மிக மிக நம்பிக்கை தரும் நல்ல செய்தியொன்று….!!!



கொரோனா வைரஸ் பரவலால் இந்தியாவில் ஏற்படக்கூடிய
பாதிப்புகள் குறித்து, ஆராய்ச்சியாளர் டாக்டர் என்.தேவநேசன்
அவர்கள் எழுதியுள்ள மிக மிக நம்பிக்கை தரும் கட்டுரை ஒன்றை
கீழே பிரசுரித்திருக்கிறேன்.

கட்டுரையை எழுதியவர் எந்த அளவிற்கு முக்கியமானவர்
என்பது பற்றிய குறிப்புகளும், இதிலேயே அடங்கியுள்ளன.
விவரமாக கட்டுரையைப் படியுங்கள்…
உங்களுக்கும் நம்பிக்கை வரும்…!!!

சுருக்கமாகச் சொல்ல வேண்டுமானால் –

1) The bottom line is that the data available so far suggests that
the novel coronavirus may not infect millions of people in India
as predicted by some mathematical simulations.

2) Most patients would possibly only suffer from a
cough and fever and recover without any residue.
Some will succumb to this virus, but the numbers will
most likely not be as high as predicted.

————————

N Devadasan | Graphic by Nithya Subramanian
Apr 01, 2020 · 04:29 pm

—————————————————

Dr N Devadasan is a public health professional with more than
30 years of experience both at the grassroots level as well as
in research and teaching. He has worked with the World Health
Organisation as its national programme officer for
communicable diseases in India.

He has contributed significantly to the design of the health ministry’s
Integrated Disease Surveillance Programme. He has also investigated
various outbreaks, including three Nipah outbreaks in Bangladesh and
India. He is currently the technical advisor to Health Systems
Transformation Platform, a non-profit organisation.

In this piece, Devadasan examines the available data for India’s
coronavirus outbreak and argues that the country may have
overreacted. He addresses four common questions in light of
the available evidence.

1. Will the coronavirus infect millions in India?

In Wuhan in China and Italy, tens of thousands are affected and
thousands have died. While the disease spread at both these
centres at alarming rates, other countries and especially India
are currently not showing a similar trend.

Until March 3, India had only three confirmed Covid-19 cases
– students who had returned to Kerala from Wuhan. In the month
since then, Covid-19 cases have cropped up across the country,
but the number remains 1,251 as of 4 pm, March 31.

Compare this with other European countries or China, where
the number of cases has rapidly crossed the 10,000 mark,
as the chart below shows.

Among the 195 countries that have patients with Covid-19,
India ranks 41st in terms of the number of confirmed cases.
Considering that India is the second-most populous nation
in the world and usually during epidemics, larger countries
tend to have a higher number of cases, what explains the fact
that there are fewer cases in the country?

Standardising the cases by population, the number of cases
in India is 500 to 2,000 times lower than other countries,
especially the European countries.

2. Are the numbers in India low because of inadequate testing
and underreporting?

Many experts have complained that the government has not
been testing enough people for Covid-19. However, most
textbooks of applied epidemiology will tell you that once the
agent of an outbreak or epidemic is established, there is
no need to test new symptomatic patients. It is a waste of
resources since there is no difference in the treatment provided
to a “probable” Covid-19 case and a “confirmed” Covid-19 case.

At this point, we should consider anybody with a fever and cough
as a probable Covid-19 patient and ask them to be self
quarantined. The patient and their contacts should be monitored
closely for any deterioration in clinical conditions (temperature,
respiratory rate, fatigue) and if there is a deterioration, then and
only then should they be shifted to a hospital where they may be
tested for Covid-19 to confirm the diagnosis. This strategy will

save beds, health staff time and will also keep 80% of patients
out of hospitals.

Therefore, the government is right in limiting the testing to those
who may be at risk. The effort should not be to diagnose more
cases but to ensure that those who are sick are treated promptly.

