A three-week lockdown is a reasonable starting point to contain the coronavirus pandemic in a country like India, an eminent Indian-American epidemiologist has said, cautioning that a successful fight against the deadly virus might require some more time.
Rajeev Venkayya, Special Assistant to the President for Biodefense at the White House during the Bush administration who oversaw US preparedness for bioterrorism and biological threats, told PTI it was difficult to say how much more time India would require to thwart the COVID-19 challenge.
On March 24, Prime Minister Narendra Modi announced a 21-day nationwide lockdown in India to stem the spread of coronavirus in the country.
"From an epidemiologic standpoint, I don't know if three weeks will be enough. It may require more time," said Venkayya, who was responsible for the development and implementation of the National Strategy for Influenza pandemic during the second term of the Bush administration.
He currently serves as president of the Global Vaccine Business Unit of pharmaceutical company Takeda.
"We will have to look at what is happening in other countries," he said.
"But if you were to ask me whether that will be enough given the size of the population, the healthcare capacity, the uniformity or lack of uniformity that is inevitable in a federated country like India where there's a lot of State autonomy on what to do and how to do it, and varying levels of compliance, I think this could easily go much longer," Venkayya said.
Three weeks is a reasonable starting point. "It gives people the signal that this (lockdown) is not just a few days. It is epidemiologically reasonable because it gives you some time to see if you're actually changing the rate of the emergence of new cases so you can see whether it's working or not or what adjustments need to be made," he said.
Since joining Takeda in 2012, he has established a high-impact vaccine pipeline that includes promising late-stage candidates for dengue and norovirus, gained through the acquisitions of LigoCyte and Inviragen Inc.
As Special Assistant to the President for Biodefense at the White House, he was responsible for the America's first development and implementation of the National Strategy for Pandemic Influenza in 2007. The White House published this federal guidance in 2007.
"It's now called the flattening the curve strategy. At that time, we called it a targeted layered containment and then it became called community mitigation. But the first flattening the curve graph was published in our federal guidance in 2007," he said.
"When I was in the white house, we were preparing for an influenza pandemic we realized that vaccines would not be available for many months after a pandemic started. And based on the 1918 experience, we expected there would be multiple waves of the pandemic and that for at least the first wave we would not have vaccines," he said.
As such, the White House team led by him had to find other ways to protect communities from this pandemic virus.
Based on some early modelling and additional modelling commissioned in 2006, they found the relevance of non-pharmaceutical interventions, community measures like closing schools and cancelling public gatherings, social distancing as well as isolation and quarantine for people that have been confirmed or suspected to have the virus.
"If you put all of these things together, and importantly if you did them early in a coordinated fashion, you could have a very big impact on the transmission of the virus in a community," he said, adding that this guidance was published in 2007.
Emphasising the importance of doing these things early in the outbreak, he cautioned that else it would be much harder to prevent a large number of people from getting infected and accomplishing the goals of flattening the curve and delaying the peak of the curve.
"So here I think it's very important that India took (lockdown) action now... like many countries, there isn't widespread availability of diagnostic testing. And so it's hard to know how much virus is in any given community in India," he said.
"We also know that the threat is greater in India than it may be in other places because of the population density. Also, there are significant portions of the population that don't have access to the healthcare services that would be necessary to take care of large numbers of sick people. So, it (social mitigation measures) becomes even more important in India," Venkayya said.
Observing that none of the community interventions are perfect, he said if one puts a number of imperfect interventions together, then one can have a very significant positive impact on reducing virus transmission.
Prior to Takeda, Venkayya served as director of Vaccine Delivery in the Global Health Program at the Bill & Melinda Gates Foundation, where he was responsible for the Foundation's efforts in polio eradication and new vaccine introduction.
While at the foundation, he served on the Board of the Global Alliance for Vaccines and Immunization (GAVI).
The death toll due to COVID-19 has gone up to 273 and the number of cases has climbed to 8,356 in India, according to the Health Ministry.
Globally, the novel coronavirus has killed 108,862 people and infected over 1.7 million people globally. The US has the highest number of infections at 529,887, according to Johns Hopkins University data.
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