Tag Archives: immunity

Can COVID Burst America’s Bubble While The World Battles The Virus?

On May 13, after combating three waves of the coronavirus, the CDC released guidelines stating that  Americans who are fully vaccinated against Covid-19 can resume activities without wearing masks or physically distancing in most settings, indicating that the pandemic may be near an end.

“If you are fully vaccinated you can start doing the things you had stopped doing because of the pandemic,” announced CDC Director Dr. Rochelle Walensky.

But experts at a May 14 Ethnic Media Services briefing questioned whether it was too soon to go back to normal.

“Bubbles are beautiful, but bubbles do not last long in this world,” remarked Dr. Ben Neuman, Chief Virologist at the Global Health Research Complex at Texas A&M University.  “Any vaccine bubble that may exist is going to be fragile, unfortunately.”

As Covid-19 outbreaks occur in Michigan, Florida and Puerto Rico, the AMA reports  there is potential for a fourth pandemic surge.

And yes, the Indian B.1.617 variant is here, says the CDC. It’s monitoring the Indian mutation that the World Health Organization classified as “a variant of concern at a global level” because it may spread easily. According to the CDC, new mutations of the virus are more transmissible and are resistant to treatments or vaccines. These include five notable variants – B.1.1.7: (UK),  B.1.351 (S. Africa), P.1 (Japan/Brazil), B.1.427 and B.1.429 (identified in CA).

Going back to normal could expose adults and children to deadly new strains of the virus and its variants, rippling across the US and elsewhere in the world.

Peter Maybarduk
Dr. Ben Neuman
Dr. Marc Lipsitch
Dr Rosane Guerra

 

Can America survive in its Covid-19 bubble?

Variants can burst our bubble said experts, voicing concerns about our vulnerability to virus mutations and the prospect of ever reaching herd immunity.

Dr. Neuman has been sequencing the virus strains in Texas, and has identified different variants thriving even locally. At the peak of Covid-19 in January, he found that 30% variants of concern were from the B.1.1.7. UK variant. By late April and early May however, he added, “every single virus …has been a variant of concern.”

The virus is changing in unexpected ways, explained Dr. Neuman, driving certain lineages of the virus out of existence.  It’s a Darwinian process that  showcases “an increase in viral fitness.”

But, without any checks or balances on the virus which operates on a short-term risk-reward cycle – a 6-to-8-hour timetable – scientists find it difficult to predict long-term movement.

You can trust a snake, a chicken, or a cat to act in its own best interests to the best of its ability said Dr. Neuman, but “a virus has no such impulse.” Instead, it has an evolutionary incentive that drives it not in the direction we would hope or expect, but in the direction of more severe, sustained disease.

Over time the virus will continue to mutate, and vary unpredictably, warned Dr. Neuman, and solutions will have to be updated continually.

“In this particular place and time, there is approximately a 100% chance that you will run into something that grows faster, and has the potential to spread farther, and perhaps hit harder than one would be expecting otherwise.”

The world has underestimated the virus over and over by relaxing restrictions and causing a virus resurgence, reiterated Dr. Neuman.

 

The question is, “Can we do the wrong things and still expect the right results?”

One outcome that scientists predict could keep the virus at bay or banished altogether is Herd Immunity, a popular concept that is mired in misconception and misunderstanding. Dr. Marc Lipsitch, Professor of Epidemiology and Director of the Center for Communicable Disease Dynamics at the Harvard School of Public Health, described herd immunity as a state in which completely immune completely or partially immune people in a population slow down transmission by making it impossible for the virus to pass through them from one person to another in a sustained way, “till the virus essentially goes away.”

Will vaccinations and infections create herd immunity in the current phase of the pandemic? Dr. Lipsitch believes that’s an unlikely scenario – even with the vaccines we have.

At the start of the pandemic, before lockdowns and social distancing, a person infected up to 21/2 or 3 people each. But compared to early versions of the virus, contagious new variants have increased transmissibility by up 4 to 5 persons each. To reduce transmissibility by a factor of 5, explained Dr. Lipsitch, means immunizing 80% of the population,  a challenge that may be impossible given a number of factors.

At the moment, every variant in the world is present in the US.  Immunizing the nation won’t be easy because vulnerable populations – especially racial/ethnic minority groups and economically and socially disadvantaged communities – lack equitable vaccine access, children under the age of 12 are ineligible, and vaccine hesitancy is prevalent.

