One of the United Kingdom’s most highly regarded epidemiologists has said that India’s great advantage is its youthful population – 90% of the country is under the age of 60 – and the government should have devised a strategy to respond to COVID-19 built upon this instead of imposing total lockdowns that pushed hundreds of millions of poor Indians into destitution and hunger.
Prof. Sunetra Gupta, Professor of Theoretical Epidemiology at Oxford University, said that she completely agreed with the views of Indian epidemiologists like Jayaprakash Muliyil and T. Jacob John that the right response for India was not a total lockdown but to protect the elderly and those with comorbidities while relying on its young population to keep the economy running.
She said that their youthfulness would ensure that only a small fraction would get infected, probably only mildly, and an even smaller number would die. India’s healthcare would have been able to cope with this and keep most of them healthy and alive. In fact, Prof. Gupta added that she had had the same advice for the United Kingdom.
In a 45-minute interview to Karan Thapar for The Wire, Prof. Gupta said the statistics that the Indian government repeats at its almost daily press conferences which suggest the virus is behaving differently in India or that India has a capacity to handle it that is better than other countries are, in fact, a reflection of India’s young population. She said this specifically in response to individual questions about India’s recovery rate of 48%, its mortality rate of 2.82% and its doubling rate, which is 15 days as of now.
Asked by The Wire how she viewed health minister Harsh Vardhan’s claim (to the Economic Times on May 23) that the virus is “not that virulent” in India, she said there was no biological reason whatsoever for believing that the strain of the virus in India was less virulent. She said the fact that only 6.4% of Indian cases end up in hospital and only 3% needs ICU whilst under 0.5% require ventilator support (compared to 3% globally) was explained by the youthful profile of the population.
However, Prof. Gupta did not seem to disagree with the Indian government’s reluctance to accept that even though the country has over 200,000 cases it has still not entered the community stage of transmission. In fact, she questioned what that term means and suggested that it is perfectly possible that there are areas where the transmission and infection is very large and others where it is closer to small or negligible.
Prof. Gupta said that what India needed to do is to increase its testing. She specifically said it needs to carry out nationwide serological testing to assess both the spread of infection and to discover areas where the infection has perhaps not reached at all and which need to be protected from any future second wave. When told that the ICMR was conducting a serological survey in 69 of the country’s 739 districts (under 10%) she agreed that this was probably too small and needed to be done on a nationwide basis. All of this is in part two of The Wire’s interview with Prof. Gupta i.e. after the commercial break. The second half is entirely about India.
However, in part one, Prof. Gupta spoke about the global spread of COVID-19. Prof. Gupta was sceptical, if not critical, of the fact that most countries resorted to lockdowns as their first response to the Coronavirus. In particular, she said lockdowns cannot stamp out the virus. All they can do is to slow down the rate of deaths and delay the cost of the epidemic. She said lockdowns only made sense in limited areas specifically to stop the virus spreading outside. Even in New Zealand, where a nationwide lockdown has prevented the virus attacking the population, it was successful because it was imposed before the virus got to the country. A lockdown that is imposed after the virus has arrived cannot exterminate it. In fact, Prof. Gupta asks how long New Zealand would keep the lockdown going, suggesting that when it’s lifted the virus is likely to return.
Prof. Gupta told The Wire that Sweden was absolutely right not to impose a lockdown even though it has ended up with 443 COVID-19 deaths per million of population which is 10 times more than Norway, 7.5 times more than Finland and 4 times more than Denmark, its Scandinavian neighbours. She said Sweden kept in mind the cost of the lockdown not just on the economy but also on people and their lives. She said the fact the Swedish Central Bank was forecasting the country’s GDP could fall by up to 10% was probably a reflection of what is happening to the international economy and, possibly, that even a small measure of social distancing and carefulness does impact growth.
Speaking at length specifically about herd immunity and at what percentage level of the population it becomes effective – a subject on which she is an acknowledged expert – Prof. Gupta told The Wire that what you need is an equilibrium level of infection in the population and not necessarily 50 or 60% levels. She said it all depends upon the number of people an infected person could in turn infect i.e. the RO factor. To illustrate her point she said if the RO is two, in other words every infected person infects two more, you could reach the desired equilibrium at 30 or 40% levels of infection in the population.
Finally, Prof. Gupta was asked by The Wire about a report published on the 2nd by Public Health England which suggests black people and Asians in Britain are more vulnerable to COVID-19 than white people and which specifically says Bangladeshis are at almost twice greater risk. Prof. Gupta said this was probably to do with their socio- economic conditions. She explained that she not only meant the difference in levels of income and living but also the fact that this, in turn, means higher levels of comorbidities like diabetes and obesity. However, she kept open the possibility that genetic factors could also play a role.