COLUMN/ THE WRITE LINE
Dr. Amitav Banerjee
December 27, 2022: In response to reports of a new Covid-19 surge in many countries, especially in China, India’s health ministry issued a letter on December 20, 2022 to all the states and Union Territories, stating that India controlled the spread of the coronavirus using the five-fold strategy of test-track-treat-vaccinate and Covid-appropriate behaviour.
The letter goes on to bring to the notice operational guidelines for revised surveillance strategy for Covid-19 issued in June this year, which calls for early detection, isolation, testing, and timely management of suspected and confirmed cases to detect and confirm outbreaks of new SARS-CoV-2 variants.
The letter also advises the states and UTs to gear up genome sequencing through designated laboratories to enable timely detection of newer variants that will help in undertaking requisite public health measures.
Dr. V K Paul, a member of the national public policy think tank Niti Aayog, has called upon the masses to use face masks in enclosed places and take precautionary doses of the coronavirus vaccine. At the same time, the government has decided to re-introduce random testing of inbound international passengers at the country’s airports.
Are these knee jerk reactions based on evidence? The pandemic has been with us for the past three years. We have enough evidence to direct our actions, if we care to heed them. Instead, what do we have here? We get bureaucratic letters parroting the failed strategies that caused much misery and collateral harm.
Science is being suppressed to make way for ritualism. We may pardon the lapses during the early phase of the pandemic when enough evidence was not available. However, if these blunders are repeated when enough evidence is available and the virus is no longer novel, then these would be acts of commission rather than omission.
Let us take stock of available evidence around these directives. Our country is an ocean of people living mostly in crowded conditions. Most have recovered from natural infection over these past three years with different strains of the coronavirus. Even in the earlier phase of the pandemic, the “test, trace, isolate” mantra hardly made any dent on the spread of the infection. Only a miniscule number of infections were identified by this strategy. It was very costly, time-consuming, and labour intensive, inconveniencing a large number of people who were asymptomatic.
It’s important here to recall that a round of serosurvey conducted by the Indian Council of Medical Research (ICMR) in June 2021 showed that 67.7% of Indians had antibodies at that time. From this, we can infer that a staggering 92 crore plus had developed immunity following mostly natural infection – and very little due to vaccination. That’s because only about 5% of the Indian population had taken both doses of the coronavirus vaccine at that time.
The total number of coronavirus cases detected by June 2021 with the “test, tract, isolate” strategy was only three crores, which was about 4% of hidden cases at that time. In spite of our best efforts, we missed 96% of cases in the community.
Given these statistics, the “test, trace, isolate” ritual can be said to be futile to check the transmission. It will only generate fear, stigma, and exploitation of the commoners by high-handed officials. Population-level panic can have adverse health outcomes. Similarly, random checks of international travellers at airports would be like looking for a needle in the haystack while inconveniencing the travellers and making them vulnerable to exploitation.
A peer-reviewed paper by the US CDC (Center for Disease Control and Prevention) found that among 540,667 adults hospitalised with Covid-19, anxiety and fear-related disorders were the highest risk factors after obesity leading to death from the coronavirus disease.
Against this evidence and the Indian experience during the second wave when fear precipitated a medical stampede contributing to numerous deaths, it is highly irresponsible for authorities to issue such directives. These are promptly taken up by the 24X7 media to raise the population-level panic to new heights, which can prove catastrophic, as we witnessed during the second wave in our country.
On the other hand, the detection of hidden past infections by this serosurvey established the extremely low infection fatality rate in our country at around 0.05%, while another study estimated it at around 0.17%.
These figures of low mortality should have been widely communicated to the public to allay fear, anxiety and panic. Such positive messages would also restore trust of the people in public health institutions, which is at an all-time low worldwide.
Of course, such panic mitigation measures would be a major setback for those who profit by using the “fear is the key” strategy to sell their products. Genomic surveillance for new variants, too, is a costly but futile exercise, just like “test, trace, isolate”.
Mutations are common among coronaviruses. The common cold is caused by four circulating coronaviruses, milder than the original SARS-CoV-2. Once a person has a cold from any of these viruses, they are not permanently immune to future colds. The immunity wears off or the person can encounter other strains of circulating coronaviruses. Moreover, common cold viruses constantly mutate, making it impossible to create an effective vaccine that will protect against all circulating strains. Even if one is created, the immunity produced by it would not last.
If SARS-CoV-2 behaves like other coronaviruses, and there is no reason to believe otherwise, then most probably, we will be unable to make an effective and long-lasting vaccine even if many are developed and deployed in record time as was done in unholy haste during the ongoing pandemic.
