Herd Immunity

‘India Has Attained Herd Immunity; No Need To Fear Covid Variants’

Dr AK Arun, a renowned public health scientist, rues that India lacks accurate data on treatment and deaths due to Covid, which would help us prepare for any future health emergency

There have been reports of a resurge of Covid cases in many countries. According to the Center for Disease Control and Prevention (CDC), the risk of the new sub-variant XBB.1.5 is rising. This is more dangerous in spreading infection than the sub-variant BF.7.

There are ten different sub-variants of SARS-CoV-2 in India and BF.7 is one of them. So far, all of the four known cases of BF.7 in India have recovered by home isolation. They did not need to be admitted to the hospital. Dr Soumya Swaminathan, chief scientist at the World Health Organization has expressed concern over XBB.1.5, another sub-variant of the omicron variant. There are more than 300 subtypes of Omicron itself, of which XBB.1.5 is a recombinant virus that can kill antibodies in the body. Therefore, there is a need to monitor the situation.

It is being said that the situation has worsened in China after the lockdown was completely lifted. Epidemiologists also blame China’s “zero Covid policy” for the resurgence of Corona infections in the country. Due to strict lockdowns, herd immunity in people could not be achieved.

India’s case is different. Over last two year when Covid infection was rampant, Indians have achieved herd immunity. Thus the chances of controlling it are high and there is no need to panic. Although the Omicron variant of Corona has been constantly mutating into new forms since last month, its deadly impact has not been witnessed in India so far.

ALSO READ: ‘If Covid Rebounds, All Must Be Treated Uniformly’

In the absence of proper protocol in the initial phase of the epidemic, doctors indiscriminately used steroids etc. Unnecessary medicines given to a Corona-affected patient were also black-marketed because the doctors themselves were not clear about what and why the medicine should be given. In most cases, the patient’s attendants were deciding whether to administer such a medicine to the patient, whatever the price. It is possible that post-Covid complications are the outcome of indiscriminate use of these medicines than the infection itself.

There have also been different viewpoints on the Covid deaths in India. Data related to any epidemic, especially a global epidemic, is important for any study. Since 2021, no concrete data has been available from government institutions. Atul Kotwal, executive director of the National Health System Resource Center, admits that there are problems with the Covid data. Dr T. Sundararaman, former executive director of the same institute, justifies the WHO figures in terms of deaths due to Corona in India. For, we lack an accurate mechanism to collect death data; only 21 per cent of the deaths are recorded by the registrar.

Another challenge is to handle the fear mongering about the Covid virus. The atmosphere of anxiety that has arisen among people post two Covid waves can lead to ill-will about certain people, places or communities. This can have serious impact on society as well the mental health of people. We must deal with this sense of stigma.

For this, we have to understand that the virus does not look at social class, race, community or nationality. In such cases, we should put ourselves in the shoes of an affected person or community. The dissemination of information must be fair and free of any bigotry.

(Dr AK Arun is a national award-winning Homeopathy practitioner and headed the research team of the Delhi Government on alternative cures for COVID-19)

As told to Abhishek Srivastava

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Omicron And Future Of Covid Variants

Nearly half a year ago, I wrote an article stating that the Covid-19 virus wasn’t going away anytime soon. And here I am again, discussing a different variant of the virus this time: Omicron. Here too, I shall repeat once again: the virus is here to stay. While the Omicron variant is peaking, it does not necessarily imply that the Delta variant is weakening down or is losing its potential to cause serious harm. In fact, we are now having mixed infections at the community level.

The third wave is raging, at least in the state of Maharashtra, Delhi, and to a great extent in Kolkata, though like the past waves there is no synchronised peaking all over the country. Meanwhile, globally, there are different co-infections emerging like the “Delmicron” (co-infection of Delta and Omicron) or the “Flurona” (Flu with COVID-19). But yes, rarity is an issue with these new combinations as of now.

