Of Cross-immunity, Herd Immunity and Country-specific Plans: Experiences from COVID-19 in India

Date

2020-12-01

Authors

Chakrabarti, Sankha Shubhra
Kaur, Upinder
Singh, Anup
Chakrabarti, Suddhachitta
Krishnatreya, Manigreeva
Agrawal, Bimal Kumar
Mittal, Amit
Singh, Amit
Khanna, Rahul
Gambhir, Indrajeet Singh

ORCID

0000-0002-1336-348X (Jin, Kunlin)

Journal Title

Journal ISSN

Volume Title

Publisher

JKL International

Abstract

India has witnessed a high number of COVID-19 cases, but mortality has been quite low, and most cases have been asymptomatic or mild. In early April, we had hypothesized a low COVID-19 mortality in India, based on the concept of cross-immunity. The presence of cross-immunity is presumed to lead to a milder course of disease and allow the time necessary for the development of adaptive immunity by the body to eliminate the virus. Evidence supporting our hypothesis has started showing up. Multiple studies have shown the generation of different T cell subsets and B cells responding to epitopes of viral proteins, especially of the spike protein, as a part of adaptive immunity against SARS-CoV-2. Cross-reactive T-cells have been demonstrated in patients who have been previously exposed to endemic coronaviruses. The interplay of cross-immunity and herd immunity is apparent in the COVID-19 scenario in India from the presence of a large number of asymptomatic or mild cases, a low infection-fatality ratio and a generally flat curve of percentage positivity of cases with respect to total testing, both in periods of strict lock-down and step-wise unlocking. It seems that cross-immunity resulted in faster generation of herd immunity. Although the initial restrictive measures such as lockdown prevented the rapid spread of the outbreak, further extension of such measures and overly expensive ones such as enhanced testing in India will result in a huge burden on the health economics as well as the society. Hence, we propose a restructuring of the health services and approach to COVID-19. The restructured health services should move away from indiscriminate testing, isolation and quarantine, and instead, the emphasis should be on improving facilities for testing and management of only critical COVID cases and the replacement of complete lockdowns by the selective isolation and quarantine of susceptible persons such as the aged and those with co-morbidities. In the process of describing India-specific plans, we emphasize why the development of country-specific plans for tackling epidemics is important, instead of adopting a "one policy fits all" approach.

Description

Citation

Chakrabarti, S. S., Kaur, U., Singh, A., Chakrabarti, S., Krishnatreya, M., Agrawal, B. K., Mittal, A., Singh, A., Khanna, R., Gambhir, I. S., Jin, K., & Chakrabarti, S. (2020). Of Cross-immunity, Herd Immunity and Country-specific Plans: Experiences from COVID-19 in India. Aging and disease, 11(6), 1339-1344. https://doi.org/10.14336/AD.2020.1104