Flattening the Covid-19 curve: Amyth or reality-A questionnaire based study

Mukil P Sunil1, Abilasha R*2, Preetha S3 1Saveetha Dental College and Hospitals,Saveetha Institute Of Medical and Technological Sciences, Saveetha University,Chennai, India 2Department Of Oral Pathology,Saveetha Dental College and Hospitals,Saveetha Institute Of Medical and Technological Sciences, Saveetha University,Chennai, India 3Department of Physiology,Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India


INTRODUCTION
Flattening the curve is a public health strategy to slow down the spread of SARS-COV -2 viruses during the covid-19 pandemics. The curve being lattened is the actual and visual representation of the number of infected people versus those needing health care over time. Flattening the curve slows the spread of an epidemic so that the peak number of people requiring attention at a time is reduced, and health care devices no longer exceed its capacity (Schramm, 2020). Flattening the curve relies on mitigation strategies which include social distancing. A complementary measure is to increase health care capability. Preventing the health care from being crushed requires a society to do things: ' latten the curve'-that is, slow down the pace of the spread of the infection, so there are not too many cases that need to be hospitalised at one time.and "increase the line"-that is, increase the hospital capacity to treat big numbers of patients (Tao, 2020). As of April 2020, with the exponential rise in the cases of the covid-19 pandemic, key measures are to increase the numbers of available ICU beds and ventilators that are in the system.                     Although COVID-19 has symptoms similar to seasonal in luenza, SARS-CoV-2 has much higher transmissibility, the incubation period is different, and the mortality rate is higher. Based on the reproduction number, R0 2.2-2.68 (number of cases directly generated by one case) while in the seasonal in luenza virus R0 is 1.3 and 1.5 in H1N1 in luenza, SARS had an R0 between 2 and 3 while the MERS R0 is <1. The mortality rate is also much higher (2.3% in COVID-19 vs 0.13% in seasonal in luenza and 0.20% in H1N1 in luenza) (Team, 2020).
The two important strategies to latten curve as suggested by (Schramm, 2020) would be to decrease the infectivity parameter or increase the speed of recovery.
The countermeasures to decrease the spread would be the following suggestions put forth by many experts in the ield. Decrease the chances of exposure by increasing sanitation measures, such as masks, hand washing, hand sanitising, by reducing the intensity with which people interact, limiting travel, encouraging people to work from home and reduce large gatherings. Also quarantining infected individuals and include self-quarantine might increase the speed of recovery (Schramm, 2020).
Many regulations were brought about by the WHO during the pandemic situation in the previous years, mainly after the 2002-2004 SARS outbreak (Gopalan and Misra, 2020). Governments including the United States and France, before 2009 swine lu pandemic, and during the last decade following the pandemic, bolstered their health care capacities after which the facilities were weakened (Sharfstein, 2018). At the time of the covid-19 pandemic, health care systems in many nations have been functioning their maximum capacities. Empathy is important to handle patients with covid-19 (Prasanna and Gheena, 2016). Medical negligence should be avoided as the clinician has to face several legal problems when he shows medical negligence (Uma et al., 2020). Coronavirus gets worse, when it affects old age individuals especially those in nursing homes (Palati et al., 2020).
Coronavirus can affect at the same level in both males and females, and there is no difference for different genders even though a slight male predilection has been reported. In a situation like this, when a widespread new pandemic rises and the demand surpasses the ability to control, then the prevailing health facilities cannot adequately cope with the patients, resulting in more deaths than if preparations had been made (Marques, 2020). Our previous research was conducted in many topics like surgical specimen handover (Krishnan et al., 2018), diagnostic studies (Shree et al., 2019) age estimation, identi ication based on gender (Palati et al., 2019;Abitha and Santhanam, 2019), ethics and scope of dental photography (Hannah et al., 2018), tooth sensitivity among residential university students (Gunasekaran and Abilasha, 2016) and microbial variation in climatic change (Gunasekaran and Abilasha, 2016;Sarbeen and Gheena, 2016) which have shown that it's essential to follow safety precautions and maintain hygiene to overcome various challenges.

