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COVID Situation – How to develop Herd immunity in India

6 min read

By Dr. Chetan Ginigiri,MBBS(JIPMER), MD (PGIMER) Fellowship PICU (Kings College London), Head of Dept – Paediatric & Neonatal services, Aster CMI Hospital

Since the coronavirus pandemic began, You might have probably heard the term “herd immunity.” It is suggested that developing herd immunity might be a good way to devastate or control the spread of the novel coronavirus.  Here are some important thoughts on the Developing of Herd immunity In India: 

COVID

What is Herd Immunity?

Herd immunity happens when the greater part of people in a geographic region/ community become immune to an infectious disease. When enough people from a region are immune to a disease, the chains of transmission to be broken, and the disease eventually stops from spreading.  This usually happens in two ways:

  • Developing natural immunity: The majority of people contract the disease and, in due course, start to build natural immunity against that trait of infection.
  • Vaccination: Vaccinating the majority of people in a community against the disease to achieve immunity.

Even though natural immunity can help create herd immunity, it doesn’t work as well as vaccinations. Herd immunity is known to give excellent results in non-fatal diseases like polio, mumps, etc.

Isn’t It Dangerous To Wait for The Herd Immunity To Develop Automatically During The Course Of A Pandemic?

Yes. As mentioned earlier, developing herd immunity is wise only in the case of non-fatal diseases like polio. Exposing an entire community to a deadly disease like corona, waiting for herd immunity to automatically develop, risking the lives of many during the course of the pandemic is not at all an option.  

What Is the “R0” (R-naught) value?

 Ro value is a statistical term that points out how contagious an infectious disease is. R0 value shows the average number of people who will catch a disease from one contagious person. For example, if R0 of a disease is 9, every infected person has the potential to cause nine new infections. R0 value is only relevant when a new disease emerges, and an entire population is vulnerable to it.

Interesting facts:  R0 value indicates potential transmissibility only. It will not show the speed of spreading. For example, the R0 value of seasonal flu is just about 1.3, yet it yearly infects millions of people. On the other hand, SARS had an R0 of 2 to 5, but only around 8,000 people contracts it. The R0 of the novel coronavirus is 2 to 5, which is similar to those for SARS and HIV. It is way lower than those for measles (R0 is as high as 18).

Can Herd Immunity Protect Us From COVID-19

Infectivity in COVID is one of the highest known to mankind ever. Therefore it is likely to have a very high “R0” (The Health Ministry has said, one positive case from a Delhi cluster had infected up to 405 people). The Higher the R0, the higher is the “HIT” (Herd immunity threshold). Therefore, going for herd immunity at this point” will risk many more lives than necessary.

And in the present case of COVID-19, having such a  high rate of infectivity & mortality, (10 times higher mortality than flu), with no drug or vaccine at least for next six months insight, with the virus likely to have high HIT -maybe even – 100%, the situation is grim!  It means a 100% population must get infected before the herd immunity develops. If 100% of Indians are infected by letting it loose,  with its known 5% mortality rate, it will kill 6 to 7 crore Indians within the next two months. It is senseless to allow this. People aged 50+ & with existing co-morbidities like hypertension, diabetes, heart/lung disease – they would constitute 80% of the above COVID deaths – and they need not have died otherwise, just so that Herd Immunity can be developed!

How Did We Overcome Pandemics In The Past?

  • In the 1918- flu pandemic in India (it was brought into India by the British soldiers traveling by ship from England) that lasted for three years, it killed two crores out of 30 crores of Indians in the then undivided India. (Globally then, it had killed ten crores).
  • Moreover, In polio & smallpox with R0 between 5 &7, 80 to 85% of the population must get naturally infected (or vaccinated), to generate herd immunity in the community. These diseases in question have a vaccine now, & it took around 100 years to eradicate them through herd immunity. But they don’t have a high fatality and don’t kill many.  So it was logical to work on protection through Herd Immunity here. 
  • Ebola and flu have RO between 1 & 2 with HIT between 30 & 50%. It means, if 30 to 50% of the population gets infected, the community then gets herd immunity. But they have a fairly high mortality rate too.

How To Break the COVID Chain Logically?

