COVID-19: "as much as 55% of India’s population could be infected"

[xyxmt]

WOW!!! WE LIVE IN EXCITING TIMES. MY DREAM OF APOCALYPSE CAME TRUE.

LOVE YOU MAN!!

- PRTP GWD

your RSS Gau mata curse actually did work!!
now all the muslims, christians and low cast will be wiped out

 

[Pakistan Space Agency]

The UK is bracing for 60% infections. I assume it's going to be around that figure for the entire planet.

 

[Pandora]

number in India and Pakstan are much higher than being told on media. Several who are infected are so scared that they are not going to hospitals out of fear of being quarantined. There are several examples where people reported sick people sitting in their homes and they had to be dragged quarantine centres.

 

[JafarQureshi]

Instead of vaccine, hindu regime will make sure all Muslims are infected.
I think it's detrimental moment for Muslims of India.
We should have not spared any stone un-turned on 27th February.

Muslims will survive as they do not consume haram food like cow urine.

 

[masterchief_mirza]

Community transmission has started.

We knew this. Plenty of chest thumpers here said otherwise.

The sub-clinical infection rate [people who are getting infected but not showing manifestations] in H1N1 was 20%. For Covid, the best estimate that I have is from China. That is 50 %. So, half the people who get the infection may not even know that they are infected.

Yep, we tried telling Indians this one too. They are at least consistent in believing their own bakwas.

 

[JafarQureshi]

Holy moly! ...

Interview: ‘Suppression won’t work in India. Slow down the coronavirus. This will be a long haul’

One of India’s most renowned epidemiologists cautions against unsustainable lockdowns and says community participation is the key to fight the disease.

March 23 2020 04:38 pm | Arunabh Saikia | Scroll.in

Jayaprakash Muliyil is one of India’s foremost epidemiologists, with decades of experience in the study of infectious diseases. The former principal of the Christian Medical College in Vellore spoke to Scroll.in about India’s response to the coronavirus outbreak.

He said the stage of community transmission, when the source of infection for a large number of patients cannot be traced to a confirmed case, has already set in the country, even though the government is reluctant to admit it. He estimates that as much as 55% of India’s population could be infected. Yet, he cautioned against adopting a strategy of “suppression” involving complete lockdowns.

“Suppression is not going to work in India in my opinion,” he said. “In an organised society, where food can be delivered into each house, it is possible, not in India... That is not my response to a public health emergency. Community participation is.”

https://imgur.com/vPRB9Yd

Edited excerpts from the interview.

What lessons can India learn from our past experience with infectious diseases? Most recently, how did the country deal with the H1N1 or swine flu outbreak?
We did little about the H1N1 outbreak, because we could not either stop it or control it. There was nothing that the state or hospitals could do except taking care of patients. So, what the state did was check the temperature of people at the airport. The goal was to prevent H1N1 from coming into India. But it was obvious to everybody else in the world that that is not possible. The comical part was even after the pandemic struck India and the first wave settled down, the government still had men with machines in the airport measuring temperature. We could not do anything as drugs were not working and transmission was so fast. Nothing could be done.

By the time the vaccine came through, the first wave had gone. H1N1 ran its course and settled down on its own – not because we did anything or because of government orders.

What is different this time and why do health experts fear there will be many more infections and deaths before the novel coronavirus runs its course?
First of all, in the case of H1N1, the generation time [time between the infection time of an infected person and the infection time of their infector] was much shorter: less than a day. In the case of the new virus, it is longer: probably around three days.

Second, In the case of H1N1, most infections took place within the first two days [of the virus entering the host] and no infection after the fifth. Covid-19 seems to have a little more infectivity over a longer period of time.

The sub-clinical infection rate [people who are getting infected but not showing manifestations] in H1N1 was 20%. For Covid, the best estimate that I have is from China. That is 50 %. So, half the people who get the infection may not even know that they are infected. The million-dollar question is: can they take part in the transmission process? We do not know yet.

Has India done enough so far to contain the outbreak in your opinion?
We did try. But there was a lot of state-to-state difference. Some states did excellently well. They fought it zealously, passionately. Some chose to be very complacent about it.

