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Study COVID Nature and Strategise Accordingly


The New Indian Express - BHUBANESWAR l FRIDAY l APRIL 17, 2020  (News Link)
India’s efforts to combat SARS Cov-2 (Covid-19) have been effective so far but there is no scope for complacency. Distinctive features of the infection in India should be studied intensively to devise country-specific strategies, infectious disease specialist and Director of International Microbiome Research of Georgetown University Medical Centre, US, Prof Pinaki Panigrahi tells SN Agragami.

Three weeks into nationwide total lockdown and its extension till May 3, how do you see India’s battle against coronavirus?
Preparedness by the Centre and states have been excellent and timely. Without the bold steps taken swiftly, we would be seeing many more cases and deaths. The situation would have gone out of control by now. Any delay or callousness (like in the US) on lockdown would have only created more infections.
Now, the lockdown should continue as we are seeing new cases emerge. India’s ability to test more and more people for SARS Cov-2 positivity will also greatly aid the decision making on when to relax the lockdown and when to fully open.

Odisha has been a frontrunner in the country in taking extensive measures - from imposing lockdown early to setting up dedicated Covid hospitals and training and deployment of healthcare workers. What is your observation?
Odisha’s proactive measures have certainly helped in prevention of the spread of SARS Cov-2. The numbers that we are seeing are primarily from single sources spreading to contacts. There seems to be no community transmission as yet but it can be more emphatically stated only after the tests increase so as to generate conclusive data. Creation of dedicated facilities is another important issue. During these times, I emphasise again to ensure preparedness of healthcare workers to protect themselves. Finally, collecting and storing all samples of the virus from sick patients and serum properly will help scientists in the coming months to understand the pathogenesis.

Though cases continue to rise significantly, positivity rate in India still appears to be greatly lower than the West. Is the virus behaving differently here and has less potency?
With available research, there is no indication that the SARS Cov-2 strains from China, Europe, or USA have different virulence. It is well established that this is a highly contagious virus but has less virulence than some others, say Ebola. In many ways, this is in agreement with evolution of strains – i.e. if they kill the host quickly, they will not be able to infect too many. Most of SARS CoV-2 cases remain symptomatic for several days and pass on the infection to others.
We also know about a phenomenon called ADE (antibody dependent enhancement) of disease. Against conventional wisdom, previous infection or antibodies to other similar viruses make the host sicker stead of protecting (Dengue is a good example). About 60 per cent of the population in the West is colonised by some coronavirus strains with mild to no disease. Still, the case and fatality rates with SARS Cov-2 are high.
May be, there is less ADE but greater general immunity to infections in Indians. In Indian setting, the population gets exposed to many viruses including influenza (although a different virus altogether) and no vaccine is used in contrast to the West. Age demographics could also be in play. India’s median age is about 20 years younger than Italy and 10 years younger than USA, which might be a factor.

There are contentions about BCG vaccination enhancing immunity among Indian population and some are even calling for another round of vaccination to provide protection to the vulnerable sections?
There is a strong indication of non-specific immunity by BCG vaccination in India as well as Asian and African countries. Western countries have stopped BCG for many years and may be lacking such immunity. In this context, when specific vaccine for SARS Cov-2 is yet to be developed, BCG could be tried. However, there is enough evidence that the vaccines based on Indian and Russian strains are far less effective than Japan and EU countries. If vaccination should be carried out, those strains should be used. Will weather play a more important role in containing Covid-19 in India as the country grows hotter and humid with advent of summer?
When transmission of a viral disease is considered, temperature and humidity always comes to picture. It is presumed that the droplets that carry the virus cannot float in the air for too long when it is humid and hot. Similarly, the virus dies faster on hot surfaces inhibiting its spread by touching. However, there is no reason to believe that human to human transmission is less in summer months.
We have to learn from Smallpox. Although the West had typically recorded high transmission and disease burden in winter months, in countries like India, it was mostly year round. Once the virus enters a human body (temperature of 37 degree Celsius), whether it is hot or cold, it will multiply. Now, for India, warmer temperature is not expected to help much in reducing transmission, because, in densely populated households and society, person to person transmission cannot be prevented.

In next few weeks, how do you foresee the situation evolving in India? 
In states and cities where several thousands have been recorded, the number is definitely going to grow at a much faster rate than in states like Odisha where the number is still small and the cases are moderately well controlled. Even if new pockets surface, as long as they are immediately quarantined, the infection in those individuals will end in two weeks. The ones infected by them will take another week to show sign symptoms. So, in three weeks time, we will know the future course of this disease really well. I hope that there will be enough test kits available soon to comment on disease burden as well as the virus behaviour with confidence. That will also allow authorities to lift the lockdown in a judicious and step-wise manner.

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