In the US vaccine hesitancy is based on a lack of trust in its efficacy. At issue also, is that all vaccines currently available in the US do not offer 100% protection. But added Dr. Neuman, “I trust the virus less!”

While Yale Medicine rated Pfizer-BioNTech at 95% for preventing symptomatic disease, its stability depends on strict storage requirements; Moderna has a similar high efficacy of 90% upon full immunization, while the single shot Johnson & Johnson vaccine has a 72% overall efficacy.

There is also concern about waning immunity and about revaccination. Limited studies that exist clarify that antibodies decrease over time, but there is uncertainty about at which point a person is no longer protected.

Annual boosters may be necessary at a minimum, confirmed Dr. Neuman, but although each of the vaccines is reasonably effective against each of the variants, there is definitely a lower effectiveness against some, like those coming out of Brazil and South Africa.

It’s more the virus changing than waning immunity that will drive the vaccination cycle.

 

Defanging Not Defeating the Virus

In the wake of the CDC’s new mask guidelines, Dr. Neuman noted that people calculating what precautions to take – to mask, social distance, or get vaccinated – are making decisions predicated on the original versions of the virus.

As ‘stay-at-home’ lockdown measures gradually ease, NIH reports also say that much of the population may return to spending increasing amounts of time in inadequately ventilated workplaces, offices, schools and other public buildings, where they may be exposed to a risk of acquiring viral infections by inhalation.

So, in the midst of an ongoing epidemic, as social barriers to transmission are lowered without reaching herd immunity, and high-risk populations in the other parts of the world face vaccine shortages, we are “in some sense “ said Dr. Lipsitch, “not ‘totally defeating, but simply defanging the virus,” – just making it less dangerous to have transmission.

He predicts “a quiet summer” followed by “some virus resurgence in the fall” as people move indoors and continue to lower their guard.

 

Fighting the Virus at Warp Speed

All the experts argued that the only way out of the pandemic is to ensure that more vulnerable populations across the world get vaccinated.

Peter Maybarduk, Director of Public Citizen’s Access to Medicines Group, called for a global response at warp speed for the world – a catalyst for more funding, sharing resources and technical assistance, more manufacturing, and a definite plan to vaccinate everyone, everywhere, with at least 8 billion doses of MRNA vaccine within a year to make up the global shortfall.

Apart from the moral argument, added Dr. Lipsitch, “we like having interactions with the rest of the world, and for all the reasons we value the rest of the world, we should value their health as well.”

Dr. Neuman called for a single global solution to vaccinate everyone within a window of six months to a year.

Maybarduk, an expert on the Covax initiative which partners with the World Health Organization to get vaccines to low-income countries by sharing vaccines equitably, pointed out that wealthy countries have purchased much of the global supply of doses in bulk, so less than 5 % of the world’s population – only 340 million (one quarter of the doses already administered in the US alone) – have been vaccinated worldwide.

In Brazil only 17% of Brazilians have been vaccinated, said Dr. Rosane Guerra from the Department of Pathology, Biological and Health Sciences Center at the Federal University of Maranhao (UFMA). Brazil does not have an adequate supply of medication to prevent or control the virus.

Covax aims to vaccinate 20 percent of the world with a 2 billion dose target for 2021 but has only been able to ship 64 million doses, stated Maybarduk.  Worldwide access to vaccines is hobbled by the lack of manufacturing capacity, inefficient distribution channels, and low production volumes, access to raw materials, export controls, meeting regulatory requirements for safety and efficacy, obtaining qualifications from WHO for manufacturing facilities, and by politicians prioritizing their own citizens for vaccination first.

Sharing vaccines and vaccine knowledge (like the Trips waiver) is imperative to overcome the vaccine shortfall Maybarduk suggested, and getting vaccines to those who desperately need it in other countries..

“We should not cross our fingers and assume all is going to work out.”

Fighting the virus is like mobilizing for a world war which requires collective, integrated human effort towards achieving one goal. “I don’t think halfway solutions are going to get us there,” said Dr. Neuman. Getting to the next stage requires an integrated effort that scientists know is doable but is ultimately a political decision that world leaders must make.

