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> I believe community transmission has not started or rampant: Because our hospitals are not overrun with people with breathing issues

That is a serious, potentially fatal (literally!) mistake. One of the things that makes covid-19 so nasty is that it is transmissible long before the onset of symptoms.

I have wondered for quite a while about this so maybe you can help. How does it spread without symptoms?

Like, I get that you start shedding the virus, but if you don't cough or sneeze and practice generally good hygene it should not spread, right?

In some cases it's enough just to breath to infect people - https://pubmed.ncbi.nlm.nih.gov/25816216/

I'm speculating, but there are a lot of normal, asymptomatic ways in which a virus may be spread.

1. Mucus. Cold weather can trigger a brief runny nose, which in turn is easy to wipe on sleeves, arms, or the back of the hand without much/any thought.

2. Saliva. Spittle from speaking is just about impossible to stop.

Yeah, totally forgot about the second one. Thanks!

> How does it spread without symptoms?

People cough and sneeze all the time even if they are healthy. Also, when you talk, you expel droplets of saliva when you make sounds like "P" or "B" or "K". The virus travels in those droplets. They float through the air, someone else breathes them in, and voila.

This is still up in the air. The WHO says that, while there are documented cases of pre-symptomatic transmission, it is not the main driver of infection like with the flu, see: https://www.who.int/dg/speeches/detail/who-director-general-...

"First, COVID-19 does not transmit as efficiently as influenza, from the data we have so far.

With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19.

Evidence from China is that only 1% of reported cases do not have symptoms, and most of those cases develop symptoms within 2 days."

This report is from March 3rd, so maybe our understanding has evolved.

> it is not the main driver

That may well be, but "not the main driver" != "not a driver". Do you really want to roll those dice?

I will here simply point you to the countries which have had great success combating this epidemic, such as Singapore and Taiwan. They exercise strict quarantine of infected (note, not uninfected) individuals plus contact tracing.

Yes, and contact tracing involves testing people regardless of whether they have symptoms, and quarantining them if they test positive.

Yes, infected individuals are infected individuals. We are talking about asymptomatic spread. It can be difficult to tell whether you have symptoms or it's just a particularly bad pollen day. For this reason quarantining known-infected individuals is a good idea, rather than having them mill around until the very second they get a sore throat.

Okay, I think we're agreeing...otherwise I really don't understand what your position is about asymptomatic people.

> Evidence from China is that only 1% of reported cases do not have symptoms

I may be missing something here, but this seems like selection bias. If they're not showing symptoms, they're much less likely to get tested and, as such, reported.

> This report is from March 3rd, so maybe our understanding has evolved.

A speech from the director-general. Not a report?

> With influenza, people who are infected but not yet sick are major drivers of transmission, which does not appear to be the case for COVID-19.

This is the same WHO that claimed "no evidence of human to human transmission" not long ago. Regardless, iirc, the R0 for SARS-CoV-2 is estimated at 2.5 to 3.5, much higher than Influenza's, which is at 1.8. It doesn't matter if SARS-CoV-2 is spread by the infected yet not sick, because the R0 is significantly higher, plus the incubation period is too damn long and there's no therapeutic treatment nor a vaccine.

When the dust settles, and more conclusive and complete research is done to learn about the virus, we will have all the answers, but given the current state of affairs, imo, it is highly unlikely that SARS-CoV-2 is any less infectious than Influenza.

The method of infection matters. Singapore and Taiwan have done amazingly well specifically because they enforce quarantine of infected individuals along with various levels of testing to identify those individuals, for example people having their temperature checked outside public buildings.

Fair point.

Does WHO reference any studies that prove asymptomatic folks don't infect others?

If you happen to know, what explains the higher R0 and higher rate of infection world-wide?

> ...for example people having their temperature checked outside public buildings.

That isn't bullet-proof, tbh. India saw instances of people popping paracetamols to work around temperature checks.

Nothing is bulletproof, all we can do is take actions to reduce probability of transmission and the actions chosen should target the greatest drivers of transmission.

I am not aware of any studies but on the other hand it would be incredibly easy for cases of asymptomatic spread to actually have been infected by a symptomatic person, in a chaotic environment it's difficult to get good data.

I don't disagree it would be a fatal mistake, but the logic I am trying to calm my self with is: it has been 3 weeks, if an outbreak was to happen, it would have drowned our medical infrastructure already

>As an Indian why do I believe community transmission has not started or rampant: Because our hospitals are not overrun with people with breathing issues

Labourer travelling in train (usually it's general class, cheapest ticket) have contracted COVID-19 a week back[1].

Person who has not travelled much outside his home and has no known contact with anyone from foreign travel has contracted COVID-19[2].

How many poor people in India visit doctor for systems similar to common cold/flu? Even if they visit Govt. hospital and die from it, How many deaths of people with such symptoms in Govt. hospitals published?

>Is this the right thing to do? Well, we don't have the capacity to treat the entire population, this we need to "cut the curve" rather than flatten it. Will this work? Your guess is as good as mine.

