India is now in its third week of a quarantine first imposed on March 24 — some are already eyeing a post-quarantine coronavirus endgame scenario.
An article published in The Hindustan Times has suggested that in place of a quarantine, the concept of herd immunity could be a “more feasible option” moving forward. Such a prospect is hotly debated, with the UK government having suggested the option before imposing a similar lockdown themselves.
“Herd immunity” refers to the concept of a majority of the population already having developed an immunity to a disease, therefore limiting the possibility of the disease spreading among the population. This in turn makes it far less likely for the disease to pass on to those who have not yet developed immunity.
Typically the concept of herd immunity refers to immunity developed through immunisation campaigns. In these circumstances a vaccination drive could reach an overwhelming majority of the population. Those then missed by the campaign are then significantly less likely to contract the disease as they are far less likely to come into contact with an unvaccinated individual.
It is in this instance where the concept of herd immunity for the coronavirus differs — there is no current vaccine. As such herd immunity can only be theoretically achieved through infection of the population. Herd immunity is also an inferior alternative to vaccination, with the Vaccine Knowledge Project noting that “unlike vaccination, herd immunity does not give a high level of individual protection, and so it is not a good alternative to getting vaccinated.”
In the UK, the “business as usual” herd immunity approach was swiftly shot down as the achievement of herd immunity would – in this instance – be effectively bought with human lives. The delay of the imposition of a quarantine, coupled by low testing rates for a number of weeks, has had some studies suggesting the UK’s death toll could rise to be the highest in Europe. In India, a country already burdened by a high toll of infectious disease combined with the world’s second highest population, the allowance of immunity to develop through uncontrolled spread could claim millions of lives.
Reducing the concept down to numbers, the predicted mortality rate of coronavirus was originally two percent — a number then revised to 3.4 percent in early March by the World Health Organization (WHO). Figures for the development of herd immunity vary, though typically range from sixty to seventy percent. The Hindustan Times gives the figure as 65 percent.
Therefore, of India’s population of 1.377 billion, a total of 895,050,000 would need to be infected. The mortality rate of 3.4 applied to the infected population would therefore translate to 30,431,700 deaths from the virus (not inclusive of any further deaths after herd immunity is achieved, or a higher death rate in India due to health systems likely being overwhelmed).
India’s current death rate is around 7.5 per 1,000 population — or roughly 10,327,500 per year. The total toll of coronavirus before herd immunity is even achieved is therefore the cumulative deaths of every single potential cause of mortality — heart disease, cancer, infectious diseases, pollution — for three years in a row. All of this for the achievement of a concept which could leave 35 percent of the population still prone to infection.
The Hindustan Times, however, has suggested India may be in a unique position to develop herd immunity without death on a colossal scale
“India’s biggest asset in this situation is its demography. Sixty-five percent of our population is under the age of 35 and only six percent is above the age of 65. In comparison, 22 percent of Italy and ten percent of China is in the older, higher risk age group. The bulk of infections in younger individuals are mild and asymptomatic. Exposure to this group at a pace that is controlled would allow for smaller epidemic peaks.”
India’s population does hold a greater number of young people when compared to the relatively elderly populations of southern Europe. However, a gradual and controlled suspension of the quarantine for specific groups of individuals based on age — as suggested by The Hindustan Times — would be a logistical nightmare to enforce. It also ignores the fact that those young people allowed to leave their homes and potentially spread the virus to ensure 65 percent of the population has been infected could be returning home to elderly relatives, spreading the virus to the very group that herd immunity is meant to protect.
Currently, the position of the government has been to avoid mass outbreaks of the disease through quarantine measures (which themselves are not free of criticism). Individuals within the government have been calling for extensions of the quarantine over the course of the lockdown. Vice President Muppavarapu Venkaiah Naidu stated that “between the considerations of the health of the people and stabilisation of our economy being debated, the former shall take precedence over the latter.
“In my view, while the concerns of the economy can wait for another day, that of health can’t. I appeal to people to abide by whatever decision is ultimately taken by the leadership and cooperate in the ongoing national effort… even if it means continuing with some degree of hardship still beyond April 14th.”
This has culminated in the announcement by Prime Minister Narendra Modi of an extension of the lockdown until May 3rd, with a gradual reopening of the economy following this period. In some selected areas where the coronavirus has been deemed to be either prevented or contained, there will also be a partial withdrawal of the lockdown as of April 20th.
The announcement is likely to draw both praise and further scrutiny from some. Harsh criticisms of the quarantine have been abundant, with its negative impacts patent in urban areas where day labourers — who lost their jobs in the thousands in the space of a day — fleeing en masse from urban centres to their home villages often hundreds of miles away.
Many of these day labourers, along with sizable homeless populations now simply cannot afford to eat, joining unmasked and unprotected queues at homeless shelters hoping for enough food to keep them going through the day. As one individual described the situation, “hunger will kill us before any disease does.”
The global situation is dire, with overall cases now exceeding two million. There have been 2,008,164 cases to date, with 127,147 associated deaths. 486,247 have recovered, leaving 1,394,770 ongoing cases. In India, numbers have risen to 11,555, with 396 deaths at the time of writing.
The coronavirus situation is unprecedented in recent memory, and presents two options that are both decidedly unsavoury. On one hand, a lockdown of the economy for an extended period of time has and will continue to destroy the livelihoods of millions of individuals. Many already face the prospect of losing their homes, or even being unable to feed themselves, risking starvation. Given this situation has not occurred in modern memory it is difficult to anticipate and prepare for the economic and social ramifications of the decision.
On the other hand, not implementing quarantine measures and allowing the coronavirus to proliferate unchecked would overwhelm the health system in a matter of days. Only a fragment of those who needed intensive care services would receive them, causing potentially millions of lives to be lost. The situation thus sparks a question, which does a nation prioritise, its immediate health, or its economy?