“It’s impossible to have any kind of bubble in a world when people can move between countries in the middle of an epidemic. We have to close every border to control the disease,” Dr.Guerra concluded.

The bubble could burst as restrictions are relaxed before the pandemic is under control, said Dr. Neuman. “I don’t think that is the path that leads to the fastest extinction of the virus.”

“Get the vaccine, wear a mask, and when the numbers go down, then you know it’s safe to relax!”

Meera Kymal is the Contributing Editor at India Currents

Photo by Marc Sendra Martorell on Unsplash

Photo by Fusion Medical Animation on Unsplash

 

Stanford’s Dr. Nirav Shah on Vaccines VS. Variants

Breaking news that virulent variants from Brazil, South Africa, and the UK are multiplying across borders even as homegrown strains are mutating on US soil, has raised a number of questions.

Are variants more contagious?
Will they cause worse infections?
Are current vaccines effective against mutating variants?
And should we take different precautions to keep safe?

Dr. Nirav Shah, MD, MPH, of Stanford University’s Clinical Excellence Research Center, fielded questions and concerns from ethnic media reporters at a press briefing on March 19. Along with other COVID 19 experts from the Bay Area, Dr. Shah shared information about new strains of the virus and safety net information for communities of color who want to sign up to get their vaccine shot.

“We cannot start to celebrate just yet,” said Shah, even though America reached an important milestone when the 100 millionth vaccine was administered on March 19.

The Story of Virus Variants

The emergence of variants has raised the specter that the current generation of vaccines might be rendered obsolete before they have even been fully rolled out. Are variants gaining ground and will they be immune to distinct vaccines before we reach herd immunity?

“It’s a race between how fast we get people fully vaccinated versus the level of disease in a community and how much transmission is going on,” explained Shah, about how a variant becomes dominant.

In heavily infected communities, the more virus particles there are, the greater the chance of one being different. All you need is a spike protein change, said Shah, which will give the variant a better chance of attaching to cells, so it spreads better and faster, becoming the dominant strain.

Simultaneously, as more people get vaccinated to combat COVID19, “the selective advantage of some particles relative to other particles, allow them to spread much faster.”

Now the race is on to get everyone vaccinated before the B.1.1.7. variant – the most dominant variant takes over.

“The story of virus variants is the story of evolution and natural selection,” added Shah.

Investigations of Variants

Currently, the CDC and WHO are studying the spread of three designated variants. Variants of interest -like the P2 which have ‘caused a cluster of infections’  in some countries, seem to be driving a surge in cases, though less is known about their transmissibility and lethality, or even if vaccine recipients are ‘fully neutralized against them or not’.

Their genetic sequence has some changes which suggest they may be more contagious, said Shah, and likely to be resistant to immunity bestowed by vaccines, treatments, or tests.

People are at greater risk from variants of concern that could reinfect survivors of certain Covid19 strains. Therapies and vaccines may be less effective against these strains which have “proven to be more contagious and cause more severe disease,” explained Shah.

Recent studies report that COVID-19 survivors and fully vaccinated people seem able to fight off infection from the virulent B.1.1.7 variant but may have less protection against the B.1.3.5.1 variant. Shah referred to research that shows the B.1.1.7 variant spreads about 50% faster and is more lethal, relative to prior strains of the virus.

The good news is that the existing range of vaccines (Pfizer, Moderna, Oxford/Astra Zeneca, and Novavax) have proven effective against this variant.  But less is known about the transmissibility and lethality of the P1, B.1.4.2.7, and  B.1.4.2.9 strains.

So far, however, assured Shah, no variants have met the definition for variants of high consequence which refer to strains that cause “more severe disease, more hospitalizations, and have been shown to defeat medical countermeasures” – like vaccines, anti-viral drugs, or monoclonal antibodies.

In the contest between vaccines and variants, “We will win the race by …vaccinating people as quickly…and broadly as possible” noted Shah.

An Annual Shot

Infectious disease experts liken variants to flu viruses which require new flu vaccines every year; scientists are even considering the possibility of multivalent vaccines designed to immunize against two or more strains of the virus.

“It’s a race of the mutant viruses against the vaccines…and to date, none of the mutants have escaped fully the major vaccines. The hope is that with minor modifications, we can get the continued evolution of the vaccines to match the evolution of the viruses.” It wouldn’t be surprising if the COVID vaccine was administered like a flu shot every year, added Shah.

