Target those who might die due to COVID-19, say experts advising India to shift focus of testing to ‘mortality rate’ from ‘infection rate’

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Target those who might die due to COVID-19, say experts advising India to shift focus of testing to ‘mortality rate’ from ‘infection rate’
People wait to receive free food at an industrial area, during an extended nationwide lockdown to slow the spreading of the coronavirus disease (COVID-19) in New Delhi, India, April 23, 2020. REUTERS/Danish Siddiqui
  • Infections will rise but deaths must not and therefore testing should focus on the more vulnerable people.
  • Testing in the initial part has the same purpose as the lockdown— which is you are trying to slow down the virus. We have now crossed that stage
  • Old people in affected areas should be tested first, people with existing medical conditions that make them vulnerable should be tested,as opposed to picking up random people based on their symptoms.
The Health Ministry officials in India share the daily infection numbers and the amount of time it takes to double. Experts say the time to use this metric is over and now the policymakers should target people who are vulnerable and more likely to die because of COVID-19 infection.

The rate at which the infections are doubling, and comparing it with the progression in other countries, will only lead to anxiety in people who are consuming this via news, and will mislead policy decisions. “In the initial phase, we wanted to test a lot because then you would find where the pockets of infection are, and then you can contain those people to slow down the virus. So the testing in the initial part has the same purpose as the lockdown— which is you are trying to slow down the virus. We have now crossed that stage,” Ramanan Laxminarayan, Director, the Center for Disease Dynamics, Economics & Policy (CDDEP) told Business Insider.

According to Laxminarayan, it may be inevitable that India will eventually have 300 million infected people. But that does not matter because most of them will be young, given the country’s demography. For a country like India, where the health infrastructure is weak, the focus should be on saving those who might not have the immunity to fight the disease.

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“India has poor nutritional co-morbidities in many of our younger people, that's where we have a problem, of not being that immune to which the 60 years old are. Even younger people are also showing the same thing. The US data shows the younger people who succumbed were also obese. So this is the kind of immunity factor we need to look at,” Kiran Mazumdar Shaw, Biocon executive chairperson, said in a conversation with Business Insider highlighting the need to target the vulnerable population as opposed to large, random samples.

In essence, the rise in infection rate just means that the virus is spreading, which is inevitable. But if the mortality rate spikes, it would mean the way policymakers’ approach was not focussed on the most-vulnerable people. “The high number of cases in Maharashtra, Gujarat and Delhi is a reflection of natural progression,” Laxminarayan said to make the point about focussing on the right metric.

So, old people should be tested, people with existing medical conditions that make them vulnerable should be tested,as opposed to picking up random people based on their symptoms. Even if a young, healthy individual is infected, the risk of him/her spreading it to older people is more than they themselves succumbing to the coronavirus.

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Similarly, comparing the rate at which infections are doubling in different countries will also be moot. “Comparing a five-year-old with a twenty-year-old and saying the five-year-old is growing so much faster. Similarly, this is just a different stage in the epidemic in different countries,” Laxminarayan added.

CountriesCoronavirus death rate
US5.90%
Spain10%
Italy13.84%
UK14.90%
India3.30%

“We don’t have one epidemic in India; we probably have 20 different epidemics. So, considering India as one curve and saying what’s happening here. Maharashtra is doing so bad. UP is doing so much better doesn’t make sense, nor does it make sense to compare India with any country like Spain, Italy or the US. We are just in a different stage,” said Laxminarayan.


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The daily bombardment of infection rate will also push up the anxiety levels among the common people who are locked inside their homes watching the news. The World Health Organisation director-general Tedros Adhanom Ghebreyesus also said on March 20 that the stress of staying indoors and watching cases and the death toll rise across the globe can take a toll on your mental health.