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US epidemiologist flags Covid uptick in 4 Indian states, warns against full unlock

Bhramar Mukherjee, Professor of Biostatistics & Epidemiology at University of Michigan, says India needs to vaccinate 1 crore people every day or face trouble.

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New Delhi: The week-on-week rate of growth for Covid-19 cases is beginning to show a slight uptick in Maharashtra, Kerala, Andhra Pradesh and Delhi, and it may be time to impose more restrictions in these places right away, said Bhramar Mukherjee, the John D. Kalbfleisch Collegiate Professor of Biostatistics at the University of Michigan. 

The warning from Mukherjee came as Delhi entered a new phase of unlocking Monday amid a steady decline in daily case and death numbers over several weeks.

Mukherjee and her team monitor the week-on-week relative rate of change of cases, rather than just the absolute numbers, to plot trends. They had predicted an imminent second wave in India in February.

Mukherjee said doom’s day predictions about a third Covid wave — including about its impact on children — are still without enough scientific evidence. However, she added, a vaccination rate of anything less than 10 million (1 crore) per day in India may spell trouble in the coming months. 

On Sunday, India logged just 1.7 million (17 lakh) vaccinations. 

“Lockdowns in April in almost every state to some extent suppressed and brought the case count down. But there is still enough virus in the community and there are new mutations happening, so it is a very dangerous time to reopen fully and let your guard down…,” said Mukherjee, also a Professor of Epidemiology and Global Public Health in the School of Public Health at the university, in an exclusive interview to ThePrint.

“The last seven days, we have seen an uptick in Maharashtra, Kerala, Andhra Pradesh and slightly even in Delhi… data-nimble policymaking is the key here. As soon as you see an uptick, you need to hunker down and not let it explode. Letting it simmer is absolutely the wrong strategy for this virus, so there should be more restrictions coming in these states right away.”

Weighing in on the trends for Kerala, Maharashtra and Delhi, she said they were surprising because there has already been a lot of infections in these places. “That (prior infection) gives some protection. Also around 30 per cent people have received at least one vaccine dose in Kerala and Delhi and 20 per cent in Maharashtra. We are still seeing upticks… in Delhi, it is still minuscule, but in Maharashtra and Kerala, the R had come down to 0.4-0.5 but is now inching back up to 0.8,” she said. 

R is a measure of the infectivity of a pathogen and estimates the number of people one infected person is likely to transmit the virus to. Opening up when a country is not yet in full control of the virus can be problematic, she said.

Also Read: An alien kind of grief — how surge of Covid deaths has changed the way we mourn 

No basis for saying third wave will affect children 

Professor Mukherjee said recent trends seem to indicate some causes for concern but added that she is not willing to venture into the realm of third-wave predictions. 

“I do not believe that we can prophetically say that the third wave will come and kill a lot of people, kill a lot of children because there is no data to support it…the world over, we have seen that fatality and clinical severity of the disease in kids is low. We should not create panic but denial is not good either. We should keep our eyes open and be ready to intercept early.”

For India in particular, vaccinations in the paediatric age group could really hold the key to controlling the pandemic, she said. 

“In the US, it (0-18-year age group) is 24 per cent of the population. In India, that number is 40 per cent. In the US, most 12-18-year-olds are vaccinated now. But if you think herd immunity can be achieved with 40 per cent of the population having no vaccine, that won’t be possible. That is why it is important for India to start vaccinating children,” she added.

She noted that when there is a surge, as during the second Covid wave, and medical infrastructure is stretched, there are deaths that occur because of lack of medical care — deaths that, in better times, would have been preventable. India has known constraints in paediatric health infrastructure.

India needs to vaccinate 10 million per day 

Seeking to emphasise the importance of Covid vaccination, Mukherjee said those in her family who had got the shot were far less severely affected by Covid than those who weren’t. 

Vaccination, she said, is especially important given the fast pace of mutations of the virus.

“India needs to get to 10 million per day or there is no hope. We need to get there consistently, not like one day when there is a special initiative and we do 8 million and the next day again plummet to 6 million… I am very excited by the G7 plan for a billion vaccines, we have to see how many India gets,” she said referring to the G7 commitment to distribute 1 billion vaccines among poorer nations.

“But the fact is that India has 18 per cent of the world’s population, unless India can control the virus, the world cannot,” she said.

Talking about the intensifying threat of virus mutations, she said the SARS-CoV-2 — the virus that causes Covid-19 — started with an R of about 2.5-3 but is now up to 5-8, which is a far higher level of infectivity. This also pushes up the threshold of reaching herd immunity from 67 per cent to 80-90 per cent. So, the more time vaccinations take, more people would need to be covered to reach herd immunity, she said.

Also Read: Bihar & UP worst performers on state ​Covid vaccination list, only 10% have got 1st dose

‘Don’t believe govt claim on infection fatality rate’

Mukherjee said she doesn’t believe the Indian government’s estimate for infection fatality rate — 0.05 per cent — or the percentage of infected people dying. As of 15 May, she estimated, India could have been underreporting cases by a factor of six, acknowledging six deaths for every 30.  

“In India, the underreporting factor is around 6 on 15 May. On 15 May, the official number was 270,000 deaths. The total number we estimate to be about 1.25 million by that time. Now we are at 400,000 deaths so the true estimate would be 2-2.2 million…we have seen that one of 15-20 cases was reported. When India reported 30 million cases truly it was 600 million…”

The government estimate of 0.05 per cent infection fatality does not seem to reflect the true picture and is “dishonest”, she said. “See, this is a ratio so one cannot say that the numerator is intact while the denominator is inflated. We factored in underreporting in both the number of cases and deaths and reached an infection fatality of 0.24 per cent, which is more on a par with the global median IFR (infection fatality rate) of 0.27 per cent,” Professor Mukherjee said.

Asked how long the SARS-CoV-2 is likely to keep the world on tenterhooks, she said 2022 could still be a year of the unexpected and 2023 may be when the world finally learns to live with the virus. 

Also Read: Global spread of Delta variant shows ‘no one is safe until everyone is safe’ from Covid


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