Getting to Herd Immunity

The likelihood of reaching herd immunity will be a reality if at least  70% or more of the population are resistant to existing strains of the virus. However, as states relax public health restrictions as well as mask and social distancing mandates, herd immunity may be challenging to achieve.  “More people getting infected simply means more chance of variants,” cautioned Shah.

I asked Dr. Shah if we would need a new generation of vaccines before the current vaccine roll is complete and if boosters would be introduced. “I am an optimist”, said Shah. “I imagine we would have booster shots by the fall but what’s important is that we all get that first shot, and make sure the vulnerable and elderly get theirs. That will make us collectively win”.

Dr. Shah reiterated that the Moderna, Pfizer, and Johnson & Johnson vaccines authorized by the Food and Drug Administration (FDA) for emergency use, are still the most powerful tools to fight all the strains of COVID-19.

“This is a race for the world,” said Dr. Nirav Shah. “We know the virus doesn’t respect any borders, and so we should be as broad as possible in our thinking about getting the vaccine to everyone across the world.”

Helpful links:

Meera Kymal is the Contributing Editor at India Currents

Indian Kitchen Secrets That Boost Your Health

It is not an understatement to say that along with words like quarantine and lockdown, immunity was also one of 2020’s buzz words.  Immunity simply means protection and in the context of the human body, refers to its capacity to fight infections by resisting the action of ‘foreign’ bodies or toxins, thereby protecting the body.  

Immunity is built over a period of time through lifestyle and dietary changes.  Nourishing your body with the right foods, exercising, keeping your mind stress free and getting enough sleep, are just some of the ways you can help keep your body healthy and strong.

Indian Kitchen: a treasure house for immunity boosting foods

There are several foods that help build immunity in the body and with seasonal changes around the corner, it is important to include them in your diet to keep protected against colds, coughs and minor infections of the throat.  

Citrus fruits, whole nuts, leafy greens and fermented foods like yogurt work wonders in nourishing the immune system. 

It’s no secret that the Indian kitchen is replete with foods that boost immunity.  The Indian pantry is full of indigenous ingredients used for centuries to keep the body nourished and healthy.  Traditional recipes, basically the ones grandma always recommended – “haldi doodh” (popularly called turmeric latte in the west), dry fruit ladoos made from ghee, or even the amala (gooseberry) candies you pop into your mouth to fight nausea, are some of the commonly known home remedies to boost internal health.  

While the benefits of pepper, ginger, garlic and turmeric are well known, other commonly used ingredients like cinnamon, cumin, honey, and jaggery also have anti-inflammatory, antiviral and antibacterial properties that help keep the body healthy.    

Here’s a look at the benefits of these spices:

  • Cinnamon: a delectable spice we are all familiar with, cinnamon is highly effective against bacterial and fungal infections and is known to have positive effects on heart health as well as blood sugar levels.
  • Coriander seeds (dhania): are rich in vitamin A and C, effective in curing coughs and colds, and also aids digestion.
  • Cumin seeds (jeera): a commonly used spice, jeera has several anti-inflammatory and anti-cancer properties and is known to aid in weight loss as well improve digestive health.
  • Carom (ajwain): is yet another elixir for gut health, flatulence and helps aid weight loss.
  • Fennel seeds (saunf): has several nutrients like vitamin C, calcium, potassium etc. and helps aid digestion.
  • Jaggery is rich in minerals like iron and zinc and is a good source of energy.  It is a blood purifier, cleanses the body and is excellent for liver and intestinal health.
  • Honey has healing properties and is a good source of antioxidants apart from having positive effects on cholesterol and blood pressure levels.  It is used to heal coughs, colds and sore throats and builds immunity.

Here are some home remedies that are effective in protecting your body against common ailments.

Home-made mixture for cough, cold and sore throat

  • Ginger powder: 1 tbsp or 2 tbsp freshly extracted ginger juice
  • Cinnamon powder: 1 tsp
  • Turmeric: 1 tsp
  • Pepper: 1 tsp
  • Honey: 2-3 tbsp
  • Mix the above powders thoroughly and then add honey.  Mix well.  Consume 2-3 times a day.