  • Like Influenza, Corona is also a disease with highly variable surface proteins caused by mutations in its strain. The flu vaccine needs to be freshly made every year because of such changes (called ‘antigenic shift and drift’). The same shall apply to the COVID virus too.
  • Breaking the chain by prolonged lockdown, Case targeting, tracing, testing, isolating, and treating positive cases can be the magic bullet.
  • Additionally, following all hand hygiene steps, wearing Mask by all, wearing of PPE by frontline workers, is also important.
  • COVID virus is a large-sized virus that cannot enter through a double-layered cloth mask. You don’t need an N-95 mask for the general community, except for the frontline staff.
  • Physical distancing (with social closeness if need be through phone/ social media), Sincere hygienic etiquette in cough/ sneeze/ no spitting, etc., can save lives by breaking the infectivity chain.
  • Quarantined people also should not be exposed to each other, as no one knows who will turn out positive in the designated two weeks. Also, anyone may cough and sneeze anywhere with no warning. Therefore, wearing a mask by the community is a must too.

Breaking the chain by these steps mentioned above is the most economical, logical &  and lifesaving way. It will be unworkable to even think of letting people die to render the needed herd immunity to society.

Effects Of Lockdown

**Nonstop minimum of eight weeks of strict lockdown** is recommended by mathematical modelers considering – up to 2 weeks of incubation period and six weeks of viral persistence in the human body.  Eight weeks lockdown can end the virus multiplication in most asymptomatic carriers too. In Exceptional cases, people may have a higher incubation period and longer viral persistence in the body. This, of course, is rare, and hopefully, they will acquire herd immunity later too.

Is It Wise To Lockdown Prematurely To Save the Economy?

A premature lifting of lockdown will spread the disease from the asymptomatic and those still undetected, to the whole community – ushering in a plethora of prolonged misery, preventable and avoidable deaths, & even famine and social unrest.

Regarding the economy, it may be extremely short-sightedness to lift the lockdown prematurely. Singapore had a resurgence after two weeks of lifting a short lockdown. Vietnam, however, controlled well by strict measures. In spite of people announcing otherwise, the economy will get ravaged if the lockdown is prematurely lifted (by anything short of 8 to 10 weeks).

Life is the first priority, and the economy only the second priority. If people die through thoughtless actions triggered by some political leaders, our economy will spiral into an unending misery in the years ahead. Saving lives through controlling the pandemic by breaking the chain is the only economic investment now.

By the end of April / May, the infection should peak. By July end, it should come to a situation like in Wuhan now (as many predict). Till then, no business house should be impatient. It is in their best interest that they serve by feeding the poor now.  India, hopefully, can feed its people even till the next six months. 

After six months or so, the economy should bounce back, though with initial slowness. We can’t help that.

COVID- Possibility Of Food Shortage

Generally, most Indians shouldn’t complain much as long as two meals a day are made available to them. The Indian government has to ensure this much – for 6-8 weeks from now.

The government must especially take care of the farmers. They should be treated as heroes like healthcare workers and sanitation staff. The government should take all necessary measures to by buying their products and supporting them to continue cultivation. Otherwise, food shortages will threaten to turn into famine-like conditions in 6 months or so. Farmers, (like healthcare workers and sanitation staff), should be prevented from getting COVID disease. If there is no one fit to grow food, it will be a disaster.

Wrapping up

This COVID-19 disease is not that simple given the fact that even recovered patients need not be necessarily healthy and fit, for the disease doesn’t confer lifelong immunity. Unlike what some Out -of -power Political parties are now crying out – breaking the chain of transmission seems the most viable option to tackle this scourge presently, till some specific treatment mode comes up.

It is a calculated gamble, but as of now, a known Devil (ie, lockdown) is far better than an unknown awaited Angel (ie, Development of Herd immunity). So let us all tighten our belts and prepare for the long haul to success

...
Dr. Chetan Ginigiri,MBBS(JIPMER), MD (PGIMER) Fellowship PICU (Kings College London), Head of Dept – Paediatric & Neonatal services, Aster CMI Hospital

Dr Chetan Ginigeri is an experienced Pediatric Intensivist with national and international training. With 15 years of experience, he is one among very few Intensivists in India trained to take care of children who need/had organ transplants. He has been responsible for coordinating the Pediatric Organ Transplant program.Read more.

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