A related question arises: if India is indeed underreporting
the numbers for Covid-19 and there are thousands of untested
patients out there, then why have they not shown up in hospitals
already? It is nearly a month since the first case of local
transmission was reported. Given the panic, it is unlikely that

patients are sitting at home. For more than a week now,
because of the lockdown, clinics and health centres have been
closed, which makes it more likely that the patients will end up
in the hospitals, which are few and easily monitored.

While it is true that most diseases are underreported in India,
some states do better at disease surveillance: Maharashtra and
Kerala, which are reporting high number of Covid-19 cases,
are both relatively well-performing states. It is unlikely that the
new cases and deaths will be missed in these two states. If there
is a surge in patients with respiratory symptoms in hospitals,
it is unlikely to miss the attention of the media. Such information
is hard to suppress in a country like India. So where are these
untested patients?

Maybe they do not exist.

3. Will the epidemic explode uncontrollably in India?

The fear is part of the “spread to millions” discourse. However,
comparing countries that confirmed their first Covid-19 cases
around March 3, we see two different groups of countries,
as visible in the chart below.

European countries (red lines) have an exponential trajectory.
In contrast, countries located in North Africa and the Middle East
(blue lines), as well as India (the thick green line) have a linear
trajectory. This is further highlighted when we compare the most
affected countries with India.

The X-axis is the number of days since the onset of the outbreak,
and we see once again that India is performing very differently
from other countries. The number of Covid-19 cases in India is
rising by a factor of 1.45, compared to a factor of 198 in Italy.

We are currently not following an exponential trajectory compared
to other countries. This begets the question: will the epidemic
play out differently in India compared to European countries?

4. Will the coronavirus kill lakhs in India?

Many have been rattled by the mortality rate often cited in the
media: 3%-5%.
However, one needs to look closely at this figure. As of March 27,
the average case fatality rate in India was 4.5 deaths among
100 patients.

However, the average is not the right measure to use in such
a situation since it is affected by extreme values. For example,
in Tanzania, out of three Covid-19 patients, one died,
so the case fatality rate is 33%. You will see this similar pattern
in countries with low incidence of the Covid-19. Their case
fatality rate is high and this contributes to the higher average.

On the other hand, the median is not affected by extreme values
and gives you the 50th percentile of the case fatality rate.
Using the median, the case fatality rate for India drops to
0.4 deaths per 100 patients, nearly ten times.

Data from 195 countries shows 95% of the countries will suffer
a case fatality rate between 0 and 0.8 deaths per 100 patients.

This case fatality rate further falls if we include the untested
asymptomatic patients into the calculation. As I do not have
those figures, I hesitate to arrive at any conclusion.

However, it is worth looking at population-based death rates
to get some perspective. Hubei province where Wuhan is
situated has a population of 5.85 crores, comparable to any
of our medium-sized states. This province saw a total number
of 3,295 Covid-19 deaths, that is, a death rate of five persons
per one lakh population.

Without the Covid-19 outbreak, an Indian state with a
population of six crore would have seen about 420,000 deaths
every year, that is, 1,150 deaths every day because of heart
attacks, strokes, road traffic accidents, diarrhoea, pneumonia
and cancers. At the current rate of cases in India, Covid-19
related deaths are likely to be less than 1% of this usual
number of deaths.

In Italy, the estimated deaths for a similar population size
would be 27,000 – nine times more than Wuhan. The point
to note is that most of the deaths happened among adults
more than 70 years of age. Given that 23% of the Italian
population is elderly, it is not surprising that the death rate
in Italy is high. On the other hand, India, with only 6.3%
of its population above 65 years of age, is unlikely to see
this level of mortality.

More questions –
Indians have been driven into a panic mode because of the
deaths reported in Italy and Wuhan.

But India is not Italy, it is not China: our genetics,
environment and people are very different.