The discovery of the Omicron variant in South Africa was the turning point of the pandemic for the better as this strain tended to be milder, just like the common cold. Even the doyen of vaccines, Bill Gates, conceded that Omicron was “sadly” better than vaccines at building immunity against Covid-19.
In spite of this, the world media and experts went overboard in sensationalising the emergence of Omicron, pushing for boosters with gusto. As a knee jerk reaction, some countries such as the UK and the US banned trade and travel, overlooking the evidence of much milder disease and hardly any hospitalisation and deaths in South Africa due to this emerging variant.
The bans failed to prevent the spread of Omicron, but harmed the already struggling South African economy. The global medical-political community seemed to overlook the fact that in spite of a very modest mass vaccination roll-out in South Africa, the Omicron variant hardly caused a ripple over there.
Whether humans, being anthropocentric, like it or not, nature offers equal opportunities for survival to all beings. To survive, all living beings that thrive follow nature’s way of adaptation – Darwin’s Law. These adaptations are by way of mutations, due to fortuitous errors during replication, and selection pressure perhaps by mass vaccination during a pandemic.
According to the principles of successful parasitism, such errors are beneficial to both the virus and humans. Errors that make the virus fittest for survival propagate, while others lose out in the evolutionary race for natural selection. A lethal virus does not go far, perishing with the unfortunate host leading to a dead-end infection.
Even a variant that will cause severe symptoms will not go far as such patients will isolate themselves and not mix. The virus in them will phase out due to lack of opportunity for transmission. The strains that will survive and go far, from China to Chandni Chowk, would be the less virulent variants that do not kill the host, producing very mild to no symptoms.
People infected with such strains will mingle and transmit benign progenies of the virus far and wide. High transmissibility is inversely proportional to high lethality. On the other hand, benign variants will induce far more robust population-level immunity by mild natural infections with negligible casualties.
Studies from Israel have established that natural immunity is 13 to 27 times stronger than vaccine-induced immunity. And the added advantage will be that this natural immunity will be provided by the latest strain circulating while the vaccine-induced immunity will always be due to a previous strain that the current strain will easily evade.
These dynamics in our densely populated country applied the brakes to the pandemic, not the clumsy and inefficient interventions. Do we have to worry? Do we blindly scale up mass vaccination? In our arrogance, should we assume that only human interventions can outperform natural laws of natural selection, leading to peaceful coexistence with the virus?
At the start of the pandemic, sterile mathematical models wrongly predicted doomsday, leading to draconian measures and associated collateral harm and economical setbacks. Just when the pandemic is trotting to a halt, genomic sequencing and surveillance should not make us trigger panic, leading to similar irrational catastrophic interventions.
Genomic studies should be academic exercises, while policy should be based on ground situations such as how many serious cases land up in hospitals and ICUs. Chasing mutants of viruses is like chasing a deer in the jungle. Thousands of mutations take place naturally while only a few get detected by resource-intensive measures.
Detecting a mutant by genomic surveillance and raising panic leading to restrictive policies is like shutting the stable door after the horse has bolted. Before a new variant is detected, it has spread widely in the community, imperceptibly.
Nature achieves ecological balance silently and efficiently, unlike humans, who do it clumsily and with much propaganda and fanfare, most of them to be proved futile later. The prudent policy would be to achieve overall physical and mental health at individual level as the pandemic proved to be a pandemic of comorbidities, and improve our public health infrastructure, which got exposed during the second wave in the country.
Futile chase of a fast-mutating virus with low lethality should be abandoned. Alas, most experts continue to persuade people to take their boosters, again without any evidence or logic, as these are made from earlier variants. Science without attention to basics has a tendency to regress to ritualism. While rituals in religion are mostly benign and provide solace to the soul, ritualism in science is not always benign as intervention involves introducing active ingredients with occasional short-term side-effects and uncertain long-term harms.
And mindless restrictive measures such as lockdowns and social distancing, without evidence of efficacy, cause much misery and economic setbacks to the poor.
(Dr. Amitav Banerjee, MD, is a clinical epidemiologist, professor, and Head of Community Medicine at Dr. DY Patil Medical College, Pune. He has over two decades of experience in the Indian Armed Forces as a field epidemiologist. He led the Mobile Epidemic Investigation Team at the Armed Forces Medical College Pune from 2000-2004, when he investigated many outbreaks. He was awarded for his work on Tribal Malaria and its impact on soldiers serving in hostile terrain.)
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