Of cross-immunity, herd immunity and country-specific plans: Experiences from COVID-19 in India

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

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


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.

Original languageEnglish
Pages (from-to)1339-1344
Number of pages6
JournalAging and Disease
Issue number6
StatePublished - 19 Nov 2020


  • Hygiene hypothesis
  • Integration
  • Lockdown
  • Restructuring
  • T cells


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