But none of that matters anymore: we are going to face the epidemic anyway.

What do you think we have not done that we should have?
Let’s begin with what China should have done. It should have restrained the whole infection around the place where it started. Remember that China has good scientists and they could have done it. But it did not happen. This happens in dictatorial societies where free speech is not allowed.

As far as India is concerned, I think we as a country did not move together very fast. I don’t think people at the grassroots level understood the meaning of containment.

See, in a dictionary next to the word mitigate, there is often a small box that says: Don’t confuse with militate. While mitigate has an undercurrent of facilitation, militate is more of a suppressive, authoritarian thing.

In India, as we tried controlling the virus we got into a mode of “catch the fellows coming from abroad, don’t let them out”. That is dangerous because it creates a stigma against the carrier as that is something each one of us is going to get in the future. That was a wrong start. Now, we need a very good leadership to change that attitude.

There has been some criticism about India’s testing strategy – that the government has not tested enough. Do you agree?
I think the problem that the government had at that time was that we had a weak test. It was a test not just for this particular strain, but generally the coronavirus. [Editor’s note: There are many kinds of coronavirus. The current outbreak is caused by a newly discovered coronavirus]. It would lead to many unnecessary positives and unnecessarily people being quarantined. The government did not really have an option.

The government had to make a choice: test only suspects. When you say suspects, the probability of having the disease is high. So, if such a person tests positive, you can choose what to do with that gut.

But now we have excellent test kits with sensitivity and specificity almost next to 100%. I am sure now the ICMR [Indian Council of Medical Research] and the government of India will start testing, testing, testing.

Several epidemiologists have said that statistically it is unlikely that there is no community transmission yet, though, the government is still to confirm it. What is your opinion?
Community transmission has started. We know this from the fact there have emerged a few cases without any contact or travel history. Now, people have stood up and said that no, it is not an indigenous case. It is easy to say that, but the cost of mistakes at this stage is high. We have to get ready for the next stage.

See, nobody is going to blame [the government] if you can’t hold the disease down in a country like India. It’s fine if it didn’t work, but we have to get ready and figure out how will you [the government] manage if there is a large number of cases.

Internationally, there seems to be a debate about two possible approaches going forward: mitigation vs suppression. While the former involves isolating suspected cases, quarantining households with suspected cases and socially distancing those most vulnerable, at the heart of the latter is a drastic lockdown. Which of these two strategies would you recommend for India
About 80,000 women will deliver today all over India. They will be looking for a place to go and deliver. Do you know how they travel in the villages? Think of them when there is no auto rickshaw, no bus service. Do we think of them when we give orders?

When people say suppress, suppress, there are people dying in India for all kinds of reasons. Fine you suppress it [the spread of the novel coronavirus] again, but anyway it will come back again.

Suppression is not going to work in India in my opinion. In an organised society, where food can be delivered into each house, it is possible, not in India.

In India, suppression would mean hurting each other, exploitation, giving power to wrong kinds of people. That is not my response to a public health emergency. Community participation is. And community participation and suppression do not go together.

This is going to be a long haul. You have to be sensible about it.

For example, there is no need for everyone who is corona-positive to come to the hospital. Only the subset which has difficulty breathing should. Everybody else should self-discipline and quarantine themselves.

Don’t have any large gatherings, overloading of buses and crowding in general. Maintain social distancing for six to nine months. Basically, slow the virus down.

But if you apply drastic measures, people will rebel if they don’t have food and milk for their children – and healthcare for other ailments.

What is a reasonable period to keep social distancing measures in place, taking into account India’s socioeconomic realities?
The time frame I cannot be specific about since I have not done any modelling, but say six-nine months.

Any ballpark figure on how many dead people that would mean and what percentage of population will be affected?
See, there are unavoidable deaths and then there are avoidable deaths. Avoidable death means pulling off life support, oxygen, etc, to people who are in the ICU because you don’t have enough beds. On the other hand, people with co-morbidities like heart problems, etc, who would anyway die are cases of unavoidable deaths. But we can reduce mortality by bringing down cases of avoidable deaths. That is why we need to make sure there is no overcrowding of hospitals.

