NEW DELHI : Unlike many people wary amid the Covid-19 outbreak, Gagandeep Kang, renowned clinician scientist and executive director at the Translational Health Science and Technology Institute, an autonomous body under the ministry of science and technology, in Faridabad, doesn’t hesitate to shake hands when we meet.
The recent novel coronavirus outbreak has had a cascading effect on global population, with more than 40 reported cases in India so far. Kang, the first woman from India to be elected a fellow of the Royal Society, says the Indian healthcare system is well-equipped to handle the situation, as and when it evolves. However, collaboration between the public and private health system, she adds, will be key. Edited excerpts from an interview:
How close is anyone to finding a vaccine for this new strain of coronavirus?
Usually it takes five to 20-plus years to develop a vaccine. In the case of the novel coronavirus, we actually have one vaccine candidate and we have the prospect of many more emerging in the next few weeks, months. Right now, there are over 30 projects around the world that are looking at developing vaccines. I am engaged with a group called CEPI, the Coalition for Epidemic Preparedness Innovations.
One vaccine, the one that is out now and going into human trials next month, is supported by funding from CEPI. The second candidate that has been developed, but is not intended to go into humans, but being used to evaluate new production of technologies from the University of Queensland, has also come from a CEPI-funded project. The US government, the EU, major multinational vaccine companies and a lot of people are working on vaccines. If we are lucky, out of these 30 vaccine candidates, we may have one or two successful vaccines. We have never made a vaccine with such speed before. Hopefully, by next year, we will be celebrating a vaccine. It’s not guaranteed though. You can do two things with antivirals. One, you can take existing antivirals and see if they have activity against this new virus, or you can try and develop a new one. There are efforts on for both. People are repurposing antivirals that are used for HIV, called antiretrovirals, and combinations of those to see if they work against the coronavirus. In preclinical studies, some antivirals that were developed by other companies have also been shown reasonable activity against the novel coronavirus. They are currently in clinical trials. There are also new therapies like monoclonal antibodies that could come from patients who have recovered from the disease.
What are the possibilities of the Covid-19 becoming seasonal, like seasonal influenza?
It’s very feasible that this might happen, but this is somewhere between SARS and seasonal influenza. In terms of not being like SARS, it doesn’t seem to have as high a case fatality rate, but in terms of being like SARS, containment can stop the spread. I think there are some features that are relevant to SARS, which could be controlled very well by quarantine and ensuring good barrier precautions. That alone doesn’t seem to be sufficient to control this new virus. In that sense, it behaves much more like influenza, in being more easily transmissible than SARS was.
Who is more susceptible to this virus?
If you have comorbid conditions, cardiovascular disease, hypertension and diabetes, and if you are an older individual, you are likely to develop more severe disease. Chances of mortality in that population are also higher. Children seem, for some reason, to be protected. Young adults who have been infected, chances of mortality have been very low. So, for young people, who are out and walking about, there is much less need to panic than if you think about infections in your parents.
There has been a lot of panic as soon as some cases were detected in India.
I think people need to understand infectious diseases. We are exposed to them all the time. Every day you encounter new viruses, new bacteria that you have never seen before. Most of them will not cause severe disease. In this case as well, if you look at it, 80% of the people already have relatively mild infections.
If you weren’t testing, you might not even know that this was SARS coronavirus-2 (SARS-CoV-2). Fever and a dry cough, happens to everybody, almost every year. That’s not something unusual. There is an element of severity which occurs in about 15% of people. It is important to be aware to not get infected if you are likely to have a more severe disease.
Would warm weather or a rise in temperatures help keep the virus at bay?
Temperature and humidity are important, but the other thing that is important for the spread of a disease is how much people come in contact with other people. If people are close to other people for prolonged periods of time, diseases are going to spread. The main reason you see diseases in winters more is because people tend to stay indoors and are in contact with other people for longer periods of time.
With the SARS coronavirus, the nice thing is that it’s really quite a delicate virus. It’s enveloped. If you get rid of that lipid envelope—the fat envelope it has around it—then the virus can’t get into people and cause infections. Wiping down surfaces with disinfectant is a good way of getting rid of the virus.
As far as temperature and warmer weather is concerned, we really don’t have any evidence at the moment how this is going to play out. We haven’t been through a summer with this virus. It arrived in winter and we think that it’s going to disappear when summer comes. Until it happens, we won’t really know, but there are no characteristics that are predicting that unequivocally at the moment.
Primary schools in Delhi have been shut down till the end of March. What more can private institutions and companies do?
You have to decide what kind of control measure you want at what stage of an infection. When you have one case, you can try contact tracing, you can ensure that you quarantine, you can quarantine the contacts as well, you can test them, etc. When you have a 1,000, or 10,000 cases, or when you have a million (cases), that becomes more difficult. So, it’s really at the stage of infection globally that you try to figure out what’s the most appropriate control strategy that we should try. We are in a situation where actually we have very few cases (latest reports suggest more than 40 cases in India).
So, the approach we are taking right now makes sense for this situation: Closing offices, telling people to work remotely. You are stopping immediate spread and slowing population spread. These are exactly the right kinds of things to do.
Is the Indian healthcare system prepared to handle the situation if the outbreak worsens?
We are fine for 10 cases, 1,000 cases, 10,000 cases, or a million severe cases. I think it’s really a question of how this grows. Certainly, the government is trying to do everything it can to prepare. The only thing that I would point out is that, in India, we deliver most of our care outside of the public system.
So, it makes sense to be communicating with private healthcare providers and prepare them as well, in case it becomes such a large number that the public healthcare system can’t really handle the load. Both in terms of testing as well as in having beds available to treat people, I think communicating with the private healthcare systems is very important. I am sure private providers are thinking about what might be required of their ICUs, respiratory physicians already, but I think a coordinated action with the government — that includes the private sector – might be helpful.
How crucial is it to understand when to use masks and hand sanitizers and what is the right way to do so?
It’s very important. These are viruses that are spread by droplet infections. You are probably safer by ensuring that you stand 6-10 feet from somebody who is coughing and also make sure to not touch things that may have been touched or coughed on by other people, rather than just wearing a mask. Masks should be given to people who are potentially infected or infected, so that they don’t spread disease to other people. It’s not intended for personal protection for the wider population. You should leave the masks for healthcare professionals and get them only if you have somebody that you suspect of having the infection. The hand sanitizer is always a good thing.
This is not only about SARS coronavirus. It’s about a lot of things that you eat and a lot of respiratory infections that you have. I think if we learn anything from this episode and we can change people’s behaviour about keeping their hands clean and washing them frequently, that will be a huge public health advance. If you look at the history of healthcare, what changed how healthcare functions, infection control in healthcare, was (Ignaz) Semmelweis teaching people in the medical profession to wash their hands. What changed healthcare in terms of hospital infection control in the West was handwashing and hand hygiene using sanitizers. In India, we have a huge problem with hospital infection control. So both for health care workers as well as for the general public, if there is one piece of advice I’d give: Keep your hands clean. Don’t touch too many surfaces.-Livemint