Renowned epidemiologist Jayaprakash Muliyil says the ‘shutdown’ over the current pandemic has affected people diagnosed with other serious illnesses like cancer.
New Delhi: One of India’s most renowned epidemiologists and chairperson of the Scientific Advisory Committee of the National Institute of Epidemiology, Jayaprakash Muliyil, spoke to The Sunday Guardian regarding the Covid-19 situation in India, if India could witness a second wave, apprehensions over a spike in Covid-19 cases after the festive season, among other such issues. Excerpts:
Q: Now that we are witnessing a steady decline in the number of daily Covid-19 positive cases, can we say that the worst is over?
A: Well, unlocking is going on everywhere, more economic activity is coming in so there was an anxiety that there would be a huge rise in the number of Covid-19 positive cases, but that is being negated. Remember that the rules are very simple, as long as there are too many susceptible people, there will be a spread of infection till the amount of herd immunity that is required is reached. Now my own feeling is that some areas are very close to herd immunity, while some areas have finished achieving herd immunity and some areas are still far behind so it is a mixture. When we look at the picture of India as a whole, the situation seems reasonable, but remember the virus is making its own track and it is travelling the way it is supposed to. If there are too many susceptible people, it will infect those people. We hope that the moment we go above 50% of infection rate, at least in the cities, we can fairly say that herd immunity is achieved there. Rural areas would take some more time, but they won’t be so bad since it is scattered as against what it is in cities.
Please don’t forget that there are many other diseases in India and corona is not the only one. Hospitals would have to look after all kinds of patients and this lockdown has really affected many people who are diagnosed with other serious illnesses like cancer. I feel a little more relaxed that the number is coming down because we can confidently face the true realities.
Q: You had been very vocal about herd immunity from the very first day and was completely against lockdown, but don’t you think for a country like India, going for herd immunity without lockdown would have been more dangerous?
A: I think I should clarify it, first of all I said lockdown is not for India. Rich countries like New Zealand can have a lockdown, but we cannot afford it. A complete lockdown is a tremendous burden on the people of India and we are paying the price for it. Coming to herd immunity, it is not an invention or my idea; it is a well-established phenomenon in viral epidemics, the virus comes and infects the susceptible people and when they reach a particular saturation of immune people, the disease will cease transmission and it will go into hiding. It will come up once again only when the susceptible people build up and susceptible people builds up through new birth, which takes a long time. That is the principle I was talking about and that is called a herd immunity threshold. Take for example, many containment zones which have now stopped producing fresh cases and that is because they have reached the level of herd immunity. This is what I was talking about.
Q: What are your apprehensions related to the spike in the Covid-19 numbers during and post the festive season as is being predicted by many doctors and epidemiologists?
A: I do not have to take a side on this, because it all depends on individual people’s behaviour. If everybody celebrates Diwali wearing masks, that itself would reduce the transmissions. Similarly, if you do not have big gatherings, there will be less transmission, so I think a little bit more responsible behaviour will make sure that there isn’t undue transmission.
Having said this, I would like to add that there would be some transmission and one can’t help it because in family get-togethers how do you wear a mask, but then again one should stick to immediate family and not have big family get together. At least for one year, we can have a Zoom Diwali.
Q: There have also been some studies which say that there could be a second wave in India from December, because of the winter and the festive season. What is your opinion?
A: Well, I don’t know. Some people have said this, but in my opinion, we are having this one wave, we are still in the first wave. There might be ups and downs in the cases which will be based on crowding, but there will be nothing called a second wave as far as India is concerned. Remember, a second wave comes after the first wave has subsided, we haven’t subsided yet, so what is the point of worrying about a second wave or a third wave.
Q: So, the big question is have we peaked or are we yet to peak?
A: Well, yes and no both, because peaking is an area wise phenomenon in India. Dharavi in Mumbai peaked and finished their pyramid. So, here in our country, it is an individual locality and community wise phenomenon, some places have peaked and some areas are yet to reach its peak. In many rural areas, the diseases have just arrived so this question cannot be answered in one word for the whole of India. we have to take it area by area. Wherever you see serology is about 50% or more, we can say that area has peaked and finished.
Q: Many experts have raised concerns over the states undertaking a greater number of antigen testing than that of the RT-PCR which is considered as the Gold Standard test for Covid-19. Your opinion
A: First of all, when you do counting, the real number of cases is only found out when you do serology and the number of cases we have been diagnosing is only 1/30th of the total number of cases that is evolving in India. You see one case and 30 other cases you don’t see. It does not make a difference. In a clinical situation, we need to test all people who are sick.
In my mind, a person with a Covid-19 virus is not a case unless that person is sick and having antigen positivity is not a disease, there are many viruses that infect our body every day and our body knows how to deal with them. The public health problem is for people falling ill. The question, therefore, is to look for the infectiousness of the person affected with the virus and infectiousness is better tested through antigen testing than RT-PCR, and in that context, RT-PCR is very often false positive, they show positivity but people are not infectious. The antigen picks up not everybody, but only those with a reasonable viral load. Then also look at the cost and time taken for RT-PCR testing; it is huge.
Q; India has one of the lowest death rates in the world and one of the highest recovery rates. How do you think have we been able to achieve this?
A: There are two possibilities here–either Indians are superior to any other human beings in the world. Secondly, that there is considerable under-reporting of deaths. So, we have to do a scientific study to see which is true.
Q: There are at least three vaccine candidates in advance stages; how soon are we likely to see a vaccine for Covid-19 and what would be the efficacy of that vaccine?
A: We have nothing yet and we are searching for it. What is the protective effect of the vaccine? Are there any major side effects etc, all these will have to be taken into consideration.
We do not know the efficacy of these vaccines. Clinical efficacy has to be demonstrated. No vaccine candidate has reached that stage. We do not have any data yet, Because the virus is very immunogenic, we hope the vaccine will also be immunogenic. If the virus was not immunogenic, then the vaccine would not work.
Q: You are saying that the virus is immunogenic, but there have been some cases of re-infection. How did that happen then?
A: Some people have sold this theory that the virus is transient. Our studies now show in the world that it is not and it has good memory and people who once infected will always remember. There are two issues about reinfection. Very often virus can come and visit you again briefly that is one thing, and this can happen in many diseases, but then this virus can’t hurt you because the immunity knocks it off quickly. A previously infected person will show immune response in hours. can you get any diseases second time, by and large no. There may be exceptions, in one in a million case.