Like most Asian and African countries, we do have a demographic advantage. We have a broad base of young adults and children to cushion the full impact of the pandemic. Sweden, which did not close schools during the pandemic, supports this proposition. In spite of schools being open throughout, there was no excess morbidity or mortality among the Swedish school children or their school staff.
Comparison of overweight prevalence based on Body Mass Index (BMI) show that countries in the West, all have overweight prevalence around 60% compared to around 20% in the Asian and African Countries. Age and obesity drive mortality rates from coronavirus 10 to 20 times higher in the developed world compared to developing countries.
Two outlier countries provide another clue to this question and present interesting contrasts.
Japan has the highest age profile, but their obesity profile is one-third of the West. Their mortality from Covid-19 is almost 15 times less than the Western countries. The strongest factor in Japan appears to be overall good health as evidenced by low BMI of the population.
The other outlier country is Brazil, which holds important lessons for India. It has lower age profile but obesity profile is similar to the West. Like India it is a rapidly developing economy with change in lifestyle, physical activity and diet. The mortality from Covid-19 in Brazil is exceeding that in many Western countries. Obesity is a greater driver of lethality than age.
Will the third wave impact the young? While overall we have a lean population, there is a tendency for the recently affluent population to adopt sedentary lifestyles, fast food, alcohol and smoking. Moreover, due to genetic handicap, Indians are more prone to diabetes and diseases of coronary heart disease a decade or two earlier than their Caucasian counterpart.
What is the way forward? We have to beef up the public health infrastructure equitably, and address the lifestyle changes among the newly affluent. A number of studies in our field practice areas brought out these incipient trends among the youth and young adults.
We found the younger generation four times more likely to be deficient in Vitamin D compared to the older generation. Diabetes was fairly prevalent in our rural and urban population, and more than half younger diabetics in the 35 to 45 years age group were not aware of their diabetes status. Risk factors of non-communicable diseases were prevalent both among urban and rural youth and young people.
Childhood malnutrition remains quite high as brought out in studies by our postgraduates and faculty.
We lose about 2000 under five children every day due to preventable diseases against a background of child malnutrition. Loss of livelihoods and interruption of child community nutrition programs at the community level will increase child malnutrition and child deaths. While Covid-19 may be mild on the child with normal nutrition, severe malnutrition in children may make them vulnerable to Covid-19.
If we do not address these concerns, we may face the third wave in which young people and children will bear the brunt, not due to lack of vaccination, as the present amateurish consensus seem to suggest, but as a result of not addressing the modifiable risk factors.
If like an amateur strategist we look only at the major piece the new queen, the vaccine, we may be left holding the queen but losing the game.
(The writer is Professor and Head, Department of Community Health and Clinical Epidemeologist, DY Patil Medical College, Pune)
