14 thoughts on “India’s COVID-19 heterogeneity”

  1. Yesterday i went thru 2 contradictory twitter threads on India;s testing practice. Still undecided on what path is better. Perhaps folks more knowledgeable can comment



    Frankly the way they are attacking each other arguments are so standoff-ish is that i think they are not so sure themselves, and leaving a way out , in case they are wrong. Its very unlike other polarized arguments we have on twitter. But that could be just my impression.

    1. Don’t trust Karthik at all..he used some strawman arguments regarding the accuracy of testing which logically does not detract from the idea of testing (as the other guy picked up).

      Definitely at the very least testing and contact tracing of the high probability groups should be carried out and those who were in their proximity.

  2. Perhaps i am not getting it. The thread u linked is precisely doing what i said. Picking up best of both sides of the arguments, lest they are wrong. This guy own bullet points are contradicting each other. LOL.

    The scroll article which has been linked says the reason India didn’t do “test,test,test” is because India had weak testing capability and made a choice of testing only suspects.

    Pretty sure folks who follow India knew that already, what is the whole criticism of India not testing enough? It made an impression that India choose to not test more because of ideological reasons, even though it had the capacity, its trying to artificially suppress the numbers.

    1. What I understood:

      1. Initially India had low testing capacity and a not very accurate test that was used for corona viruses generally and not specifically for covid-19. So we tested only suspected cases. We did do some tests on random samples to check community transmission, which we didn’t find then.
      2. Now we have more testing capacity and more accurate tests so we can expand.
      3. But there is no point in looking at per million numbers when we know there are hotspots.
      4. So testing should be based on criteria instead of mass testing like in Germany. Kerala/Japan have been able to control the curve with very limited testing criteria.
      5. These criteria can be of different strictness based on the region. You can also have random sampling. People should specify these criteria and sampling rate instead of asking for testing of everyone. Major disagreement seems to be here. Anupam is asking people to specify what they want and why.

      From the article:
      6. Even high testing and contact tracing is not going to save us if there is community transmission, which it seems there is even if the government has denied it.
      7. In that case we have to rely on communities behaving themselves as lockdown can’t go on forever.

      Someone more knowledgeable can possibly correct me or add more insight.
      I have tuned off Twitter and covid for the last couple of weeks.

      1. 4. So testing should be based on criteria instead of mass testing like in Germany. Kerala/Japan have been able to control the curve with very limited testing criteria.

        Different countries have had different experiences on both counts (good and bad).
        But some patterns are emerging across the board for those who have done well and that is Testing at large scale happened. Meaning IF there is a country out there which didn’t test but still was a success it would be an outlier (if it exists at all).

        After testing is case tracking and then isolation. Home Isolation is not an effective strategy for all places, Chinese medical staff was warning about this for months that it didn’t work early on in Wuhan because Chinese households have multiple generations and a lot of people under the same roof, which India also has so India can’t use a Germany like approach where generations usually don’t live together. Even Italy was similar to China in that respect.

        Test-CaseTrack-Isolate. Everything else was local specific.

        6. Even high testing and contact tracing is not going to save us if there is community transmission, which it seems there is even if the government has denied it.

        This is not a given. China prevented it from seeping into other provinces (which is why they were able to send 40,000 medical staff from other regions into Hubei, if other regions were hit they wouldn’t have been able to do this, this is why Europe suffered because everyone basically got hit and one couldn’t help another).

        Testing works because you can not make a decision about something (good or bad) if you lack Hard Data.

    2. Also AM seems to have more medical knowledge than Karthik. He is right regarding the asymptomatic spread which we have known for weeks. Just testing the symptomatic people will not arrest the problem. Indian is blessed with a hot climate which will inhibit spread compared to cold countries, so that buys some time.

  3. God knows what’s going on here. Its very tough to pin point anything when either side is so slippery. Neither side has any answers.

    The “more testing” guys dont say how much testing should be sufficient (not universal, just their own view), but somehow they are dead sure that India is not testing enough, hence lower cases. That would mean if India starts testing 50 percent they could say oh actually we meant 50.01 percent, so India isn’t testing enough. “Not testing enough” is a pretty vague term.

    1. I don’t know how much more testing we need to do (I’m not an epidemiologist), but given what I’m seeing now (cases rising steadily on a daily basis), I’d say we need to do a lot more.

      Why? Because, if the current trend continues, there is NO CASE FOR ENDING THE LOCKDOWN EVER. On what basis would Modi declare an easing of restrictions on May 3 if the number of cases on May 2 is equal to or more than that on May 1 (all of this based on very incomplete data)?

      How much more testing we need to do to determine whether it’s safe to end the lockdown, at least on a district-by-district basis, I don’t know. I’ll leave it to the experts to figure it out.

  4. Been thinking a bit about poor countries response to the crises. IMO it’s a mistake to follow rich countries blindly in a shut down.

    Let’s take Afghanistan as an extreme example.

    Median age: 18
    Average life expectancy: 48
    Nominal GDP per capita: $520

    Should they really follow the same sort of protocol as a developed country with an average age in the 40s, life expectancy in the 80s, and a median income of $50,000 ?

    There needs to be an adult discussion of the tradeoffs of an extreme shutdown. And coming up with the best risk / reward tradeoff.

    I find some of the stories I am seeing coming out of India, about poorest segments of society struggling with the lockdown, to be disheartening.

    On the other hand poor people in India are used to a much higher level of daily hardship compared to people from developed countries.

    So in some sense they are battle hardened, and have good informal social networks. And I think they will come out of this better than one would expect based on income levels.

    1. The problem to apply this approach is 2 fold.

      One- left is already drinking wine with the global elite and will lambast any hint of such pragmatism with vocabulary borrowed from Bernie Sanders or who ever they favour at the moment.

      Second- Modi & team has sold everyone the illusion that we have arrived on world stage. Now accepting the reality would be a big U turn.

    2. So in some sense they are battle hardened, and have good informal social networks.

      But those social networks have been disrupted by the lockdown, so I believe our poor are in a lot more distress than you think.

      Yet I also believe that compliance with isolation or “social distancing” norms are patchy at best in that class of society. As you likely know, our law enforcement capacity is extremely low (which is why our average cop behaves in a high-handed manner, to present an illusion of control), so we have to rely on the average person understanding the need and purpose of such norms and practice self-restraint far more than in richer countries.

      But the concept of social distancing is so utterly alien to Indians, and penetration of scientific thinking so low in our society, that I’m not sure people are really doing what’s required. The low incidence of the disease in India I attribute to the the relative lack of international connections and super-spreaders.

  5. https://theprint.in/national-interest/covid-hasnt-gone-viral-in-india-yet-but-some-in-the-world-at-home-cant-accept-the-truth/404178/

    Covid hasn’t gone viral in India yet, but some in the world & at home can’t accept the truth

    India isn’t going through a picnic. But our drains aren’t filled with bodies, hospitals haven’t run out of beds, crematoriums and graveyards not out of wood or space.

    That good news, or absence of expected bad news, is the truth that so many in the international community, and also within India, seem unable to handle. Isn’t it too good to be true?

    They all got away with it, including so many in our bureaucracy, activists and health NGOs, who had joined that well-funded, wine ’n cheese war to ‘save’ India.

  6. I understand that new testing kits have reached India. Now we would know if ICMR really wants to keep testing according to its set criteria or it was a way to keep the number of ‘required’ test within the available quantity.
    Do people here have any feel which way it will play out in coming days?

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