New Zealand could see a "devastating" community outbreak if it moves to allow repatriation flights for New Zealand citizens out of India, according to an epidemiologist.
University of Melbourne professor Tony Blakely, who has been monitoring the outbreak, told Q+A with Jack Tame there was a "vast underreporting" of cases and deaths due to Covid-19 in the country, which could be as high as "0.5 to 1 per cent of the Indian population being infected per day".
Blakely said the number of people infected in India may be "20 per cent or so," meaning it "will, at some point, start to peter out" through the assistance of greater vaccination rates.
“This is the catastrophe that we were worried about happening at some point, somewhere, during this pandemic. It is happening now.”
While some attributed the controversial decision by New Zealand and Australia to ban travellers from India to racism over the belief the country's rate of infection is "just as high as what they were in the UK over Christmas", Blakely said it was not the case.
“If you actually look at the underlying infection rates that allow for underreporting, the situation in India now is probably 10 times higher infection rates than what it was in the UK around Christmas time," he said.
He said the situation in India being "10 times as worse" and working with an overloaded health system will see the case fatality rate rise over an inability to treat people, making it "a lot worse than what it was in the UK or the US at their peaks".
While Australian Prime Minister Scott Morrison announced earlier this week that repatriation flights for Australian citizens in India are on track to resume when the ban is lifted on May 15, New Zealand should not follow suit, Blakely said.
"I find this very difficult. As an epidemiologist, the risk is too high from India and Nepal. It needs to fall by about 50, 75 per cent before I’d be opening that up.
"If you’ve got citizens overseas, you should be repatriating based on human rights and the citizen rights arguments and I get that but epidemiologically, it’s quite risky because we know – we know – in Australasia, Australia, New Zealand – for every 200 Covid cases coming in, one will cause an outbreak somewhere in the community and we know how devastating that can be with lockdowns and stuff like that.
"It will be easy to get to at least 200 people infected coming back from India, which means that if they’re going to the hotel CBD where it’s more risky, the chance of an outbreak in Auckland is real. It’s not fictitious – it’s real."
Blakely said the situation in the neighbouring country of Nepal is "up 50 per cent higher - again" than that of India, according to the Institute of Health Metrics and Evaluation group in Seattle.
"We’re starting to hear reports of the health system’s groaning, lack of oxygen, all that sort of stuff in Nepal – just as bad, if not worse – than India so Nepal is bad."
He also expressed concerns about the situation in Pakistan, adding that while its rates are "about one-fifth, maybe one-tenth of India," Pakistan "could just blow at any point in the same way that India has".
However, the number of infections in Bangladesh is "on the way down".
Blakely said epidemiologists made a lot of assumptions about the Covid-19 situation in South Asia – himself included.
He said while India did not see as many Covid-19 infections despite its high-density population due to the hard lockdown at the start of the pandemic, it eventually gave way to complacency by holding religious festivals and failing to adhere to stringent health measures.
One positive aspect of the Covid-19 outbreak in India, however, is that it "does mean that more people have been infected, so places like India will be getting closer to what we would normally call herd immunity", he said.
"It’s not the way you want a pandemic to play out where you’re actually seeing a lot of morbidity, mortality in that country, but it will see the move towards some form of resilience through some form of herd immunity."
Blakely said the situation in India serves as a lesson to other countries not to put concerns around the economic damage of lockdowns over the health and safety of its citizens through social restrictions, which should be in place until the countries have "20, 30, 40 per cent immunisation".
"Once they’re getting to that level, that will dampen down the spread and maybe you don’t need to do lockdowns at that point. Those types of restrictions that Australia, New Zealand have used and other countries have at various times, will still be necessary until we get those vaccine rates well up."