Global health experts on Wednesday said novel coronavirus is here to stay for more than a year and called for aggressive testing to prevent its spread in the latest episode of Congress leader Rahul Gandhi's ‘in conversation with…’ series.
The 30-minute conversation, a substantial chunk of it with Jha, director of Harvard Global Health Institute and Dean at the Brown University School of Public Health, focused on whether lockdown is an effective way of combating the coronavirus pandemic and how India can prepare for the fight that lies ahead.
Jha exuded confidence that a vaccine will be available in a year's time. But the other expert, Prof. Johan Giesecke, a member of the Strategic and Technical Advisory Group for Infectious Hazards at the WHO and advisor to the Public Health Agency of Sweden, disagreed with the approach for a nationwide lockdown. He said India should practice a lockdown that is as 'soft' as possible, as a severe lockdown will ruin its economy very quickly.
Jha insisted that the virus was here to stay. He said, “No matter what we do, we are not going to be through with this problem by July or November; this is going to be with us till 2021 and if everything goes really very well and if we have a vaccine that is widely available, only then life can start getting back to normal sometime in 2021… people need to understand this time frame and for people who are very poor, this uncertainty is very costly.”
Jha said there are two or three probable vaccines currently under trial which show some promise but it wasn't confirmed which one would ultimately work. He, however, said that while he was confident of a vaccine being developed by next year, “India has to have a plan because it would need 50 to 60 crore vaccines available.”
The Harvard professor backed the need for an aggressive testing strategy and claimed that around 20 per cent infected individuals may transmit the virus to others before they begin to display symptoms of coronavirus. The observation assumes significance given the resumption of flight and train services and claims by a section of central policymakers that asymptomatic patients do not transmit Covid-19. “You have to test everyone with symptoms and have a surveillance system for high-risk areas,” Jha said, adding that he is “not convinced that India cannot do much larger testing than what it is doing right now.”
Rahul also asked Jha for his views on claims that Indians have a certain level of immunity against the infection. Jha said he disagrees with the argument that populous countries like India should be allowed to develop herd immunity against the virus and claimed that such an approach “will lead to millions of people dying”. He said that there was “some circumstantial evidence that the BCG vaccine (administered to most Indians at birth) can be helpful in reducing the severity of the infection but it is not very good evidence”.
Painting a somewhat alarming picture, Jha also predicted that the world was now entering “an age of global pandemics” and the frequency of a coronavirus-like crisis across the world would increase over the next 20 years. Explaining his position, Jha said that since the last global pandemic triggered in 2009 by the less severe H1N1 flu much had changed around the world. “(Because of) globalization, a virus that starts somewhere else spreads globally very quickly; secondly, there are big environmental changes because of deforestation and encroachment into areas where there were more animals – most pandemics are jumps from animals to humans… this virus (Covid-19) was present in bats but a small change in genome made it suitable for human hosts – climate change is going to make this worse… I am confident that we will have more global pandemics,” Jha said.
With India now approaching towards the end of the fourth consecutive lockdown and Covid-19 cases across the country still growing exponentially, Rahul asked Jha and Giesecke on how they viewed lockdown as a strategy to fight the health pandemic. Though the two public health experts differed in their views on the contours and efficacy of lockdown with Jha asserting that it does slow down the spread of the virus, both agreed that a strategy for easing the restrictions should have been carefully thought out before the lockdown was clamped.
Jha said that a lockdown has inter-related public health and psychological aspects which “policy people have not understood”. He said that a lockdown slows down progress of the infection since the virus, on an average, spreads to three people from a single infected host, thereby triggering an exponential growth. “The way to stop this is to take infected people and separate them from the uninfected… you have two choices, you can do vigorous testing, tracing and isolation but if you can’t do that then you have to lock everything down,” he said. A lockdown, Jha said, “sends a very clear psychological signal to the people… that this is much more serious and devastating; so when you open up, you have to create a level of confidence because your economy relies on it and if people are scared, they will not engage in economic activity.” Jha insisted that it is also important for policymakers to use the period of the lockdown to communicate to the people that “life for the next 12 to 18 months is going to be very different.”
Giesecke, a member of the Strategic and Technical Advisory Group for Infectious Hazards at the WHO and advisor to the Public Health Agency of Sweden, disagreed with the approach for a nationwide lockdown. Although admitting that Covid-19 was “spreading like a wildfire” across the world and that “everyone will be infected” by it at some point, Giesecke indicated that the infection would be fatal for only about 1 per cent of those who contract it. “All countries in Europe that instituted a lockdown a month or two months ago; did they ever think of an exit strategy? It (lifting of the lockdown) has to be step-wise. You soften one restriction and then wait for a week or two and assess if it has stopped the disease, if it hasn’t then you take one step back and try something else. It will take months to really ease out the world from the lockdown,” Giesecke said.
The Swedish public health expert said the immediate need is to “protect the old and the frail” and India could “soon create more harm than good with a severe lockdown” from an economic and humanitarian perspective. “India will ruin its economy very quickly,” Giesecke said, adding that the country may create “more deaths by a severe lockdown than those caused by the disease itself… you should have gone for as soft a lockdown as possible.”