India's technology hub Bengaluru, among the cities that are seeing the highest number of COVID-19 cases being reported may be nearing its peak in a week but the surge is likely to continue in other districts of Karnataka. That's the word coming in from Dr Giridhara R Babu, Professor, and Head- Life course epidemiology at the Public Health Foundation of India, who is also a member of the technical advisory committee on COVID-19 for Karnataka.
He also spoke on IHME's projection of India reporting a million deaths by August, why the country doesn't need a national lockdown and why rural India should be looked at on an urgent basis. Excerpts:
Karnataka is reporting a high number of covid cases, deaths and may overtake Maharashtra in terms of the active caseload. The Government has now announced a full lockdown till May 24. By when do you see this peaking, falling and how effective has the lockdown been so far?
It is concerning that the bed capacity is almost near its maximum potential in Bengaluru and also, at least 10 districts are surging as we speak. So, as a result of that, the focus will probably have to be shifted in terms of saving lives, in the districts, where the case surge is occurring right now, Bengaluru, we are already entering the phase of somewhere near the peak. The speed of transmission seems to be indicating that we will have the peak over the next week or so, towards the next weekend, we should be looking at at least some models project that Bangalore will see the peak, but the cases will still continue to be there. Because the way the effective reproduction number works- Even if the number of people who are infected from those who are already infected is decreasing, the number of cases will continue to be there. So, the priority for critical care beds will still be there, even in Bengaluru till the first week of June. Whereas the district headquarters where there is limited capacity for critical care, I think that's where we need to strengthen both in terms of oxygen supply and also how we can redistribute. some of the resources internally within the state. For any lockdown to have an impact in terms of reduction in a number of cases, we'll have to wait at least 10 to 14 days, the incubation period is only 14 days. So all the infections which have occurred nearly 10 to 14 days ago, they're the ones who are developing symptoms and are getting detected in the initial phase of the lockdown.
And any reason why Karnataka or Bangalore is seeing such a big surge, because, in terms of the number of cases compared to other states?
I like to make this very clear, there is nothing unique to Maharashtra or Karnataka, or for that matter Kerala earlier, that the cases are higher only in these states and not in the other states. I would want to turn this around, and then ask a different question. When we know that these variants of concern are more contagious than the earlier variants when we know that test, track and treat is the only strategy for this, why are we not getting similar numbers from other states? That's an important question to ask. The summary here is the states which have more cases, are only because they report more cases as a function of testing and case detection. And if some states have not done enough case detection, or have this poor testing strategy, then did not find enough cases. So I think we should encourage better reporting of cases. So that's the first reason second reason is that, you know, that we now know that at least, there are three important variants of concern. And there are also one or two homegrown variants of concern, of which one is very contagious. Therefore, we have more cases, and we are bound to get more cases. In addition to that, all the super spreader events are going unchecked.
An editorial in the Lancet journal said India could potentially see one million deaths due to Covid19 by August, citing estimates from IHME. Is this a plausible scenario?
I don't think any reliable modeling can predict for, beyond two weeks, I have examined several models, but most models look at a horizon of the end of this peak towards the end of May. And early June is when we start receding and start going towards the baseline. So I don't see a major adverse impact beyond the second to the third week of June for now, because that's when probably most of the deaths will also reduce. There is a rapid ascent of the second wave, there should be rapid descent also. And I don't think we should be worried about a continued wave for a really long time. However, as the susceptible pools get built up, multiple waves are the future of this virus. And we have seen in Europe, the US, UK, that there are at least three or four waves. So we should not dismantle all that we have done, use them, build-in mechanisms so that whenever there is another wave, you immediately bring all of these mechanisms into work. We all know that there is undercounting of deaths. I will not be able to put a figure but what we really need to do is look at the data from crematorium burial grounds and the death registration system and strengthen that because without counting the death, it is a sort of insult to the entire life of that person. So it is time that we get our reporting systems accurate.
You said there will be multiple waves before they settle down. So people are saying that the next wave, might impact children more. How do you see this panning out?
The virus will go in search of people who are not infected. We are seeing more and more young adults getting infected in the second wave, and this will continue Compared to the adults, most of the children do well, even when they're infected. But that's no solace in saying that because even if a minor proportion of children get this multi-system infection, we simply do not have the critical care capacity to take care of that. So, therefore, the right strategy is to prevent widespread transmission. And the next strategy to ensure vaccine trials are done. A lot of hopes are on this intranasal vaccine from Bharat Biotech. Since it induces local immunity, and also it's not invasive, because it's intranasal administration, that might have a lot more promise, but we can't jump there one step at a time, we need to first prevent the infections, make sure children are safe, and then see how to tackle the vaccination issue.
Also in terms of reports that the virus is airborne. What impact will that have in terms of the protocols involved in terms of the behavioral changes that this will necessitate? Have you seen evidence to support this in India?
The CDC, World Health Organization has always noted that at least in the medical care settings, there is a possibility of airborne transmission. Whether this is a very dominant route, it's completely not clear because imagine if it were to be airborne in India, would we have had only these many cases? Or would there be at least more millions more cases? So that is the distinction that we need to make. I'm not negating, it is still possible but we need detailed studies to establish for how long it can stay. Irrespective of whether it is true or not, I am of the opinion that the strategy won't change if you wear a mask, and if you wear a good mask, and or some experts are even saying double masking. If you're wearing a mask and following physical distancing, I don't think there should be any newer strategy at least to the external settings for the internal or within closed spaces, we still need to be very careful whether it is airborne or just droplet. we have to be very careful in those spaces.
I definitely respect whatever opinion Dr Fauci has for India and his advice is welcome. But I am of the firm opinion that India does not require national lockdown at this stage mainly because if you look at Mumbai, it is already coming out of the kind of desperate situation they were in for a long time. In Karnataka, Bengaluru seems to probably come under control maybe by next week, but the rest of Karnataka will start having increasing cases. The same thing with other states, which are in different stages of transmission. And they have different kinds of resource requirements. I think we should use focused citywide or even district or statewide lockdowns depending on how much the health system can cater. Until we resolve the supply constraint on vaccines, even if we do a lockdown of one month, we are not going to solve it.
And in terms of the impact on rural India- in the first wave, young working adults and rural India largely escaped the wrath of the virus, something that is changing now. How worried should one be, since they lack testing, healthcare infra?
Yeah, I think you said it well. Compared to the first wave. I'm really concerned about what happens in rural India now, mostly because this is at least we know that there are contagious variants, they'll spread faster, especially in the villages where the population density is really high, it can result in many more infections. And again, as you said, the testing levels are inadequate in the rural areas, health system access is poor in some of the rural areas. So there are already anecdotal reports of higher deaths, unnoticed, home deaths in some of the rural areas. So these are concerning. I think, as a matter of priority, we have to place our focus on these equity issues, looking at the most vulnerable, most remote, and in the rural areas, who require services.
