“We can only delay it, but India may have its peak somewhere in July,” said SK Sarin, Chairman of the task force constituted by the Delhi government for Covid-19 management. Sarin, who is Director, Institute of Liver and Biliary Sciences, is also known for his contributions to reforms in medical education and health sciences. As India, along with the rest of the world, battles the rogue virus, BusinessLine caught up with Sarin to demystify the unknown. “Infection is not a major cause of worry… the challenge is to ensure nobody dies of it,” he said. Almost 10 per cent of all Covid-19 cases in India are from the capital city. Excerpts:

What is it about the SARS-COV2 virus, which causes Covid-19, that we should know and we don’t?

The virus is known to live in animals such as bats and snakes. Once mutated, it is able to breach the human resistance and get entry into humans. SARS and Ebola are previous examples of such mutation. One can assume that the birth of the virus was sometime in November. The current virus has mutated nearly 20 times, there are so many variants of the virus already existing.

It is a rogue virus, it keeps changing shape. Lack of any memory makes the human body totally unaware of how to deal with the virus.

It is an upper respiratory virus, so Covid-19 is ten times more rapidly contagious than, for example, SARS, which was a lower respiratory tract virus. The virus is produced in high quantity, and multiplies in mucosa of nose and throat. It is extremely infectious. Once the virus is in the throat, it gets mixed with the saliva, and enters the digestive system. Then, it can multiply in the intestinal cells, colon, even in the bile duct. It makes home in the lungs.

How long before it spreads?

In a period of about five days, it spreads to all tissues causing clotting, cell death in lungs, low oxygen levels, pneumonia and respiratory failure. The second common organ to be involved is the kidney. We know now that it involves heart and blood vessels, pulmonary injury, kidney injury, cardiac injury, which are common causes of deaths. It also affects slightly the liver.

What kind of medications or combinations are being worked out for Covid-19? Is social distancing an answer?

We have to understand that by social distancing, we decrease the reproductive number, that is one person affecting a number of people, and we decrease it further by lockdown, but we cannot remove the curve.

We can only delay the peak. India may have its peak somewhere in July. It is still some time away, about four to six weeks. Infection is not a major cause of worry, but the worry is how to ensure people don’t die. To decrease death it is important that people come out and get tested. Sometimes you don’t have even a 24-hour window.

Prevention is by a vaccine which is not there. There is no drug available, at present. Remdesivir, previously tried in Ebola, only decreased the duration of stay (hospital) by four days, so we are nowhere close to a good drug. Cytokines (protective antibodies) are the only way to fight the bacteria or viruses, but since body has no memory of the virus it overdoes it and in the process kills itself.

Overreaction of the body to clear the virus, or a cytokine storm, is a cause of death in patients.

How do you prevent deaths then?

To prevent death, there are three approaches. First is — plasma therapy from a person who has recovered and has got good antibodies, given to a sick patient, which will bind the virus, and protective proteins — IgG may save patients.

The second approach is getting specific antibodies from plasma taken out, called IvIG, which have high immunoglobulin content, and giving them to patients.

Another technique that is becoming popular is non-invasive ventilation which is better than invasive ventilation and is conducted without inserting tubes in the patient’s lung. Our goal is to also prevent cardiac injuries. However, there are no drugs. Also, raising immunity through Ayurveda or hot water gargles is a good approach. Throat is the place where virus multiples. There is no scientific study on this, but it is said that if the temperature is around 76 degree Celsius the virus dies in 5-10 minutes and at 56 degrees it is inactivated in 30 minutes or so. Also, every citizen necessarily should wear a three-layer surgical mask to block the life cycle of the virus. One has to be smart, as no drug is available.

But ICMR came out with a statement saying plasma therapy is illegal outside clinical study settings...

ICMR was right. There was a huge expectation that everyone will be given plasma and all will be saved, which is not correct. The Institute of Liver and Biliary Sciences (ILBS), along with Maulana Azad Medical College, got the first approval from Drug Controller General of India, before ICMR or Kerala. The randomised trials are on since three weeks and we will know about the safety and efficacy of plasma therapy in the next few weeks.

Is the virus affecting all age groups?

The virus affects all ages. Even the Spanish flu, in 1918, it affected all ages, but deaths occur in people who are elderly. The Korean boy who went out to five night clubs infected so many persons, just two days ago. But, remember, 90 per cent of the flat tyre occur in the remaining 10 per cent of the tyre’s life and so mortality is higher if someone is above 65 years, having high blood pressure, cardiac disease or diabetes.

What is the procedure for undertaking a death audit for Covid-19 dates as discrepancies have now emerged between the data gathered from funeral sites, deaths recorded in hospital, and those put in official state bulletin?

It is a complicated thing, not only in India but everywhere. Some people die within 12 hours, and the test results are not available by that time. It takes 24 hours to 48 hours to get the report. Also, how do you test people who come in late and die within 24 hours, there is no way. Our first aim is to save the patient and not just do the test. Therefore, the criteria of suspected Covid-19 or probable Covid-19 have now been added recently.

What is your view on rapid antibody testing for Covid-19?

Rapid tests are blood tests for checking your protection levels, not for testing infection. The diagnosis of Covid-19 is by virus testing by RT-PCR method, which is done by taking the nasal swab. Antibody tests take an hour or two to do and to check if you have developed antibodies against virus. These are first generation tests, and be they Chinese or American make, they claim up to 80 per cent sensitivity and reliability.

As far as the testing strategy in Delhi is concerned, we are testing as many people as we can, apart from contact tracing, which is an important part. Delhi has a very good testing capacity, but we are not using antibody tests right now. In New York, 20 per cent individuals, almost one in five, were antibody positive, which means they were exposed and recovered. When the Centre decides if Delhi will be a part of the seroprevalence surveys (using antibody tests), we will be a part of it.

Related Topics
comment COMMENT NOW