‘We need to follow the virus and not count cases’
As the city continues to report a surge in cases amid low vaccination coverage among children, speaks to professor of microbiology at Christian Medical College, Vellore. Kang, an expert on vaccines, Covid-19 variants and waves, was in Mumbai for an event at Tata Institute of Fundamental Research on Monday.
Somita Pal Kang, Dr Gagandeep Mumbai has reported an uptick in Covid-19 cases in June. Would you describe this situation as one of concern or is it just a blip as some doctors describe it?
It is probably caused by the BA. 4 and BA. 5 variants of Omicron. It depends on what we want to call it -- a surge or a wave. But, in a vaccinated population, counting cases is pretty useless if you are not going to back it up with clinical data and sequencing. In South Africa, we saw cases go up. They were able to do sequencing rapidly which showed that it was because of BA. 4 and BA. 5 and cases came down without hospitals feeling the consequences. We will very likely be in a similar situation.
Is there a mechanism to predict pandemic waves?
There is no mechanism. Even the best infectious disease modellers will give you very general predictions on a large population and if you want specific predictions, they will give them for a short duration of time. So, if I know what is happening today, I can tell you what the situation will be two weeks to three from now. But I will not try and predict the situation after three months because a lot of things can happen in that time frame. So long-term situations are difficult to predict.
Doesn’t the absence of a mask mandate and unreported Covid cases (owing to low tests, self-tests and no tests) make the situation a fertile ground for a new variant?
We need to remember the purpose of the mask. If it is to protect an individual, then that individual should be masked. If the goal is to decrease transmissymptoms sion in the community, everyone needs to wear a good-quality mask. The ideal situation is everyone wearing a mask every day at all times but that is not going to happen. Like other things in public health, we need to strike a balance between what people will accept doing with the benefit that you derive. The situation today is very different from when we had 1,00,000 and 4,00,000 cases. I don’t think the risk is so high that we need to insist on masking everyone but if you are vulnerable, you should wear an N95 mask and protect yourself.
Many doctors are prescribing monoclonal antibodies and the antiviral drug molnupiravir to high-risk patients with mild symptoms. Your take?
Unless the symptoms look like that of delta variant, they shouldn’t be prescribed. Omicron variant infection symptoms don’t need these drugs.
Covid-19 is known to induce coagulation disorders. While the present variant/ subvariants are milder, should people be worried about post-covid phase?
It looks like there is an association between Covid-19 and vascular events that are persisting beyond acute illness. We are not seeing as many coagulation events with Omicron variants as we saw in the original variants. You should always watch out for though and get investigated. We have known about tuberculosis for 100 years and we still don’t know everything. We have known Covid-19 for three years. So, there is still a lot to know about the virus.
It is not the end of the world. While I am a vaccine enthusiast, I will wait and understand which vaccine is best for my child before giving it. No drug, no vaccine is 100% safe. If your risk of getting the disease is low then the benefit that you will get from the vaccine is also low. There is a risk of getting side effects, which is very low too. It is a balancing act. You do not want to hurry up to vaccinate the child and instead wait for the best product. There will be an incremental benefit to children with any product. But is it the best product, is the question? This is my personal opinion.
In some people, the virus tends to stay for three to six months too. Is it transmissible? Is it a cause of worry for the person?
It is a small fraction of people that stay infected beyond a month. They are unlikely to be a threat to public health unless they are immunocompromised. In such cases, the viruses may change enough to be the next variant that infects people as the immune system is unable to shut down the viral replication. However, it is difficult to find and track such people all the time.
Since Covid-19 is here to stay, how should it be managed in the future?
We have been in an endemic stage for the last one year. Endemic doesn’t mean that there will be no waves, patterns or an outbreak. It means it is a disease in the population which is going to stay. We are dealing with it pretty well. We need to follow vaccinated people to make sure we understand when they need a booster dose. We need to follow the virus but no longer follow case counting.