In an interview that will cheer the government and give reassurance to the Indian people, an expert considered the country’s top epidemiologist by his peers has said the fact that India’s daily tally of COVID-19 cases has been declining for 11 days is “quite exciting, it means well and I am optimistic”. Prof. Jayaprakash Muliyil, the former Principal, Christian Medical College, Vellore and the Chairman of Scientific Advisory Committee of the National Institute of Epidemiology, did, however, add two notes of caution. He said he would like “to wait a few more days to finally make up my mind”. He also pointed out that the data largely reports what’s happening in India’s cities and rural areas are not adequately reflected.
However, what will make the government bristle is the strong and unequivocal words with which Prof. Muliyil criticised the nationwide lockdown imposed on the country at the end of March, which lasted for almost 60 days. He said, “What we did wrong was to impose a nationwide lockdown. It was not called for.”
He said the lockdown “unnecessarily tortured the economy and cost people their livelihood”. When told the government and the prime minister in particular have claimed the lockdown ensured the number of cases was small and the number of deaths limited, Prof. Muliyil unabashedly made clear that he disagrees with the government. He said the cases and deaths would have been limited without a lockdown. It was not necessary, he insisted.
In a 35-minute interview to Karan Thapar for The Wire, Prof. Muliyil said he was not worried that the heavy reliance on rapid antigen testing, where up to 50% tests can show a false negative, raises doubts about whether the numbers are actually falling in reality or because of faulty and poor testing. He said, “The ones you miss out on are not likely to be infectious.”
He added that RT-PCR tests have a tendency to show false positives. He said the reliance on antigen testing did not worry him.
Speaking about the op-ed in The Hindu’s September 29 edition by T. Jacob John and M.S. Seshadri which claims India peaked in the middle of September and is now slowly but steadily declining, Prof. Muliyil said this was probably true of urban India but he was not at all sure if it was true of the situation in rural India.
Asked by The Wire if there was some discordance between the fact the seven-day rolling average of daily cases is declining whilst the seven-day average of daily deaths has increased and, as a result, deaths per million increased in September alone by 42% from 50 per million to 71 per million, Prof. Muliyil said, “New cases and deaths are not correlated in time, they are sequential.” He said in a week or two, the deaths would also start coming down.
Speaking specifically about the situation in Kerala, where cases are increasing by over 7,000 a day, the positivity rate has crossed 13% and the government is said to be considering another lockdown, Prof. Muliyil said he had told the authorities in the state that “it’s possible the virus may return”. He said, “I told them it would not be a failure on your part. It’s in the nature of the virus”. He praised the Kerala government for the good job it has done in handling cases and ensuring the state has the lowest Covid death toll in south India. However, he warned that another lockdown would be a mistake.
Prof. Muliyil told The Wire that there are two reasons that can explain the differences between the two serological surveys conducted by the Indian Council of Medical Research in terms of how many undetected cases there are likely to be for every confirmed case. He said the first survey clearly suffered from sampling errors. He said it lacked precision because it was done when the frequency of the disease was less than 1%. The second survey, which was done much later, when the frequency was higher, would reflect better precision. Secondly, Prof. Muliyil said at the time of the first survey testing had not reached village level. Data from there was not available. At the time of the second survey the outreach was much better.
Prof. Muliyil said one can estimate the number of undetected cases in India by extrapolating from the second ICMR serological survey. The survey has said that for every known case there are perhaps something between 26 and 32 undetected cases. On that basis if India has 6 million confirmed cases then one can estimate that the number of undetected cases would be between 156 million and 192 million. As he put it: “The actual number of cases would be very large … this is like an iceberg, you only see the top. The bottom is hidden from view.”
Speaking about claims made the article in The Hindu, that in six month’s time 70% of the country’s population could be infected and herd immunity levels reached, Prof. Muliyil pointed out that herd immunity depends on the density of the population and that differs from place to place. In villages, the density is very low, in cities its very high. He said in considering herd immunity it’s a mistake to take India as a whole. Instead, the country should be considered in terms of specific regions or even individual cities and rural areas.
Prof. Muliyil told The Wire that the time has come to rethink the country’s strategy of handling the Covid problem. He said the old strategy has a tendency to stigmatise the disease and that must change and that we should now focus on protecting the elderly and those with co-morbidities, whilst telling everyone else to wear masks and maintain social distancing and get back to their lives. He said India’s comparatively low mortality rate supports and corroborates this approach.
However, Prof. Muliyil said some restrictions would be necessary over Dussehra and Diwali largely because many Indian people do not exercise discipline and self-control.
Asked how he would assess the government’s strategy to tackle the Covid crisis over the last six months, Prof. Muliyil praised the government for its management of cases and for the way it has handled testing. He said: “India is a tough country to handle because people vary in terms of information, knowledge, capacity and ability”. However, he said the fairly widespread variability between states in terms of their Covid response is “worrying”.
It was in this context that Prof. Muliyil strongly and sharply criticised the nationwide lockdown. He said he did not accept the government’s claim that the lockdown resulted in fewer cases and fewer deaths. That, he said, would anyway have been the case.
Finally, in a very carefully nuanced answer, Prof. Muliyil said when the head of the ICMR, Dr. Balram Bhargava, said to the British paper The Financial Times that India has “shown the world how to fight emerging diseases” he would like to believe that Dr. Bhargava was referring to doctors, nurses, healthcare staff and hospitals. He very pointedly did not mention the lockdown, which the government has frequently said is the centre point of its strategy. Instead he added that the Indian people are “resilient” and “have suffered in silence and took it all”. He concluded his answer by saying “anywhere else there would have been violence.”
The above is a paraphrased precis of Prof. Jayaprakash Muliyil’s interview to Karan Thapar for The Wire. Please see the full interview for a proper appreciation of Prof. Muliyil’s arguments and a better understanding of his position.