Mumbai, August 11, 2020 : While India currently has low fatality rate and high recovery rate for Covid patients compared to many other nations like the US and Brazil, the country needs to stick to basics like wearing masks, physical distancing and maintaining hand hygiene and surface disinfection till a safe and effective Covid vaccine is found and the pandemic abates. This was stated by distinguished panelists who took part in a Webinar organized by the Association of Healthcare Providers of India,AHPI on the theme of “Covid Care:  Community Transmission and Herd Immunity” recently.

Addressing the audiences, Dr. Girdhar J. Gyani, Director General, Association of Healthcare Providers of India, said: “India is in a much better position than countries like Brazil or the US in terms of Covid-related fatalities or recovery rate. India is seeing only 30 deaths per million Covid patients compared to a staggering 464 for Brazil and 492 for US. India’s recovery rate has gone up to 65 percent, which is good. Fatality rate too has been continuously dropping. From 3.6 percent at one time, it has dropped to 2 percent now, though our wish is to see it go down to 1.5 percent.”

Dr. Sanjeev Singh, Chief Medical Superintendent, Amrita Institute of Medical Sciences, Faridabad, said: “Covid 19 is a public health crisis. Though the infection rate is high, the fatality rate is low in India, with low per lakh death rate, low crude mortality rate, low case fatality rate and low crude infection rate. The best way to approach the pandemic is screening actively, conducting contact tracing, testing in accordance to symptoms, with RT PCR being the gold standard diagnostic test, and symptomatic management. Early recognition and referrals to high-dependency unit or critical care unit is essential. To reduce community transmission, vaccination would play an important role. Six study groups are in Phase 3 trials and promising results are expected on short-term and long-term immunity. The most urgent step is to go back to basics with wearing masks, adhering to physical distancing and maintaining hand hygiene and adequate surface disinfection.”

According to Dr. Suneela Garg, Director Professor, Dept. Of Community Medicine, Maulana Azad Medical College: “There has been a shifting in epicenters of Covid in the last one month whereby Andhra Pradesh and Karnataka have maximum growth rate while Delhi is faring much better. If community transmission begins to occur, isolation and quarantine will have limited or no role to play. Community driven social changes will then play an important role in containing the spread such as wearing masks, washing hands regularly and maintaining social distancing. Lockdown in specific clusters will also be required. Herd immunity is indirect protection from a contagious infectious disease of a population through vaccination or through immunity developed from a previous infection. While isolation and quarantine open doors to reinfection, herd immunity offers protection in the long run. However, community transmission in a country like India may prove to be catastrophic and reinfection will prove to be a major factor preventing herd immunity.”

Dr. Alok Roy, Chair, FICCI, Health Services Committee, and Chairman, Medica Group of Hospitals, said: “The pandemic has had a cataclysmic effect on the socio-economic fabric of India. Private hospitals are facing the stark financial reality of liquidity crunch in keeping patients safe. The healthcare delivery space is extremely capital and people intensive. We at FICCI have been urging the Government to provide financial stimulus up to minimum 3% of GDP. The private healthcare domain should be incentivized to develop skills to handle a pandemic of this nature. Specific funds like Healthcare Infrastructure Fund and Healthcare Innovation Fund should be developed to boost entrepreneurship, start-ups and newer business models, which are needed to improve access, availability and quality, especially in smaller cities and rural areas. The serological surveys being conducted are effective as they help authorities make informed decisions about interventions that are needed to contain the pandemic. It will give us an outlook whether India can achieve herd immunity”.

He further added “The infection rate has been rapidly rising since the government began to ease lockdown restrictions. India has logged a million new cases since then, but the recovery rate stood at 67.61%, which means that over 13 lakh people have recuperated. While hospitals treat the patients affected by the virus, they should simultaneously take adequate precaution for non-COVID critical care patients. With timely case identifications and better and quicker turnaround of testing facilities, we are moving towards a phase which will help us stay ahead of the pandemic.”

Dr. Narottam Puri, Advisor, FICCI Health Services Committee: says “Healthcare is going to fundamentally change after this pandemic. It is increasingly being seen as a basic human need and there will be lot of pressure from the masses on policy makers and politicians to deliver quality and affordable healthcare for all. Covid has also triggered social and cultural changes with the need for social distancing. These will have an impact on overall healthcare because a large part of our diseases comprises of respiratory infections, and this preventive social behavior will help bring down their incidence. Another change will be in how our hospitals are functioning.

Pandemics are never won by the hospitals; they are won by communities and individuals. So we will now need to move from hospital mitigation to community mitigation, and from community mitigation to individual mitigation. We have been caught napping as were too focused on non-communicable diseases. Hospitals design and structural changes may become imperative now to prevent infections from passing on from one patient to another. Digital technology is going to change the face of healthcare delivery. We are already seeing the increase use of telemedicine which will become important in chronic disease management. Home healthcare will also get a major boost.”

