India - flattened curve

[nowaytoclever]

Very interesting to see a densely populated country like India deal with Covid and flatten the curve. I'm sure there is massive underreporting of numbers going on, but the curve has certainly flattened, and I hear from friends and family there that life is almost back to normal. My friends in India seem to be going out to eat all the time now, going on holidays, attending sports events, etc. School is not back open yet.

I think they did a few things very well.

• They shut down borders in March 2020 and ensured mandatory quarantine for all incoming travellers regardless of country of origin. Those restrictions are still in place.
• During home quarantine, the local police come and check on you to ensure you are in mandatory quarantine. If you've come from a high risk country (the UK included!) you have to do institutional quarantine, but you get to pick from hotels of different budgets, locations, etc.
• The Covid frontline police, airport staff, healthcare workers and all medical staff wear full PPE at all times.
• All domestic travel (trains, buses, planes, etc) was banned for a few months to ensure there was no 'mixing' within the country.
• Aggressive test and trace to prevent community spread
• Vaccine production on existing infrastructure in-country

Interesting article on what Kerala did:
www.theguardian.com/lifeandstyle/2020/dec/22/how-kk-shailaja-and-her-covid-brigade-won-a-victory-against-the-virus

What I found most interesting (with NHS in mind) is that the system coped!

At no point have more than a quarter of its ventilators been occupied, and on 1 December, fewer than one in 10 intensive care beds were filled.

I find this quite remarkable to be honest! If the reporting is correct...

I’ve also been following India closely, a key benefit for them was also a very young population - median age 27 compared to UK’s 40. Similarly, sadly people tend to live shorter lives in India - life expectancy of 69 compared to UK’s 81, so whilst they not only have a young population, their elder population will be largely younger than the elder population in the U.K.

Agree. But Kerala has a life expectancy of 75, and a median age of 32, and they have one of the lowest mortality rates across the whole country. I don’t understand it either!

Someone on another forum claimed their brother became ill in India, breathing difficulties, they refused to test for covid because there wasn't any covid in India. Obviously just heresay, but there's something odd going on.

I think Kerala has had some issues with under-reporting which might be impacting on their rates compared to India as a whole

www.google.co.uk/amp/s/www.bbc.com/news/amp/world-asia-india-54985981

but overall I think they have done a really good job. I think there has been an underlying element of immunity within large swathes of the population, because when this first started I was very worried for how it would pan out, but life is much more normal in India.

Some similar factors to other countries that have successfully controlled their outbreaks:

Restricting travel into country, Quarantine of travellers, No mass travel internally, enforcement of self-isolation

All things the UK government refused to do and is only half-heartedly doing now.

tbh - cases are falling in most countries regardless of any measures they have in place

I suspect the vast majority will have been exposed now. Same in South Africa.

Manufacturing vaccines under licence does seem like a good way to increase worldwide supply.

I think it's a bit naive to put India's "success" down to measures like shutting borders or PPE.

We know that in some regions of India 50-60% of people have antibodies. There was a slum where I think they found a c.80% antibody rate. So clearly the measures haven't been successful in stopping people getting covid across India. We don't have anything like those antibody rates.

Also, if you have ever been to India, the idea that social distancing could be maintained seems unrealistic. The living conditions of some of the population and population density just don't allow for it. See from the bbc last year www.bbc.co.uk/news/world-asia-india-52393382

India did have a very harsh initial lockdown but it was badly managed in many ways e.g. thousands of migrant workers were left without employment when factories were closed and were therefore crowding together to try to get on public transport. There wasn't the same financial support for people to stay at home so many were probably forced to work. This initial lockdown didn't get covid under control long term but generally speaking India has had much lighter restrictions than most of Europe since then - in February Delhi had a limit on numbers at weddings of 200 for example.

I suspect demographics is a huge factor with an element of climate and herd immunity creeping in.

If it’s indeed herd immunity, it’s probably the first real case study of herd immunity working. Sweden is similar, but less effective with herd immunity as it has such a low population. I am really pleased it’s gone well though, and all industries are back up and running.

@StarCat2020 They’ve said they will do that - India has already delivered 22 million vaccines to neighbours and island nations like Seychelles.

Also it’s winter in the northern parts of India, so climate is not a huge factor in the current flattening (unless we count herd immunity).

I would be interested to know what their overall deaths/excess deaths are as opposed to just covid deaths.
I assume a lot of people in India don’t have access to healthcare and a lot of the more remote areas won’t have as much official testing and reporting.

