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India’s large young population could actually make Covid herd immunity strategy work

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Employees of Health Tele Helpline center work during a nationwide lockdown in the wake of coronavirus pandemic, at IMA house Ernakulam District in Kochi on 18 April, 2020 | PTI
Employees of Health Tele Helpline center work during a nationwide lockdown in the wake of coronavirus pandemic, at IMA house Ernakulam District in Kochi on 18 April, 2020 (representational image) | PTI


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Mumbai: Controversial given the high risk of deaths, a coronavirus strategy discarded by the U.K. is being touted as the solution for poor but young countries like India.

The herd immunity strategy, which would allow a majority of the population to gain resistance to the virus by becoming infected and then recovering, could result in less economic devastation and human suffering than restrictive lockdowns designed to stop the virus’s spread, a number of experts have begun to argue in the nation of 1.3 billion people.

“No country can afford a prolonged period of lockdowns, and least of all a country like India,” said Jayaprakash Muliyil, a prominent Indian epidemiologist. “You may be able to reach a point of herd immunity without infection really catching up with the elderly. And when the herd immunity reaches a sufficient number the outbreak will stop, and the elderly are also safe.”

A team of researchers at Princeton University and the Center for Disease Dynamics, Economics and Policy, a public health advocacy group based in New Delhi and Washington, has identified India as a place where this strategy could be successful because its disproportionately young population would face less risk of hospitalization and death.

They said allowing the virus to be unleashed in a controlled way for the next seven months would give 60% of the country’s people immunity by November, and thus halt the disease.

Mortality could be limited as the virus spreads compared to European nations like Italy given that 93.5% of the Indian population is younger than 65, they said, though no death toll projections were released.

The radical proposal underscores the challenges that poorer developing countries — including nations like Indonesia and some in sub-Saharan Africa — face in curbing the epidemic using the lockdown measures that have been adopted by advanced economies.

The impossibility of social distancing in crowded living conditions like in many cities and villages in India, the lack of testing kits to detect infections and the human suffering that occurs in lockdowns suggests a different path may be needed in these places.

To do this, the Princeton and CDDEP team recommends lifting India’s strict lockdown — which has been extended to May 3 — and letting most of the population younger than 60 return to normal life, though social distancing still would be encouraged, masks would be required and large gatherings would be banned. The reopening would be accompanied by an effort to test as many people as possible and isolate confirmed and suspected cases.

The government of Prime Minister Narendra Modi has given no indication it plans to adopt such a strategy.

Yet the government has laid out criteria that effectively rations coronavirus tests, limiting them to the very sick or most at risk. Critics who suspect the disease has spread much more widely than the official numbers suggest say the government’s restrictive criteria amounts to allowing the disease to spread.

“In some sense, you are saying, we will let them get infected and recover, and take care only of those who are sick,” said T. Sundararaman, the New Delhi-based global coordinator of the People’s Health Movement, a public health group. “That’s the policy, that’s what it amounts to.”

The government has maintained its testing criteria gives an accurate tally of India’s number of cases, and says the disease is not spreading untracked in the community. Nevertheless, as India has ramped up testing, it is finding more cases each day, bringing the nationwide tally to 18,658, with 592 deaths, as of April 20.

But if questions remain as to the extent and severity of India’s outbreak, the costs of the government’s lockdown are clear. Local governments have had to set up camps to house 1.25 million migrants who left cities when they lost work, while food camps feed 7.5 million daily wage earners also rendered destitute by the lockdown. There are already signs these stopgap measures are starting to fray.

“We’re dealing with a trade-off against starvation, hunger, all this other stuff,” said Ramanan Laxminarayan, the director of the CDDEP and a Princeton researcher. By allowing the coronavirus to spread in a controlled way, “undoubtedly there will be deaths, but it will be much smaller this way, and it opens us up for business by November,” he said.

But the strategy has already proved controversial internationally. The U.K. adopted and then abandoned it early in the pandemic after projections showed its health care system would be overwhelmed by the resulting hospitalizations. That brief dalliance is still being blamed for the British government’s slow response in testing for the virus.

Risky Strategy

Even in a country like India with a young population, the concept has inherent risks. Allowing people to become infected will inevitably bring many more patients to hospitals. The researchers say India will have to urgently expand critical care and isolation-bed capacity to ensure that multiple waves of patients don’t become casualties before herd immunity is reached.

Another risk is that India’s worst-in the-world air pollution and high rates of hypertension and diabetes have compromised young people’s health, meaning that mortality from the virus could be higher than expected. People may let their guards down and fail to follow social distancing guidelines.

