India’s doubling rate, remarkable spread containment: WHO Special Envoy Covid-19

British physician David Nabarro was named as one of six WHO special envoys at Covid-19 in February. (Photo: Twitter / @ davidnabarro)

David Nabarro, a British physician and public health expert, was named in February by the Director-General of the World Health Organization as one of six special envoys on Covid-19 disease. Its tasks include providing strategic advice to countries and participating in high-level political advocacy on the disease.

In this interview with Amitabh Sinha, Nabarro gave his assessment of the Covid-19 situation in India, the success of India’s containment strategy, and the key steps needed in the coming days. He said he had not seen any vaccines to help humanity before the next two years, and that it was crucial that countries and people learn to live with the virus for at least that long.

Edited excerpts:

Q: When you look at the numbers for India, what are the key indicators you look at to get a better idea of ​​the country’s situation? What are the indicators that best summarize the current state of India?

Nabarro: Of course, a lot depends on how many tests are done. If generalized testing is done, then the number of positive detected cases is very helpful. If not many tests are done, then it is necessary to use other indicators of the disease, such as the number of people who are not well and who go to health centers, the number of deaths that are reported, etc.

One of the things that I watch from your country is to double the time of the number of cases. I found out a few days ago, the doubling time in your country seems to be about 11 days. That is very good information because what we know from other places is that if this virus does what it wants to do, and there is no effort to limit transmission, then the doubling time is about two and a half days. . So if you have an 11-day doubling time, then what it means is that the streaming opportunities have been substantially reduced.

Two things become apparent. One is that it shows the effort to find and isolate cases, track contacts, and quarantine them. That has an immediate impact on the interruption of the transmission. The second thing it shows is that the movement restriction has been effective. Because if you can restrict movement, you reduce the number of people who come into contact with a person with the disease.

So this combination of transmission interruption and movement restriction seems to be having a really powerful impact. Because a doubling time of 11 days is quite remarkable. It means that there has been a real effort, and a successful effort, to stop the spread of this virus. So I have been saying that I see signs of incredible achievement in a country that is normally very populated in urban areas, and there is a lot of movement.

The second thing I want to know is where exactly the virus is located. The virus is found in Maharashtra, particularly Mumbai, Gujarat, particularly Ahmedabad, New Delhi, and urban areas of Rajasthan and Tamil Nadu.

Now, at the start of the Covid outbreak, the virus is expected to be found virtually in urban areas, because people who arrive in the country largely import it by plane. In India, even two months after the outbreak or more, it is surprising that early data suggests that the virus remains fairly well localized in urban areas.

According to the data, I heard that out of 750 districts in India, there are currently no viruses in 450. You are telling me two things. One is that India managed this disease quite effectively from the start, and secondly it managed to restrict the spread of the disease to a relatively small number of urban areas.

Now, as movement restrictions are released, and people start moving again, more outbreaks are inevitable in some places. And that would require that this now very well-organized government response be ready for it. You have to suppress new shoots very quickly.

The second is that the disease is currently in very densely populated areas of these cities, and I think it is really difficult to manage containment in densely populated areas. We are discovering all over the world that all of the Covid transmission accumulates when there are people around. So in settlements that are overcrowded, like in parts of Mumbai, or parts of Delhi or Ahmedabad, interrupting transmission and then suppressing outbreaks is absolutely difficult. And I think we are all observing and learning from what is happening in India, particularly in these densely populated areas. There is no magic solution.

I mean, let’s take the example of Singapore. They have contracted the virus in very dense worker settlements. And Singaporeans are having to put in place a very intense isolation and quarantine program. And I think even then they find it difficult. So this is one of the difficult things that almost all countries are struggling with right now.

So when I look at India what I find is that it is working very well by containing the virus and stopping its spread. It has had a huge cost, of course. There are massive economic costs to prevent people from moving … it’s huge. But at least it has managed to contain the virus, although it still has problems in these densely populated areas.

Dr. Nabarro said he was impressed by the efforts to try to support poor people trapped between cities and their places of origin.

But I am totally impressed by what I see being done in the cities I spoke of, what is being done across the country, the efforts to try to support the poor people who are trapped in many places, between the cities and their homes. places. I understand that there are tens of millions of people trapped. It is just a massive human challenge. And from here, all I have to say is that I’m constantly impressed. I have no other word to say it because it is a great challenge.

Q: The epidemic seems to have ended in China, at least for now. In many other countries, it seems that the worst is over, while in India it is still starting to get big. Considering its size and population, do you think that India would be the main driver of the new spread of the coronavirus in the coming days?

Nabarro: That’s the kind of question I don’t want to answer, and the reason I don’t want to answer is because I don’t know the answer. I’m just going to say a couple of things. India can live with Covid and can really keep the virus at bay just by doing the following.

One is that every person in the country must be aware of the virus so they know the importance of interrupting transmission as soon as an outbreak occurs. And second, each panchayat and Zilla parishad in India should develop the ability to suppress outbreaks quickly.

That, of course, would have to be accompanied by providing support to the people affected by this repression, because the poor people suffer a lot for it. But having this ability to suppress the outbreak while protecting the poor is the second requirement that India must have.