As for as infections, I think in the first wave it will be around 55%. That is my conservative estimate. The virus is likely to come back, but we don’t know for sure now.

Why is the fatality rate so drastically different across countries?
There are two ways to calculate mortality. The numerator will be same in both cases: the number of people who have died of the Covid-19.

The denominator can vary. One, it can be diagnosed cases which showed clinical symptoms and were tested positive subsequently as in Italy. On the other hand, is South Korea, that tested aggressively even without symptoms and found many people to be positive.

55% is conservative estimate. I would say over a billion people would be infected this year and 99% by 2021.

 

[masterchief_mirza]

Indians are superhumans then. 55% infected and deaths less than fingers on my hand.

Utter speculative shit that PDF feeds on

Yah except you misunderstood what the epidemiologist said. He expects 55% infection rates by the end of the first wave. He didn't say 55% of Indians are presently infected.

So what if India's population would be infected? It is Flu, and like any other virus, the human body will develop immunity against it. Locking up people like animals and destroying economies is the not the answer.

It's true that ultimately the same number will get infected. Lockdowns are not going to stop that and indeed, one doesn't want to stop it in epidemiological terms. But lockdowns will slow its advance and allow time for preparing specialist treatment centres.

 

[ziaulislam]

Holy moly! ...

Interview: ‘Suppression won’t work in India. Slow down the coronavirus. This will be a long haul’

One of India’s most renowned epidemiologists cautions against unsustainable lockdowns and says community participation is the key to fight the disease.

March 23 2020 04:38 pm | Arunabh Saikia | Scroll.in

Jayaprakash Muliyil is one of India’s foremost epidemiologists, with decades of experience in the study of infectious diseases. The former principal of the Christian Medical College in Vellore spoke to Scroll.in about India’s response to the coronavirus outbreak.

He said the stage of community transmission, when the source of infection for a large number of patients cannot be traced to a confirmed case, has already set in the country, even though the government is reluctant to admit it. He estimates that as much as 55% of India’s population could be infected. Yet, he cautioned against adopting a strategy of “suppression” involving complete lockdowns.

“Suppression is not going to work in India in my opinion,” he said. “In an organised society, where food can be delivered into each house, it is possible, not in India... That is not my response to a public health emergency. Community participation is.”

https://imgur.com/vPRB9Yd

Edited excerpts from the interview.

What lessons can India learn from our past experience with infectious diseases? Most recently, how did the country deal with the H1N1 or swine flu outbreak?
We did little about the H1N1 outbreak, because we could not either stop it or control it. There was nothing that the state or hospitals could do except taking care of patients. So, what the state did was check the temperature of people at the airport. The goal was to prevent H1N1 from coming into India. But it was obvious to everybody else in the world that that is not possible. The comical part was even after the pandemic struck India and the first wave settled down, the government still had men with machines in the airport measuring temperature. We could not do anything as drugs were not working and transmission was so fast. Nothing could be done.

By the time the vaccine came through, the first wave had gone. H1N1 ran its course and settled down on its own – not because we did anything or because of government orders.

What is different this time and why do health experts fear there will be many more infections and deaths before the novel coronavirus runs its course?
First of all, in the case of H1N1, the generation time [time between the infection time of an infected person and the infection time of their infector] was much shorter: less than a day. In the case of the new virus, it is longer: probably around three days.

Second, In the case of H1N1, most infections took place within the first two days [of the virus entering the host] and no infection after the fifth. Covid-19 seems to have a little more infectivity over a longer period of time.

The sub-clinical infection rate [people who are getting infected but not showing manifestations] in H1N1 was 20%. For Covid, the best estimate that I have is from China. That is 50 %. So, half the people who get the infection may not even know that they are infected. The million-dollar question is: can they take part in the transmission process? We do not know yet.

Has India done enough so far to contain the outbreak in your opinion?
We did try. But there was a lot of state-to-state difference. Some states did excellently well. They fought it zealously, passionately. Some chose to be very complacent about it.

