The fourth nationwide sero-prevalence survey of SARS COV-2 antibodies conducted by the Indian Council of Medical Research (ICMR) has revealed data, alerting about the upcoming multiple waves of COVID-19 and several observations on the current scenario.
The survey was conducted in 28,975 children and 7,252 health care workers in the age group of 6 to 17 years, after which the conclusions were drawn. The survey was conducted in 70 districts of 21 states of the country, 10 villages/wards in each district were first selected, identifying 40 persons per village/ward. So a total of 400 persons aged six years and above were screened per district, while 100 health care workers per district were also selected from district and sub-district hospitals for the survey.
As per the survey, a total of 62.3% vaccinations have been done, of which 89.8% are fully immunized (dual dose). And 81% have taken the first dose of the Kovid 19 vaccine and had antibodies. But of all these figures, the eye-catching number is that of health care workers who have not taken the job even once—about 10.5% of health care workers have not taken any vaccine, the survey noted. Many health professionals were initially reluctant to ban it, but their numbers continue to rise seven months after the vaccination program began.
In parallel, 13.4% of healthcare workers have taken a single dose and 76.1% have taken two doses. The overall seroprevalence (presence of COVID antibodies) in the country is 85.2%. This means that two-thirds of the general population have antibodies to SARS-CoV-2. But one third of the population does not yet have antibodies and their number is around 400 million which is not a negligible proportion. States, districts and areas without antibodies are at risk of waves of infection, alert experts.
children are stronger than expected
The survey reported that more than half of the children in the age group of 6 to 17 years were seropositive. And there is not much difference in population, sero-prevalence was similar in both rural and urban areas. This raises questions as experts say that the pattern of rural and urban population will never be the same. This is a national level survey and is not a substitute for local (state/district) variations, the survey report says.
Alerts of future waves and tips
The report clearly mentions state heterogeneity indicating the possibility of future waves of infection and therefore suggests avoiding social, public, religious and political gatherings.
Also, a major restriction on travel has been suggested by the survey. Non-essential travel should be discouraged and travel should be allowed only to those who have been fully vaccinated, highlights the report. It clearly recommended ensuring full immunization of all health workers and expediting vaccination coverage in vulnerable population groups. In addition, ensuring adherence to non-pharmaceutical interventions and continued tracking of COVID-infections in SARI cases in district hospitals, as well as cluster identification and clinical severity, is of prime importance, the report said.
Meanwhile, experts say that the national serosurvey is general data and such surveys need to be done at the state level in a more specific manner to measure the antibody levels of the population and hence plan to deal with the next wave.
Epidemiologist and Public Health Research Specialist Dr Sunil Kumar DR has noticed some major flaws in the nationwide survey. “Many European countries are dealing with the third wave and facing the fourth wave. But these countries have not seen infections targeting the pediatric population. We can therefore conclude that the third wave will have an impact on the child and adult population alike. There is no evidence that the target population is pediatric.”
Also, we can note the official statements of ICMR which are contradictory in the period of 2 months. Initially, the ICMR had warned the health sector to be on alert and said that children will be most affected by the third wave. But AIIMS chief Dr Guleria had said a few days ago that children are safe in the third wave as their immunity is very good and hence schools can be opened gradually.
Although, so far, vaccination is only for adults, yet, children have shown immunity that is equal to that of adults. Therefore, children are stronger than adults in terms of immunity or antibody production. Furthermore, there is no data to substantiate the high mortality rate in children that calls for extra vigilance.
There is a dire need to do state wise sero surveillance. This is a nationwide survey and does not address specific ground conditions. Also, after all these months of a nationwide vaccine campaign, a significant group of health workers who are not getting a single shot of the vaccine are at a greater risk to be considered. Dr Sunil Kumar suggests that vaccines should be made mandatory for healthcare workers as they will be in direct contact with patients and hence are at risk of becoming a super spreader if infected.
How to be afraid?
We should also note that the report does not mention genomic sequencing at all. Given the situation where different forms of the virus are making headlines and creating confusion and fear among people, that information was much needed. Delta, Delta Plus, Kappa and others have been described as scary but where and how much is still unclear. According to experts, state level sero surveys, data on variants and their presence will play a major role in tackling the coming waves.
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