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India COVID cases could peak early May; herd immunity likely by winter: Srinath Reddy

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India COVID cases could peak early May; herd immunity likely by winter: Srinath Reddy

India COVID cases could peak early May; herd immunity likely by winter: Srinath Reddy
A fair share of Indian population can acquire herd immunity probably by winter this year or early next year, said Professor K Srinath Reddy of the Public Health Foundation of India.
A phased  lifting of the lockdown will help to slowly get more people exposed to the virus and build immunity. However, certain sections of the population like the elderly and vulnerable should be protected as this is being done. Reddy expects  COVID-19 cases in the country to peak out by early May in an event of a successful lockdown.
India has 12,759 confirmed COVID-19 cases as of April 15, and 420 people have died of it.
“It is actually the number of serious cases we need to reduce and not the number of people with the virus," Reddy said.
"So we need a staged release from lockdown. If we open the gates right now, we are going to see a huge surge of infection which will overload the health system and lead to unnecessarily loss of life,” he says.
Reddy, also a member of the National Task Force on COVID-19 management, says testing is a useful tool, but not a panacea to control infection. He said testing had to be ramped up as the lockdown lifted, but good controls with proper contact tracing and isolation of confirmed and suspected cases was equally important in controlling the spread of the virus.
Till now India has tested close to 3 lakh samples, of which around 30,000 samples were tested on April 15.
Edited excerpts from the interview with CNBC-TV18:
An extension of 19 days indicates more ground needs to be covered on controlling the spread of the virus? Where are we in the disease curve?
We have to take multiple sources of data into consideration. Testing is being done based on travel exposure, contact exposure and on symptoms. But since testing is incomplete relatively, we also have to check hospital admissions and wherever household visits are being conducted (syndromic surveillance). From all these sources of data, it appears we are not seeing too much case-loads in hospitals. Number of tests are increasing, the period of interval in which the cases are doubling is also getting wider. Household visits are not revealing high burden of COVID infections. All of these suggest that the lockdown has worked in reducing the rate of transmission.
The biggest concern raised is that we are not testing enough. There are reports that we are not testing asymptomatic contacts, like BMC changing its testing strategy. Will this not be leading to under-reporting of cases? How about those who die with COVID like symptoms? Are we really looking at a correct picture?
The purpose of testing is not so much to treat; it is to isolate. We have already had three weeks of lockdown and now an extended period. Virtually everyone is going to be confined to homes or follow social distancing even outdoors; the purpose of testing which is primarily isolation has been achieved. It is only when we really start coming out of lockdown, testing has to be ramped up. Ramping up testing is also based on certain logistical and supply hurdles. Do we have sufficient number of kits to address all the tests need to be conducted or not? For example, Kerala has not done as much testing as Delhi, but Kerala has had a much better control. And that is because they have combined several methods of identification. They had excellent contact tracing, good home confinement. So, it’s not as though testing is a panacea for control of the infection. It is one of the useful tools and certainly needs to be ramped up when we come out of lockdown.
How long will people need to stay locked up in their homes? When do you see the peak of this disease spread ?
If the lockdown is absolutely effective, then we should be seeing the peak by the end of April and then the downward movement. Of course there will be new cases but we will see a downward movement if the lockdown has been effective. Since there are certain slip-ups, we have to expect that somewhere by end of April or early May, the impact should be seen but for the remaining period of the lockdown we should be as careful as possible in observing social distancingthat has been prescribed to interrupt the dissemination of virus.
Certain countries like China are seeing a reoccurrence of the viral infection as second wave.  How can India be better prepared for a second wave?
China has had infection not from international travellers, but from travellers within China. They were confined but now they have started moving back to other cities and towns. Therefore, they are carrying some residual infection in them. But that is now being contained. We also have to be very careful when we resume travel. Particularly about urban to rural travel, except for essential goods and services. Because by and large our rural areas would have been protected from the virus entry and highly mobile urban communities. We definitely would like to ensure that rural community are further protected by social support and essential goods and services.
Will partially opening up certain industrial and business units post April 20 lead to chances of further to more transmission considering more people will be travelling in and around although in a phased manner?
I don’t think the purpose is to prevent every single person from getting infected. The purpose is to slow down the rate of infection from person to person and from section to section. It is to prolong the period of dissemination of the virus till it comes down naturally or immunity sets in across the population. It is to slow it down so that we can handle the cases as they come up, particularly to protect the elder and the vulnerable section of the people, but not to lock down the economically productive younger population.
How much time is needed to build herd immunity for COVID-19 – considering we are still seeing rising numbers and are in a second phase of lockdown?
We have to have a staged release from the lockdown with section of the population still protected initially like rural areas, elderly, but over a period of time we should see more and more people getting exposed and getting herd immunity. It is actually the number of serious cases we need to reduce and not the number of people with the virus. And therefore, if we actually allow this to happen in a controlled manner, we can acquire herd immunity probably by winter or next year. But if we open the gates right now, we are going to see a huge surge of infection which will overload the health system and lead to unnecessarily loss of life.
What happens to the migrant population in bigger cities like Mumbai, Delhi, Surat. They seem to be getting desperate with poor living conditions, and limited resources in slums or camps. In this scenario, are we looking at another health crisis? What can be a better way to handle this situation?
Frankly I feel that migrants should have been allowed and assisted in getting back to their villages even after the lockdown began. It is highly unlikely that given the nature of their occupation and nature of their dwellings, they would have come in contact with foreign-return travellers or their contacts. So, the likelihood of the virus travelling with them to the villages I think was miniscule. But since they were confined and kept back in urban environments, now we have to make sure they receive all the social amenities and protection, income security and are kept are far as possible socially distances so that they don’t become victims in urban exposure.
 Is random rapid testing in slums and migration camps is a way forward? ICMR says it wants to expand, multiple states have drawn up their plans, but the kits are still not available and that has delayed the process. Are we losing time?
Random testing will tell you how prevalent the virus is in the population. The idea is to find out what is the level of dissemination in urban and rural areas, how many people have been exposed and how many have developed immunity?  I am not bothered about the virus being transmitted from person to person in a younger age group, as they remain unaffected in severity of illness. I am particularly worried about people who are likely to develop severe illness and those numbers ramp up suddenly. Let us keep a careful watch on these people and do random testing and find out what the magnitude of the problem is. By doing syndromic surveillance to find out who are the kind of people who are having influenza-like illness, fever and cough. And also look at rate of hospitalization of people with severe illness, that is going to be a better tracker for us.
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