MATERIALS AND METHODS
The present study was carried out among a group of people in the region of Kerala selected by random sampling method. A questionnaire-based observational cross-sectional type of study comprising 100 people was conducted. A self-administered questionnaire was circulated through an online survey and created in google forms. The data was analysed and represented in the pie chart and bar graphs. The data collected in google forms were converted to excel sheet. The data in the excel sheet was transferred to SPSS software. It involves both statistical and percentage analysis, and results were in the form of a bar graph with conclusions. The independent variables used were age, gender, and knowledge, while the dependent variables include awareness and knowledge.

RESULTS AND DISCUSSION
There are extensive knowledge and awareness on lattening the covid-19 pandemic among the participants. The respondents were of different age groups (Figure 1) shows that 50.7% were from 15-25 years age group,39.1% of the respondents were from the 25-40 years age group.8.7% of the respondents were from 40-60 years of age and different gender (Figure 2). In the present study, the majority of the respondents(71%) are aware of the covid-19 curve. In a similar kind of research by L Thungstorm, the results are supporting the present study (Thunstrom, 2020) ( Figure 3) shows that X axis represents whether respondents are aware about the covid-19 curve and Y axis represents the number of respondents who said yes or no. Percentage of respondents who are aware -71 % Percentage of respondents who are not aware -29 %. In the present study, the majority of the respondents believed that community transmission is increasing in their area (Figure 4) shows that X axis represents whether the respondents feel there is increase in community transmission or not and Y axis represents no. of responses. Respondents who feel there is transmission -53.6%, Percentage of respondents who feel there is no transmission -46.4 %. In this study, most of the people thought that India is lattening the curve(55.1%) and they also supported that Kerala is the irst state in India to latten the curve(63.8%) ( Figure 5) shows that X axis represents whether the respondents agree or disagree that Kerala is lattening the curve and Y axis represents number of responses. Percentage of respondents who agree -63.8 % those who do not agree -36.2 %. When we took the count of people who wanted to start the lockdown earlier in India before other countries, almost 85% of the respondents supported it ( Figure 6) shows that X axis represents whether respondents agree that lockdown was earlier in India before other countries or disagree and Y axis represents the number of responses. Those who agree -84.1 % those who do not agree -15.9%. When the respondents were asked, if lockdown can affect India's economic capital, the majority of the respondents (71%) believed it affects (Figure 7). In a similar kind of study by S Agarwal, they had the same types of results supporting the present study. In this study, the majority of the people (71%) believe lockdown implemented in India is effective (Figure 8). In a study by P Pulla, the results were contradictory to the present study. It may be because of the geographical area of the respondents who attended the survey (Pulla, 2020). In this study, 82.6% of the respondents believed that the mortality rate would be less if the curve is lattened (Figure 9) shows that X axis represents whether people agree or disagree and Y axis represents the no. of responses. Those who agree that the curve lattening will decrease mortality -82.6% those who disagree -17.4%. In another study by V Rotondi, the results are supporting the present study (Rotondi, 2020). In the present study, the majority of the respondents were aware of the meaning of ' lattening the curve' (Figure 10) shows that X axis represents whether the respon-dents are aware or not aware, Y axis represents the no. pof response. Those who are aware -77.9 %, those who are not aware -22.1%.
Association between the age and the various parameters in lattening of the covid-19 curve was analysed using chi-square test and mentioned in the graphs (Figures 11, 12, 13, 14, 15, 16 and 17), pvalue more than 0.05 was considered to be statistically insigni icant.
Numerous research has been done by our team previously, on the determination of physical height using the crown length of deciduous teeth (Harrita and Santhanam, 2019), evidence-based dentistry among dental practitioners (Ahad and Gheena, 2016), molar incisor hypomineralisation (Sukumaran and Padavala, 2018), a study on causes of pigmentation on gingiva (Manohar and Abilasha, 2019) and knowledge and awareness on oral biopsy. (Sheriff and Santhanam, 2018), which are general awareness studies done among dental students. Such studies have to be conducted often to improve the knowledge of individuals about a particular situation or condition.

CONCLUSIONS
In the present study, most of the respondents are aware of lattening the covid-19 curve. More awareness has to be created to make everyone know the importance of lattening the curve. The limitations in the present study include the number of people involved in the research and limited geographical area. More number of people should be included in the survey, and it should not stick into a particular geographic area or a homogenous community. Otherwise, we cannot generalise the results. Including more participants and comparing with the present study can help in giving precise results in the coming future, thus assisting the government to " latten the curve."

Con lict of Interest
None.