Home-made Kashayam (herbal tea) that helps build immunity

Dry roast the below ingredients and blend into a fine powder:

  • Coriander seeds: 2 tbsp
  • Jeera seeds: 1 tbsp
  • Fennel seeds: 2 tsp
  • Carom seeds: 2 tsp
  • Peppercorns: 1 tsp

You can increase the quantities and store the powder in an airtight jar.

Take 2 tsp of Kashayam, add it to a glass of hot milk.  Add 1-2 tsp of jaggery per your taste and consume hot. This Kashayam is a perfect panacea if you are down with body ache, sore throat or slight temperature.  

Herbal teas to prepare at home using greens that are a powerhouse of nutrients.

  • Lemon grass: replete with antioxidants, this fragrant shrub has eugenol which is a stress reliever.  It also helps regulate blood sugar levels and is rich in vitamin A, C and potassium.
  • Rosemary: again, an excellent herb known for its aromatic flavor, rosemary is anti-inflammatory, anti-bacterial and known to improve blood circulation.  Excellent for the skin and hair, it is also a great stress reliever and helps improve one’s mood.
  • Brahmi: known as the herb of grace, brahmi is intrinsic to all Ayurvedic medicines and is known for its anti-inflammatory and anti-cancer properties.  Apart from being good for the hair and skin, it is a memory booster, effective for reducing fever and is known for its positive effects on patients suffering from diseases like Dementia and Alzheimer’s.  

For preparing the tea, just brew 3-4 leaves of brahmi (or 1 small strand of Lemon grass or 1 sprig in case of rosemary) in water for about five minutes.  You can add a tsp of pepper, elaichi powder and some jaggery (or honey) for taste.  Mix well and drink when hot.  

Natural mixture for inhalation

Nothing compares to the relief rendered by a quick steam inhalation when you are down with a flu, stuffy nose or headache.  Consider using some ingredients mentioned above to prepare a healthy mix for inhalation.  Take a thick bottom vessel, add sufficient water and add in a tsp of turmeric powder along with one or more of any of the following ingredients:

  • 2-3 used lemon peels left over after extracting the juice
  • Peel of half an orange 
  • Peel of a small piece of ginger 
  • 3-4 strands of lemon grass
  • a sprig of rosemary

Boil the water thoroughly, cover your head with a towel  and inhale for at least 2 minutes. 

Rashmi Gopal Rao is a freelance writer from Bangalore, India. She mainly writes on lifestyle, culture, food, and decor. She has been published in Indian national newspapers and international publications like NatGeo Traveller.
Photo by Ratul Ghosh on Unsplash
Photo by Marion Botella on Unsplash

Eat Yourself To Health

Viruses are smart, they are masters of survival. They can hijack our body’s own mechanisms to live and multiply. During a productive infection, viruses hijack, multiply and destroy the cell that they call home for a very short time. Bacteria and parasites have also devised various intelligent and opportunistic methods of attacking the human body. To protect ourselves from these infectious agents, the immune system is the frontline of a preemptive defense, while some infections may be controlled by therapeutics. 

Vaccines are the most overtly and urgently effective route to control these infectious agents as they specifically direct the body’s immune defenses against these intruders in multiple ways. However, we can take the initiative to maintain a strong healthy baseline. In addition to stress alleviation and staying active, we can consciously incorporate a few things in our diet to hone our intrinsic defenses. One aspect of this could be accomplished with a few spices, herbs, and condiments that we are familiar with. 

Spices and herbs have fragrant oils that impart the flavors that we know and love, but they also pack alkaloids and other compounds which can have specific effects on the human body. Although detailed ayurvedic knowledge about the effects of these dietary inclusions exist, this article is meant only to raise awareness, and not delve into the depths of beneficial and harmful aspects of the few spices mentioned below. 

Black pepper

Dubbed the ‘queen of spices’ and ‘black gold’, pepper is native to the Malabar coast of Kerala, and was the original spice that fueled the European spice trade. It was the mainstay for introducing pungency and heat in Indian cooking until the Portuguese introduced chillis to India in the 16th century. Among other effects, pepper has antipyretic properties. However, another important property of piperine, an alkaloid in pepper, is to increase the bioavailability of other compounds. That is, it increases the absorption of other chemical entities that are by themselves not readily absorbed. This leads us directly to the next spice, turmeric.