Said Dr. Vinay Aggarwal, MD, Pushpanjali Medical Centre, New Delhi: “The gold standard to contain Covid still involves the proper use of masks, sanitization and social distancing, followed by testing and home isolation. Initial mismanagement led to where we are today. There was a lack of coordination from officers from the state to district level regarding Covid management, due to which cases have exponentially increased. In the last 15 days, the cases have doubled in the country. Covid has given hard lesson to healthcare organizations to reorganize, reframe and restructure. Digital platforms and telemedicine are going to be the main paradigm shift in healthcare going forward.”

Said Dr Alexander Thomas, President, AHPI: “Things are still evolving with respect to Covid. Prevention of Covid cases and fatalities includes steps like coming early to hospital if one has symptoms, focus on elderly and those with comorbidities, wearing masks, physical distancing and sanitization. Government has to enforce wearing of masks strictly as many people are still not wearing these or wearing them improperly below their nose. We need adequate availability of beds equipped with oxygen and ventilators, as well as human resources such as doctors and nurses. Private hospitals are overwhelmed while there are few takers for beds in Government hospitals. Public private partnership is critical in meeting healthcare challenges like Covid.”

Also Read: NO COMMUNITY TRANSMISSION, INDIA HAS BEEN SAVED

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New Delhi : The COVID-19 pandemic has shaken the world to its very core. Certain norms have been found instrumental in protecting oneself from the virus- physical distancing, staying at home, sanitising from time-to-time, using an N95 mask when heading out, and so on. At the same time, countries all over the globe are trying to find a vaccine or a solution which can help us return to a normal, pre-COVID world. While research and testing are in full swing, scientists all over are also open to experimenting with other tactics that might help the public become immune to the virus.

We will be able to achieve herd immunity:

In the midst of this discussion and deliberation, the concept of ‘herd immunity’ arose. A form of indirect protection from infectious diseases like COVID-19, the phenomenon of ‘herd immunity’ ensures that a large percentage of the population becomes immune to the infection, either through vaccination or previous infections.

Now that schools and colleges have diverted to virtual learning, the idea of in-person classes seems rather distant. However, in-spite of us finding an alternate for the time-being, online classes in the long term are not feasible for all. Online classes are especially a problem for those middle-class families with multiple children in school, or those belonging to economically-weaker sections of society. While online classes have their own advantages and disadvantages, scientists and researchers have located a new plus-point to the reopening of schools and colleges eventually, once the cases get out of control.

Elaborating on this, Dr. Amitav Banerjee, Professor & Head Community Medicine, Dr DY Patil Medical College, Pune says, “If we choose to open schools and colleges once the curve stabilises, there are very strong chances that we will be able to achieve herd immunity. Children & young adults have a fresh immunity, which makes them better prepared to fight infections. It has a multiplier effect- if we develop it, we can protect many people. If we study USA data, 24 districts in USA do not have a single child fatality”. “The mean age & BMI has been an important factor in number of deaths. Recent CDC update mentions that obesity is major risk factor for fatality from Covid-19 virus. Japan never had a lockdown & despite having higher mean age there were very few fatalities, which reconfirm CDC findings”, Dr Banerjee added.

How exactly herd immunity is achieved?

The idea behind achieving herd mentality, however simple it may sound, is actually quite complex in terms of achievement. Explaining how exactly herd immunity is achieved, Dr. Sanjay K. Rai, Professor, Centre of Community Medicine, AIIMS New Delhi elaborated, “there are two basic ways of achieving herd immunity- by developing a vaccine, and by exposure to infection. Since there is no possible way of knowing by when we can find a vaccine and how effective it will be, the only other alternative is through infection.”

The opening of schools and colleges, at present, seems like a bizarre idea which will only put the future of the country at risk. However, in this dark situation, Dr. Rai finds a silver lining, “If schools and colleges go back to functioning in full swing, keeping in mind distancing and sanitisation norms, there is a possibility that sooner or later, everyone will get exposed. Children have fresh immunity, and they can be major contributors to us achieving herd immunity. The process is quite complex, though- careful interpretation and increase in testing are vital for it to be successful.”

Lockdown may not be the ultimate solution:

Dr Chandrakant S Pandav, Former HoD, Center of Community Medicine, said, “Lockdown may not be the ultimate solution to fight COVID 19. It may delay the infection but cannot protect us forever. There are multiple diseases, vaccine for which remained elusive & if that happens with COVID 19, herd immunity is our only solution to end the pandemic.”

Dr Swadeep Srivastava, Founder, Heal Foundation said, “The experts have presented a new perspective about immunity at large. The limited activity & exposure of sunlight have a negative effect on the immunity of a person. Schools have moved to online classes and most corporates have accepted the work from home culture, the changed, which were supposed to safe people from COVID, may be making them vulnerable to infections due to decreasing immunity. With no certainty around vaccine, herd immunity seems to be only option & opening schools & colleges can be rational call.”

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