Total cases of coronavirus infections in India are above 9 million and the death toll — so far — hovers above 1,33,738 but the active Covid cases are below 5%. The pandemic has dealt a devastating blow to the economy, education, and family life, impacting every aspect of daily life.
One of India’s top infectious diseases experts — Dr. R. Gangakhedkar — Dr CG Pandit National Chair at the Indian Council of Medical Research, ICMR (and former Head, Division of Epidemiology and Communicable Diseases, ICMR), spoke to Gulf News about the various facets of the coronavirus pandemic in the Indian context.
On anti-Covid vaccines
The progress in developing vaccines is astounding and quite surprisingly the vaccines are highly efficacious. If one considers the bar that was set by the WHO — which said efficacy of over 50% is acceptable — the results coming in from various vaccine manufacturers have over 90% efficacy. The human ability to produce a vaccine in less than one year’s time is a surprise because we have never done in the past.
All of them used spiked protein, which appears to be highly immunogenic and provokes immune system strongly. In India, The Serum institute, Cadila and Bharat Biotech vaccines are using an inactivated virus, which can’t replicate in the body. Notably, India may have 2-3 vaccines so that scaling up vaccine administration would be easier here compared to the West.
On the actual vaccine delivery
All these people are already producing vaccines, so by March, we should have a programme that will look at vaccine delivery across the country. The storage requirement of minus 80-degree Celsius is just for the Pfizer vaccine. When it comes to mRNA vaccine that Oxford is producing in India, it doesn’t require any such stringent refrigeration. One may store them as we store other vaccines.
Same is the case with Bharat Biotech vaccine. So, we should be able to deliver it quickly. The cost of Indian vaccine (Serum Institute’s) will be around Rs. 500 per dose. India should not have difficulty in the vaccination programme given the health infrastructure and strong political will. But, we should have adequate supplies. One problem would be a two-dose vaccine.
Since it is two dosages which are spread 28 days apart, the challenges will increase because people may not come forward to take the second dose in time due to competing priorities. Also, the choice of the vaccine will become complex because you will have multiple choices of almost equal efficacy.
On the vaccine protocols
Now, this is one grey area whether one would need a booster dose because we don’t know how long a person will be protected once he/she takes the vaccine. Among scientists, there is a clear division with some people believing that antibodies disappear so you will have to take a vaccine booster dose quickly but, I think, even if the antibody levels go down, we may not necessarily require a booster.
This is reinforced by the fact that reinfection is a rare entity. It occurs in less than 0.5% of the population who previously had Covid infection. The sensitisation of memory T-cells may ensure generation of adequate antibody levels when challenged by the virus again.
Due to lockdown the Indian outbreak started late so we will now have an opportunity to try and curb its spread better because vaccines may become available in India by February 2021. So, I see a smaller chance that the second wave would strike India.
The surge that you see is in smaller geographic areas. The intensity of the Covid growth depends on three major issues: one is population density, the second is mobility and the third is migration. Not all states or cities have similar kinds of patterns across India.
The ups and downs in daily new cases, are actually city-based. A few days back, Pune and Mumbai were very bad and now suddenly Delhi is bad, the surge is due to local conditions. You don’t see that it is mimicked at the National level as it remains a local event.
Side-effects of the virus
We call these as long-haulers or post-Covid syndrome. This virus is unique. It is only there for around 10 days on an average in the body of an individual. But the impact that you are seeing is because of your own immune system which mounts an attack vigorously against this particular virus. Now that’s the reason why you have multiple multi-systemic involvements, it will involve the brain, heart, lungs or kidneys but that’s happening due to your own immune response.
10-30% of people may continue to have symptoms like fatigue or sometimes lung fibrosis etc after the Covid infection. Perhaps, the Covid might unmask the tendencies of one’s body to develop diabetes and will advance it. Patients will also have the psychological or neuropsychological symptoms often due to the psychological trauma of facing a near fatal event. One need to undertake the breathing and physical exercise after COVID infection.
On what we don’t know
The surprises that have come in last 8 months were more related to transmission dynamics and how transmission occurs. The way the disease goes in the body, one thought it must be spreading through blood to other organs. The impression that the virus goes through the throat to pneumocytes and then via blood was proved to be wrong!
You are rarely likely to see this virus in the bloodstream. The damage that occurs mostly is through our own immune response. It is our immune response against the virus that leads to damage in severe Covid cases.