But none of that matters anymore: we are going to face the epidemic anyway.

What do you think we have not done that we should have?
Let’s begin with what China should have done. It should have restrained the whole infection around the place where it started. Remember that China has good scientists and they could have done it. But it did not happen. This happens in dictatorial societies where free speech is not allowed.

As far as India is concerned, I think we as a country did not move together very fast. I don’t think people at the grassroots level understood the meaning of containment.

See, in a dictionary next to the word mitigate, there is often a small box that says: Don’t confuse with militate. While mitigate has an undercurrent of facilitation, militate is more of a suppressive, authoritarian thing.

In India, as we tried controlling the virus we got into a mode of “catch the fellows coming from abroad, don’t let them out”. That is dangerous because it creates a stigma against the carrier as that is something each one of us is going to get in the future. That was a wrong start. Now, we need a very good leadership to change that attitude.

There has been some criticism about India’s testing strategy – that the government has not tested enough. Do you agree?
I think the problem that the government had at that time was that we had a weak test. It was a test not just for this particular strain, but generally the coronavirus. [Editor’s note: There are many kinds of coronavirus. The current outbreak is caused by a newly discovered coronavirus]. It would lead to many unnecessary positives and unnecessarily people being quarantined. The government did not really have an option.

The government had to make a choice: test only suspects. When you say suspects, the probability of having the disease is high. So, if such a person tests positive, you can choose what to do with that gut.

But now we have excellent test kits with sensitivity and specificity almost next to 100%. I am sure now the ICMR [Indian Council of Medical Research] and the government of India will start testing, testing, testing.

Several epidemiologists have said that statistically it is unlikely that there is no community transmission yet, though, the government is still to confirm it. What is your opinion?
Community transmission has started. We know this from the fact there have emerged a few cases without any contact or travel history. Now, people have stood up and said that no, it is not an indigenous case. It is easy to say that, but the cost of mistakes at this stage is high. We have to get ready for the next stage.

See, nobody is going to blame [the government] if you can’t hold the disease down in a country like India. It’s fine if it didn’t work, but we have to get ready and figure out how will you [the government] manage if there is a large number of cases.

Internationally, there seems to be a debate about two possible approaches going forward: mitigation vs suppression. While the former involves isolating suspected cases, quarantining households with suspected cases and socially distancing those most vulnerable, at the heart of the latter is a drastic lockdown. Which of these two strategies would you recommend for India
About 80,000 women will deliver today all over India. They will be looking for a place to go and deliver. Do you know how they travel in the villages? Think of them when there is no auto rickshaw, no bus service. Do we think of them when we give orders?

When people say suppress, suppress, there are people dying in India for all kinds of reasons. Fine you suppress it [the spread of the novel coronavirus] again, but anyway it will come back again.

Suppression is not going to work in India in my opinion. In an organised society, where food can be delivered into each house, it is possible, not in India.

In India, suppression would mean hurting each other, exploitation, giving power to wrong kinds of people. That is not my response to a public health emergency. Community participation is. And community participation and suppression do not go together.

This is going to be a long haul. You have to be sensible about it.

For example, there is no need for everyone who is corona-positive to come to the hospital. Only the subset which has difficulty breathing should. Everybody else should self-discipline and quarantine themselves.

Don’t have any large gatherings, overloading of buses and crowding in general. Maintain social distancing for six to nine months. Basically, slow the virus down.

But if you apply drastic measures, people will rebel if they don’t have food and milk for their children – and healthcare for other ailments.

What is a reasonable period to keep social distancing measures in place, taking into account India’s socioeconomic realities?
The time frame I cannot be specific about since I have not done any modelling, but say six-nine months.

Any ballpark figure on how many dead people that would mean and what percentage of population will be affected?
See, there are unavoidable deaths and then there are avoidable deaths. Avoidable death means pulling off life support, oxygen, etc, to people who are in the ICU because you don’t have enough beds. On the other hand, people with co-morbidities like heart problems, etc, who would anyway die are cases of unavoidable deaths. But we can reduce mortality by bringing down cases of avoidable deaths. That is why we need to make sure there is no overcrowding of hospitals.

