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India in community transmission: Expert

India in community transmission: Expert
Dr R. Laxminarayan (File)
NEW DELHI, JUL 28 (AGENCIES) | Publish Date: 7/28/2020 12:48:30 PM IST

 Rampant spread of virus indicates that we are gradually moving towards herd immunity - Dr Laxminarayan -

India is seeing record spike in daily Covid-19 cases and the virus is spreading deep into the hinterland where social distancing is a herculean task. “It is going to be a tough few months ahead for the country, but things will get better over time,” eminent epidemiologist and the director of US-based Centre for Disease Dynamics, Economics and Policy, Dr Ramanan Laxminarayan said. 

In an interview with Business Standard, he also said there is clearly community transmission in India and the rampant spread of the virus indicates that we are gradually moving towards herd immunity. 

On being asked what would be the peak scenario even as India is seeing over 45,000 daily cases for the past three days. Dr. Laxminarayan said it was difficult to see a correct picture as the government was not sharing data and without raw data on testing and outcomes, one could only guess. However, he said the summary figures only suggest that COVID was a “peaking epidemic” in Delhi, Maharashtra and Tamil Nadu while it was a “growing epidemic” in other states where the epidemic-like surge was seen such as in UP, Bihar and Madhya Pradesh.

  States that are testing more are both doing better at containment and are also reporting more cases. Dr. Laximinarayan said he considered case reporting to be an indicator of the quality of the health system. And states that are hiding cases and deaths clearly have weak health systems and inadequate testing. When drawn to the government’s refusal to accept that community transmission (Stage 3) has been reached despite COVID-19 cases having crossed 10 lakhs and Kerala having acknowledged it, Dr. Laxminarayan said the term was not important as it has been defined arbitrarily by some. He however added that community transmission has already taken place as defined by international standard since March 2020. 

He said though India’s fatality rate was below  2.5% it needs to test intelligently. The switch to the rapid antigen test which is far less sensitive has likely resulted in a lower test positivity rate and therefore a less fatality rate, he pointed out. 

He said this also gave the impression that things are under control. However, ramping up RT-PCR is not possible beyond a point. He said a combination of testing for comorbidities, severity markers, antigens, antibodies and RT-PCR in a systematic manner could help. He also however said ICMR’s guidance does not even refer to differential testing for people with higher risk factors. The scientific guidance is lagging behind the epidemic.

When asked if India was moving towards herd immunity and if so how does it help to break COVID transmission, he said  herd immunity is when a certain percentage of the population has been infected and that segment becomes  immune and consequently not everyone has to be infected. He said the rampant spread of the virus certainly indicates that far more people have been infected than RT-PCR testing has showed. He said India is certainly moving in the direction of herd immunity, which has been discussed for a while.

Asked about the Oxford vaccine candidate which has show promise in trials, Dr. Laxminarayan said he remained hopeful but there was a long way to go and too early to make conclusions. Dr. Laxminarayan said the government has done well in many ways in trying to contain COVID-19 such as in providing early leadership, and communicating the importance of a strong response. He however said testing has lagged behind and there has been some confusion around the science. 

The scientific leadership during this time has been confused between unrealistic vaccine deadlines, recommendations on hydroxychloroquine (HCQ) that are not validated with global data and the lack of much serious scientific research on Covid coming out of India. However, Dr. Laxminarayan said India has done reasonably well overall.

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