The Delta variant was severe but its ability to spread was comparatively lower than the Omicron variant. There is an important distinction here. The Omicron variant is merely ‘less severe’ than Delta, but that doesn’t mean in itself that it is ‘mild’ as is being reporting in sections of the media. People cannot be slipshod about it. There have also been reports that say that the Omicron variant will act as a natural vaccine since it is less severe, does not require hospitalisation and its higher-spread potential means herd immunity can be achieved.

These are dangerous, sweeping statements to make. No, Omicron variant isn’t a natural vaccine. There is so much that we don’t know about the nature of the virus and its recurring mutations and the strains that develop from those mutations, yet. There are various permutations and combinations by way of which a particular strain may affect a particular person and we should avoid making blanket statements like these. Such assertions merely encourage people to go about with business as usual and deliberately expose themselves to the contagion; this would amount to playing with fire.

As the medical situation stands in India currently, the Delta virus is still the dominant infection even as Omicron cases are on the rise. There is a difference in disease manifestations and severity! For instance, a person who hasn’t been exposed to the virus at all during the previous two waves will show a different set of symptoms and response, when infected with Omicron, than somebody who is fully vaccinated and has already been infected during one the first two waves.

ALSO READ: Omicron, The Crafty Virus

Throw in co-morbidities, age and immunity factors into the mix and the symptoms get even more complex. Some people develop immunity because of their natural body milieu and vaccine while some remain dependent on vaccine-induced immunity alone.

  • Omicron is not a natural vaccine
  • The virus will continue to mutate
  • ‘One Health’ approach best remedy
  • Human, animal, climate are linked
  • Covid-appropriate behaviour must

A person who has been infected after vaccination is called to have a ‘vaccine breakthrough infection’. The Omicron variant has huge mutations in the spike protein of the virus which often helps it dodge the immunity. It may so happen that the newer variants will slowly drive out the older variants, e.g. the Omicron variant may push out Delta with time. But no one can say for sure whether future variants will be less or more severe, or if at all this will happen.

So, Where Does The Solution Lie?

If we are to beat the virus at all or at least have a semblance of control over it, we need to focus on the concept of ‘One Health’. When we discuss about health putting together people, animals, and environment they make the One Health Triad. One Health is in fact a rational unification of local, national, and global practices for optimal health in the interaction between human, animals, and their environment.

In simple language: One health means the health of humans doesn’t exist in vacuum and is deeply connected to that of animals and our shared environment. Zoonotic diseases (diseases that can easily be passed on from animals to humans) like coronavirus will be on the rise if we do not consider humans, animals and other components of nature as ‘one collective unit’. We need to move in tandem with nature.

As we have seen, the emergence of the newer virus strains is also connected to the socio-economic condition of a country. Both the Delta and Omicron variant have emerged (read detected) from developing nations. Even the original novel coronavirus emerged from Wuhan, whose socio-economic condition is not as good compared to other parts of China. So, it is developing nations that will have to take the lead in working with the concept of ‘One Health’ and implement what is known as ‘Systems Thinking’ in public health.

‘Systems thinking’ approach is a holistic one that analyses the intricacies in complex systems – it can be any system. Through this, in Public Health we can try to understand how different societies or its different strata act to achieve collective health goals, and also how and where the external influencers have an impact.

The ‘third wave’ may become the end of waves in which huge number of people get infected at once and the pressure on healthcare system is staggering, but it is not necessarily the end of the coronavirus. With the passage of time it might turn ‘endemic’, meaning we might learn to live with it. A disease becomes endemic when it stops becoming a major problem, although one cannot say that those infected will have it mild or it will just wash away like the common cold or viral fever. A lot of it then boils down to our individual approach to our health. As of now, the World Health Organisation has warned against declaring the pandemic as an endemic (which Spain already has) because the transmission rates globally are still very high and might spiral anytime, we still need cooperation of global proportions in fighting the virus.