And if you can make everyone alert by interrupting transmission and having a widespread ability to suppress outbreaks, which would mean restricting movement, but in very local areas, then the rest of society can live, can be happy, can have their job. You can live with this virus in your midst. It is not going to be comfortable, of course, and the first few weeks and months after the closure is over will be difficult, but it is doable. And I think India will because the ability they had on so many issues to organize at the zilla parishad or panchayat level, locally … that’s the key. And I think it is that capacity for organizing at the community level that will mean that India, after a rather rough period, will come to terms with this virus and be able to deal with it.

So I don’t think I’m going to tell you that India is going to be the global driver of coronavirus cases because I’m convinced that India, its people, its local authorities, its state governments, and the federal government, will really find ways to keep at bay this virus.

Q: But what is important, as you say, is learning to live with the virus for at least two years, if not more?

Nabarro: Let’s be clear in time. Of course, all of these people say a vaccine will appear by the end of this year. But having the vaccine does not mean you have gotten the answer to the problem. You must test the vaccine to make sure it works, to make sure it is safe. And there is a fairly large community out there that is very skeptical about the vaccine.

Security is paramount. That means it would be a miracle to have a proven, safe and effective vaccine in less than 18 months. And then you have to manage it for everyone. And we know from episodes of smallpox and polio that global immunization from a vaccine is not easy. It’s a great job.

Dr. Nabarro said in India, even two months after the outbreak or more, it was “somewhat surprising that early data suggests that the virus remains fairly well localized in urban areas.” (Express photo)

So I tell people that if we are lucky, we can have a vaccine and allow people to access it anywhere in about two or two and a half years. If we are not lucky, due to some problems in developing a vaccine, it could take much longer. And we must remember that there is another virus, HIV that causes AIDS, which we have known for about 25 years. And we still haven’t received a vaccine despite spending billions of dollars.

So I am going to emphasize that I am encouraging everyone to think in terms of living with this virus for at least two years. And that applies to all 7.8 billion people on our planet. It will be a universal learning process.

Q: The main argument for imposing a blockade has been that the first priority for any country must be to save lives. When it comes to livelihoods or anything else, there’s little debate about where priority should be. But what if it becomes lives vs. lives? Is there a danger that by imposing a prolonged blockade, we have opened up the possibility of many deaths related to hunger or deaths from diseases related to poverty or stress? Is there a possibility that we could have endangered many more lives than we could have saved?

Nabarro: Let me start by saying that if this virus were allowed to move around the world without any effort to contain it, we believe that a huge number of people would get sick and die. We still don’t fully understand many things about this virus. It appears to be capable of causing more than respiratory illnesses. It is also known to have other impacts. All of us who are working with it, and have also worked with other Coronaviruses, have learned to be extremely cautious with these viruses.

I want to emphasize that there is another key feature about this pandemic. These outbreaks accumulate exponentially. They do not grow linearly. Therefore, the longer you wait to act, the deeper the problem will be. Due to exponential spread, it can increase many thousands of times in just four to five weeks. So honestly, I say to anyone who talks to me that the potential impact of letting this virus spread without trying to contain it is absolutely huge. We have seen what is happening in the United States. It really wouldn’t be feasible for someone with a good conscience to say “Ok virus, do your thing.”

At the same time, I want to make it clear that blocking does not remove the virus. It just freezes the situation as it was. So every time a crash is done, as India has shown, you need to implement all the things you need to defend against the virus, like training everyone on what they are dealing with, educating people, setting up testing virus, make sure hospitals are ready.

There is a large preparatory piece that has to be put together. And for countries like India, which imposed an early blockade, the main reason for the blockade is to stop the spread of the virus as much as possible and to have everything ready so that when the blockade is released you will not feel overwhelmed by the large number of infected patients.

But I would be the first person to also tell you that the blockades are brutal, they damage many things, they damage livelihoods, they also have an impact on other health problems besides Covid, they undermine the national economy. It’s a terrible thing. So for me, the important thing is to get the right health defenses, and quickly, so that the blockage can be released quickly.

Q: China reached about 83,000 cases more than a month ago. It’s been roughly the same number since then. These types of epidemics tend to slow down slowly before ending, while China appears to have immediately and abruptly stopped the epidemic. Chinese numbers surprise you? What exactly has China done to end the epidemic so abruptly, at least for now? Is there any learning from China, especially for a country like India?

Nabarro: I will tell you what I know, when listening to colleagues from China. It appears that China has actually implemented a national network of community health personnel who monitor cases regularly, and is backed by evidence. The moment they find a case, they immediately isolate them. They have really managed to do this well, across the country. This is what they tell me.

Number two, they have really made sure that the entire population knows how serious this is. And number three, they are being very very cautious. Because they know that new people will arrive in the country and are aware that they will receive multiple resurgences. Therefore, they want to be ready to contain them as quickly as possible. I think India will have to do the same. Everyone should know what is going on.

My Chinese colleagues tell me that China has managed to get public health readiness everywhere, across the country. They are so alert to Covid right now that any new case is done really quickly. I think we are seeing the same thing in many other countries as well. And I think that’s what it has to be for everyone too. We would simply have to be alert to disease everywhere all the time.

When I speak to colleagues from China, they don’t think this is the end. They know that they are going to receive more cases because as they open up and start moving, etc., they know that the cases will come back. This is not something that will just go away.

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