Alternating lockdown, relaxation a flawed idea, say experts after European report – Times of India


Bengaluru: Alternating 50 days of lockdown with 30 days of relaxation for a period of 18 months is an effective strategy to contain spread of Covid-19 and curb deaths, says a recent study published in European Journal of Epidemiology. But Indian epidemiologists have rejected the idea, saying the study is far from reality.
The study is based on scenarios in 16 countries of diverse economies, including India. Its claim that India would have the highest number of deaths due to Covid-19 has also been opposed by Indian epidemiologists, who call it a biased view.
D Prabhakaran, professor of epidemiology, vice-president, research & policy, Public Health Foundation of India (PHFI), New Delhi, said while the proposition on the face of it appears attractive, it is impractical in case of India.
“While the authors have conducted a better mathematical modelling using up-to-date data as well as age and some demographic structure, they have not accounted for several factors in India. India is subcontinental in size with varying age structures between states, demographic differences, differences in health systems, highly variable urbanisation and varying density of population, all of which require modelling. In fact, assuming a single R0 (‘R-naught’ — a measure of how infectious a disease is) is fraught with several limitations,” he explained.
Prof Prabhakaran, however, said short periods of lockdown are feasible whenever there is the need but shouldn’t be the only option.
According to epidemiologist Dr Giridhar Babu, member, epidemiology and surveillance research group constituted by ICMR National Task Force for Covid-I9 and Covid-19 Technical Analysis Committee of the government of Karnataka, the SEIR (Susceptible-Exposed-Infectious-Recovered) model used in the research paper is a compartment model, the estimates of which mostly haven’t been reliable in India till now.
“The model doesn’t account for changes in case detection over time, how good is case detection, if a syndromic approach was followed, testing rates and heterogeneity in healthcare-seeking pattern and health system. Also, recent evidence suggests that dispersion index, that accounts for clusters and super-spreader events, is equally important, if not more than R0 in predicting the natural course of infection,” Dr Babu said.
“This appears like there is a bias against India. The country has done far better than other nations in Covid-19 management and prevention,” he added.
Dr Anant Bhan, an adjunct professor and researcher in bioethics at Yenepoya (deemed to be) University, Mangaluru, said India has a state like Maharashtra which has a high number of cases and a state like Sikkim that has not reported a single case. “There can’t be one rule for the entire country. It’s not practical to switch on and off the lockdown and make people adhere to it. It can be disruptive. I’m sceptical about such measures, unless it’s contextualised to real life. We need more locally nuanced planning,” said Dr Bhan.
Needs validation by expert team
Dr MK Sudarshan, chairman, Covid-19 technical committee, Karnataka, said: “The application of mathematics to biology and medicine and reading its outcome is tricky and often controversial. It certainly needs validation by an independent expert team. The opinions of individuals take us nowhere.”