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Insights into Editorial: New questions: On COVID-19 infecting one-fifth of Indian population

 

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Context:

With its 1.3 billion population, India has the world’s second-highest number of coronavirus infections more than 10.8 million but new cases and deaths have fallen sharply in recent weeks.

The results of the ICMR’s third serological survey to ascertain the spread of COVID-19 show that nearly one in five Indians about 270 million may have been infected.

However, what is known so far is that compared to August when data for the second serological survey was announced there has been a three-fold rise in infections.

There has also been a five-fold rise (in percentage terms) of the infection in those aged 10-17 years.

The third edition also included a serological survey of doctors, nurses and paramedical staff, revealing that nearly 25% significantly above the national average had been infected.

Questions that needs to be create awareness are:

Rather, such surveys must shift focus to asking more granular questions:

  1. Should the rise in spread among teenagers and children mean that they be considered for vaccination earlier than scheduled?
  2. Should companies accelerate trials to test protection in children?
  3. Should the rise in rural India the survey is designed in a way to sample more villages than urban pockets mean that they be given vaccines earlier?

One in five Indians have been exposed to coronavirus, ICMR survey finds:

  1. Nearly one in five Indians had been infected by the SARS-CoV-2 coronavirus until December 2020, the third round of the Indian Council of Medical Research’s (ICMR) serological survey has found.
  2. This is roughly a three-fold increase since August 2020 and a 30-fold increase since May 2020, when previous rounds of the survey were conducted.
  3. The message is that a large proportion of the population remains vulnerable. Vaccines are necessary and there can be no complacency with regards to masks, social distancing and hand hygiene.
  4. Compared to reports of city-focused serology surveys in Delhi and mathematical modelling estimates, the ICMR survey-results appear to be more conservative in estimating the true spread.
  5. The overall prevalence in the population was 21.5%, which averaged over India’s population indicates that about 270 million may have been exposed to the virus.
  6. India has so far confirmed a little over 10 million infections or 27 cases to each confirmed case of infection.
  7. In the previous survey, there were 26 to 31 undetected cases for every confirmed case.
  8. India is showing a declining number in fresh infections since September, with only around 12,899 new infections on an average everyday, and 6 lakh active cases.
  9. Experts, however, have previously noted that serosurveys don’t capture the extent of the spread, and other modelling studies have shown that as much as 50% of the population may have been exposed.

India Working On 7 More COVID-19 Vaccines, Says Health Minister:

  1. Union Health Minister has said that the country is developing seven more COVID-19 vaccines and also working on further vaccine development to inoculate every citizen of India.
  2. The Centre does not have any immediate plan to make the vaccines available in the open market and a decision will be taken as the situation demands.
  3. The COVID-9 inoculation process for people aged above 50 will start in March.
  4. We are not dependent only on the two vaccines as the country is working on seven more indigenous vaccines.
  5. Simultaneously, we are also working on the development of more vaccines because India is a huge country and we need more players and research to reach out to everyone.
  6. Presently, COVID-19 vaccines are being administered on an emergency basis, under full observation and in a controlled manner.
  7. If the vaccines are released in the open market, there won’t be any control over them. The decision will be taken as the situation demands.

Herd immunity in India?

  1. Experts said that without conclusive data, it was impossible to say why India’s figures had fallen so dramatically.
  2. There are mixed views on whether herd immunity when a significant proportion of a population is immune to an infectious disease may be present in much of India.
  3. My understanding is that there are enough people in India who have been exposed to the virus. And that’s possibly why the numbers are going down. But in the absence of real numbers, it’s really hard to say.
  4. The World Health Organization’s regional director praised the country’s mask wearing, distancing and hygiene, saying they had proved effective in curtailing transmission.
  5. India is a vast and diverse country and it’s hard to attribute the decline in cases to herd immunity.
  6. Meanwhile, India has rapidly rolled out vaccinations with the ambitious goal of inoculating 300 million people by July.

Conclusion:

Experts of various hues point to the declining trend in infections since September, and the absence of multiple peaks in coronavirus cases as a pointer to the spread being far wider and speeding up ‘herd immunity’ a state when a significant proportion of people in a locale have been infected, thereby retarding future spread. But it would be wrong to derive comfort from this situation.

The ICMR emphasises that the results point to a significant number still potentially vulnerable, underscoring the need to be vaccinated and continuing with distancing and masking up.

Also, neither this survey nor any city-wide survey has evaluated how long antibodies persist and if certain virus mutant variants can overcome the protection from antibodies.

Given that vaccines are round the corner for the general public and that no district has been immune from the virus, it is now no longer useful to know that 80% of India is still vulnerable.

There are many more questions and doubt already on the minds of specialist researchers.

Alongside the vaccination drives, the ICMR and the government health facilities must coordinate with a broader spectrum of specialists to investigate questions that can be used to guide and modify vaccination policy.