"India has always made the mistake of waiting to see the surge, but that's not how we stop exponential rise in cases. You have to act very early when the variant is beginning to circulate," says Dr Bhramar Mukherjee, a professor of epidemiology, as India is firmly in the midst of a rapidly spreading third wave led by COVID-19 variant of concern Omicron.
She also dismissing the argument that Omicron is some sort of a 'nature's vaccine' and that it will bestow on us the famed herd immunity, warning that it will be a fallacy to dismiss the variant of concern as 'mild.' She also warns that it will be wishful thinking that we've seen the last of the variants, warning that the pandemics end in a damp oscillatory manner.
In an interview with The Quint, Dr Mukherjee shares her insights on India's handling of the Omicron crisis, lockdowns, lack of data and how it continues to govern policy, and India's monitoring of access deaths during the second wave.
What do you make of the narrative that Omicron variant of concern is mild, and will act as 'nature's vaccine'?
Even if we have five percent hospitalisation, less than Delta, five percent of a large number, when 50-60 percent of the population is infected, is enough to crumble the healthcare system. It maybe true that we do not need as much ICU hospitalisation, but the experience in the US is that we may need hospitalisation for supportive care.
I think it is very unwise to say let Omicron rip through the population and have unrestricted mitigation.
We do not know the long-COVID or breakthrough impact of this variant and this is a big unknown.
We also know that in India 40 percent of the population is under 18 and is unvaccinated. While it may be true that the variant is 'mild' in the vaccinated, we don't know if it will be 'mild' in the unvaccinated, who are filling up hospitals in the United States.
Also, when we say the variant is mild, it maybe at population level, but for those living with comorbidities, it is not mild, and by saying that you are undervaluing the life of the vulnerable.
Finally, while we are seeing a lot of people in the hospitals for COVID, we are also seeing a large number with COVID, who also have to be isolated. A large number of serious patients need specialised care, but half the hospital workforce is out sick.
Why are we moving for the policy of 'test, test, test' to no RT PCR testing for asymptomatic patients? How do you track the pandemic if you don't test?
We have to change some of our policies when we have a vaccinated population as compared to earlier, particularly with something like Omicron when we know our testing capacity will not be able to keep pace. We have to keep in mind a more pragmatic testing policy. We'll need to see what is the purpose of testing - is it for personal diagnosis or is it for surveillance?
In India, we had testing data available nationally everyday, hospitalisation data we never had. Ideally we should change our key metrics to say watch out for hospitalisation data, because cases are not predictive of that any more. Previously in an unvaccinated population, the case trajectory and death trajectory was really compatible at a lag, now it is not so depending upon the immunity quilt of the population.
But I do believe we need to test so we know what is going in with the virus in the population. If we had a dashboard of hospitalisation data from across India, I would say don't test. But without that it is going to be very hard to track the pandemic.
Do you also feel that India's booster dose policy is driven more by lack of data rather than on population-based Indian data?
People are smart, so if you show based on data that for some reason, on Indian population, there isn't so much of waning effect of the vaccines, or you show that hybrid immunity is working, or if you have data on breakthrough infections that show that we don't need to worry about delaying booster doses, people will buy it.
But if you say we don't have our data, we are borrowing data of science from another population, then you have to go with that recommendation. I am due my fourth booster dose in February, and my parents are still not due their first booster dose, it makes me ask how can biology and recommendations be so different. And if they are, then it should be governed and driven by data.
Do lockdowns work in 2022?
The world has seen two years of experiments on what works and what doesn't work. In a paper we are coming out with, we have looked at what has worked historically in Mumbai and Delhi, and if the same kind of interventions were imposed 14 days early, when the curve was still in early stages, what could have happened? Could we have mitigated and blunted the surge?
What we find interesting in our paper is that the timing really matters. India has always made the mistake of waiting to see the surge, before taking action. But that's not how we mitigate a surge. The time for restrictions is before, when the variant is just beginning to show itself, and that's when the impact of mitigation can be seen.
A new study in the Science magazine suggests India may have had access deaths of around 3 million. Is India still undercounting the dead, what lessons can we learn from the second wave?
In a paper we have worked on, we've found that the underreporting factors have been all over the place, from 4 to 12 times, and that amounts to anywhere between 2 to 6 million. Not all of these deaths are attributed to COVID, only a fraction is, but because of delay in care, because of transportation access barriers there has been a lot of loss of life, and we have no way to really account for that. In the US, we know that 72 percent of access deaths are attributed to COVID, and 28 percent are to other tertiary causes which are not directly linked to COVID. It is very important to understand what fraction of these deaths in India are attributed to COVID.
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