Why scientists are touting coronavirus ‘herd immunity’ for India when it didn’t work for the U.K.

Researchers have identified India as a place where this strategy could be successful because its disproportionately young population would face less risk of hospitalization and death.

Why scientists are touting coronavirus ‘herd immunity’ for India when it didn’t work for the U.K.

Controversial given the high risk of deaths, a coronavirus strategy discarded by the U.K. is being touted as the solution for poor but young countries like India.

Herd immunity, which allows a majority of the population to gain resistance to the virus by becoming infected and then recovering, could result in less economic devastation and human suffering than restrictive lockdowns designed to stop its spread, according to a growing group of experts.

“No country can afford a prolonged period of lockdowns, and least of all a country like India,” said Jayaprakash Muliyil, a prominent Indian epidemiologist. “You may be able to reach a point of herd immunity without infection really catching up with the elderly. And when the herd immunity reaches a sufficient number the outbreak will stop, and the elderly are also safe.”

A team of researchers at Princeton University and the Center for Disease Dynamics, Economics and Policy, a public health advocacy group based in New Delhi and Washington, has identified India as a place where this strategy could be successful because its disproportionately young population would face less risk of hospitalization and death.

They said allowing the virus to be unleashed in a controlled way for the next seven months would give 60% of the country’s people immunity by November, and thus halt the disease.

Mortality could be limited as the virus spreads compared to European nations like Italy given that 93.5% of the Indian population is younger than 65, they said, though no death toll projections were released.

The radical proposal underscores the challenges that poorer developing countries — including nations like Indonesia and some in sub-Saharan Africa — face in curbing the epidemic using the lockdown measures that have been adopted by advanced economies.

The impossibility of social distancing in crowded living conditions like in many cities and villages in India, the lack of testing kits to detect infections and the human suffering that occurs in lockdowns suggests a different path may be needed in these places.

To do this, the Princeton and CDDEP team recommends lifting India’s strict lockdown — which has been extended to May 3 — and letting most of the population younger than 60 return to normal life, though social distancing still would be encouraged, masks would be required and large gatherings would be banned. The reopening would be accompanied by an effort to test as many people as possible and isolate confirmed and suspected cases.

People over 60 would essentially have to remain under lockdown until herd immunity is achieved, and be prioritized for testing and treatment if they fell sick.

The government of Prime Minister Narendra Modi has given no indication it plans to adopt such a strategy.

Yet India’s government has laid out criteria that effectively rations coronavirus tests, limiting them to the very sick or most at risk. Critics who suspect the disease has dispersed much more widely than the official numbers suggest say the government’s restrictive criteria amounts to allowing the disease to spread.

“In some sense, you are saying, we will let them get infected and recover, and take care only of those who are sick,” said T. Sundararaman, the New Delhi-based global coordinator of the People’s Health Movement, a public health group. “That’s the policy, that’s what it amounts to.”

The government has maintained its testing criteria gives an accurate tally of India’s number of cases, and says the disease is not spreading untracked in the community. Nevertheless, as India has ramped up testing, it is finding more cases each day, bringing the nationwide tally to 20,080, with 645 deaths, as of April 21.

But while questions remain as to the extent and severity of India’s outbreak, the costs of the lockdown are clear. Local governments have had to set up camps to house 1.25 million migrants who left cities when they lost work, while food camps feed 7.5 million daily wage earners also rendered destitute by the lockdown. There are already signs these stopgap measures are starting to fray.

“We’re dealing with a trade-off against starvation, hunger, all this other stuff,” said Ramanan Laxminarayan, the director of the CDDEP and a Princeton researcher. By allowing the coronavirus to spread in a controlled way, “undoubtedly there will be deaths, but it will be much smaller this way, and it opens us up for business by November,” he said.

But the strategy has already proved controversial internationally. The U.K. adopted and then abandoned it early in the pandemic after projections showed its health care system would be overwhelmed by the resulting hospitalizations. That brief dalliance is still being blamed for the British government’s slow response in testing for the virus.

Risky Strategy

Even in a country like India with a young population, the concept has inherent risks. Allowing people to become infected will inevitably bring many more patients to hospitals. The researchers say India will have to urgently expand critical care and isolation-bed capacity to ensure that multiple waves of patients don’t become casualties before herd immunity is reached.

Another risk is that India’s worst-in the-world air pollution and high rates of hypertension and diabetes have compromised young people’s health, meaning that mortality from the virus could be higher than expected. People may let their guards down and fail to follow social distancing guidelines.

“I would worry that it would relax concerns of younger individuals, who still remain at substantial risk themselves,” Jason Andrews, an assistant professor of medicine at Stanford University, said in an email. “The messaging in particular may lead younger people to perceive themselves as at lower risk than they are, and to fail to understand their potential role in transmission.”

And given the novel coronavirus only made its debut in humans some time late last year, there’s still a lot that’s unknown. Immunity from the virus may be a more complex process than expected. One group of researchers estimated as much as 82% of the population would have to be infected before herd immunity is reached.

“My view is there are a number of questions about whether it can work,” said Marc Lipsitch, a professor of epidemiology at Harvard University’s T.H. Chan School of Public Health. “The main questions being how much immunity do we need in the population, and how much immunity does each person get as a result of infection.”

