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COVID-19: 'Elderly should be kept away from this battleground'

April 23, 2020 16:02 IST
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'Otherwise, there will be too many casualties among them.'

IMAGE: An elderly lady shows a 500 rupee note withdrawn from her Jan Dhan account during the lockdown in Nadia district, West Bengal, April 16, 2020. Photograph: PTI Photo

"We need to protect the elderly, see that they don't go out and even at home keep a distance from relatives," Dr Jayaprakash Muliyil, one of India's leading epidemiologists, tells's Archana Masih in the concluding segment of a two-part interview.

What is your reading of the situation in Mumbai and Maharashtra?

At the moment, I think the state is detecting cases, people are coming for Covid treatment, Maharashtra is not under-reporting and is giving out information.

When there are no cases being reported (in a state), then you worry about what kind of a system do they have.

Mumbai is expected to have a large number of cases because it is the gateway to India. It is making sure that as many people are treated, but there are certain things that go beyond human control.

Maharashtra has made a good effort to detect. A place like Dharavi is a very dense area, naturally it will spread. Remember even if you isolate, you will hardly be touching the tip of the iceberg.

You should assume that everybody has got it and focus on preventing deaths by not allowing the elderly to get infected.

Very often, you need a couple of days of real care like oxygen, the most serious ones will go on to ventilator support. The disease is basically overcome by the body, not by drugs, because we don't have any drugs.

The body has to fight the disease, we can just support them and tide over the crisis.

First it was said that travellers were bringing the virus, where are the infections coming from now after almost a month of lockdown?

Where do you think?

It is all around us.

For every case that is detected, there are about 65 subclinical cases around. You are only catching the small percentage of the total.

You have spoken about herd immunity where a proportion of the population has to be infected for the epidemic to stop. Since we don't know the actual number of those who could be positive, do you think a percentage of the population has already developed antibodies and is immune to COVID-19?

Absolutely. It is a large percentage. People think everybody has to be in hospital and on oxygen before they get immune. Not at all!

In a majority of cases, the immunity you get is through subclinical infection or a very mild infection.

They may just get a cough for a couple of days, get better and by that time they are already immune.

That is the bright side of the disease. We are only looking at the bad side -- of people dying.

There is a huge number of us getting a free vaccination without even having to undergo the pain of a poke.

IMAGE: A member of the Centre's Inter Ministerial Central Team, which visited Mumbai to assess the city's response to the coronavirus pandemic, confers with local officials in Dharavi, north central Mumbai, one of the city's COVID-19 hotspots, April 22, 2020. Photograph: Arun Patil

Because of the population density, will it become worse after the lockdown is lifted in Mumbai?

Depends on your definition, worse.

When it opens up, there will be more cases in the wards, but will there be more people getting immune through subclinical infection? Yes.

So there is a positive there?

People tell me I am favouring a strategy of herd immunity. It is not a strategy, but a natural reality of an epidemic.

All I am saying is to make use of that reality to your advantage. Be smart.

What is it about this virus that intrigues you the most?

We think about where it came from. I know there are conspiracy theories, but it happens in the viral world all the time.

Sometimes, it is very lethal and kills. There are viruses that never become well known as nobody sees them because when they kill the host, they also die. They don't live to transmit the disease.

This particular virus infects people, it multiplies to trillions of virus particles and goes to the next person.

Viruses don't have the intention of killing anybody, they just want to multiply. That is the genetic role.

There are many diseases that hardly affect children. By the age of 5, most children get affected by hepatitis A, but hardly any die because of it. It is very rare.

If you come out of it, then you are immune for the rest of your life. While in adults it can be a more serious disease.

With COVID-19, the older you are, the more chances of you getting into trouble. It differentiates in the way it affects people according to their age.

What is the best way to manage a disease that is prevalent all around us and is spreading fast?

We can't stop it. We agree that we can't be in lockdown and if you start normal activity people will get infected.

The point I am trying to get across is that it means that people have to get infected to develop herd immunity.

That is a dilemma. On one hand, you want the rates to reach herd immunity and we also don't want to lose lives.

Is there a solution? For young people, it is actually a mild disease. If 100,000 25 year olds get infected, maybe 30 will die. But for 80 year olds, the probability is 8,400 out of 100,000.

When you look at the mortality rate, 80% of deaths are in the 60 and above age group.

8.5% of the population is 60 and above, while 91.5% is below 60 years of age. This offers a strategy to face the disease.

We need to protect the elderly, see that they don't go out and even at home keep a distance from relatives. Don't hug grandchildren.

The context is very important. Of all the infections, the majority are subclinical. You can't make out who has got it and who hasn't.

So you just assume that all have got it and keep a distance from everyone till this is over.

IMAGE: Health workers take samples of a person for a rapid test at a mobile COVID-19 testing van in Chennai, April 21, 2020. Photograph: PTI Photo

How will life change after the lockdown?

Everything cannot be restarted all together. Weddings, festivals, cricket and football matches should be temporarily stopped and everyone continues to maintain physical distancing. This will slow down the rate of infection.

You will notice that the death rate is much lower and we have kept our elderly safe.

If you open up to everybody, you will mess up the picture.

The elderly should be kept away from this battleground. Otherwise, there will be too many casualties among them.

While the younger population will not get the opportunity to get the healthcare they deserve.

Is it easy to do it? Not at all.

We need to pass the message to all villages that elderly are the key people to protect. Look after them, but keep physical distance of two metres.

This will lead to a palpable reduction in mortality.

The elderly in the middle class can do this because they usually have a house large enough to maintain that distance. But in urban slums and poorer sections this will not be possible.

If it can be practiced in 75% of the elderly, there will be a big reduction in the number of people seeking healthcare in a hospital.

This will make a difference in our capacity to manage cases and reduce mortality.

For three months they should practice physical distance. And when the battle is over, though the elderly did not participate they will benefit from herd immunity.

When the virus returns, it will be another day and we may have a vaccine by then.

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