the police concentrating on responding to serious offences and maintaining public order if the number of officers declines. In hospitals, non-urgent cases could be put on hold and staff leavers and retirees could be called back to work.

The stages of contain, delay and mitigate dont necessarily have to be separate. Some countries are opting for parts of all three stages simultaneously. The steps don’t have to happen in isolation. In some parts of the world, containment may not be practical or feasible.

If we model out the epidemic, we will get 50% of all the cases over a 3-week period and 95% of the cases over a 9-week period.

Like UK, India is also using both the modes, contain and delay, at the same time.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA