COVID-19-India in the early phase of deceleration: Epidemiologist
India could have 4 million cases and 40 million infections by mid-September … however, the 7 days moving average of positivity and fatalities suggest Covid-19 could be in the early phase of deceleration even if the number of cases is rising … but we need to double our tests per million and reassess who we test … our mortality rate is genuinely low and there is no significant under-counting … deaths cannot be hidden in the case of Covid-19, sooner or later they get reported due to a vigilant media and an active civil society”: Giridhar Babu, Professor of Epidemiology, Public Health Foundation of India, Bangalore.
In one of the first interviews by a leading and well-regarded independent epidemiologist to strike a positive note about the trajectory of Covid-19 in India, Giridhar Babu, who is Professor of Epidemiology at the Public Health Foundation of India in Bangalore, says that the 7 days moving average of test positivity and fatalities is going down and this could be the early phase of deceleration of Covid-19 even though the number of cases is steadily increasing. Prof. Babu also says that the increase in the number of cases is a result of the sharp increase in testing levels and should not overly worry about the country. He additionally pointed out that the increase in cases ensures an increase in the number of people isolated and quarantined and that would further slow down or retard the spread of the virus.
A detailed statement issued by Karan Thapar’s office gave this information and said:
“In a 57-minute interview to Karan Thapar for The Wire, which will go up on The Wire’s website sometime between 8 and 9 p.m. tonight (18/8), Prof. Babu said he won’t deny that the number of cases (over 2.6 million as of 18/8) is concerning but given the size of India’s population it is to be expected. He, in fact, made a point of questioning how did China, a country of comparable population size, contains its total number of cases at 84,871? As of today, India has more than three times as many.
Asked by The Wire what he believes will be the Covid-19 situation facing the country three months from now i.e. around Diwali, Prof. Babu said that he was reluctant to project beyond two incubation periods i.e. 28 days. He said he expects 4 million cases around September 12-15. He said on the assumption that for every known case there are 10 infections he believes the total number of additional infections would be 40 million on that date.
Asked whether he accepts the government’s insistent claim that India, despite having over 2.6 million cases increasing on average by over 60,000 a day, is still not at the community transmission stage, Prof. Babu said “there are cities and states in community transmission” but not the entire country.
Prof. Babu said the WHO’s definition of community transmission is when you cannot trace the source of infection and suggested that this did not presently apply to India but then clearly resiled when he was asked if he was claiming that India could trace the source of the 60,000 plus new cases that happen every day. This is when he accepted that there are cities and states which are in community transmission.
Prof. Babu said India needs to double its level of testing which is presently 22,393 per million. He said countries with more than 100,000 cases were testing up to and above 50,000 per million. India needs to rapidly go up to that level of testing.
Prof. Babu also said that in addition to increasing the number of tests India needs to rethink whom it tests. He said the testing needs to be done syndromically and we must ensure that ICMR guidelines to re-test all those found negative through an initial antigen test are scrupulously followed. He believes there are many states that are not doing this.
Prof. Babu, who has been closely monitoring India’s low mortality rate (38 per million as of 18/8), seemed to veer between two somewhat different positions on the accuracy of the mortality rate. On the one hand, he said “there may be under-counting and we don’t know the extent of under-counting” and added that there could be under-counting by a factor of 1 or 2 but on the other hand he also said there was no significant under-counting and “deaths cannot be hidden in the case of Covid-19, sooner or later they get reported due to a vigilant media and active civil society.”
Asked by The Wire if he was confident nearly all Covid-19 deaths in rural India were being reported, Prof. Babu said the rural health system, through the Asha-network, is more robust than in urban India. There may be delays in reporting COVID deaths but they will not be missed. He said one Asha caters for a thousand people and one Auxiliary Nurse Midwife caters to 5,000 people. As a result, it’s unlikely COVID deaths will be missed. Yet, once again, Prof. Babu seemed to say something different when he accepted “we don’t have a robust system which captures the cause of death”. This means that there could be several or many Covid-19 deaths in rural India which are not certified as such.
As per the government’s statistics, 86% of all deaths in India are registered but only 22% get medically certified by a doctor. In many states the latter figure is under 10%. For instance, in UP its 5% and in Bihar its 2.4%.
Prof. Babu told The Wire there are four reasons or hypotheses why India’s mortality rate of 38 per million is so much better than that of the Western world. For instance, the mortality rate in the UK is 609 per million, in Spain it’s 613 and in Italy, it’s 586.
Prof. Babu said the first reason is the age profile of the Indian population. The median age in India is about 28-29. In Europe it’s in the mid or late 40s. 90% of the Indian population is under 60, 83% under 50. A second reason is Indians have been subjected to more viruses and infections than people in Europe and America and, therefore, have innate immunity. A third reason is Indians have been diligent in wearing masks whereas in Europe the population has been reluctant to accept and adhere to these practices. A fourth reason could be genetic but this needs to be further studied.
However, Prof. Babu does not believe vitamin D has a role to play in explaining the difference in mortality between India and Europe.
Prof. Babu pointed out that India is not unique. All our neighboring countries as well as others further afield like the Philippines, Thailand, Malaysia, and Indonesia and, of course, all of sub-Saharan Africa, with the exception of South Africa, have similar low mortality rates. COVID-19-India/ COVID-19-India
The above is a paraphrased precis of Prof. Giridhar Babu’s interview to Karan Thapar for The Wire. Although not inaccurate it’s recounted from memory. There’s a lot more in the interview that has not been covered by this precis. For instance, in part two, i.e. after the commercial break, there’s a substantial discussion about herd immunity and Dr. Friston’s theory of immunological dark matter which suggests that 50% of any population is not susceptible to any virus. There’s also a discussion about how long the immunity you get from a Coronavirus infection lasts and whether T-cell immunity is a better defense against Covid-19 than antibodies.
Disclaimer: The opinions expressed in this article are based on a press release issued by the interviewer’s office. The facts and opinions appearing in the article do not reflect the views of newsabode.com. newsabode.com does not assume any responsibility or liability for the same.)
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