India could pioneer the 'Thrust and Shield' in dealing with Covid-19

Those under 50 could "thrust" their way back from social distancing - no partying, no festivals, just a sober return to work - and "shield" the elderly, vulnerable and those particularly at risk

For the past four weeks, I have had the privilege of leading over a hundred of Australia’s brightest medical scientists, economists and political scientists to chart possible options to recover from Covid-19. We call it the ‘Roadmap to Recovery’ a report to the nation. We outline two options – the elimination of the virus, or the controlled adaptation to it. We roundly rejected the idea of letting the virus run unchecked, leading to a “herd immunity”. The two options suggested have a real chance in Australia – four of our states on the track for elimination, and the total number of cases in Australia have decreased from a high of 500 a day, to less than 10.

I have wondered about what these kinds of options mean for India. Sadly, I have come to the conclusion that none of the options above are realistic for India. I hope I am wrong. But, here is why I might not be.

Australia is a small nation on a big continent. Some 26 million people, with great physical distancing across geography, and a well-developed public health and healthcare system. This may make elimination possible for Australia – but in a country of India’s scale, size and density; with the healthcare system it has for the masses, this is not possible. So, let’s leave this aside.

The “let it rip” idea is also unthinkable. Left to itself, Covid-19 would build a momentum to millions of cases and thousands of deaths a day. No one needs this option.

The option that most of the high-resource countries seem to be aiming for, with varying success, is to suppress the virus to very low levels – and then hold it there while gradually releasing restrictions and using a very active regime of extensive testing, tracing and isolation. This strategy assumes two preconditions. First, that the current level of known cases is close to the true number; and that testing, linked to very effective tracing and isolation will be available in scale of the population.

As of the time of writing, the total number of declared cases in India was close to 40,000. However, it is well known that countries have generally seriously underestimated the total number of cases when their testing levels are low. A recent paper from the London School of Hygiene estimates that the current number of known cases in India are likely only 17 per cent of the true case count – which suggests that total real number could be above 200,000, and rising faster than currently thought.

The second challenge is the level of testing needed to control the virus at stable low numbers. Estimates from countries that have done it successfully ranges from 10,000 to 20,000 per million; India is currently at about 600 per million. It is remarkable that India has already done close to a million total tests. However, given its overall population, this falls short by a factor of 20. No country as yet has the ability to do that many tests.

Thus, I feel the options being actively explored by nations with high-resource settings where governments can lay out huge stimulus to support the individuals and economies will just not work for India.

India needs a different approach. It should pioneer a pragmatic response for the low-resource countries, which have a relatively young population and a greater need to immediately return to productivity.

This approach capitalises on the realities of the virus and of India.

Data show that the virus is much less dangerous, by a factor of nearly 20-100, for those under 50. Three fourths of India belong to this group. And they account for more than 80 per cent of its productivity. And it is this segment that earns to feed the young and the old. India under 50 could “thrust” its way back from social distancing. No partying, no festivals – just a sober return to work, wearing home-made masks, and practising pragmatic physical distancing; and symptom-based isolation, with testing and tracing where possible.

While allowing this, one would selectively “shield” the elderly, the vulnerable and those who feel particularly at risk – they should continue to practise social distancing as they are now, and should use face masks and hygiene when interacting with the young.

Modelling by the London School of Hygiene shows that if the above “thrust” was implemented along with “shielding” the vulnerable – one could get the benefits of an earlier economic recovery, a sizeable proportion getting immunity over the next many months, and dramatically decrease the number of cases requiring hospitalisation and death – decreasing the number of deaths closer to those incurred from smoking and air pollution every year.

The strategies of the West will not work for India and for another 3 billion in this world. Following them will lead to economic and humanitarian crises much larger than that of Covid-19. India has the opportunity to show the better way with its own version of ‘thrust and shield’.

The author is dean of the Faculty of Medicine, Dentistry and Health Sciences, and assistant vice-chancellor for health at The University of Melbourne

The views express my individual views and not that of my Institution