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Over 400 million Indians continue to remain vulnerable to covid-19 as two third of the general population was found to have SARS-CoV-2 antibodies during fourth round of the national serological survey conducted by Indian Council of Medical Research (ICMR).

Showing that majority of the Indian population has been exposed to the virus in last two months, over 67.6% population was found to have antibodies against SARS CoV2 virus that causes covid-19 during the survey.

The serological survey was conducted from June to July 2021 on over 28,975 individuals including adults and children (aged 6-17 year), apart from 7,252 healthcare workers in 70 districts where earlier three rounds were also conducted.

Among the population covered under the fourth survey, 10% people were aged between 6-9 years, 20% were aged 10-17 years, and people aged 18 years and above constituted 70% of the survey sample.

More than half of the children surveyed (6 -17 years) were seropositive with the sero-prevalence similar in rural and urban areas for all age groups, the survey showed.

In an upward trend, the seropositivity has only been increasing in the consecutive serological surveys done by the government. The first sero survey conducted in May-June 2020 found 0.7% seroprevalence, second such survey was conducted in August- September 2020 which found 7.1% seropositivity and the third survey carried out in December 2020- January 2021 found 24.1% people to have SARS CoV2 antibodies.

“In the fourth round of national sero-survey for covid19, the overall sero-prevalence is 67.6% in the entire population. Amongst the adults in the survey, 62.2% people were not vaccinated, while 24.8% had taken single dose of vaccine and 13% were fully vaccinated," said Dr Balram Bhargava, director general, Indian Council of Medical Research (ICMR).

“A third of population did not have antibodies which means that 40 crores still remain vulnerable to the coronavirus. The implications of the Sero-Survey show that there is a ray of hope but there is no room for complacency. Non-essential travel must be discouraged and travel only if fully vaccinated," said Bhargav.

The government has warned that States/districts/areas without antibodies run the risk of infection waves. The government has asked the states to ensure full vaccination of all healthcare workers and accelerate vaccination coverage in vulnerable population groups. The government further said that people should ensure adherence to non-pharmaceutical interventions. “The governments should continue tracking Covid-infection in severe acute respiratory infection (SARI) cases district hospitals and identify clusters and clinical severity while the Indian SARS-CoV-2 Consortium on Genomics (INSACOG) is tracking variants of concern," said ICMR chief.

“85% healthcare workers had antibodies against SARS-CoV-2 and one tenth of the healthcare workers were unvaccinated. It is very important to accelerate covid-19 vaccination," said Bhargava.

With a growing debate whether India is inching towards herd immunity with more and more people getting infected, public health experts have said that larger population having antibodies doesn’t ensure protection against the virus.

Dr Lalit Kant, an epidemiologist argued that sero surveys only tell the level of exposure of population to the virus but has no importance of herd immunity against coronavirus with the current availability of research. “What we know from the available research is that antibodies against covid-19 last for around 9-10 months. After this immunity wanes, a person is susceptible to the virus again. India has seen several breakthrough infections either natural infections or vaccinations," said Kant.

Public health experts have further called for larger population surveys for deeper understanding of covid-19 and antibody response. “Although over 28,975 residents and 7252 HCW were a part of the sero-surveillance, larger surveys are needed for more clarity. People should continue to remain cautious about disease spread because we are still unaware about the incidence rate of different variants and its co-relation with antibody response," said Dr Rahul Tambe, Senior Consultant, Internal Medicine and Infectious Disease, Nanavati Max Super Speciality, Mumbai. “Most importantly, presence of antibodies doesn’t guarantee 100% protection against covid-19 infection," said Tambe.

The pandemic has hit all sectors ranging from economy, health infrastruture to education. India has seen the strictest lockdown due to covid-19 pandemic and has so far failed to resume in person schooling due to resurgence of covid-19 cases. Urging countries to open schools, a joint United Nations report this week said that in fewer than a third of low and middle-income countries, all students have returned to in-person schooling, heightening the risk of learning loss as well as drop-out.

The ICMR survey has shown that the children too have been infected and still remain vulnerable, ICMR has backed the opening of primary schools on condition of full vaccination of all the school staff.

“It will be wise to reopen primary schools before secondary schools as children can handle viral infections much better than adults. Antibody exposure is also similar in children as adults. Some Scandinavian countries didn't shut their primary schools in any wave of covid-19 waves," Bhargava said.

"Once India starts considering, it'll be wise to open primary schools first before opening secondary schools. All the support staff whether it be school bus drivers, teachers and other staff in the school need to be vaccinated," he said.

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