Then there’s also the question of whether it’s possible to wall off the higher-risk portion of the population in densely packed India, where multiple generations commonly live under one roof.

Ultimately, the researchers lobbying for the strategy argue that cultivating herd immunity may be the best of various bad options.

“I think eventually all countries will follow this Indian model,” Laxminarayan said. “Because otherwise we are going to be in lockdown on and off all the way through until June of next year.”

More coronavirus coverage from Fortune:

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New coronavirus deaths in California show U.S. had COVID-19 victims weeks earlier than thought

Santa Clara County officials said the people died at home Feb. 6 and Feb. 17. The first COVID-19 death in the nation had previously been reported on Feb. 29 in Kirkland, Wash.

New coronavirus deaths in California show U.S. had COVID-19 victims weeks earlier than thought

Health officials say two people died with the coronavirus in California weeks before the first reported death from the disease.

Santa Clara County officials said Tuesday the people died at home Feb. 6 and Feb. 17, with the first death in the nation from the virus reported on Feb. 29 in Kirkland, Washington. The Medical Examiner-Coroner received confirmation Tuesday that tissue samples sent to the U.S. Centers for Disease Control and Prevention tested positive for the virus, officials said.

The announcement came after California Gov. Gavin Newsom promised a “deep dive” update Wednesday of the state’s ability to test for the coronavirus and to track and isolate people who have it, one of the six indicators he says is key to lifting a “stay-at-home” order that has slowed the spread of the disease while forcing millions of people to file for unemployment benefits.

“This will go to the obvious questions and queries that all of us are asking: When? … When do you see a little bit of a release in the valve so that we can let out a little of this pressure,” Newsom said Tuesday, teasing what he says will be the first of regular weekly updates on the state’s progress toward reopening.

Newsom says the state is testing an average of 14,500 people per day, up from just 2,000 tests per day at the beginning of April. Still, in a state of nearly 40 million people, that’s not enough for public health officials to know for sure the reach of the highly contagious virus that is still causing outbreaks across the state in nursing homes and homeless shelters.

Newsom said he wants the state to test at least 25,000 people per day by the end of April.

Over the weekend, the California Department of Public Health issued new testing guidance that, for the first time, recommends testing for people in high-risk settings even if they do not have symptoms. The new advice is aimed at hospitals, jails and homeless shelters — three places where physical distancing is difficult.

California has more than 35,600 confirmed coronavirus cases and 1,300 deaths, according to data compiled by Johns Hopkins University.

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.

California has been under a mandatory, statewide stay-at-home order for more than a month. Last week, Newsom said he won’t consider loosening that order until hospitalizations, particularly those in intensive care units, flatten and start to decline for at least two weeks. Tuesday, Newsom announced intensive care hospitalizations rose 3.8%.

Other indicators Newsom says he is monitoring include whether the state has adequate protective gear for health care workers, better treatment for the disease and expanded testing.

Some local governments are already loosening their stay-at-home orders. Officials in Riverside County, east of Los Angeles, have allowed public and private golf courses to reopen while limiting play to foursomes, requiring physical distancing and face coverings and banning caddies, gatherings and dining in clubhouses.

At Van Buren Golf Center in Riverside, supervisor Angel Zabala said business was steady when the nine-hole course reopened Tuesday.

“A lot of people are happy,” Zabala said. “People have expressed relief as far as we’re finally open.”

Newsom said his administration is getting calls from local governments around the state with questions about how they might gradually loosen their stay-at-home orders.

“Everybody has a different timeline. So that’s the challenge,” Newsom said.

Newsom’s news conference, scheduled for noon Wednesday, will be watched closely by business groups who are clamoring to reopen so they can start paying their workers again.

“We just hope (Wednesday) we might hear of some additional steps from the governor that small businesses will be able to take towards opening their doors and turning their lights on,” said John Kabateck, state director of the National Federation of Independent Business.

Restaurants were some of the first businesses ordered to close because of the virus outbreak, and they have suffered some of the heaviest job losses. A survey of restaurant operators conducted by the National Restaurant Association found more than 1 million workers had either lost their jobs or been furloughed since March — at least 70% of all restaurant employees that were working in February.

But like most industries, restaurant operators are torn between the desire to get back to work and not wanting to rush back too soon and risk setting off another deadly outbreak of the disease, said Jot Condie, CEO of the California Restaurant Association.

“We’re hopeful that we get this right the first time,” he said.

More coronavirus coverage from Fortune:

—The trillion-dollar question: —After stocks, —Google, Andrew Yang, and Ariana Grande back a new effort to send an extra $1,000 to 100,000 U.S. families in need
—How live-event companies pivoted to building —5 veteran investors on —How Hong Kong squashed its —The comfort economy gains momentum during the coronavirus pandemic
—PODCAST: COVID-19 might have upended the concept of the —VIDEO: 401(k) withdrawal penalties waived for anyone hurt by COVID-19

, a daily newsletter roundup of stories on the coronavirus pandemic and its impact on global business. It’s free to get it in your inbox.

Source : Fortune More   

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