One of India’s foremost virologists and the winner of the coveted Shanti Swarup Bhatnagar Prize in 2000, Shahid Jameel, says if the ICMR serological survey results, made public on June 11, are correct, then it follows that India has 140-150 million coronavirus infected people today.
Dr Jameel, the CEO of the Wellcome Trust DBT India Alliance, says this follows from the findings that at the end of April 0.73% of the population, which is 10 million people, had the virus. Seventy five days later, given India’s doubling rate of 20 days, the number of people infected today would be 140-150 million.
In a 44-minute interview to Karan Thapar for The Wire, Jameel pointed out that there are three other ways of calculating the total number of people infected by the virus as of today and these methods lead to very different numbers.
First, if you go by the infection fatality rate of 0.08% and the fact India has 23,727 deaths, the number infected is around 30 million.
A second way of calculating the total number of people infected today is to use what Jameel called the ‘death model’. This assumes an infection fatality rate of 0.5% based on several studies reported in the Lancet. This method shows that between 8-10 million people are infected with the virus.
Yet another model is the one designed by Murad Banaji at Middlesex University in the UK which also assumes an infection fatality rate of 0.5%. In this case, the total number of people infected is between 20-50 million.
Therefore, depending upon which method you use for calculating the number of people infected with the coronavirus as of today in India, the figure is between 140-150 million, at the upper end, using the ICMR serological survey findings, and 8-10 million at the lower end, using the death model. Each of these methods is described in the interview.
Speaking about the fact that India will cross one million COVID-19 cases in a couple of days and is growing at nearly 30,000 per day, Jameel said that whilst “a million is worrisome, we must remember India is a big country”. He added that “the rate of 3% daily increase is not a runaway trend”.
Jameel also told The Wire that whilst Delhi has done well in bringing down the daily cases to under 1,300 it’s still not testing enough. At the moment, he said, for every 10 tests a confirmed case is found in Delhi. That needs to be one for every 20 tests. In other words, the positivity rate in Delhi needs to be driven down to 5%.
Jameel added that the same number holds for India as a whole. From his calculations, the positivity rate in the last week of June was 7.8%. However, between July 5 and July 12, it has risen to 11.4%. This, he said, is a clear sign that we are not testing enough. He agreed with Soumya Swaminathan, the chief scientist of the WHO, that India needs to increase its testing until the positivity rate – both nationwide and in containment zones – falls under 5%.
Looking down the road for the next three months and speaking about the strategy the government should follow, Jameel said that, first, the government must “test at scale”, trace contacts and isolate them. However, he elaborated on how this isolation should be done. He said it was essential to isolate people with those they feel comfortable with otherwise they will resist isolation. He said isolation needs to be village-based or, even, mohalla-based. Therefore, he said, strategies need to be city-specific or even locality-specific. As he summed up, it’s important to “go local”.
Speaking about the disease COVID-19, Jameel said that an increasing number of studies suggest it not only affects the lungs but also the brain, the kidneys and the heart. “It’s more of a multi-system disease,” he said. However, he added what we still don’t know is whether the attack on organs such as the brain, heart and kidneys is a direct impact of the disease or an indirect effect of a cytokine storm created by an overreaction of the body’s immune system.
Jameel said a second aspect of the disease that we are newly discovering is that recovery can be prolonged, slow and tortuous. As he put it, “the virus is showing very very strange features”. Once again, he said, we are not sure whether the instances we’ve seen of prolonged and slow recovery are because of the direct impact of the virus or because of the inflammatory response triggered by the virus.
Speaking to The Wire about how long lasting immunity from infection is likely to be, Jameel said that studies undertaken by King’s College in the UK suggested that immunity may only last for months. He said that it was a very ‘new’ virus and that it is only just being studied, and thus we don’t have a clear idea about the efficacy of immunity from infection.
However, he added, in addition to antibody immunity there’s also what he called the memory response of the body, which is the body’s capacity to recall earlier fights against infection and repeat them again when necessary. A third factor is the protection we already have from T-cells in our blood. This, he added, is something that is still being studied.
Finally, speaking to The Wire about a recent letter written by 239 scientists to the WHO claiming that the virus is airborne and is not restricted to transmission by droplets, Jameel said, “too much is being made of airborne transmission”. He did not deny that very small proportions of the virus could be carried in minuscule aerosols but added that you have to ingest a very large amount to get infected. He said that wearing masks is sufficient even, possibly, without maintaining two-metre distances.
The above is a paraphrased precis of Dr Shahid Jameel’s interview to Karan Thapar for The Wire. Please see the full interview for further details.