All of us are in this together. The virus still has a vice-like grip on people, especially among the poor, the unprivileged who cannot afford to isolate for long because their livelihood depends on going out. Thus to make everyone’s lives easier, the community as a whole needs to practise Covid-appropriate behaviour: wearing masks, maintaining social distancing, frequent hand-wash, and avoiding public gatherings like political rallies, religious congregations, marriages, social parties etc. as much as we can. Taking our vaccines, taking care of other aspects of our health, especially mental health, and pursuing a holistic approach to our lives is what will usher us into a ‘One Health’ era.

The writer is an Epidemiologist and Health Researcher, posted as Assistant Professor (Community Medicine) in Dr B C Roy Multi-Speciality Medical Research Centre, IIT Kharagpur

Weekly Update: Delhi’s Hazardous Air; A New Strain Of COVID

A social media meme drenched in black humour has been doing the rounds in Delhi for the past couple of weeks. It goes: “If you don’t gulp down your peg of Glenfiddich quickly enough on an evening in Delhi, it can turn into a Laphroiag.” The reference here to the lighter coloured Speyside whisky turning into a darker, more peaty Islay whisky is all about pollution in Delhi. On Saturday evening around 7 pm, the Air Quality Index (AQI), which measures the levels of suspended particulate matter in the air, in Delhi was around 745. The higher the AQI value, the greater the level of air pollution and the greater the health concern. For example, an AQI value of 50 or below represents good air quality, while an AQI value over 300 represents hazardous air quality. At 745, it is a grievously terrible situation.

While jokes and memes, tapped out on phones from well-endowed and privileged Delhiites, gives one side of the picture in Delhi, the story from the streets of India’s capital city is not one that could make you guffaw. Delhi has an estimated 150,000-200,000 homeless people, the majority of whom live on the streets. CNN had a heart-rending story about an 84-year-old homeless man begging for food on the sidewalk outside Delhi’s South Campus Metro station, breathing the air noxiously full of smog. Millions of Delhiites eke out their living in the sprawling city with a population of more than 20 million by working on the streets, on construction sites, in open-air food and vegetable markets, or simply by plying auto rickshaws and handcarts. Hawkers, policemen, security guards, food delivery couriers–you name it–they are constantly exposed to air quality that is life-threatening.

The situation is a repeat every year, especially as winter sets in and cold air traps emissions from stubble burning on farms around Delhi, poorly regulated factories in and around the city, and the mesh of foul emission spewing traffic. Every year, when this happens, there is media outrage and huge concerns. But everyone, including the government, has become so inured to it that even as it gets warmer and the air clears even a little bit–although even then the AQI levels are dangerous–the outrage dies down. Year in and year out, it is the same story.

It is not that the government–both at the centre and in the Delhi state–have not done anything. A few years ago, they tried an experiment of restricting traffic by allowing only vehicles with licence numbers that were even to be out on the streets on one day and ones with odd numbers the next. The experiment wasn’t given time enough for its efficacy to be assessed before it was shelved.

This year, following a judicial order after an environmental activist had moved court, schools and colleges were shut down; construction projects were stopped and some of the coal-fired power plants around the city were ordered to be closed down. But as the air quality improved marginally, everything was back to business as usual.

Delhi isn’t the only Indian city that is reeling from the adverse effects of air pollution. Nine of the ten most polluted cities in the world are in India, which depends heavily on fossil fuel as a source of energy. At the COP26 summit that recently concluded in Glasgow, India was one of the countries that wanted to phase down coal instead of phasing it out.

It is a classic conundrum. Industrialised countries have reached a level of advanced development, (much of it achieved through decades of burning fossil fuel) where they can now decide to move to a non-fossil fuel environment. Countries such as India, which are still grappling with basic development goals cannot afford to do so. What then is the solution? The answers remain elusive.

Yet Another COVID Variant From S Africa

Even as a new and potentially more dangerous COVID strain was discovered in South Africa and travel restrictions were imposed by many countries on movement of people from there, many Indian states have imposed fresh restrictions on people travelling to those states from international as well as domestic areas. In Maharashtra, all domestic travellers will have to either be fully vaccinated or have a favourable RT-PCR test that is valid for 72 hours.

