Would the strategy to get ‘zero’ covid infection for a safe living be practical? Or living with the virus like the ‘seasonal flu’ be viable? The authorities in countries, such as Australia, New Zealand, South Korea and Singapore, aspire for zero virus approach, while Israel, UK, US and European countries have ventured into trying an alternate option, called, ‘soft suppression [1]’.

What is soft suppression? Adjust its safe management measures in stages, subject to trends in serious cases. This could mean fewer restrictions on social gatherings, larger dine-in groups and lower requirements and higher capacity for events. Vaccinated individuals will be able to engage in a wider range of social activities and in larger groups, while unvaccinated individuals may only do so with negative pre-event testing results. Practically all social and workplace restrictions can be lifted, although some critical measures, such as mask-wearing and precautions for large events may remain.

If the incidence of severe illness from COVID-19 remains low despite clusters emerging from time to time, one would eventually be able to arrive at a truly endemic state. This would be the roadmap of transitioning to a “Covid-resilient” society in which the virus is part of daily life.

Israel is the first country to embark publicly on this new strategy, ‘soft suppression’ for life in the era of coronavirus, based on the assumption that the pandemic is here to stay but can be managed with minimal damage to the economy. This involves issuing ‘green pass’ to those vaccinated or with negative RT- PCR for any indoor gathering or immigration into the country! Knowing that the virus has an incubation period of at least a week, is it not a risk to allow passive carriers that could potentially initiate super spreader events? Yes.. but it is a calculated risk! How?

Not that it would be zero cases! But the cases would not raise very much and would be within manageable limits. This is based on the fact that the world is no more the same like the one last year at the peak of the pandemic when the cases rose exponentially sharply. Now there would be many around who had developed immunity due to infection and many more with vaccination! Is it not a safer world now? If a large population have antibodies, the chances of spreading the infection is that much less! This can be achieved either by vaccination or by natural infection. Sero survey is a cost effective method to assess the fraction having antibodies. The assessment is done by identifying presence of covid-19 antibodies in the blood samples. Those who are sero positives, even if they are exposed to infection would not be infected. If a large fraction is a community are sero positives, the infection not only would not spread but ultimately would die out. A quantitative number to achieve this state is not yet available for covid, though it is expected to be higher than 75%.

For example, a sero survey conducted in June in Ahmedabad city municipal corporation (AMC) in India, with a population of 7.5 million, showed 81% sero positivity [2]! Even though, when the survey was done it had hardly vaccinated less than half its population even once. The presence of antibodies in such high fraction could only be explained by massive natural infection in the second wave in late March- April.

It has also been reported that these antibodies detected in sero surveys wane over time but the resistance to the infection is sustained with the cell mediated immunity; studies have shown such protection could even last for one’s life time [3]. Studies indicate that the adeno type vaccines, such as Asteazenica, JJ and Sputnik, would provoke stronger cell mediated responses than the novel mRNA type vaccines!

In the case of AMC, it was found around 30% of those who had past infection did not show antibodies in earlier surveys. Thus the fraction with cell mediated immunity could easily add an additional 10 to 15% to those detected to be having antibodies in the present survey, making the total up to even 95%! It does reflect in the daily number of new cases which has fallen steeply from a peak of 5500 in late April to double digit by June itself and to a single digit soon thereafter! There is no lockdown in this city presently. Not even 60% of the population have received the jab even once as of today! The city has been logging in single digit daily cases for over a month indicating ‘herd immunity’!

In contrast, those states that have lower sero positivities are struggling to bring down the case numbers: for example, in another Indian state, Kerala, only around 45 per cent people have developed antibodies against the national average of 67% in a survey conducted in late June [4]! Only around 40% have received at least one jab in this state till now. Even then, test positivities continue to hover over 10% for over a month even now. Kerala pursued aggressive contact tracing policy through which it could bring down the daily case numbers during the peak of infection but the flattening has been found counterproductive as it has dragged the duration of the menace! A state which was patted for effective management of the infection last year, is paradoxically the only Indian state, that is struggling to bring down the cases!

Obviously the lesson, to those countries trying to drive away the virus by draconian lockouts, is to adopt ‘soft suppression’ and get on to live with the virus! Especially when vaccination is aggressively being pursued and are with over 70% sero positives. Singapore would soon embark on this strategy given its high vax compliance [5].