As for as infections, I think in the first wave it will be around 55%. That is my conservative estimate. The virus is likely to come back, but we don’t know for sure now.

Why is the fatality rate so drastically different across countries?
There are two ways to calculate mortality. The numerator will be same in both cases: the number of people who have died of the Covid-19.

The denominator can vary. One, it can be diagnosed cases which showed clinical symptoms and were tested positive subsequently as in Italy. On the other hand, is South Korea, that tested aggressively even without symptoms and found many people to be positive.

Because of population being so difference
E.g average death age was 78 yrs old in italy
Vulnerable population in india pakistan has already been killed by preventive diseases like flu(no flu shots), pneumonia (no penumonia shots), renal failure(no HD or transplant) and heart disease(no advance heart care)

Essentally only healthy people are dying because unhealthy dont exist!!

 

[masterchief_mirza]

Because of population being so difference
E.g average death age was 78 yrs old in italy
Vulnerable population in india pakistan has already been killed by preventive diseases like flu(no flu shots), pneumonia (no penumonia shots), renal failure(no HD or transplant) and heart disease(no advance heart care)

Essentally only healthy people are dying because unhealthy dont exist!!

Fascinating suggestion this.

 

[ziaulislam]

Fascinating suggestion this.

We r treating 5 covid 19 patients all of them above 70 from nursing homes..i havenot seen a single healthy person yet

 

[masterchief_mirza]

We r treating 5 covid 19 patients all of them above 70 from nursing homes..i havenot seen a single healthy person yet

God speed with your efforts sir.

 

[ziaulislam]

Death rate is 20% in above 80 and 0.02% in under 40(who are sick enough to be hospitalized)

 

[masterchief_mirza]

Death rate is 20% in above 80 and 0.02% in under 40(who are sick enough to be hospitalized)

Well look, if this is true, then why is the "let people get infected and rapidly attain herd immunity" approach so ridiculous in countries like Pakistan and India? I can understand that in Europe, the fatalities will be too great for the vulnerabilities of an aged population that you mentioned. .

In India and Pakistan, would it be so ridiculous to allow the infection to spread and let the relatively younger, healthier population take their chances and hope the low death rate in their cohort gives everyone a good chance of survival?

I can see the point made when folks like the Indian epidemiologist say that lockdown in our countries creates its own set of potentially fatal implications.

 

[ARMalik]

Well look, if this is true, then why is the "let people get infected and rapidly attain herd immunity" approach so ridiculous in countries like Pakistan and India? I can understand that in Europe, the fatalities will be too great for the vulnerabilities of an aged population that you mentioned. .

In India and Pakistan, would it be so ridiculous to allow the infection to spread and let the relatively younger, healthier population take their chances and hope the low death rate in their cohort gives everyone a good chance of survival?

I can see the point made when folks like the Indian epidemiologist say that lockdown in our countries creates its own set of potentially fatal implications.

I think in Pakistan and to some extent in India, they are doing this to get relief from the foreign debt. There are already rumors that IMF and others will provide some debt relief.

As far as the virus is concerned, unfortunately the game is much, much bigger, and extremely dangerous. I will explain later.

 

[ziaulislam]

Well look, if this is true, then why is the "let people get infected and rapidly attain herd immunity" approach so ridiculous in countries like Pakistan and India? I can understand that in Europe, the fatalities will be too great for the vulnerabilities of an aged population that you mentioned. .

In India and Pakistan, would it be so ridiculous to allow the infection to spread and let the relatively younger, healthier population take their chances and hope the low death rate in their cohort gives everyone a good chance of survival?

I can see the point made when folks like the Indian epidemiologist say that lockdown in our countries creates its own set of potentially fatal implications.

Because slow spread of virus is always preferred.
Fewer patients will die and less hospitalization and summer will also slow down the spread.
Early studies from china shows that as expected corona virus family is suspectible to heat and sunlight

Also with time most viruses become less virulent (to survive in carriers).

So overall slowing the infection is effective even in pakistan