In Kerala, where the COVID situation has remained alarming, the emergence of the new strain, named Omicron, has given cause for concern. Kerala has been so badly affected by COVID this year that in August there were days when the relatively small state accounted for more than 50% of the total number of cases in the country.

Epidemiologists have had no concrete answers to why Kerala has been so badly affected. Some say it is because the state is able to test people for COVID at a much higher rate than what other states are able to do. Others point to population density in the state. But it is also a fact that Kerala has been able to vaccinate its population more efficiently than other states and that last year it was able to control the spread of the virus better than several other states.

But given India’s huge population, high levels of poverty and low levels of awareness, the emergence of a new strain of COVID, albeit for now in S. Africa, should be a reason for worry. And state as well as central governments have to constantly monitor travel, vaccination programmes and precautionary measures such as mandatory social distancing and the use of masks.

Schools Reopened After A Gap of Several Months

‘Won’t Send My Child To School Till He Is Fully Vaccinated’

Anita Jha (39) did not send her 15-year-old son, studying is Class 10, to his school in Faridabad when it reopened after a gap of several months. She narrates the reasons behind her decision

On August 1, 2021 we received a communication from my son’s school that they were planning to reopen and asked us to convey if we would be willing to send our ward to the school. The notice also mentioned that the offline and online classes will continue simultaneously, and parent were free to choose any option.

I decided NOT to send my son to school.

The reason is simple: Saket, my son, is not vaccinated. I know virology experts say that even after vaccination, an infection may occur and we need to follow same prescribed precautions as earlier. However, the inoculation does provide the body a better ability to fight and defeat Covid-19 infection. And therefore a jab would have given us some assurance of our child’s safety.

Having stated my reasons, I fully support the government decision to reopen schools. Nothing can compensate a physical classroom when it comes to inclusive learning. But, till the time Saket is fully vaccinated I don’t want to take any risk. Some of my friends have chosen otherwise. In my son’s class of 37 students, about one fourth have chosen to attend the school. To each its own; let this be a personal choice for every parent.

Some people may argue that if parents can take their children to shopping malls, outdoor parks and other public spaces, what is the harm in sending them to a school. My counter to them is: in all such cases, the children are under direct supervision of the parents while at school, the children, either carelessly or under peer pressure, may throw caution to the wind.

Anita Jha says her son Saket improved his grades while attending online classes

This is what happened when the schools reopened last time. Infections soared and the government had to hastily retract their decision. We should have learnt our lessons from that.

I do not doubt the preparedness of the school. Over the last few months, my son went to school for collection of some study material and he told me that proper social distancing was being maintained and in one class they were asked to sit leaving two benches in between. And since only class 9-12 are called, social distancing norms are easily maintained.

ALSO READ: Online Classes Drain The Parents Completely

However, how does one keep a watch on the kids all the time? Even if a few children follow Covid-19 protocol, they cannot enforce similar pandemic-appropriate behavior on others in the absence of the teacher. We all know how teenagers are.

Besides, thanks to our access to high-speed Internet and other gadgets, I didn’t see any challenges in my son’s academic performance during online classes. In fact, there is now some self-discipline and improvement in his grades. If the purpose is taken care of by online class then why rush with offline learning in these uncertain times! Why can’t we wait till the vaccination of children is also complete?

It is not only about maintaining precautions in school premises. Not every family can afford a personal vehicle to pick and drop the child from school and hence they have to end up taking a shared or public transport. This increases the risk manifold.

Already, there have been talks of a looming third wave and new variants of the virus that may infect young children too. That worries me. Of course, if the government makes attending schools mandatory, we would have no choice. But I sincerely hope that we make quick progress on vaccination of adolescents and only after that think of reopening schools.

As Told To Mamta Sharma