Credits:

1. https://www.timesofisrael.com/new-government-said-to-unroll-soft-suppression-strategy-on-resurgent-pandemic/

2. https://www.thehindu.com/opinion/lead/a-serosurvey-template-for-the-whole-of-india/article35499672.ece

3. https://www.nature.com/articles/s41590-021-00969-3.pdf?fbclid=IwAR3qvHT2wM6JU2bQPWtZAYFS9QOAfiNSmwD9SoUy2YBtJecn1D06CKzc1yQ

4. https://www.onmanorama.com/news/kerala/2021/07/23/sero-survey-kerala-45-percent-have-covid-antibodies.html

5. https://www.livemint.com/news/world/singapore-will-progressively-open-international-travel-amid-covid-minister-11627294725024.html

Ramdev’s acrimonious encounter (1) with Indian Medical Association: is there a need to deride other systems of medicines than the one you are trained? Yes, only to those practitioners who are threatened of their livelihood by the competitors and would thus wish to scuttle their business by sullying them; But for those, who suffer from ailments, it does not matter who cures, the ones that ‘would’ cure is the most sought after!

Many a times, it is by the word of mouth (and now social media) that picks up the better ones. How else can one explain the crowd that thronged (2) in ‘krishnapatnam’ village near Nellore district in AP, hearing a wonder cure ‘eye drops’ for covid? There were many, reportedly even with oxygen support, waiting in ambulances, leaving their ICUs, among the thousands that swarmed to get this ‘traditional’ preparation! Does it not show the extreme distress? People are driven from pillar to post with the sole objective of ‘எத்தைத்தின்னால் பித்தம் குறையும்’ syndrome!

Being an ardent follower of Homoeopathy over three decades, I am witness to many wonder cures for melodies such as jaundice, shrilling cries and tantrums of babies, mental depression, etc., that allopathy could not alleviate! There are countless cases of reliefs using Ayurvedic treatment, like the one for joint pains. My chronic Achilles tendonitis, of heel for which I was advised surgical procedure as the possible cure, could get relieved with Chinese foot massaging! I would only advocate an open mind for any ailment! Human body has evolved over eons with checks and balances, which is difficult to decipher by any one completely as yet!

Unlike the west, the east and far eastern civilisations, that dates back to centuries, have a host of concoctions to offer for any ailment. Many a times, it is wholistic unlike the ‘modern’ system that primarily relies on ‘signs and symptoms’! Though these old systems have survived centuries with unrecorded successes, acrimonious challenge by the evidence based allopathy, continue to bewilder the empirical evidences by the legions of these traditional medicines. I do not know, why?

With seemingly a large understanding of the genes in the recent times, people tend to arrogantly believe, there is cure for any melody; they can even deliver ‘designer babies’ meeting the required ‘specifications’! I would not be surprised if one day we end up in ‘Frankensteins’ through this genetic engineering, that has entered into therapeutics; fortunately this research is either banned or restricted in many ‘saner’ countries! Who knows – even covid virus might have been an outcome of one such research!

The audacious front line researchers of the cutting edge research apart, there are a still quite a few medical practitioners who understand the limitations of their own system and do not mind advising the “goods” in the other; leave alone some of them even furtively ‘cross’ prescribing, though it may be a ‘bitter pill’ to swallow for the ‘purists’!

This puddled topic reminds me of a sanskrit satirical verse by Neelakanta Dhikshidar who lived in the 17th century, in his ‘kalividambana’ on doctors:

that translates roughly into: ‘A doctor can treat a patient as he likes but he should prescribe strict diet restrictions. If restored to health, the credit goes to the treatment and if otherwise, the blame can be passed on to non adherence of dietary regimen’. To be precise, you can continue to be a successful doctor, once you know how to coverup the failures!

Is this not true even today? Does this not depict the present dilemma of the society?

Credits:

1. https://youtu.be/tIxlH0JOoUA

2. https://youtu.be/CcZE0ofp7R4

A few small countries have claimed near normalcy while a few bigger ones have feigned the same by unmasking, even-though the infection has not really abated. As per WHO guidelines, a country is considered infection free only when, no single case of new infection is reported for two incubation periods. That is, zero case for a month or so. This must be when no external constraints are in force for mobility and social gatherings. It doesn’t appear so anywhere in the near future.

