‘Epidemiologic models show we need aggressive measures in the early phase … lockdown buys us time’

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Statistical modelling provided an insight into the likely global spread of Covid-19 and catalysed action on the part of governments. Two scholars who worked on an India model, Bhramar Mukherjee, Professor of Epidemiology, University of Michigan and Debashree Ray, Assistant Professor in the Department of Biostatistics, Johns Hopkins University, give an update on their initial projections in an email exchange with Pratigyan Das:

Prior to the lockdown, your research indicated India may see up to 13 lakh coronavirus cases by May. What’s the current situation?

Please note that these projections were made under the assumption that the virus took its natural course without any interventions. In the same report, we did some hypothetical mathematical modelling where a strict lockdown and centralised quarantine was “theoretically” implemented which could reduce the R0, the basic reproduction number, and the total number of cases greatly from millions to the order of tens of thousands. But we have to keep in mind all mathematical/ statistical models are wrinkled with assumptions about the strength of intervention and limited by the data that are being reported based on number of confirmed cases rather than the “true” number of infected individuals – reported data may be a gross underestimate due to lack of testing. The projections are associated with large uncertainty, and different models give different answers. However, the reassuring thing is that the lessons we learn and the takeaway messages from all projections are the same. Epidemiologic models show that we do need aggressive measures in the early phase of the epidemic so that we can contain the number of cases and buy time to prepare ourselves. We have to use this time to enhance testing and treatment infrastructure.

Will India be able to flatten its curve with this lockdown?

India has already a much overstretched healthcare system. The number of hospital beds, ICU beds and ventilators is much less than the other countries affected by the pandemic. The mortality rates in countries that were able to arrest the pandemic in early phase by doing large-scale testing (like South Korea) is around 1% whereas in China, the US and Italy it is 3-5%. India also has a large number of uninsured people and people at higher risk of fatalities due to Covid-19 (people with diabetes and heart disease). The lockdown is not a magic potion and is not going to eliminate the virus. It just buys us time. We need to really escalate our testing capabilities, identify and isolate cases, quarantine the contacts of the cases, create temporary quarantine and treatment facilities and acquire/ arrange protective gear for our frontline health workers. This is a very hard decision for India and has to be rolled out with great caution to protect the most vulnerable. The collateral damage from Covid-19 interventions can easily exceed the damage from the virus itself but at this point there is no choice but to stop the virus transmission. Unfortunately there is no easy solution as humanity is facing this crisis, not just in India, but across the globe.

How would you rate India’s tackling of Covid-19 in comparison to other countries?

India has been very proactive and taken the right public health measures in terms of social distancing, and ensuring that the chance of an infected person meeting a susceptible person goes down with these interventions. However, they need to provide support through this transition to a complete lockdown for common people and also escalate testing and contact tracing capabilities. The small number of tests performed has been a major limitation in the data from India, and we need to get closer to knowing the number of truly affected cases.

What are the major challenges for India?

Community inspection and contact tracing has to accelerate. We have to be flexible in terms of taking decisions based on data as they are coming in, in real time.

How well equipped is India on testing?

This is where much work is needed and India is behind. The number of tests performed has to escalate and return of results has to be prompt. Private partnerships may be necessary to manufacture testing kits. One also needs to pay attention to disease surveillance, monitor respiratory illness cases across the country, look at spikes in insurance claims due to such illnesses in the hotspot metro areas and watch out for emerging hotspots and outbreaks. We cannot fight this war blindfolded.

What lessons should we take from this pandemic to avert them in the future?

Set up disease surveillance, testing, contact tracing, create high alert pandemic response team. We need to build public health forces and trained professionals across the country. Trust and invest in science. Fight with united resolve beyond the boundaries of a nation, as a world.

DISCLAIMER : Views expressed above are the author’s own.

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