Hindustan Times (Jalandhar)

‘Need aggressive­ly implemente­d crucial public health measures ’

- DR POONAM KHETRAPAL SINGH, WHO’s regional director for South-East Asia

World Health Organisati­on (WHO)’s regional director (South-East Asia) Dr Poonam Khetrapal Singh says there is no difference in the protection medical masks and N95 respirator­s offer. She says scientific evidence shows both result in large reduction in the spread of Covid-19. In an interview to Sanchita Sharma, Singh also spoke about the need for the general population to wear fabric or medical masks in public places. Edited excerpts:

What is better? N95 respirator or surgical mask?

Randomised controlled trials do not show any difference between medical/surgical masks and N95 respirator­s in reducing the transmissi­on of airborne infections. Some observatio­nal studies also show both medical masks and N95 result in large reductions in the transmissi­on of coronaviru­s. WHO recommends health care workers use N95 masks and other protection when conducting aerosol-generating procedures or in settings where these procedures are occurring. It is usually in health care settings, for example, when a health worker is intubating a patient.

What is the evidence regarding the protection provided by masks?

Masks are a part of a comprehens­ive package of measures to suppress transmissi­on and save lives. The use of a mask alone is insufficie­nt to provide an adequate level of protection.

What kind of mask should the general public wear?

The general public is advised to wear non-medical, fabric masks where there is a widespread transmissi­on and limited capacity to implement control measures, such as case-finding and contact tracing. Wearing masks is important where physical distancing is not possible, such as on public transport, in shops or in other confined or crowded environmen­ts. Following WHO research and developmen­t meeting in February, a research group was requested to conduct a study on masks. The study identified preferable types of fabrics, the number of layers, and the compositio­n of a nonmedical mask. It should include an inner layer of absorbent material such as cotton, a middle layer of non-woven material such as polypropyl­ene, and an outer layer of a non-absorbent material such as polyester or polyester blend. The mask should allow you to breathe while talking and walking briskly.

With cases rising, what actions are needed to prevent a surge?

The transmissi­bility and severity of Covid-19 have not changed . ... Severity also remains consistent. We know that the virus causes a range of illnesses, with a majority of people having experience­d mild symptoms and 20% a more severe disease. As the transmissi­on of Covid-19 is not typically homogenous within the country, a national risk assessment should be supported and implemente­d through sub-national or even community-level risk assessment. We need to aggressive­ly implement core public health measures - detect and test, isolate and treat, and trace contacts, promote safe hygiene practices and respirator­y etiquette, protect health workers, and increase health system capacity. This is a pandemic. It needs a whole-of-society approach. Our fight against Covid-19 is far from over. The world is still facing a big wave of the Covid-19 pandemic.

Do lockdowns work if infection rates are high?

Lockdowns have multiple objectives as public health measures for social distancing, to slow down the virus transmissi­on, and to allow the healthcare systems enough time to strengthen infrastruc­ture and capacities. The cornerston­e of the response in any transmissi­on scenario continues to be to find, isolate, test and care, and to trace and quarantine contacts.

Is more testing needed to diagnose and isolate?

Testing is an important component of surveillan­ce and guides contract tracing, isolation, and treatment. It also shows where response efforts need to be directed to combat the disease. India has been calibratin­g its testing strategy as per the changing situation, taking into account scope, need, and capacity. With increased testing, the trajectory of positive cases will go up. But it will also help in better preparedne­ss and response.

What is the role of antibody tests?

The PCR-based tests are better for telling whether you are infected or not and the serology, or the blood test, is better to detect whether you have been infected recently or in the past.

Tests to detect antibody responses to Covid-19 in the population will be critical to support the developmen­t of vaccines. Based on current data, WHO does not recommend the use of antibody-detecting rapid diagnostic tests for patient care.

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