Turmeric

Hailing from the ginger family, the root of turmeric is used as a spice with a familiar hue. In addition to imparting a rich yellow color to food, turmeric is known for its antiseptic and anti-infective properties. Curcumin, an alkaloid in turmeric, also has anti-inflammatory and anti-oxidant properties and has been studied extensively for its properties in ameliorating diseases, and in promoting general health. However, curcumin is not easily absorbed by the body, and combining its use with black pepper improves its absorption.

Tulsi

Otherwise called Holy Basil (appropriately called Ocimum sanctum in latin), tulsi is more associated with religious ceremonies and Ayurveda than with cooking. It is related to, but distinct from, the basil used popularly in Thai cuisine. I have often wondered why tulsi is not used in Indian cooking given its amazing flavor, but it appears its religious associations preclude its use in something as mundane as food. Tulsi is an adaptogen, in addition to having several other medicinal properties, including antibiotics, and blood pressure control to name a couple. As an adaptogen tulsi is advocated for general wellbeing and stress reduction. Tulsi when added to tea imparts a soothing flavor, and occasionally adding a couple of fresh leaves (for those of us who have a plant at home) or a pinch of dried tulsi leaves while brewing a cuppa makes for an excellent beverage.

Oregano

Since we are in the age of fast food, and Italian food can be a popular healthy option, oregano is a spice that we are all familiar with although it is not commonly used in Asian cuisines. In terms of flavor, it is a close cousin to ajwain belonging to the cumin family that is used in Indian cuisine, but the plants are not related. Oregano packs an intense flavor and has several essential oils, including thymol, which are thought to be antiseptic among other properties. Oregano can also be taken for general well-being, and both tulsi and oregano can potentially boost the immune system. Not surprisingly, they belong to the same super-family of fragrant herbs, Labiatae.

Garlic

The medicinal properties of garlic were known to several ancient cultures, and its health benefits are thought to range from digestive to respiratory and circulatory systems but, of current relevance, it is anti-microbial. The pungent odor and taste of garlic are due to sulfur-containing compounds that are released when it is cut or crushed, and the best known of these is called Allicin. In addition to being anti-bacterial, allicin is also thought to have anti-viral properties. Other members of the garlic family, including onion, share the same compounds, but in reduced amounts.

This article is not advocating the ingestion of these spices at the level of a therapeutic or dietary supplement, but only regular inclusion of these as spices in day-to-day cooking. It is also not an exhaustive list of all the benefits these spices are thought, and known empirically, to confer. Several other spices and condiments that we are familiar with also have beneficial health effects: cumin (jeera– anti-parasitic), ginger (anti-inflammatory), fenugreek (methi seeds– anti-bacterial and laxative), yogurt (pro-biotic), cardamom (blood pressure control), cinnamon (anti-microbial), green and red chillis, and so the list goes on. Finally, it should be mentioned that cooking could destroy a percentage of the active principles and the ensuing health benefit, and frying (including seasoning or tadka) would inactivate a higher percentage.

So, a periodic shot of rasam may not be a bad idea. In fact, variations on the theme of this thin soupy concoction are found in most Asian cuisines. Mix in different spices for variety: pepper, turmeric, lemon, cilantro, lemongrass, oregano, basil, neem leaves, garlic, red chilies, and others to complement your daily creativity and menu. It adds variety, in addition to providing an excuse for an excellent sinus-clearing aperitif! 

L Iyengar has lived and worked in India and the USA. A scientist by training, she enjoys experiencing diverse cultures and ideas. She can be found on Twitter at @l_iyengar and at www.liyengar.com.

Dharavi slum in Mumbai

India’s Low COVID Death Rate Is Puzzling

Though the COVID-19 crisis hit India hard – over 9 million cases have been reported and more than 138 thousand people have died  – the mortality rate from COVID-19 is inexplicably lower compared to other countries.

For instance, while the US leads the world with more than 14 million cases and over 276 thousand deaths, according to the John Hopkins Coronavirus Research Center, India accounts for only 10% of deaths globally and has the highest number of recovered patients of COVID-19 at 94%, even though its coronavirus caseload is second only to the US.

With such a significant share of the world’s coronavirus cases, shouldn’t COVID-19 have been more devastating in India?

Krishnaraj Rao

“Then again it has not,” announced Krishnaraj Rao, an investigative journalist from Mumbai, India, at an EMS briefing (November 20) on the pandemic.

