Serosurvey Vs Herd Immunity Vs Vaccination In India!

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The 4th Serosurvey done by the apex medical body ICMR (Indian Council of Medical Research) in June-July 2021 taking in over 28,000 samples in 21 states has shown that about 70% of the people of India (including children) have antibodies, that is to say, relative immunity against COVID-19 infections-which is a big jump from the 3rd survey done in January-February this year that showed only around 21% of people having antibodies. However, the ICMR study does not distinguish antibodies developed through natural viral infections or through vaccination in terms of numbers. Coming after the disastrously uncontrollable COVID-19 second wave which is yet to subside the result is extremely significant: it definitely shows a light of hope in terms of India coming closer to developing herd immunity, because earlier in 2020 experts said that at least 80% of population of any country must develop immunity to achieve herd immunity; and that around 70% of people of India are hopefully not going to have the serious type of the disease, thus reducing hospitalization and possible fatalities and possibly diminishing the impact of the feared third wave. But the fact remains that at least 400 million of India’s population are still susceptible to infections, dominated by the more infectious Delta variants, which puts the much hyped vaccination drive in India in poor light.

Now, the argument offered against trying to go for herd immunity (including the Government of India) had been the fact that at least 80% of people would have to get infected and in a country like India even with a lower fatality rate of around 1.5% the number of deaths would be huge and immensely unavoidable. We seem to see that the horrid second wave that nobody prepared for has nearly achieved that goal, costing possibly millions of lives. We know the official numbers: about 32 million of Indians have so far got the infections of which around 0.42 million (4.2 Lakh) died; vaccination has been done in more that 410 million people so far in terms of only the first dose, and fully vaccinated people represents only around 8% of the population. Even if we take into account all the people taking at least one dose and adding to that the naturally infected people that would account for only around 440 million people, officially of course, which would leave a huge chunk of population that has developed antibodies apart from the 400 million susceptible people (India’s population is now around 1.35 billion, and it is not known how. We try to offer our arguments on this apparent paradox (may not be for experts) as to why this could have possibly happened.

There was a recent international study that said India’s COVID-19 fatalities have been grossly under-reported, and in actual terms it would be 3.4 million in the best case and 4.9 million in the worst scenario which says in volumes about the possible actual infections that raged across the country. Although, as usual all the way, the Government had stoutly denied this, there had also been disputes regarding death figures in states like Madhya Pradesh where the said difference to the actual figure shown amounts to nearly 0.3 million (3 Lakh), in Uttar Pradesh there were no accounts of the number of dead bodies floating in river Ganga which scenario also applies to the state of Bihar, and in Gujarat the numbers of deaths have been allegedly tampered with several times and in Karnataka. The state-wise data of the 4th Serological Survey present a very interesting picture in this context.

The level of immunity or rather seropositivity rate shown by Madhya Pradesh is to the extent of 79%, the highest in the country, almost achieving herd immunity. Doesn’t this example show the extent of possible unreported infections as well as deaths that would amount to unimaginable figures? Similar scenarios are also seen in Rajasthan (76.2%), Bihar (75.9%), Gujarat (75.3%), Chhattisgarh (74.6%), Uttarakhand (73.1%), Uttar Pradesh (71%), Andhra Pradesh (70.2%), Karnataka (69.8%) and Tamil Nadu (69.2%). However, out of these states there have not been any controversies so far regarding actual numbers in Chhattisgarh, Uttarakhand and Andhra Pradesh. The states of Odisha that has been seeing continuous and exponential daily infections, Punjab, Telangana, Jammu and Kashmir, Himachal Pradesh, Jharkhand, West Bengal and Haryana have seropositivity rates in the sixties. These states have been bearing the brunt of infections from the beginning of the pandemic.

Interestingly again, the frontrunners in the pandemic spread, Kerala and Maharashtra have lower immunity rates, in fact, Kerala has the lowest rate of 44.4%, and Maharashtra having the highest number of infections and deaths in the country has 58% immunity. It can be explained this way: Kerala that started the pandemic in India had been handling the situation very well with effective measures and protocols thus protecting a large number of their people, also having the highest rate of vaccination in the country; but, some aberrations later on, in terms of mainly religious appeasement, more and more people are now getting exposed to the virus and at the moment it is accounting for half of daily national infections; in case of Maharashtra the state has been maintaining the highest level of transparency both in terms of daily infections and deaths-always revising the numbers adding the backlogs, and therefore, here the official numbers are not very different from the actual ones. Assam has also a lower seropositivity rate of 50% that can be largely because the state, along with other states of the north eastern region, had been relatively spared in the first wave, but the second wave led by the Delta variant has been ripping them apart.

A bit of personal experience should ideally be added in support of our projected scenario of a possible achievement of herd immunity at least in some of the states in near future. I would like to rate the municipal authorities in Maharashtra as the best, always visible, proactive and visiting or surveying every house in every locality for possible signs of infections and on finding immediately arranging tests, and on someone being found positive sealing the building instantly enforcing strict measures. The state has its own reasons in terms population density, travels, business and congestion for having the worst spread despite its most efficient control. Even then, I have first knowledge of many residents hiding or not testing their infections and if those were mild getting recovered without anyone knowing-with some of them observing strict isolation while Covidiots moving around infecting others, almost knowingly.

This unfortunate syndrome of hiding the symptoms of fever, cough or even loss of sense of smell and not going for RT-PCR tests have been most visible in several other compromised metro cities or towns where the municipal officials are hardly visible and infections being handled behind closed doors across colonies and buildings. I have felt this and witnessed this, and even now it is happening, though to a much lesser extent as the positivity rates in most parts of the country have fallen below 5%. The impact of this syndrome could well be imagined in the vast rural areas where there were no medical facilities even if some wanted to get tested or treated. The case of the asymptomatic carriers is also to be accounted for.

If we are indeed approaching the attainment of herd immunity as we have put forward the reasons for, then this is being done the hardest way-at horrible cost of lives and livelihoods. Had the Government of India taken the vaccination drive, started in January 2021, much more seriously, devoting all the doses for its citizens, and had it heeded the warnings about the second wave and taken strict measures we could have approached the same situation most scientifically and effectively. The risks are not over even now: 400 million people are still exposed to the virus and vaccination has still not picked up despite the promise, the hype, chest-thumping and boasting. We also don’t know if the second wave has ebbed and the third wave started, because the daily numbers are falling or rising daily. Hope good sense prevail among all the governments in view of the fact that the most infectious Delta variant and the still unknown quantity called Delta Plus are still around and can still create havoc, at least in the vulnerable states.

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