As distressing images from across the world show healthcare systems overwhelmed by rising numbers of people affected by the novel coronavirus (Covid-19), estimates project an alarming increase in cases and mortality in India as well.

To contain the spread of the virus, India, too, has locked down on several fronts. Srinath Reddy, President, Public Health Foundation of India, helps make sense of the new virus and the rapidly changing scenario around it. Edited excerpts:

Statistical projections doing the rounds peg the mortality rate as being rather high. How seriously should we take these models?

Models provide estimates made on some data and several assumptions. Some factors may not have been taken into consideration, while making the predictions. For example, we have a much larger rural population than the large, much more mobile urban populations in the US and Europe. We can benefit if we block urban-to-rural transmission. The possible impact of temperature and the approaching summer is uncertain, but could be a factor in our favour. India’s early containment measures — like travel restrictions leading to a lock-out and school and college closures — too, would have an impact that has not been quantified.

Even the Imperial College modelling studies for the UK are being revised frequently with the changing input information. So, to forecast the status of the epidemic in India for mid-May or mid-June with pedantic certitude would be sliding on slippery ground. The fear is because of the unfamiliarity with the virus and its unpredictability. While both of these understandably evoke alarm, they make all prediction studies open to question.

Could the recent exodus of people from cities to villages have increased the risk? What does government need to do for enhanced surveillance in rural settings?

I am not sure that there has been an exodus. If there has been no or minimal community spread, many of those returning to villages would not pose a danger. They will be the majority. Travellers returning from abroad and their local contact do pose a threat if they have acquired the virus and travelled to rural interiors. They should be isolated for two weeks and followed up with for clinical features, if testing is not possible. These will be a minority.

How much longer will the country have to be under a lockdown? Do Indians, given our exposure, have a more resilient immunity?

The next 2-3 weeks will be critical. Mid-April will provide the signposts of where we are headed. Even if we appear to be in control by then, we need to continue with several disciplined measures of containment till June.

We cannot claim greater immunity, even though we have a younger population than the countries most affected so far. We have the challenge of undernutrition as well as hypertension and diabetes at high rates. Resilience is not a factor that can be measured or cited in infectious disease epidemics such as these. In any case, this is a new virus, and no one starts with the advantage of previously-acquired immunity.

 

Studies say that people with blood type A-positive are more susceptible. Thoughts?

As an A-positive person myself, I would like to see more data. I have seen a Chinese study on blood group associations with Covid-19 in Wuhan and Shenzhen. As the authors themselves say, the study is very preliminary. I would also like to see what the blood group distribution in the general population of these two cities is.

As the monsoon comes into the country in a few months, can people be at risk of acquiring multiple viruses at the same time? Or, can someone with HINI (swine flu), for example, get the coronavirus simultaneously?

We do not yet have evidence of cross-resistance. Co-infection or sequential infection remains a possibility, if Covid-19 is still circulating. We have to try and quell it before then.

There is no evidence yet of cross-immunity to this new virus. Otherwise, all of us who have ever had a cold would let out a sigh of relief and breathe easy through our clear or stuffed noses.

Positive outcomes are being seen with anti-malarials, anti-virals, azithromycin and Actemra on the Covid infection. Is this light at the end of the tunnel? Could this turn the tide for India?

These are definitely rays of hope. We are dealing with a threat that calls for great urgency in achieving scientific breakthroughs for saving lives. The whole world is experimenting and investigating to find effective treatments. We, too, must conduct studies in India, while hoping to benefit from studies elsewhere. Cure of sick patients does not, however, mean abandonment of prevention efforts, lest the virus mutate.

Any specific medicine or vaccine study that you suggest India should get on, that is tailored to a local population?

India can mount its own drug trials or join the WHO’s multi-country drug treatment trial, SOLIDARITY. Vaccine development has to precede a clinical trial. We have to see preliminary evidence on animal studies before human trials can be undertaken.

 

Your recent article in The BMJ spoke of the elderly bearing the brunt of the virus, as we see in Italy. But America and Australia are seeing young people getting affected too. Your thoughts?

Older persons are more vulnerable to severe complications and even fatality. Younger persons can be infected too, but usually with less severity. The high social mobility of young persons makes them more likely to be exposed to infection, but they usually fare better in escaping severe illness. In the US, some young persons have also exhibited severity. Associated hypertension, diabetes, obesity, smoking, vaping, drug use and diets low in fruit and vegetables can increase risk in younger persons too.

Governments are caught between the virus-spread, lockdowns and a hard-hit economy. Any suggestions on how to control the virus spread, while preventing a collapse of the economy by say, freezing the giving and taking of rentals, EMIs, interest (except for senior citizens), etc?

Lockdowns are a painful but necessary measure to contain viral transmission. They are usually short term. Economic slowdown has many contributory factors. We should not add an unmitigated public health crisis to those. A healthy population is the best protection against a long-term economic slump. So, let us now focus on protecting the population. I leave the economic revival measures to the Finance Minister.

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