Covid-19 is not an airborne disease, says Dr David Nabarro

Q. Do you think Covid-19 is airborne?

A. It is primarily dropletborne and most droplets do not travel further than one metre. There is a possibility that in some settings, very small droplets may carry virus further than a metre with transmission being described as airborne. WHO considers that this is not the primary mode of transmission.

 Q. Covid-19 cases in India are rising rapidly and have crossed the 10 lakh mark. What can be done to control the situation?

A. The important thing is to establish basic health infrastructure that can identify and isolate people with Covid. The people and government must maintain efforts to build this capacity everywhere. It is a difficult time. The authorities need data on where the virus is being transmitted to focus containment efforts where they are most needed. The performance of this Covid response is key to determine whether the levels of infection will continue to increase in India. The constant defence against transmission and the buildup of outbreaks is key. It is a continuous process. Detect cases, isolate, trace contacts and isolate them. This is the most effective method to control the spread.

Q. What lessons the world needs to learn from Covid-19?

A. There are lessons to be learned from our experiences of tackling Covid-19 so far. First, the command-andcontrol approach so often favoured in crisis response has to be modified when it comes to encouraging Covid readiness. There is a need for clear and well-communicated strategic principles, modified in light of new evidence. This should be accompanied by guidance on how the principles can be adapted so they enable all stakeholders to work out for themselves and how they can best contribute to the response in their own localities. Second, those responsible for managing responses should take advantage of opportunities. They have to “convene, coordinate, curate and communicate”. When these elements are prioritised, power and authority at the local level are used to their best effect. We offer four suggestions on how this can be done:

• There must be a narrative. It should describe a clear vision and identifiable pathways for societies to move into the Covid-ready state. How to encourage this to emergence from the present situation with widespread movement restrictions?

•  Information must be locally specific. If people are to be enabled to act at a local level, they depend on high quality and specific information about what is happening in their locations. Where is the virus? How many people are infected? Which groups are most at risk?
• Responses must make sense to people. This is about people being able to make sense of the narrative and updates in the news. What are the implications of the latest scientific findings? What does that say about safety in schools, on public transport, the wearing of face coverings? Every effort must be taken to avoid stigmatisation.
• Values of decision-makers must be explicit. People are bound together in solidarity, getting ahead of the virus, by a sense of what they hold in common. This includes caring for older people and those who are vulnerable. Our values are known because we state them, but they are believed when we live them. We may not be believed if we say we value care workers if it becomes clear that they are unable to be tested for the virus or to access equipment they need for protection. What we do and how we do it is much more powerful than anything we say.