Increased public health measures could have helped prevent thousands of Covid deaths in India

Strengthening public health measures amid the resurgence of SARS-CoV-2 in India in early 2021 would have controlled transmission in the country and reduced mortality by at least 40% during the second wave even without severe confinement, according to a new University of Michigan study.

Study: Lessons from SARS-CoV-2 in India: A data-driven framework for pandemic resilience

The research, published in Science Advances, provides data-driven frameworks for future pandemic response in India, the world’s second most populous. The conceptual framework can be generalized to other countries.

“We’re not trying to look back and say what went wrong and that’s how things should have been different, but we wanted to be more forward thinking about how decision makers could use real data to estimate the effectiveness of public health interventions in India. , to inform action in response to future waves of COVID-19, or even other infectious disease outbreaks,” said Maxwell SalvatorePhD student in the UM School of Public Health and lead author of the study.

The UM team, led by Bhramar Mukherjeeprofessor of biostatistics and epidemiology in the School of Public Health, has been following the COVID-19 pandemic in India since March 2020. The Michigan team collaborated with researchers from Harvard, Tufts, Johns Hopkins, Brigham and Women’s Hospital and Boston Children’s Hospital to take a closer look at the effect of public health interventions that have been rolled out in India.

The team created mathematical models to characterize the estimated effect of these interventions as they changed the start date and intensity of the measures, helping to guide future responses based on epidemiological triggers coupled with human considerations. .

India reacted quickly to the initial outbreak, announcing a nationwide lockdown when there were only around 500 cases and 11 deaths in March 2020, Salvatore said. Although effective in controlling the virus, the lockdowns have had significant economic and social costs associated with them. Harsh lockdowns were unnecessary, Mukherjee said, if modest interventions were rolled out early enough, when cases started to rise again in February 2021.

“Unlike the first wave, there was no nationwide public health response in the second wave,” Salvatore said. “Large gatherings were taking place with little or no use of face coverings. Coupled with the rise of the Delta variant, the resulting second wave in a largely unvaccinated population was worse than the first by virtually every public health metric.

Salvatore, Mukherjee and colleagues looked at four different counterfactual scenarios or levels of public health interventions, starting with the strongest: the 2020 nationwide lockdown, which was very strict. The next tier was a moderate lockdown, based on an observed intervention in the state of Maharashtra in response to the second wave in April 2021. The other two scenarios were modeled from Maharashtra data but incorporated measures of public health without lockdown.

‘At that time we were over a year into a pandemic resulting in public fatigue when lockdown was not a feasible option so we had to investigate non-lockdown scenarios and lower membership’ , said Salvatore.

Next, the researchers applied several epidemiological models of infectious disease transmission developed in Michigan by Mukherjee’s lab and the UM biostatistician. by Peter Song laboratory to characterize the effect of these interventions if they had been rolled out nationwide in February or March of last year when a slight increase was noted.

Although the model has considerable uncertainty, Salvatore said, it shows that at least 40% of reported deaths could have been avoided with measures other than lockdown, depending on the timing of the interventions implemented.

“I think because the initial lockdown was so harsh, poorly implemented and had high social and economic costs, it was difficult for national political action to take place in response to the second wave,” he said. -he declares. “In a pandemic, the timing of actions is important.

“Lockdowns can be avoided with early action. Just slowing down these waves so that the healthcare system can care for those affected is very important. Unfortunately, the confluence of different factors has led to uncontrolled transmission of the virus in India and people have died from lack of oxygen and inability to access proper healthcare.

Mukherjee said it was time to take a closer look at the data and apply principled statistical methods to find out which interventions worked in which country.

“When the next pandemic hits, we will be able to provide decision makers with a switch and switch menu based on real data,” she said. “In addition to controlling the virus, every public health intervention framework should include social and economic protection for vulnerable groups, as these interventions can have overwhelming consequences on human life. This is one of the most strengths of our proposed framework and is guided by humanitarian data science.