‘Biggest challenge for patients is fighting stigma’
to ensure social distancing, quarantining, and isolation of symptomatic persons.
Do you think the lockdown should be extended?
The situation is still evolving. No doubt, the lockdown and quarantine has tried to contain the spread among clusters, still we have a long way to go till every contact of a confirmed case is rendered safe. I would like to convey to your readers through this interview that they must honour the lockdown protocol. Staying at home is the only way of staying safe.
There is a lot of discussion or speculation as to whether the country has reached stage 3 or not. Have there been cases of community transmission?
There is no clear globally accepted definition for community transmission. Right now, India has mostly cases related to international travel, or such contacts. There have been only a few sporadic cases, which do not indicate a wider communitywide spread of infection at the national level. There are a few clusters of cases, which are being managed through cluster containment strategies. With the information at our disposal, it appears that there is no widespread transmission of Covid-19 in the community at the moment. However, we are far from being complacent, and we are maintaining stringent adherence to social distancing measures, ensuring a tight lockdown, and motivating the communities to own the social distancing strategies.
How close or far are we from finding a cure? Is a vaccine still a distant possibility?
There is no definitive cure for Covid-19 at the moment, and management is mostly symptomatic and supportive. However, a lot of investigational therapeutics are being researched, and India is part of international efforts to find a cure, such as the multi-country
“Solidarity Trial” of WHO. Several treatment alternatives are also under trial; however, a definitive cure is not yet on the charts. Some of the agents under investigation include remdesivir, favipiravir, hydroxychloroquine plus azithromycin, lopinavir/ritonavir, to name a few. Some of the recent trials have indicated that the last two options may not be very effective. However, new evidence is emerging every day.
According to WHO landscaping, there are over 40 vaccine candidates under investigation. However, most of them are in the pre-clinical evaluation stage, and only two have progressed to Phase 1 trials.
Around 100 cases have been declared as recovered. What are the lessons learnt ?
Most cases of Covid-19 are mild to moderate. Around 80-85% of cases are likely to be mild. Hence, we expect a significant proportion of infected people to recover without any significant sequelae. Our focus remains on preventing deaths. The most vulnerable groups include the elderly, or those with other conditions such as lung diseases, heart diseases and other
chronic diseases.
What is the biggest challenge in countering this virus?
The timely dissemination of critical public health information down to the last man is the challenge. The other challenge is the misinformation about Covid-19 that is spread through social media or because of certain myths. We are constantly strategising on how to meet and counter both these challenges. Central and state infrastructure is pressed into action to ensure critical information related to precautions, social distancing norms, lockdown and self-quarantine protocols is available to the common public. Official channels of information are being constantly updated and monitored.
Similarly, steps are being taken to prevent spread of misinformation that can otherwise give rise of panic amongst the people. The third challenge is to get the communities to own the process of ensuring social distancing and self-enforcing these measures so that transmissibility is reduced. My biggest challenge is to ensure that affected people are treated with compassion, and not stigmatised. This is also applicable for the health care workforce. It is through concerted, community-owned efforts, supported by the policies put in place by the government that we can contain this disease.
Are we going to increase testing, especially in rural areas?
As of April 1, 2020 there are 124 government laboratories across the nation that have been supported by ICMR [Indian Council of Medical Research]. Further, 49 private laboratory chains have also been approved for testing. In order to ensure that we have reliable and accurate results, and the laboratory staff are also not exposed to undue risks of acquiring the infection, all labs have to meet a set of minimum standards. However, we have pan-india testing capacity, and are testing more samples every day. Further, in initiating the testing work, we have to keep in mind the Indian context as well as the state of propagation of the epidemic in India. While indiscriminate testing is discouraged to ensure optimal use of resources available to us, targeted testing of higher risk groups has been the strategy to identify and contain the cases. In the near future, however, we will be scaling up testing.
When will we widen testing and make it more aggressive?
India has scaled up the capacity for testing in a massive way recently. Collection centres are located in over 16,000 places across India. At present, we are utilising only 43% of our capacity to test in public laboratories. As of April 1, 2020, 8pm, we have tested a total of 53,605 persons. The figure for today alone is 5,654 persons, who have undergone testing. Further, serologic testing is also under consideration, However, presence of antibodies indicates either past or currently active infection. They appear late in the natural history of disease between 5-7 days or so. Though these tests can be used for persons under surveillance, they cannot be used for early diagnosis.