India needs to revise COVID-19 response strategy, flag experts

According to experts, India should move beyond testing and tracing as its strategy for containing the COVID-19 pandemic, and focus on monitoring hospital admissions and virus behavior.

The positivity rate for COVID-19 in India has risen sharply in recent weeks – from 0.6 percent in early June 2022 to 3.94 percent on June 22, according to data from the Ministry of Health.

Despite this, the country’s daily tests remained in the range of 200,000-300,000, occasionally peaking to around 400,000.

However, the current positivity rate is still below the five percent threshold set by the World Health Organization (WHO) for measuring whether the pandemic is under control.

Deaths and hospitalizations have not yet reached alarming levels, an analysis of government data shows.

In these circumstances, testing and tracing is no longer our way out of the pandemic, experts argued. It’s time for India to rethink its COVID-19 response strategy, which aims to protect the vulnerable, they suggested.

Chandrakant Lahariya, a public health analyst and epidemiologist, told: Down To Earth (DTE)

The classification in terms of epidemic or endemic is more just of academic relevance. What is more relevant is that COVID-19 in India is no longer a public health problem. Therefore, the government-recommended ongoing strategy of “testing, monitoring, treating, vaccinating and coviding appropriate behavior” should be reviewed.

“Since testing and test reporting has now become less systematic in the country, the emerging numbers have become increasingly difficult to interpret,” Satyajit Rath, an immunologist and visiting lecturer at the Indian Institute of Science Education and Research in Pune, said. DTE

But indicators such as the positivity rate and hospital admissions are not yet alarming, according to public health experts.

Gradual shift

Contact tracing guidelines were relaxed in January 2022 when the Indian Council for Medical Research (ICMR) stated that asymptomatic contacts of those who tested positive for the SARS-CoV-2 virus no longer need testing unless they fall under the risk category based on age or co-morbidities.

The move was praised by experts. “It’s no longer about finding and testing everyone who has been in contact with a COVID-19-positive person,” said Gagandeep Kang, a virologist at Christian Medical College-Vellore. told DTE earlier. Her rationale was that we already miss nine out of ten asymptomatic infections.

K Srinath Reddy, president of the Public Health Foundation of India, agreed, arguing that the treatment remains the same – isolation, wearing a mask and physical distancing – as a test result has little clinical relevance to this population.

In addition to India’s testing and tracing efforts, the country’s vaccination campaign has also changed in recent months.

More than 1.96 billion doses of vaccine were administered as of June 22, according to government data. Of these, 1,014,916,146 were first doses and 906,949,409 were second doses.

In itself, the absolute figure is large, but primary vaccination has now stalled and booster dose absorption is poor.

By April 7, India had completed the initial vaccination protocol for 60 percent of the eligible population. Nearly three months ahead, the figure rose to just 65 percent on June 21, according to Our World in Data.

The trend is similar for the proportion of people who have received at least one dose. The stock rose just 10 percentage points since January 5 and was 72 percent on June 21.

Booster doses per 100 – which began administration on January 10 for health care workers and frontline workers and comorbid people aged 60 and over – was only 2.91 on June 21, despite everyone over 18 now taking it nine months after completing initial training. qualifies for. vaccination.

“We’ve also lost momentum with vaccination campaigns and since vaccines protect against serious diseases, but not so much against transmission of infections, (it allows) newer transmissible variants to appear quite quickly,” Rath said.

It is clear that both communities and governments have now abandoned all physical distancing measures for all intents and purposes while the virus is still circulating, he added.

Kang believes it is time we change our understanding of what constitutes COVID-appropriate behavior. When a population is vaccinated or heavily infected, which is now the case in India, we don’t have to worry so much.

“Now we don’t have to follow cases but hospital admissions. We need a deeper dive in terms of how the virus infects the body, understand the clinical picture, which variant causes what, who gets admitted (unvaccinated or not, which vaccine),” she said. DTE

This is the kind of information we should be collecting now, as infections will continue to happen. COVID-appropriate behavior should be applied whenever a new variant emerges, Kang said.

As the pandemic evolves, each country will have its own pattern. “The current rise in cases is somehow an artificial spike, as long as it doesn’t put people in the hospital,” she said. What’s an increase if 90 percent of hospital beds are empty, she asked.

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