Yes, should have done 2 weeks back. Unfortunately with any poor country with large inequality; it's the poorest who would be affected by this as well.

>3. Will people obey the curfew: I really hope so

It is lockdown, no curfew. Curfew (144) in India denies people not to gather in groups; now during lockdown every single person outside their house is liable to be questioned by the authorities.

>4. Should we test more?

Yes. But I'm not sure how many would take the effort to visit testing center. Again, it's poor who would not have the mechanism to even get tested.

[1]https://economictimes.indiatimes.com/news/politics-and-natio...

[2]https://www.deccanherald.com/national/south/tamil-nadu-man-w...

> As an Indian why do I believe community transmission has not started or rampant

Oh stop it! There have been confirmed cases of folks who do not have travel history but are infected with SARS-CoV-2 [0]. Plus, we aren't even testing enough to know the extent of the spread.

> Is this the right thing to do?

It is absolutely the right thing to do. Should have happened sooner.

> ...we can't test someone once and be done with it, constant testing will be needed, and at our size, we can't do it

This is not even a good excuse. The only way to get out of a quarantine or lockdown before a vaccine is ready is to extensively test anyone that wants to be tested, and if positive, contact-trace everyone else and have them tested too. There's no other way anyone is getting ahead of the spread otherwise. Repeat after me: Testing isn't sufficient by all in itself, but it is absolutely necessary.

> I really hope we can get to some scale in temperature surveillance at scale

Temperature surveillance? Jesus Christ, you do not think tests are enough but want checks for symptoms that close to 80% infected people do not display for days on end, if ever?

[0] https://hindustantimes.com/india-news/coronavirus-is-tamil-n...

Like you, I would also like to put my views on it. I make no claims that I know any more than you do.

> why do I believe community transmission has not started or rampant

We already have many unexplained cases of local transmission. So yes it has already begun.

Nothing you or me say will change this fact.

https://economictimes.indiatimes.com/news/politics-and-natio...

> Is this the right thing to do?

This is the best we can do in India. If you have anything else feel free to share. Right now I can't think of anything else with the current already crumbling medical infrastructure we have in India. > Will people obey the curfew:

No.

Is there a problem with how India is doing it?

No

Is there a problem with Indians?

No

This is human nature. People will panic.

But this is no reason to not apply a curfew.

> they are negative, it might feel like a license to go back to regular life

Finally, I see someone who thinks logically.

Otherwise, people either support whatever Modi says or oppose whatever he says. No common sense applied to understand what is right or what is wrong.

> We are in uncharted waters.

You want to stay in a comfort zone. I am sorry to disappoint you.

Corona virus is not the last pandemic you would see in your life time.

And this is yet far away from the worst humanity has seen.

Search Spanish flew. Just think about medical understanding doctors have back in those days. Yet they fought and we survived.

We would survive this also. Long live Humanity.

I am happy the Govt has imposed strict lock down starting today, but its too little too late, we should have hunkered down in beginning of March. We saw things well in advance with data of progression in China and Italy.

This govt was callous in its approach.

I pray the medical infrastructure is able to handle the upcoming deluge. Peak infection rates are known 14 days after a complete lock down, IF THERE IS COMPREHENSIVE TESTING alongside the lock down. Our testing is woefully inadequate at the moment.

How many people in India live on daily wages. In countries with large poor populations this is a very hard balance to keep. Close down everything and a few million people die of hunger keep it open and few million will die from getting infected.

I get your point, but India is country where most are multi generational homes. Supplying food and essentials to people who need it during a lock down is easy, treating people when medical infrastructure is overwhelmed is a lot harder. Also, when the medical infrastructure breaks down even cases which need basic care like IV hydration could turn fatal.

If we had a lock down in beginning of March it would be over in a week or 2. Now the lock down is 21 days. It may get worse.

It usually takes a week or two after infection for people to get so bad they need to seek help. So them not overloading hospitals yet doesn't tell you very much of the situation today. They could very well be completely overrun in two weeks, which is what happened in Italy.

It definitely can, but we had our first case more than 14 days ago.

It does not go from zero to overload in two weeks and nobody knows where India is on the curve.

Agree there. But all we can do is hope from here on.

It is easy to turn the country into a police state and lock everything down. I think what is required is what the UK called a partial-lockdown, where the essential services including food, medical care, etc remain easily available to people. As of now, India government plans on that direction has been patchy, unclear and execution pathetic.

It is a sad state when the police is beating up and arresting journalists, and those delivering or out to buy medicines/food.

Overall the government trying to be extremely paternal and the language used is lacking a humane touch.

If you follow the news. This is exactly what is happening here.

All the essentital service are avaialable.

News has reports of people getting beat up by police too.

Meds, vegetables and essential services are available. My father was able purchase vegetables without much hassle.

While I don't support police beating those who break curfew, it should be understood that India is severely underpoliced and Police do have a difficult job ahead.