|Year : 2020 | Volume
| Issue : 5 | Page : 425-426
Chasing the virus: Not only difficult but impossible. Are we going to hit a dead end?
Dr DY Patil Medical College, Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||29-Jul-2020|
|Date of Decision||01-Aug-2020|
|Date of Acceptance||04-Aug-2020|
|Date of Web Publication||10-Aug-2020|
Dr DY Patil Medical College, Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee A. Chasing the virus: Not only difficult but impossible. Are we going to hit a dead end?. Med J DY Patil Vidyapeeth 2020;13:425-6
Even on a conservative estimate, based on the serosurvey result by the ICMR undertaken some time ago almost 1 crore people in India have already been infected with Covid-19. Recent estimates from serosurvey indicate that almost 18 crores Indians have been exposed to the virus, despite the denial of community transmission.
Given the large denominator of infected, on conservative estimate, the infection fatality rate from Covid-19 is <.1%, far less than the widely reported fatality estimate of 2.5%. Unreported cases detected by serosurveys must be counted in the denominator to appraise the lethality of the virus.
This implies that for more than 99.9% of Indians this is a self-limiting infection even without specific treatment. Some do require oxygen, and still few may need ventilator support.
Data from other countries suggest that increased testing does not reduce deaths from Covid-19 [Table 1]. Japan and Sri Lanka with the lowest testing rates have the lowest fatality. UK with its highest testing rates also has the highest fatality in spite of much better public health infrastructure than most countries as well as a compact population of about 6.6 crore, smaller than most Indian states.
Testing, contact tracing and isolation are important in two phases of a pandemic, i.e., in very early stage to avoid it gaining foothold in the community, and secondly in the end-game, i.e., when there is possibility of eradicating the virus from the globe. Since the virus has taken roots in the community we are too late for the first stage, and we are too early for the end game in view of large proportion of asymptomatic cases forming a large reservoir of silent infection.
With almost 18 crore people infected in India, it is not cost-effective to identify all contacts as testing and contact tracing involve lot of money and human resources at the same time antagonizing the community. It has been estimated that cost of contact tracing in USA is 3.6 billion dollars. India's population is four times that of the USA so the cost for India for contact tracing would be over 14 billion dollars. Can India afford this amount for a disease which has much low fatality in our population compared to USA due to younger age and low prevalence of obesity?
Against this background, the more number of tests being carried out will yield more reported cases raising the panic levels without any benefit in diminishing deaths which should be the goal. Stigma associated with contact tracing also tends to make people hide their symptoms, and they report to hospital late raising the fatality rate.
Time has perhaps come to consider calling off the headlong fight against the virus and change strategy to prevent deaths from Covid-19 and not contain it which is impossible at this stage.
We should capitalize on the advantage of our much younger population who are comparatively resistant to fatality from the virus by going for testing only symptomatic particularly the elderly and those with comorbidities.
Mild and asymptomatic cases should not be admitted unnecessarily overstraining the hospitals and health workforce. Resources saved can be used to improve care of those who really need support and this will bring down the mortality from Covid-19 further.
Almost all the other communicable diseases endemic in our country such as TB, dengue, typhoid, diarrhoea, and other respiratory infections have far higher mortality than Covid-19 and chasing the covid-19 virus by testing and contact tracing will involve a large investment without commensurate returns of saved lives. Resources diverted will affect control of other communicable and noncommunicable diseases in our country which have far higher fatality. Total all causes daily deaths in India is about 25,000. Covid-19 deaths have to be viewed against the context of this daily mortality figure.
Instead of active testing, reverse transcription polymerase chain reaction/Rapid antigen tests can be still offered on a voluntary community led testing and at few sentinel sites as a means of continuous monitoring rather than contact tracing.
Contact tracing can be replaced by conducting syndromic surveillance of high-risk people with influenza-like illness. This will bring down the fatality further as people will actively report to health facility in absence of fear or stigma.
Repeated serosurveys for antibodies with their results declared in real time can give us an idea of how the virus has spread through different parts of the country. Inputs from these surveys can guide policy in an evidence-based manner.
The coronavirus has disseminated globally. Fortunately, it has not turned out as lethal as originally suspected, with the bulk of the infections silent and asymptomatic. However, the fear and panic associated with the early uncertain days have persisted, rather multiplied. Chasing the virus will lead us to a dead end.
Coronavirus is the don of pandemics, not only difficult but impossible to catch up with! Fortunately, it is a relatively benign don, ruling by fear and panic more than by the gun and the bullet. Accordingly, we should change the strategy.
Instead of chasing it we should allay the fear and panic (the main cause of stigma), of the people, and provide for the relatively few victims of the virus who require treatment in form of invasive oxygen therapy or ventilator support. This will bring down the case fatality rate still further while in the background the silent asymptomatic infections will build up herd immunity of populations.
| References|| |
Bhalwar R. Lockdown for Covid-19 in India: An alternative viewpoint and revised epidemiological estimates. Pravara Med Rev 2020; 12: 2: 4-10.
GBD 2016 Healthcare Access and Quality Collaborators. Measuring performance on the healthcare access and quality index for 195 countries and territories and selected subnational locations: A systematic analysis from the global burden of disease study 2016. Lancet 2018;391:2236-71.
[Table 1], [Table 1]