“I would worry that it would relax concerns of younger individuals, who still remain at substantial risk themselves,” Jason Andrews, an assistant professor of medicine at Stanford University, said in an email. “The messaging in particular may lead younger people to perceive themselves as at lower risk than they are, and to fail to understand their potential role in transmission.”

And given the novel coronavirus only made its debut in humans some time late last year, there’s still a lot that’s unknown. Immunity from the virus may be a more complex process than expected. One group of researchers estimated as much as 82% of the population would have to be infected before herd immunity is reached.

“My view is there are a number of questions about whether it can work,” said Marc Lipsitch, a professor of epidemiology at Harvard University’s T.H. Chan School of Public Health. “The main questions being how much immunity do we need in the population, and how much immunity does each person get as a result of infection.”

Then there’s also the question of whether it’s possible to wall off the higher-risk portion of the population in densely packed India, where multiple generations commonly live under one roof.

Ultimately, the researchers lobbying for the strategy argue that cultivating herd immunity may be the best of various bad options.

“I think eventually all countries will follow this Indian model,” Laxminarayan said. “Because otherwise we are going to be in lockdown on and off all the way through until June of next year.” –Bloomberg


Also read: India’s Covid-19 R0 down to 1.36 now, 25,000 cases by April-end at this rate: IMS scientist


 

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India

Andhra doctor, suspended for alleging PPE shortage, now beaten by cops for ‘creating nuisance’

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doctor with a stethoscope
A doctor with a stethoscope (Representative image) | Pixabay


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Bengaluru: A doctor with a government hospital in Andhra Pradesh, who was suspended for questioning the shortage of PPE kits, was admitted to a mental health facility Sunday, a day after he was allegedly manhandled by the police and arrested for creating nuisance in Visakhapatnam.

Dr Sudhakar Rao, a government civil surgeon, was beaten, his hands tied behind his back and dragged by police officers Sunday. During the incident, Sudhakar allegedly verbally abused the Jagan Mohan Reddy government in an inebriated state. Videos of the incident have since been widely shared online.

“The police control room received a call about a person creating nuisance on Beach Road Hospital in Visakhapatnam. The Fourth Town police was rushed there and found that the person was the suspended doctor, Sudhakar.

“When the police tried to control him, he snatched the mobile phone of an officer and threw it away. He is suffering from mental disorder and he was drunk. He was sent for a medical examination,” Vishakapatnam Police Commissioner R.K. Meena told the media Sunday.

Sudhakar was admitted to a mental hospital Sunday after doctors at the King George Hospital in Vishakapatnam said he suffered from anxiety.

“Since the doctor is in anxiety and talking irrelevant things, I have referred him to a mental care hospital in Visakhapatnam,” said Dr Radha Rani, medical superintendent, King George Hospital.

A statement released by the hospital said: “Dr Sudhakar was brought to the KGH casualty ward at 6.30 pm. From the smell, it was found that he was in a drunk condition. Under the influence of alcohol, he did not cooperate with anybody there and kept abusing all. Still, his pulse, BP were checked. Pulse was 98, BP 140/100. Blood samples were sent to forensic lab to ascertain alcohol content in his blood.”


Also read: 6 toilets for 20 houses, inadequate testing: Why Mumbai’s Worli chawls are a Covid hotspot


‘Treatment towards Sudhakar was inhuman’

Sudhakar, who spent more than 10 years at the Narsipatnam Government Hospital in Andhra Pradesh, was suspended from his duties in March after he openly criticised the Reddy government for failing to provide PPE kits and N95 masks to doctors treating Covid-19 patients.

He had alleged that the state government was giving N95 masks and PPE kits meant for doctors to politicians and the police.

A video of Sudhakar criticising the government was also shared widely. In the clip, he can be heard saying: “We are putting our lives at risk here. We are asked to use the same mask for 15 days and a fresh mask will be provided only twice a month.”

Speaking to ThePrint, Dr P. Gangadhar Rao, member of the National COVID Committee of the Indian Medical Association, said the manner in which Sudhakar was manhandled by the police was “inhuman” and “violated” human rights.

“We strongly condemn the way he was taken into custody. He was not carrying a weapon, he was alone, the number of policemen outnumbered him. Why treat him like that? We also saw a video where a policeman beats him with a lathi,” said Dr Gangadhar.

He added that Rao was one of the most experienced anaesthetists the Andhra Pradesh government had.

“Our next step of action is to get Sudhakar to write an unconditional apology for having used filthy language, abusing the chief minister and the government. We will then take our appeal to the CM seeking that he be reinstated,” Gangadhar said.


Also read: Face shields, gowns, masks — the new attire for cabin crew post lockdown


 

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