War against Coronavirus cannot be won without Data and Information gathering
Some people equate the large scale public health crisis as a war with Coronavirus. A war which requires mass mobilization of healthcare resources and workforce. A war which requires major re-planning of economy, healthcare system and even changing social & cultural habits. But to fight a conventional military war, a country must know and understand the enemy. What is the capacity, strength, behavior and nature of the enemy? Every war is fought on basis of this information and intelligence.
First and foremost, India's response strategy on Coronavirus needs to be based on data. Data about infections, death rate, level of community transmission, percentage of Asymptomatic people etc. And more detailed data in terms of medical research and understanding of Coronavirus like efficacy of drugs & treatment strategies. This Data will become the underlying basis of our response strategy. Hence a large scale testing is the MOST essential requirement for formulating Coronavirus response strategy.
There is some interesting data regarding studies on spread of Coronavirus in communities in various foreign countries as well as in India. These studies now needs to be expanded and further analyzed on larger scale to ascertain newly emerged assertions on Coronavirus spreads. Several studies suggest that Coronavirus has spread much deeper in the communities and most of the infected people are Asymptomatic. Secondly, the fatality rate of Coronavirus is lower than previously anticipated.
We need to carry out a wide scale testings and analysis of data to ascertain degree of community spreading and identify proportion of Asymptomatic people. Also data should be obtained differentiating Pre-symptomatic and Asymptomatic people as explained by WHO. IMCR says that 80% of people are Asymptomatic. Whether they are actually asymptomatic or are pre-symptomatic is not made clear.
Pre-symptomatic patients are those infected people who do not show any symptoms at times of testing but eventually they later develop Coronavirus symptoms. While Asymptomatic people are those who do not show any symptoms of Coronavirus at all and develop anti bodies to the virus without any medical intervention.
Some recent developments.
1. In early days of Coronavirus outbreak in America, Dr Anthony Fauci (leading medical area of Coronavirus Task force in America) was of the view that 25%-50% of the Covid-19 infected patients may are Asymptomatic.
2. There is a Study in Netherlands which postulates that as much as 3% of Population may already be infected, have developed antibodies and most people are Asymptomatic.
3. Even in India where testing is not at a large scale like other western countries, there is a trend of overwhelming majority of infected people being Asymptomatic/Pre-symptomatic. As per initial analysis with limited testing data, as much as 66% of infected people in 10 major states are Asymptomatic/Pre-symptomatic.
Just few days ago, Delhi started random testing in hotspots and found similar trend. 736 tests were carried out and it was found that 25% of people were infected but had no symptoms.
4. Air pollution increases Coronavirus death rate and severity according to a study by Harvard university. Long-term exposure to higher degree of PM 2.5 is associated with a 15 percent increase in the COVID-19 mortality rate.
Some of the implications of these developments
1. A lot depend upon analysis of data on Asymptomatic patients and spread of community transmission. If the Asymptomatic people are 50%-70% of total infected people, then the strategy of lockdown remains the same more or less. But the focus will then be large scale testing, more aggressive contact tracing, identification and quarantine as identifying Asymptomatic people will become more difficult. But suppose if Asymptomatic patients are like 90% or more of total infected people, then we need a rethinking of our Lockdown strategy. It must be noted that Lockdown comes at a great economic cost and specially for country like India where millions of people don't have food security. So we need to steadily reopen our economy with a response strategy of more targeted protection of vulnerable segment of population rather than shutting down the whole country. If proportion of Asymptomatic people is significantly higher, then it means that Death rate is much lower and hence the risk posed by virus is lower.
2. In case, the community transmission is already widespread with large scale Asymptomatic people say 10 times or more than detected cases. Then, we may eventually reach Herd immunity (at least 60% of people with immunity) sooner than we thought. Ideally, we wanted Herd immunity with vaccination but we may to arrive at Herd immunity by infection in case the fatality rate is very low (much lower than 1%). But other thing that needs to be considered is re-infection and relapse of Covid-19 in cured patients. Such things are happening in several countries and this issue is presently a subject of much research and analysis.
3. The dynamics of ventilators and other medical supplies will change. If vast majority of people are Asymptomatic, then they don't need medical treatment and ventilator support as we anticipated earlier. Ventilator supplies have been a very concerning issue for country like India which has scarcity of resources. Another hint that we may need lesser ventilators than previously estimated is the situation in New York & other big cities in America (which is presently the center of this Pandemic). Cities like New York etc were anticipating a higher number of ventilators, but fortunately they managed to get past the peak of the crisis with lesser resources. So we may need to reassess the calculations of medical resources required to deal with this crisis.
4. Coronavirus Death rate correlation with High Air pollution is a concerning issue for India as India has the most polluted cities in the world. So more studies and data needs to be compiled on impact of Coronavirus in cities like Delhi NCR which have very high Air pollution.
