A missing science pillar in the COVID response
NEWS India’s fight against the resurgence of the coronavirus is a challenge requiring strengthened data and better science.
CONTEXT Recently, there have been a sharp increase in new cases and deaths from the Covid-19. Maharashtra seems to be particularly affected, but nearly all States are reporting increases.
- Emergence of new variants from the original virus.
- Resumption of global travel meant that spread of variants into India was inevitable.
- Further, Evolutionary theory expects SARS-CoV-2, the virus that causes COVID-19, to mutate to become more transmissible.
- However, the expected concomitant decrease in lethality has not yet been documented.
- The current surge is occurring more in younger adults.
- The epidemiology of COVID-19 is poorly understood, but some early understanding of the transmission of the virus can enable a more effective science-driven response. For this, direct evidence is needed from genetic sequencing of the virus.
- The patterns of infection in India clearly suggest multi-generational transmission, with younger adults the engine of transmission into the elderly.
- Various surveys have consistently found that half or more of tested urban populations have antibodies to the virus. However,
- The high level of infection indicates that this virus transmission is higher, on the contrary low transmission is what is required for herd immunity.
- India needs to increase the quantity, quality and public availability of actual data to guide decision-making.
- Need for better understanding of the unique patterns of Indian viral transmission, which can be achieved through collection of anonymised demographic and risk details (age, sex, travel, contact with other COVID-19 patients, existing chronic conditions, current smoking) on all positive cases on a central website in each State remains a priority.
- Re-programming sequencing capacity in Indian academic and commercial laboratories is required for greatly expanded sequencing of the viral genome from many parts of India.
- Daily or weekly reporting of the total death counts by age and sex by each municipality would help track if there is a spike in presumed COVID-19 deaths.
- Need for larger and better sets of serial surveys is required.
- Finally, we need to understand better why some populations are not affected. For example, COVID-19 infection and death levels in Thailand and Vietnam are remarkably low, and cannot be assigned to their stronger testing and tracing programmes.
WHAT ELSE NEEDS TO BE DONE?
counter growing inequity:
- India can learn from Chile, which has successfully provided at least one dose to over half of its population, while in India affluent and connected urban elites are being vaccinated quickly, but the poorer and less educated Indians are being left behind.
- Vaccination campaigns need to reach the poor adults over age 45, without having to prove anything other than approximate age.
- Follow-up studies among the vaccinated can establish the durability of protection, and, ideally, reduction in transmission.
- Similarly, India must capture and report data on who is vaccinated, including by education or wealth levels.
Adult vaccination plan:
- the central government should actively consider launching a national adult vaccination programme that matches India’s commitment and success in expanding universal childhood vaccination.
- Since, we might already be in the era where major zoonotic diseases are not once-a-century events, but once a decade. Therefore, adult and child vaccination programmes are essential to prepare for future pandemics.
More draconian steps, such as another full national lockdown should be considered carefully, as they incur a huge toll on the poor and stunt education of Indian children.
The resurgence of COVID-19 presents a major challenge for governments, yet the best hope is to rapidly expand epidemiological evidence, share it with the public and build confidence that the vaccination programme will benefit all Indians.