@StarCat2020 They’ve said they will do that - India has already delivered 22 million vaccines to neighbours and island nations like Seychelles
That sounds promising.

It would be good if other countries could produce vaccines in the same way.

They have focused on treatment and not vaccines. And likely nowhere immunity in many densely populated areas . This should be looked into more but I feel it won’t as it doesn’t suit the narrative . Sweden is on the same curve but it’s less startling because of the size of the population .

There are several factors that have helped. Climate is a factor even in their ‘winter’, it’s not coronavirus friendly weather. Saw a scientist from India weighing in on this and he said Indians have strong immunity including microbiome as they are exposed to many bugs in their lives. And yes herd immunity as the virus no doubt spread throughout the population without the kind of distancing/mask behaviour we’ve been doing.

But a factor that is widely ignored by the western press as it doesn’t fit our prejudices is that India has a tripartite health system—they have from the very beginning of the pandemic used all three of their medical systems in treating covid—western medicine, Ayurveda and homeopathy. It works well for them in infectious diseases. We also don’t hear about how some East Asian countries have successfully used traditional Chinese medicine as well as western drugs. I have heard this direct from doctors in those countries.

What can you do, the media and power establishment in the west want us to think vaccines are the only way out (and already that myth is falling apart with new variants and admissions that vaccinated ppl may still be spreading it, sometimes asymptomatically).

@AlecTrevelyan006

tbh - cases are falling in most countries regardless of any measures they have in place

It’s like all these ridiculous restrictions are futile against an airborne virus 🤷‍♀️

Young population, low obesity rates, immune systems probably used to infection, haven’t tested ever time someone has a slight sniffle, low/incorrect reporting of deaths, herd immunity as no other choice in some areas.

Nerdygirl I've just looked up treatment protocols and it does seem like they focus heavily on treatment. Apparently 22 million doses of Ivermectin were given out as part of the treatment protocol and local studies show that this has been 75% effective in treatment.

There's certainly a lot of bias in western media against India's fight against Covid. I feel like we missed some lessons somewhere (possibly in March last year!) and we've been groping about in the dark.

I don't think it can be herd immunity unless the figures coming out of India are so inaccurate that they're fiction.

India is 120th in the world for infection rate and 109th for death rate. They're pretty lightly affected compared to most major countries.

As a comparison, the UK is 23rd for infection rate and 5th for death rate. So how can India have herd immunity when we're nowhere near ourselves despite being so much more badly affected?

key benefit for them was also a very young population - median age 27 compared to UK’s 40. Similarly, sadly people tend to live shorter lives in India - life expectancy of 69 compared to UK’s 81, so whilst they not only have a young population, their elder population will be largely younger than the elder population in the U.K.

Big part of it.

@manicinsomniac
The antibody testing they have done in India shows that around 50-60% have antibodies in many areas - e.g 56% in Delhi. In comparison similar testing in the UK suggests 20% antibody rates. So yes I think they are just doing nothing like as much testing.

We flattened the curve once and then got a second wave 🤷🏼‍♀️

@manicinsomniac because they have a younger population. Age is one of the largest factors in increasing poor outcomes from covid, many young people in the U.K. have been surprised to test positive when sampled randomly or through workplace or research testing. It’s not unreasonable to expect that in a large young population there would be many many cases untested/unconfirmed because people simply don’t feel ill so don’t know to test. So it’s very possible that they have reached herd immunity levels without the official covid testing figures backing this up (not through a cover up but that people weren’t aware they were unwell so didn’t get tested). There is also a further incentive not to test in poorer segments of the population where there is a reliance on daily wages and not a lot of govt. support, so people would be more likely to not test for minor symptoms.

This would also reduce the death rate - if you have a very high percentage of your population in the lower risk category you wouldn’t expect a very high death rate.

I think it's a combination of several of these factors. Here's another interesting article:
www.npr.org/sections/goatsandsoda/2021/02/01/962821038/the-mystery-of-indias-plummeting-covid-19-cases?t=1613394856660

I honestly dont know, but if you look at the projections onnworldometres, even the UK would be expected to flatten out now if we removed restrictions. Covid has mostly spread and dine it's worse I guess? But weirdly I'm still the only person i know who has it. Not dh, none of our 4 kids, none of our extended family, no colleagues in dh department, none of our friends.

It makes no sense to me. I think it's something that only make sense when we look back in a few years