It is ironic that at a time when evidence is supposed to be the guiding force, it is subjected to controversies. Such noise disturbs the momentum and the very focus of Covid-19 response. The understanding of the Novel coronavirus (nCov2019) and its effects evolves with each day.
The world leaders, backed by some scientists, cheered the concept of Herd Immunity. This meant the uncontrolled spread of the infection to achieve immunity in a reasonable proportion of the population. While the UK backtracked and implemented do-something (lockdown, improve testing) strategy, Sweden went ahead with this do-nothing strategy. In a recent interview with Swedish radio, the architect of Sweden’s strategy and chief epidemiologist admitted that the country has had too many deaths and should have done more to curb the spread of the virus.
From a humanitarian perspective, it is astonishing to propose and implement an unethical plan which has a central flaw, that it is okay that some people will die. Failing while trying is a professional hazard in science, but planning to fail is unheard of and is unethical as well. Europe and the UK are seeing a steady decrease in cases and deaths despite lifting the lockdown. Therefore, it is impossible to assume that herd immunity of around 60% of people infected is required for this pandemic to recede. It might mean either the virus adapts faster or some are more vulnerable than others; or both.
This is achieved by sustaining non-pharmacological behavioural changes, and banning large-scale events without allowing the transmission to re-establish. While the entire world went ahead with implementing preventing person-to-person transmission (and focus on doubling time), Japan had two unconventional strategies. These were retrospective contact tracing and 3Cs approach. Retrospective contact tracing is going back in time to find who the contacts are so that the infection spread can be limited. The only state that did retrospective contact tracing in India is Karnataka.
Without imposing prolonged nationwide lockdown, Japan reduced the Covid-19 burden by using a 3Cs approach — Closed Spaces with poor ventilation, Crowded Places with many people, Close-Contact settings such as close-range conversations. Yet, the world is unmoved and uninspired. Many of the strategies, including institutional quarantine, co-location of the patients in hospitals, and opening up closed spaces after lockdown are violations of the 3Cs approach. What next? Compared to global evidence, more Indians might be asymptomatic. We should follow the 3Cs approach and take abundant precautions to prevent the deaths among the vulnerable. Also, governments must set up large cohort studies of infected persons to understand the long-term sequelae.
Giridhara R Babu
Head, Lifecourse epidemiology unit, Indian Institute of Public Health, PHFI Bengaluru; Member, Covid-19 technical advisory, Government of Karnataka