So far, we have not seen an exponential growth in Covid-19
cases as predicted by various experts and simulations, despite
our large population, overcrowding, low level of hygiene
and the laissez-faire attitude of the public.

We can only speculate about the possible reasons:

Contact tracing and quarantining ensured that the outbreak
was largely limited to family contacts and did not spill over to
the community.

The weather in India is not conducive for the virus to spread
as rapidly as it did in Wuhan and Europe.

Indians have an innate immunity to the virus, thanks to
unhygienic conditions.

This hypothesis can be quickly confirmed by doing serological
surveillance among the non-contact populations to see
whether they have an antibody to the Sars-CoV2. The Indian
Council for Medical Research has already announced plans
for such surveillance.

The bottom line is that the data available so far suggests that
the novel coronavirus may not infect millions of people in India
as predicted by some mathematical simulations.

Most patients would possibly only suffer from a
cough and fever and recover without any residue.
Some will succumb to this virus, but the numbers will
most likely not be as high as predicted.

While simulations predict dire situations, we need to keep in mind
that simulations are based on assumptions. In contrast,
I have drawn conclusions based on the current path of the virus
in India based on available data.

Let us hope that I am right.

.
———————————————————————————————————————————

About vimarisanam - kavirimainthan

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4 Responses to மிக மிக நம்பிக்கை தரும் நல்ல செய்தியொன்று….!!!

  1. R KARTHIK சொல்கிறார்:

    Following the way WHO acted as a PR for China few months back. I am not feeling comfortable with these high profile WHO personnel!!! Not sure whether they are saying truth or not.

    Anyway, Let his words be true.

    • vimarisanam - kavirimainthan சொல்கிறார்:


      கார்த்திக்,

      நான் இதை இடுகையிலேயே சொல்ல வேண்டுமென்று
      நினைத்திருந்தேன். Current WHO professionals – சீனாவுக்கு
      ஆதரவாகத் தான் பேசி வருகிறார்கள் என்பது உண்மையே.
      நேற்று கூட சீனாவை பாராட்டி இருக்கிறார்கள்.
      அவர்கள் இந்தியாவைச் சேர்ந்தவர்கள் அல்ல –
      தலைமைப் பொறுப்பில் இருப்பவர் ஆப்பிரிக்கர்.. முன்னாளில்
      சீனாவில் தூதுவராக இருந்தவர்….!

      ஆனால், இந்த ஆராய்ச்சிக் கட்டுரையை எழுதியவர்
      ஒரு இந்தியர்.

      அதுமட்டுமல்ல.
      நானும் வலைத்தளத்தில், பல்வேறு நாடுகளிலிருந்து
      எழுதப்படும் ஆய்வு விவரங்களை தொடர்ந்து படித்து
      வருகிறேன். அதன் விளைவாக எனக்குள்ளும்,
      டாக்டர் தேவதாசன் கூறியுள்ள இதே கருத்துகள்
      தான் எழுந்துள்ளன…

      எனவே, இந்த கட்டுரையில் தெரிவிக்கப்பட்டுள்ள
      முடிவை – தனிப்பட்ட முறையில் நானும் நம்புகிறேன்…

      .
      -வாழ்த்துகளுடன்,
      காவிரிமைந்தன்

  2. புவியரசு சொல்கிறார்:

    இது நிஜமாகவே மிகவும் நல்ல செய்தி தான்.
    மீடியாக்கள் பயமுறுத்துவதிலேயே தான்
    இருக்கின்றனவே தவிர, இந்த மாதிரி
    assessment எல்லாம் செய்வதில்லை;
    அவர்களுக்குத் தேவை பரபரப்பு அவ்வளவே.

  3. JAYAKUMAR K சொல்கிறார்:

    நம்பிக்கை தரும் செய்தி மனதிற்கு மகிழ்வினை அளிக்கிறது

பின்னூட்டங்கள் மூடப்பட்டுள்ளது.