Data and information gathering is the most critical step of fight against Coronavirus. Without this data, we will be sleepwalking into this national crisis without any clear policy. A preliminary large scale random testing and hotspot testing is necessary to make initial assessment of the situation. Antibody testing for screening and initial assessment should be done followed by building a robust national testing system which can test at least a million samples every day keeping a long term view of the crisis in mind.
First and foremost, India's response strategy on Coronavirus needs to be based on data. Data about infections, death rate, level of community transmission, percentage of Asymptomatic people etc. And more detailed data in terms of medical research and understanding of Coronavirus like efficacy of drugs & treatment strategies. This Data will become the underlying basis of our response strategy. Hence a large scale testing is the MOST essential requirement for formulating Coronavirus response strategy.
There is some interesting data regarding studies on spread of Coronavirus in communities in various foreign countries as well as in India. These studies now needs to be expanded and further analyzed on larger scale to ascertain newly emerged assertions on Coronavirus spreads. Several studies suggest that Coronavirus has spread much deeper in the communities and most of the infected people are Asymptomatic. Secondly, the fatality rate of Coronavirus is lower than previously anticipated.
We need to carry out a wide scale testings and analysis of data to ascertain degree of community spreading and identify proportion of Asymptomatic people. Also data should be obtained differentiating Pre-symptomatic and Asymptomatic people as explained by WHO. IMCR says that 80% of people are Asymptomatic. Whether they are actually asymptomatic or are pre-symptomatic is not made clear.
Pre-symptomatic patients are those infected people who do not show any symptoms at times of testing but eventually they later develop Coronavirus symptoms. While Asymptomatic people are those who do not show any symptoms of Coronavirus at all and develop anti bodies to the virus without any medical intervention.
Some recent developments.
1. In early days of Coronavirus outbreak in America, Dr Anthony Fauci (leading medical area of Coronavirus Task force in America) was of the view that 25%-50% of the Covid-19 infected patients may are Asymptomatic.
2. There is a Study in Netherlands which postulates that as much as 3% of Population may already be infected, have developed antibodies and most people are Asymptomatic.
3. Even in India where testing is not at a large scale like other western countries, there is a trend of overwhelming majority of infected people being Asymptomatic/Pre-symptomatic. As per initial analysis with limited testing data, as much as 66% of infected people in 10 major states are Asymptomatic/Pre-symptomatic.
Just few days ago, Delhi started random testing in hotspots and found similar trend. 736 tests were carried out and it was found that 25% of people were infected but had no symptoms.
4. Air pollution increases Coronavirus death rate and severity according to a study by Harvard university. Long-term exposure to higher degree of PM 2.5 is associated with a 15 percent increase in the COVID-19 mortality rate.
Some of the implications of these developments
1. A lot depend upon analysis of data on Asymptomatic patients and spread of community transmission. If the Asymptomatic people are 50%-70% of total infected people, then the strategy of lockdown remains the same more or less. But the focus will then be large scale testing, more aggressive contact tracing, identification and quarantine as identifying Asymptomatic people will become more difficult. But suppose if Asymptomatic patients are like 90% or more of total infected people, then we need a rethinking of our Lockdown strategy. It must be noted that Lockdown comes at a great economic cost and specially for country like India where millions of people don't have food security. So we need to steadily reopen our economy with a response strategy of more targeted protection of vulnerable segment of population rather than shutting down the whole country. If proportion of Asymptomatic people is significantly higher, then it means that Death rate is much lower and hence the risk posed by virus is lower.
2. In case, the community transmission is already widespread with large scale Asymptomatic people say 10 times or more than detected cases. Then, we may eventually reach Herd immunity (at least 60% of people with immunity) sooner than we thought. Ideally, we wanted Herd immunity with vaccination but we may to arrive at Herd immunity by infection in case the fatality rate is very low (much lower than 1%). But other thing that needs to be considered is re-infection and relapse of Covid-19 in cured patients. Such things are happening in several countries and this issue is presently a subject of much research and analysis.
3. The dynamics of ventilators and other medical supplies will change. If vast majority of people are Asymptomatic, then they don't need medical treatment and ventilator support as we anticipated earlier. Ventilator supplies have been a very concerning issue for country like India which has scarcity of resources. Another hint that we may need lesser ventilators than previously estimated is the situation in New York & other big cities in America (which is presently the center of this Pandemic). Cities like New York etc were anticipating a higher number of ventilators, but fortunately they managed to get past the peak of the crisis with lesser resources. So we may need to reassess the calculations of medical resources required to deal with this crisis.
4. Coronavirus Death rate correlation with High Air pollution is a concerning issue for India as India has the most polluted cities in the world. So more studies and data needs to be compiled on impact of Coronavirus in cities like Delhi NCR which have very high Air pollution.
Data and information gathering is the most critical step of fight against Coronavirus. Without this data, we will be sleepwalking into this national crisis without any clear policy. A preliminary large scale random testing and hotspot testing is necessary to make initial assessment of the situation. Antibody testing for screening and initial assessment should be done followed by building a robust national testing system which can test at least a million samples every day keeping a long term view of the crisis in mind.
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