Lifting the lockdown will help tackle the Covid crisis better

Covid-19 finally is a fever where the infection spreads quickly but the lethality is low. Serious incidence is more among people of over 65 years of age, and immune-suppressed cases in the urban areas with some linkage with pre-existing lung diseases. There is no vaccine yet to prevent Covid and no confirmed medication exists for SARI (severe acute respiratory illness) cases though the doctors try out re-purposed therapies.

India came out with the most stringent lockdown not just to flatten the curve but to buy time to prepare for outbreak-related fallout such as RT-PCR testing, serological rapid test PPE procurement, and getting ready with quarantine wards and production of ventilators.

The initial three-week lockdown has ballooned into a more than two-month-long spell, with the future continuing to be uncertain. Somehow, the impact has been relatively benign, with limited spread and fewer deaths and that, too, mostly concentrated around 12 cities. While quarantine wards and ventilators remain underutilised, shortages of PPEs are affecting attention to other emergency medical care patients. Testing (RT-PCR) remained below par with containment zones not even being covered. Serological rapid testing for antibodies got discontinued once the machines from China started showing faulty results and with no replacement kits on the anvil.

Meanwhile, people seeking medical attention could not come to the hospitals, doctors refused to entertain cases in emergency care without test reports and PPEs, and people from the villages could not come to hospitals admitting Covid cases because of lack of transport. In slums, the spread was attempted to be contained but with limited success as 6-10 people stay in a small tenement. No one really knows how many deaths took place because of these impediments.

Information flow

But the biggest casualty is the data and flow of information. We have no idea about the numerator and the denominator There is no idea what percentage has developed antibodies. The only saving grace is that it is a phenomenon mostly limited to 12 cities and all serious cases are coming to Covid hospitals as clinics and health centres are closed.

There are doubts about death tolls in some States and infection could have spread to a much higher percentage of the population already. In the interest of healthcare in general and Covid care in particular, it is imperative to lift the lockdown forthwith. An open system will allow the Covid cases to be reported, identified, isolated and treated better in addition to taking care of cases with existing medical conditions.

A lockdown may delay spread of infection and severe cases for a while, but it will resurface again as and when restrictions are eased. Lockdown may just be pushing severe cases to the future instead of preventing them. Research from Stanford and Southern California universities show that the real infection could be five times more than one arrived at in the US. With the changed numerator, the death rate comes down to 0.1 per cent, which is slightly lower than the flu deaths.

Even studies by UC Berkeley and Santa Clara point to larger infection and smaller death percentages. In India, where testing is very limited, it could be a higher multiple as far as antibody carriers. This happens because it spreads from younger people with no symptom (asymptomatic) or weak symptoms to others who will get mild symptoms often, and in a few percentage of cases it may reach SARI stage. India’s advantage is its young population (below 60 years) is around 92 per cent.

We are not making a case for herd immunity, an epidemiological concept which describes a state where a population sufficiently immune to the disease will not spread the infection any further within the group. When most of the people — say, 50-60 per cent — become immune, this provides indirect protection to people who have not developed antibodies. The UK initially tried it as a deliberate strategy and abandoned its population above 60 — at 22 per cent, it is three times India’s.

Herd immunity

It is one thing to seek herd immunity as a strategy like Sweden and the UK did, but quite another to obtain the advantage as a collateral while taking care of physical distancing, hand-wash and other precautions. With a young population allowed to move, they are likely to get mild infection and pass it on. The vulnerable groups like those over 65 years and immune-suppressed cases can be protected in their homes for a month more. This will reduce not only the viral load for health workers but also the probability of lethality.

Knur Wittkowski, an American epidemiologist, says that for a respiratory disease people should not be kept indoors for longer than required. He even suggests that schools and colleges should reopen.

Humans have been facing viral attacks for millennia. It is their immunity which helps. Our obsession with vaccination and powerful vaccine lobby’s influence have come to mean people feel helpless without vaccine. That is not true. H1N1went away in one season, without any vaccine then.

Second wave

The real scare is the second wave which is expected to come in winter. During winter, the virus is expected to be more virulent. Currently, we are in a sweet-spot with summer in full swing. With some preparedness, low virulence of the virus and our immunity because of exposure, it’s time to open up and improve the immunity now.

The virus is swirling around us. We cannot allow life to stop, when our data is so poor and our ability to grapple with it has proven to be so limited. Huge price is also being paid by the health system and patients with existing conditions. We should allow free movement with stipulated physical distancing to get back to normalcy.

The time for calibrated opening ended three weeks back. Now there is a case for opening up all areas with smallest possible containment zones as possible. It is nice to be patient and careful but overly doing it is a flaw. If we do not lift the lockdown and allow movement now, it will be like Don Quixote tilting at the windmills.

The writers are former Secretaries to Government of India