Mathematical models on severity of COVID-19 in India carried strong bias, failed: IJMR editorial

Various mathematical models on the severity of the COVID-19 pandemic in India carried a "strong element of bias and used assumptions" to predict cases and deaths, an editorial published in ICMR's Indian Journal of Medical Research has said.

It said it "is a huge risk" to solely rely on these models for policy decisions on advance planning since predicting infectious diseases for a new pathogen is an "extremely perilous proposition" and hence it should be avoided.

The editorial 'Lessons learnt during the first 100 days of COVID-19 pandemic in India' is penned by Rajesh Bhatia, former director of Communicable Diseases for WHO's South-East Asia Regional Office, and Priya Abraham, director of ICMR-National Institute of Virology.

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Several mathematical models projected the severity of pandemic in terms of cases and deaths and at least in the context of India, none of these proved correct and failed to predict the biological phenomenon of infectious diseases, it stated.

"It was obvious that the models proposed during the COVID-19 pandemic carried a strong element of bias and used assumptions which proved to be far from real," it said, adding estimates of modelling studies are "only as good as" the validity of the epidemiological or statistical model used and accuracy of assumptions made for modelling.

Another lesson learnt during the first 100 days (Jan 30-May 10) was that evidence-based strategy to reduce viral transmission worked for a shorter time as in spite of the extensive and prolonged lockdowns, the number of new cases continued to rise in India, the authors said in the editorial.

"Multiple eruptions of cases in new locations were reported, indicating breaches in the implementation of lockdown," they said, stressing the need for developing and implementing plans through micro-planning for local area using data generated locally.

However, they added, the impact of lockdown was visible initially and it provided the much-needed time to strengthen health systems and ensure public engagement.

They also talked about the impact of uncontrolled movement of migrant populations, saying their exodus to native places was not anticipated but had to be curtailed in the context of national lockdown.

Citing increasing daily cases between May 1-10, the editorial said the COVID-19 pandemic has not been uniform in India.

It also said the pandemic has highlighted that protection and preservation of vulnerable senior citizens should be a priority and that strong risk communication strategies and access to medical care are essential to protect them.

Besides, India needs a permanent network of at least 1,000 laboratories with PCR facilities with at least one laboratory in each of its 734 districts and multiple such facilities in cities and metros, it said.

The crisis also underscored that public engagement is the key to contain COVID-19 pandemic and early response, effective command, whole of-government approach and strong political leadership ensure focused and coordinated actions.

It brought to the fore that frontline workers need protection from infection and ignorant communities as were a few unfortunate instances where communities, "out of ignorance", protested against their living in the neighbourhood.

"Active dialogue with the communities to promote their engagement to recognize and respect these workers is the need of the hour," it said.

The editorial highlighted that India could successfully and rapidly scale-up several important interventions but then "SARS-CoV-2 is an unknown treacherous enemy" and there is no space for complacency.

"It can strike in hitherto unknown ways. It has the potential of causing greater disruption and destruction. India cannot afford any complacency. Caution should be the keyword during the days to come," it said.