Festivals, travels and elections are common activities of any free country in today’s world. Majority of the population engage in these activities in normal life, but these routines do not appear to be in the horizon.

For example, consider some of the recent election exercises: US had one to choose its president in the fag end of 2020. Neither the pandemic nor elections deter with the presence of each other. USA never had a relapse from infection ever since its onset in early 2020 is another story. Elections too were held in the four major states in the more populous India in April 2021. While the numbers in India were indeed quite low in March 2021- real bottom of the wave at less than 10000 cases a day, 10% of the September, 2021 peak! TPR, the test positivity rate, also was quite low, at less than a few percentage. In April 2021, it had a phenomenal raise during the busy the multiphase schedule. The election mela ended in 2nd May; the peak of the second wave in the country was on 13th May, after a typical ten day incubation period of this virus. Look at the numbers today when many states are still under lockdown: 70% of the daily infection of the country’s 220 K, is from six states, three of the four states that had elections are in the list. Only Karnataka, Maharashtra and AP being outliers – Have they paid the price for being close neighbours?

Now take the case of festivals: How come the kumbmela states, UP, Uttarakhand are out of the woods so quickly ? The congregation should have contributed to the infection as much as election bound states – but didn’t.. why? would it have been the large scale testing that could have led to scuttling of the menace? could be! UP tests over 3.2 lakhs a day even today and it’s positivity (TPR) is less than just 1%. Even at its peak of infection the TPR was not above 18%. Uttarakhand Could keep its positivity at its peak below 24%; today it is at less than 8%. Both the states had peaks around 10 days after the festival time.

Why the election bound states could not manage well? Poor testing? For strange reasons, the authorities did not comply to the warnings to ramp up the testing in TN, Kerala, WB and are paying a heavy price now. TPRs were all above 25% and sometimes dangerously even close to 30%? WB even today continues to be well above 25% while others are just less than 20%!

Conclusion is any congregation would contribute to a wave; no doubt! As long as there is any remnant of live virus around, there is a looming threat! From the experience of Mar-May 2021 period, it can be safely concluded that even a TPR of less than 1% in random testing would not guarantee a threat free world! Till immunisation of the whole public is done like in small pox, the threat would continue: virus would not only thrive, but mutate and can potentially become resistant to the existing immunity!

Kiran Majumdar, the chairperson of Biocon, tweeted, “The vaccine situation in India is like arranged marriage. First u r not ready, then u dont like any, then u dont get any”!!

Health minister Dr Harsh Vardhan, responded equally sportively, ‘everybody will get their match, soon’.

What is the ground reality?

Out of 35 crore Indian population in the 45+ segment, more than 11 crore have been already vaccinated at least once, which is a significant 30%! Assuming only 60% are either willing or targeted to get vaccinated, central government has to plan for another 11 to 12 crore which is quite doable in the next three months at best, considering the production capacities of Indian suppliers and the commitments by way of advance payments of purchase orders. This would largely protect the most vulnerable population in the quickest feasible time period. The increased gap between the jabs is a blessing in disguise.

This leaves 59 crore adult (18 to 44) population, that is left to the responsibility of states. The immunisation program for this section has taken off in a subdued way since the beginning of this month, and till now 50 lakh or less than 1% have taken the jabs, in the last 15 days. It is quite likely that a significant fraction would have already had asymptomatic infection and have antibodies, since they unmindfully venture out often even during lockout periods.

Though health is a state subject, centre has proactively pushed the vaccination program and has set in place a system. The state leaders who engage in slanging matches have the responsibility to vaccinate only this segment of population. With the liberalised policy, a fraction of this population would anyway get vaccinated by their employers and the affluent few who can afford can pay for the jabs in comfort. Those elites who have faiths only in the latest western technology as reliable and safe compared to the ‘under developed local varieties’ can prefer Pfizer or Modena at a cost! This apart from satisfying their ego would also relieve the states’ responsibility and burden to an extent.

This young adult population, being active in the social media, embarks itself into dictating terms with the ever willing anti-government bought out press, which is apparently irrational. There is no need to issue a global tender for foreign vaccines. The government can collectively bargain for the best reasonable price as these vaccines cannot be procured on lowest bidder basis!

The global tendering by some states is either ill-conceived or knee jerk reaction or playing to the gallery!