“Something strange has been happening within the Indian subcontinent and neighboring regions,” said Rao. “For some strange reason our mortality rate per million is one eighth and our total cases seem to be in the region of one sixth per million.”

As COVID-19 began its inexorable spread across the world, the WHO recommended safety precautions to protect against the virus – physical distancing, wearing a mask, well ventilated rooms, avoiding crowds and close contact, and regularly washing hands.

But in an outcome that has puzzled epidemiologists and scientists alike, India seems to be experiencing a low mortality rate from the coronavirus, stated Rao, despite the crowded conditions in which many urban Indians live.

A large proportion of urban dwellers in a developing country like India lack access to adequate healthcare facilities and maintain poorer sanitation and hygiene practices which are known to be responsible for a higher incidence of communicable diseases.  So the virus was expected to have caused many more deaths in densely populated communities in India than it has.

Urban Indians are ‘badly housed,’ explained Rao, using Mumbai as an example to explain why crowded Indian cities offer a fertile petri-dish for catastrophic coronavirus outbreaks.  “I would say that close to 60% of the population of urban India lives closely packed together in slums.”

In a metropolis like Mumbai, home to over 20 million and India’s largest city, nearly one million people live cheek by jowl in Dharavi, one of the world’s largest slums.

“Houses are no more than two feet apart. Each house is no larger than a 10 by 12 room,” said Rao.

Each home houses about 10 to 12 people, closely packed together. It makes social distancing nearly impossible, while access to basic hygiene essentials, including toilets and hand washing are limited.

“There is only one public toilet per every two or three hundred slum dwellers,” explained Rao, highlighting the less than hygienic conditions in slums like Dharavi. “Face masks, social distancing…are close to non-existent. We take things like face masks, temperature checks and sanitizing very lightly,” he claimed.

“If it were a pandemic that was ravaging us because of a lack of social distancing,” asked Rao, why are the slums relatively less impacted than expected? And, despite overcrowding on the suburban railways, he adds, “the crisis has hit us less hard than anticipated.”

While epidemiologists attribute India’s low mortality rate to under-reporting, and even though Rao himself expected undercounting, he alleged that at least in Dharavi, there is no evidence of it. “I don’t see the bodies piling up in the streets… or the hospitals,”  nor has he noted any alarming rises in the body count.

Rao claimed he is voicing “a mainstream belief” felt across economic classes and demographics in India, that the coronavirus is not causing the high mortality rates that were anticipated.

In Dharavi, officials say that concerted public health efforts to trace, track, test and treat cases, have helped to contain community spread.

Now, recent research by Indian scientists seeking to explain why India’s death rate is so low, suggest that more Indians may be immune to COVID-19 because they live in unsanitary conditions which have created an unexpected shield from the virus.

According to one study, more than 70 percent of all COVID–19 deaths have occurred in high income countries like Italy, Spain, UK, France and USA. It hypothesized that more people died in richer countries with older populations, because better hygiene and safe sanitation practices lowered levels of immunity and made people more susceptible to the virus.

In another study scientists report, “It appears that countries with better health care, clean environment, clean food and water have higher COVID associated mortality, whereas developing and underdeveloped countries have lower mortality in terms of deaths per million population.”

Both research studies (not yet peer reviewed), suggest that in low GDP countries like India, lives of people in densely populated areas may have been saved because of poor hygiene and sanitation practices.  Unsanitary conditions and exposure to diseases from childhood may have increased their ability to ward off infections, and boosted immunity against COVID-19. Experts also suggest that the early lockdown and a younger population helped stave off a higher death toll in India.

The science is intriguing. Does greater exposure to a variety of viruses in the slums of low income countries provide a better level of protection against the coronavirus, than the overly sanitized environments of richer nations?

“Paradoxically, better sanitation leads to poor immune training and thus could be leading to higher deaths per million,” says the study. But it cautions that while the research offers a possible explanation, poor hygiene is not a solution to the pandemic.

India, and Dharavi in particular, may have pulled off a remarkable reprieve against COVID-19 for now. But the pandemic is far from over and science is still learning about this young virus. So, public health experts warn, SMS (social distance, mask, and sanitize) must remain the global mantra to keep Covid 19 at bay, until vaccines become easily available to the general public.

Meera Kymal is the contributing editor at India Currents.

photo credit: Baron Reznik