CORONAVIRUS IN THE INDIAN CONTEXT: FUTURE DIRECTIONS

The world today is at the helm of an unprecedented crisis where turmoil and uncertainty are daily realities. In the wake of this pandemic, what is truly admirable, is the courage and unwavering dedication of the medical personnel, scientists, and daily workers struggling to keep the threatened society operational. Prof. Biswanath Sarkar, Head of the Department of Medicine at the Infectious Diseases Hospital in Kolkata, currently the major testing center for the state, shared his views regarding the present health scenario.

The rampant spread of the disease caused by the novel Coronavirus SARS-CoV-2 has forced governments worldwide to initiate strict measures of lockdown and social distancing. At the same time, we have witnessed a surge in research to devise strategies in battling the virus in question. And yet, will these prove fruitful in time to curtail the spread?

“The current research is mainly in three directions,” said Dr. Sarkar. “Firstly, the effort is to develop a new vaccine against the virus so that the individuals who have not yet been infected can be protected from the disease in the future. The second focus is to screen for drugs which are currently effective against other diseases, for this one and check if there are any improvements in treatment. The third group of studies is to shed more light on the characteristics of the virus so that in case of any such events reoccurring in the future, we will be better equipped to counter it. Trials to discover new drugs or reposition old drugs to see if they work, and vaccine development would help to control the disease. Basic science research would help us know how these epidemics occur and improve our ability in dealing with similar situations in the future. And in terms of success, it is unlikely for us to have a remedy immediately as all such endeavors will definitely take time.”

The spike in cases has been exponential as seen from most mathematical models. Confirmed cases in India multiplied by a factor of nearly 10 in the last two weeks of March, necessitating stringent measures, concomitantly spelling further problems for the socio-economic landscape. The number of cases reported to date is likely to represent an underestimation of the true burden. Limited by our surveillance measures and diagnostic capacity, this does not come as much of a surprise. In the absence of any reliable and approved therapeutic intervention, the only strategy against COVID-19 is to reduce mixing of susceptible and infectious people through early ascertainment of cases or reduction of contact. Where do we stand, in statistical terms, compared to the rest of the world?

According to Dr. Sarkar, “Most affected countries have been showing similar patterns. First there is a rapid increase of cases in geometric progression, followed by a slowing of the rate at which new cases are reported, and the peak is reached. Subsequently, many patients start recovering and the number gradually comes down, with a few cases being reported infrequently in the future. Like most other viruses of this category, SARS-CoV-2 also has similar characteristics in terms of transmission through droplets, fomites or sometimes, aerosols.”

Then what is new?

“It is that, we have not yet developed any herd immunity against this virus. Say, I get a common cold and come in contact with ten other people. Out of them, maybe eight individuals have immunity and the remaining two are susceptible, of whom one gets the disease from me, but the case number does not increase drastically. Since humans have not encountered this novel coronavirus before, we do not have the immune mechanisms required to defend ourselves from it. This explains the rapid spread of the infection. The disease spread accelerates initially and then as patients start recovering, the count slows down and decreases.”

How should we aspire to modify this?

“Of course, this is a very difficult task and most countries have failed to curb the spread. But if we do not try and contain the infection, it will spread unhindered, especially for a country as heavily populated as India. As a result, the number of patients with severe conditions will surpass the medical infrastructure currently available and it would not be possible to treat such a massive influx of patients simultaneously. Hence, flattening the curve is crucial, wherein the number of cases will rise slowly, peaking only at a much later stage and then decrease. This will ease the burden on the healthcare systems and give us more time to develop possible drugs.”

There have been serious debates about how to react to the spread of this disease. Some strategies have speculated that if the virus does spread, the population herd immunity would increase. But at what cost? Prof. Sarkar says, “When there is a rapid increase in the number of cases, the vulnerable population is more likely to get affected and hence the situation worsens. Say for example, there is unchecked spread in a colony and around 70% get affected within a short period. If the colony has, say, 25% elderly people, then by the same proportion 70% of them i.e., approximately 20 people would develop severe complications. But if precautions were taken to diminish the spread, then the people who are more mobile would be infected first, recover gradually, herd immunity would develop, and the vulnerable population would be less likely to get affected to a great degree.” While strategies are functional in containing the clusters of the contagion to try and break the transmission chain, the current research is also commendable in trying to cater to the specific demands of the country. Be it insights into the molecular mechanisms employed by this covert virus, or facilitating the distribution of testing kits to the most affected areas, we can only hope that the generosity and earnest efforts of the people will make for a healthier future as we move forward.


References:

1. Kin On Kwok, Florence Lai, Wan In Wei, Samuel Yeung Shan Wong, Julian Tang, Herd immunity – estimating the level required to halt the COVID-19 epidemics in affected countries, Journal of Infection (2020), doi: https://doi.org/10.1016/j.jinf.2020.03.027

2. Lewnard, Joseph A., and Nathan C. Lo. “Scientific and ethical basis for social-distancing interventions against COVID-19.” The Lancet. Infectious diseases (2020).

3. Li, Ruiyun, et al. “Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2).” Science (2020).


Sukanya Chakraborty

This interview was submitted by Sukanya Chakraborty. She is currently pursuing her BS-MS Dual Degree at the Indian Institute of Science Education and Research, Berhampur.

1 comment

  1. nice reading your lucid writing. WHO predicted in its last report last year that we are going to face a series of novel flu waves in the near future, that would be even more severe as compated to COVID 19. Any though on that?

    Like

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