Nothing more than R=0 & P=0

FEBRUARY 2021 Download this Article

When should India lift all COVID-19 Restrictions?

In a standard definition of epidemic, the factor of R<1 means receding rate of infection.

R=0 is the most optimal solution, which everyone would like to achieve but failing to get R=0 will continue to bring cases of COVID. We have seen this cyclical surge in many countries as R varied.

The speed of contagion is another uncontrollable risk. Like the Korean patient 31 (P=31), only 1 patient (P=1) can affect an entire city or country. Hence, no government across the globe have been able to measure R precisely.

Also seen is the voraciousness of South African and Brazilian variants.

None on this planet remains unaffected. Most countries are in a lockdown, partial, complete, or operating with restricted movement of people. In future, too, we all have the potential to infect each other. Since it is just not limited to one country like Ebola, COVID is different from any other contagious diseases.

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Economic considerations are proving to skew decision making in lifting restrictions. Fully reopening will increase human interactions without a doubt. In countries like India, social distancing measures are not fundamentally workable. 

Large population live in exceedingly small and congested areas. Families are large and live in proximity. As a lifestyle, the risk of contagion is exceptionally high. 

Starting with examples from the national capital city of Delhi, where 50% of the population lives in ‘kachchi’ colonies (Unorganised Dwellings), to business capital Mumbai, where 99% population lives in tower blocks, personal physical space is a serious concern. 

These are places of high-density population and hence highly susceptible to contagion. Mumbai has been in red all this while, and the current resurgence is proving this theory right.

In a typical Indian society, social interactions are high. On an average middle-class family, interacts with 10 – 15 outsiders per day, going upwards.

 For those who are travelling to work, the interaction is much higher. Could be even hundreds in marketplace and business areas like Chandni Chowk, Karol Bagh, APMCs, Crawford, or even a small town's common vegetable market. So how can an integral part of Indian society be curtailed?

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Places like Dharavi of Mumbai are prevalent in all large cities of India. Typically, families living here come together only during the night to sleep in a single room. 

There are community toilets, and bathrooms are in the open air. Social distancing and sanitizing these areas are complicated. We should also understand that the population from these areas works in factories, offices, and households. 

It will not be wrong to assume that they are formidable frontline workers. So, they carry a risk of being infected and being super spreaders.  

Top it up with the general discipline of India, which is on the lower side of compliance. There are many factors responsible, but mostly, it is economic compulsions. 

The world has seen migrant workers leave their houses and work in cities. The exodus of millions was a result of the financial distress faced. The authorities' assurance was not enough to stop crowds of migrant workers and their families from walking hundreds of kilometres to reach their villages. Sadly though, many could not make it.

En-masse reverse migration is due now. Once the population starts to intermingle nationally, it would take just an asymptomatic patient (P=1) to restart the contagion.

There has been discussion about immunity passport and temperature check before intercity travel.

It is not a valid method, as it only applies to those who are currently active patients but not those who are incubating COVID. Suppose a passenger undertakes a 24-hour train journey between Delhi and Mumbai. 

Those crucial hours are good enough to start the contagion, even though the passenger passed the temperature check at the departure. How many passengers can our system check on arrival in a city? The same check-in and check-out system need to be setup at all city limits. A gigantic setup that I think is impractical for the size of India.

Currently, the cases of COVID in India rising again. Starting June, with monsoon onset, a large population’s general immunity will be negatively impacted. It is a known fact. We might then see a spike of cases also.

Till now, scientifically, we have no data on how long does COVID immunity last. Relapse of infection is not guaranteed.

To fully reopen India, what should be the value of R & P?

The only way out to preventing repeated lockdowns or outbreaks is to get R=0.

Since the population is large, a small value of R in India makes a large P (population) value. In rural areas, neither the health care system nor public administration is adequate to manage those volumes of COVID infections. Hence a meticulous approach is required to prevent disease rather than cure.

It would require more testing. A daily testing kit is the need of the hour, which people can use before leaving their homes.

India can be micro-monitored at pin code level as islands. For each island, R & P needs to be determined. Anything above 0 should bring the island into isolation. For the next three months, these islands must report a contagion of R=0.  And then combine those small islands into larger islands, snowballing into the entire nation.

The same can be inversely true. Any new case and that island needs to go back to restrictions and isolation. 

Any reopening without micro-level monitoring and localised R and P measurement will again result in an uncontrolled spread.

Even R=0.5 sits on a potential contagion in a country like India.

Many governments across the world have told their citizens about the compulsive coexistence of humans with COVID. Again, for India, this is not a viable solution. Indians generally move around for daily business, undertaking travel across localities, cities or countries.

 So, stay at home and cities in lockdown is not going to work for India, where more than half the population is dependent on daily wages and micro businesses.

Within India, public transport is a significant mode of travel. Travelling in public transport with suspected P=1 will bear heavily in national psychology. 

Loss of confidence in their well-being and the constant threat of infection and death will be more harmful than actual lockdown. Who would like to live in a society with fear of COVID deaths or illnesses?

Everyone is waiting for their COVID vaccination. While there are many available today, a well-tested vaccine is two years away at best.

But, like smallpox, COVID too must see its end with R=0 with P=0.

Meanwhile, the administration needs to be ready to lift and reimpose partial restrictions efficiently, lockdowns locally or city-wise if necessary. It is another complicated process and needs mastering with every cycle.

Last but not least, the only solution lies with immunity. The population need to build natural immunity to fight off COVID using a healthy lifestyle.

The government must release guidelines for healthy eating and living to make stronger citizens. Only then can COVID be ward off and fully restart India.

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