COVID-19: Pandemic to endemic – time for India to change the narrative

It’s been 46 days since the world’s second-most populous nation literally downed the shutters on almost all social and commercial activities in an attempt to counter the biggest challenge to the human race since the two World Wars – the coronavirus pandemic. With 59,662 positive cases and 1,981 deaths, according to official figures until late Saturday night, India’s tryst with COVID-19 is ‘as good as it gets’. There is no denying the fact that until now, active government intervention in the implementation of a nationwide lockdown and adherence by the public to social-distancing norms to a large extent – barring some incidents of transgression, of course – have helped ensure a ‘buffer’ for health-care providers and the establishment to try and delay the process of a community spread to a large extent.

Two areas of concern

Yet, there are primarily two areas of concern right now: One is behavioural, the other pathological.

Lockdown and social distancing have helped keep a virulent community spread of this pandemic at bay to a large extent. However, that should not lull one into complacency, thinking that the ‘curve’ has indeed been ‘flattened’. Though no figures were issued by the All India Institute of Medical Sciences until Saturday, according to unofficial estimates, it is now taking about ten to 12 days for the number of positive cases to double in India. Had a lockdown not been in place and social distancing not been practised at all, this two-fold increase in positive cases would probably have been reached in less than three to five days by a very conservative estimate.

The Indian paradigm

To put things in perspective, according to a study conducted by Imperial College London, without a lockdown, the United Kingdom and United States would have reached peak mortality in about three months. Meaning, that in about three months’ time, 81 per cent of the population of UK and US would have been infected by coronavirus, with the death toll reaching 510,000 in UK and 2.2 million in the US. In contrast, by isolating the confirmed and suspected cases and by ensuring some degree of social distancing, ‘the peak critical-care demand’ could be reduced by two-thirds in these two countries.

The same paradigm applies to a country like India as well.

So, there is a behavioural angle to this crisis that can be addressed through effective lockdowns and social-distancing norms - but only up to a point, as India is fast realising.

Scary economic data

Which brings us to the second area of concern – and that is more of a pathological factor. For a nation of 1.3 billion, a lockdown is more of a paracetamol – a tool to fight the symptom, not the disease, but a potent tool nonetheless.

According to the International Labour Union’s India Labour Market Update of 2016, more than 82 per cent of India’s entire workforce is employed in the unorganised sector. The Periodic Labour Force Survey of 2017-2018 says that even among regular salaried workers in the non-agricultural sector, 71.1 per cent had no written job contracts, 54.2 per cent was not even eligible for paid leave and 49.6 per cent had no access to social security benefits.

These were the data during normal times, with no major social or economic upheaval rocking the boat.

Now imagine the situation during a lockdown that is already in force for nearly two months. According to the Centre for Monitoring Indian Economy, by the end of last month, more than 122 million people had lost their jobs in India owing to the coronavirus crisis – 75 per cent of them being small traders and daily wage earners. The Hindu newspaper cited economic data on May 7, saying that the average employment in India reduced from an estimated 404 million during 2019-2020 to 282 million in April 2020. Likewise, the India Manufacturing Purchasing Managers’ Index fell to 27.4 in April 2020, from 51.8 during the preceding month.

The moot point, therefore, is that a lockdown for an indefinite period is bound to take its toll in sheer economic terms and the ramifications of such a debacle have already begun to be felt across boardrooms and kitchens alike in India!

So what is the way out of this mess?

According to a section of medical experts, while most of us are now aware of what a pandemic entails and have taken it in our stride, it is perhaps time to steel ourselves to the next inevitability – the natural progression from a ‘pandemic’ to an ‘endemic’.

Producing antibodies

Many medical experts based in India are of the opinion that while lockdowns and social distancing can and do help in reducing the rate at which a contagion engulfs a population, given the speed at which this novel strain of coronavirus has spread across the globe, the only way in which the scourge can be tackled is by allowing ‘herd immunity’ to set in among the community. This is particularly true for India because given the size of the country and its limited health-care infrastructure and man-power, until and unless a vast section of the population starts producing antibodies to COVID-19 by natural means and starts fighting the disease by developing immunities as a community, no amount of lockdown can ever offer a long-term and definitive answer. People who successfully develop immunities to this novel strain, will act as the most effective shield between the infected and the non-infected and thereby help break the ‘chain’ of contagion in the most definitive terms. Just like the way the human body has developed immunities to polio and tuberculosis.

One to 4,000 - in a month

To further explain the point, some experts have cited the fact that unlike a virus like say Ebola, which had a much higher death rate, the mortality rate from coronavirus infection is still quite low. Usually, viruses that are more deadly, like Ebola, tend to die along with the victim. This reduces the possibility of the infection being passed on to a second or third person. In comparison, coronavirus can spread to a far larger number of people within a much shorter time span. According to one study, one coronavirus-infected person can pass on the virus to approximately 4,000 within a month.

With no vaccination still in sight and with Asia’s third-largest economy already feeling the heat from an unprecedented lockdown, it’s herd immunity that could possibly hold the key to a long-term panacea.

Make-or-break time

How well India walks that tight rope is anybody’s guess right now. Let’s not forget the instance of the UK that had initially relied on ‘herd immunity’, though its health-care sector was not really equipped to handle an exponential rise in patient numbers. So it had to fall back on lockdown.

In India’s case, by and large, the lockdown came at the right time, but now it’s make-or-break time. A partial easing of lockdowns is perhaps the first calculated step in exposing the population towards developing herd immunity. The country has so far played it by the book and managed to keep the battleground from being overwhelmed, but the next couple of months hold the key to winning the war.